Research

New HPME Publications Focus on Hospital Priority-Setting and Performance

Last year at this time we were reporting on the publication of the 2003 Hospital Reports (www.hospitalreport.ca). In this issue of NewsBytes, we highlight several publications which focus on hospital decision-making processes and strategies for improving the quality of care. Data is a necessary input into hospital decision-making, but as these articles point out, the data does not speak for itself. Resource allocation decisions are value-laden and must consider fairness as well as efficiency and cost-effectiveness. The data itself must be interpreted in order to be acted upon, requiring staff to develop a unique skills set apart from their clinical skills. Furthermore, data is always subject to challenge as new evidence emerges.

Using a framework for priority setting in healthcare institutions called 'accountability for reasonableness', David Reeleder, Douglas Martin, Christian Keresztes and Peter Singer surveyed CEOs about the fairness of the priority-setting practices in their institutions. Results were recently published in the article, What do hospital decision-makers in Ontario, Canada, have to say about the fairness of priority setting in their institutions? [Adobe PDF] (BioMed Central Health Services Research, 5:8, 2005). They found that while CEOs rated their fairness as high on some dimensions (relevance), there was considerable room for improvement on others (publicity, appeals process and enforcement).

With the publication of the Baker/Norton Canadian Adverse Events Study, patient safety has gained in relevance as a priority among hospital decision-makers. Ross Baker and Peter Norton consider how to improve patient safety in their commentary , Next Steps for Patient Safety in Canadian Healthcare (HealthcarePapers Vol.5, No.3, 2004). They propose three key factors that are needed to reduce the numbers of adverse events in hospitals: improved processes for information-gathering on adverse events, skills-building for staff to learn to use and act on information, and leadership to develop a culture of improvement rather than blame.

A study recently published by Dr. David Urbach, Volume and Outcome in Healthcare. [Adobe PDF] (Healthcare Quarterly Vol. 7 No. 4 2004), questions conventional surgical wisdom that “practice makes perfect”. In an analysis of high volume surgery outcomes in Ontario between 1994 and 1999, a research team based out of the Institute for Clinical Evaluative Sciences (ICES) found that better outcomes for complex surgical procedures may be related to overall better hospital performance rather than the volume of specific procedures. Improving the overall care at smaller hospitals may be a better strategy to improve outcomes than transferring more resources to larger hospitals in a strategy of volume-based regionalization.

New Study on Ambulatory and Home-Based Palliative Care

HPME's Dr. Peter Coyte, Dr. Denise Guerriere, and Dr. Audrey Laporte have been awarded a three-year grant from CIHR to study the "Cost and Quality of Variations in Ambulatory and Home-Based Palliative Care".  Restructuring health care has resulted in an increasing emphasis on the provision of ambulatory and home-based end-of-life care. In spite of this trend, very little is known about the societal costs and quality of care in this setting. Acquiring economic and quality of care evidence pertinent to this setting is critical given the trend towards home-based end-of-life care and its tremendous demands on family caregivers. This dearth of evidence impedes informed decision-making by practitioners, health managers, and policy decision makers, and may give rise to insufficient levels of financial and psychosocial support for care recipients and caregivers.

The purposes of this study are to: 1) comprehensively assess the societal costs, satisfaction and quality of home-based palliative care; and 2) examine the sociodemographic and clinical factors that account for variation in costs, satisfaction and quality of care, at various time points over the course of the palliative care trajectory, from admission to death. Family caregivers will be recruited from three Regional Palliative Care Programs: Toronto, Edmonton, and Calgary. They will be asked to participate in telephone interviews to provide information about their out-of-pocket health care expenditures, the amount of time they devote to caregiving, and their satisfaction and quality of care perceptions. All other data will be obtained from existing regional databases created and maintained by the palliative care programs. It is hoped that the study findings will assist in the formulation of health planning and resource allocation initiatives pertaining to palliative care.

Coyte's Health Care Settings and Canadians Chair Renewed

After a site visit by the CHSRF/CIHR chair review panel in October 2004, Dr. Peter Coyte's Health Care Settings and Canadians chair has been renewed for the remaining six years of the program. Feedback from the site review panel was very positive:

"The most outstanding feature of the Chair's efforts to date has come in the education and mentoring dimension. He has created a superb training program for graduate students and young faculty. There is an all-around excellence in the entire process – recruitment, support, accomplishments – that bodes well for the next six years. We believe this is where the Chair Program will make its mark."

For more information about the chair program, see the website: http://hcerc.utoronto.ca.

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