Research

HPME Post-Doctoral Fellow Dr. Wendy Young Leads Evaluation of eHealth Project

Saint Elizabeth Health Care, a founding Home and Community Care Evaluation and Research Centre (HCERC) donor and decision-making partner to Health Care Settings and Canadians, has received project funding from CANARIE to evaluate the merging of three innovative e-learning and e-care applications. The "Web of Wisdom" (WOW) approach encompasses education, remote monitoring, expert assessment, and knowledge creation in the respective areas of wound care and cardiac care. Implementation sites range from urban to rural and remote locations in Ontario, Manitoba and Prince Edward Island.

The project evaluation is being led by Saint Elizabeth's senior researcher, Dr. Wendy Young, a CHSRF Post-Doctoral Fellow whose co-supervisor is CHSRF/CIHR Health Services Chair Dr. Peter C. Coyte. Based on an innovative performance measurement system, the project evaluation will provide information on client outcomes, health provider outcomes, return on investment and implementation success. The final report will be submitted to CANARIE in March 2004.

For more information, email knowledge@saintelizabeth.com.

Update on the Primary Care Performance Indicators Project

Dr. Jan Barnsley, HPME Associate Professor, is leading a research study that involves primary care performance assessment. Members of the Primary Care Performance Indicators Project include Judith MacPhail, the project coordinator; Paula Heiniger, administrative assistant; other HPME faculty including Rhonda Cockerill, Whitney Berta and Eugene Vayda; as well as primary care physicians from Western Hospital/Department of Family and Community Medicine, University of Toronto (Dr. Jeff A. Bloom); from Mount Sinai Hospital/Department of Family and Community Medicine, University of Toronto (Dr. Yves Talbot) and from the Institute for Clinical Evaluative Sciences/ Sunnybrook and Women's College Health Sciences Centre/ Department of Family and Community Medicine, University of Toronto (Dr. Liisa Jaakkimainen).

Four data collection instruments are currently being reviewed and revised based on analysis of data quality and feedback from the Field Test of Primary Care Performance Indicators. In keeping with their interest in ongoing collaboration and dialogue with family physicians and nurse practitioners, an Expert Panel is being composed of previous study participants who will be rating new and revised primary care performance indicators. The expert Panel will assess the indicator relevance for performance evaluation. A manual containing a review of the evidence associated with each indicator will be provided to the panel to assist them in the rating process. These indicators are being considered for use in a proposed study of 50 primary care practices in Ontario.

As well, some of the new project activities include:

• A Website Developer has been hired to assist the research team in the design and maintenance of a Primary Care Performance Indicators Project website. The chief purpose of this site will be to disseminate project information and activities.
• Work is currently underway to convert the paper-based data collection instruments to an electronic version.

Fall Conference Presentations

SARS Symposium

Several HPME Faculty chaired sessions and delivered presentations at the SARS Symposium, "Learning from SARS: Challenges for Public Health" held on September 17, 2003 at Mount Sinai Hospital.

• Dr. Louise Lemieux-Charles presented "Understanding Health Organizations Response" in the Public and Institutional Responses session, chaired by Dr. Ross Baker;
• Dr. Raisa Deber presented "Priorities in Public Health Policy" in the Preparing for Global Challenges to Public Health session;
• Dr. David Zakus chaired the International Perspectives from China session.

Presentations by Dr. Lemieux-Charles and Dr. Deber are available through the Public Health Sciences website.

Ontario Hospital Association Convention and Exhibition

The following members of HPME presented at the 2003 Ontario OHA Convention and Exhibition, "Today's Choices, Tomorrow's Care":

• Evidence-Based Health Care Session: "A Canadian Study to Measure Adverse Events in Canadian Hospitals", G. Ross Baker, Associate Professor
• ACHE/CCHSE Session: "Addressing the Challenges for Health Care Leaders: Current Dilemmas and Policy Initiatives", G. Ross Baker, Associate Professor
• Health Information Management Session: "The Politics of Implementing the Electronic Health Record in the Post-Romanow Era", A. Paul Williams, Associate Professor
• Women's Health Session: "Mainstreaming Women's Health Reporting", Adalsteinn D. Brown, Principal Investigator, Hospital Report Project, Assistant Professor
• Patient Satisfaction/Quality Improvement Session: "Success Stories", Michael Murray, Senior Research Associate, Hospital Report Project

International Health

Dr. David Zakus, Associate Professor in HPME, presented two papers at the 10th Canadian Conference on International Health in Ottawa, October 26-29, 2003:

• "Enhancing Health Contributions to the World's Poorest - Analyses of Several Global Health Interventions Based at the University of Toronto" and
• "Research Challenges at the Centre for International Health, Faculty of Medicine, University of Toronto".

Management of Acute Myocardial Infarction Patients

This fall Dr. Therese Stukel, HPME Professor and Research Director of the Institute for Clinical Evaluative Sciences, presented "Long-term Survival Effects of Invasive vs. Medical Management of Medicare AMI Patients; Using Area-level Exposures as Instruments" at the following conferences:

• Dartmouth Medical School Center for the Evaluative Sciences Annual Research Meeting on "Causes and Consequences of Health Care Intensity", September 15-16, 2003, Holderness, NH.
• Agency for Healthcare Research and Quality and Academy Health's 5th International Conference on the Scientific Basis of Health Services: Global Evidence for Local Decisions, September 20-22, 2003, Washington, DC (invited poster).
• International Conference on Health Policy Research (ICHPR) 2003, October 16-19, 2003, Chicago, IL.

For more information on Stukel's research on the relationship between acute myocardial infarction (AMI) spending and quality of care see the March/April 2003 issue of NewsBytes.

Rheumatology

Dr. Paul Fortin, Associate Professor in HPME, presented "Comparison of Cost-of-Illness RA Estimates Elicited by the Willingness to Pay and Human Capital Methodologies" at the American College of Rheumatology / Association of Rheumatology Health Professionals Annual Scientific Meeting, October 24-28, 2003 in Orlando, Florida.

Therese Stukel Co-Chairs 2003 International Conference on Health Policy

Therese Stukel also co-chaired the 2003 International Conference on Health Policy Research (ICHPR) Scientific Planning Committee. ICHPR is a bi-annual scientific conference sponsored by the Health Policy and Statistics Section of the American Statistical Association that focuses on the interface between research methodology and health policy. This conference provides a forum for discussing research needs and solutions to methodological challenges in health services research.

Research and Teaching Profiles

Faculty associated with the Department of Health Policy, Management and Evaluation (HPME) are involved in a broad range of research activities with a variety of organizations. Success of the HPME Knowledge Transfer initiative is dependent on presenting our stakeholders with a unified, clear image of the depth and breadth of Departmental expertise. To promote greater internal awareness of the knowledge developed through HPME, faculty research profiles will be included as a regular feature of this newsletter.

This issue of the HPME newsletter features a research profile for Professor Anthony (Tony) John Culyer.

+ + PROFILE OF THE MONTH + +

Anthony (Tony) Culyer, CBE, BA, Hon D Econ, Hon FRCP, FMedSci

Professor Tony Culyer is a specialist in health economics based in York, England, at the University of York's Department of Economics and Related Studies. He has taught health economics at universities around the world and has been advisor to governments in several countries. Professor Culyer recently accepted an Adjunct Faculty position with HPME while taking a three year leave from his position in York to serve as Chief Scientist at the Institute for Work and Health (see IWH bio). His current scholarly interests include health economics and efficiency and equity issues associated with the workplace.

Education and Work Background

Professor Culyer has held research and teaching positions at universities and research institutes in England, Canada, United States, Germany and New Zealand. He is a founding Fellow of the Academy of Medical Sciences in London. In 1999, he was awarded an honorary Doctor of Economics from the Stockholm School of Economics and in 2003 became an honorary Fellow of the Royal College of Physicians of London. At the University of York (England), Professor Culyer was for many years chair of the Department of Economics and Related Studies during which tenure he was also first Pro-Vice-Chancellor and subsequently Deputy Vice-Chancellor of the university, with special responsibilities in policies for research support and graduate school development. Before coming to Canada he was the university's Director of Health Development. He was a founding member of the Central Research and Development Committee of the National Health Service of England and Wales and founding vice-chair of the National Institute for Clinical Excellence (NICE) in London. In 1993, he chaired a national Task Force on Supporting Research and Development in the National Health Service, which produced an influential report widely known as the "Culyer Report".

In Canada, Professor Culyer has been a member of advisory groups to the (former) Ontario Workers' Compensation Board (1989-1992), the Institute for Work and Health (1990-2002), the Canadian Institute of Advanced Research (1992-8) and was appointed as the Canadian Health Services Research Foundation's first international trustee (2000-2003).

Research Activities

A co-editor of the international Journal of Health Economics, Dr. Culyer has served on journal editorial boards in health economics, medicine, medical ethics, social science and medical law. To date, he has published over 200 articles in various publications and scholarly journals. He has published more than two dozen books and many pamphlets and shorter papers.

Future Research

Professor Culyer is currently working on a new edition of his book The Economics of Social Policy, a new book Dictionary of Health Economics, papers on "rationing" health care in Europe and a policy paper for NICE on the scientific and social value judgments embodied in its health technology appraisals and clinical guidelines.

Professor Culyer has his own website which you can visit:
www-users.york.ac.uk/~ajc17/

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