Where Are We Going From Here [in health regionalization in Canada]? (original) (raw)
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Revisiting Health Regionalization in Canada
International journal of health services : planning, administration, evaluation, 2017
Twenty years ago, many of Canada's provinces began to introduce regional health authorities to address problems with their health care systems. With this action, the provinces sought to achieve advances in community decision-making, the integration of health services, and the provision of care in the home and community. The authorities were also to help restrict health care costs. An assessment of the authorities indicates, however, that over the past two decades they have been unable to meet their objectives. Community representatives continue to play little role in determining the appropriate health services for their regions. Gains have been made towards integrating health services, but the plan for a near seamless set of health services has not been realized. Funding for health services remains focused on hospital and physician care, and health care expenditures have until very recently been little affected by regional authorities. This disappointing performance has caused s...
Hospitals-As-Hubs: Integrated Care for Patients - NAO Rapid Review No. 17
North American Observatory on Health Systems and Policies Rapid Review No. 17, 2019
The creation of Ontario Health Teams represents a major shift towards integrated care across the health system in the province. Integrated models of care intend to improve the care experiences of people and providers as well as the outcomes of care for populations across the care continuum. Approaches to integrate care involve a number of organizations and providers, often with an organization or a group of providers acting as the lead of the integration effort. This rapid review aims to understand the role that hospitals can play as lead integrators of care delivery models that span multiple sectors.
Evaluation of a changed model of care delivery in a Canadian province using outcome mapping
The International Journal of Health Planning and Management, 2013
Background Collaboration between the Nova Scotia Department of Health and Wellness, the province's District Health Authorities (DHAs) and the Izaak Walton Killam (IWK) Health Center led to the development and implementation of a new collaborative model of patient-centered care delivery in the province. Objective The objective was to determine the effectiveness of the initiative in arriving at the envisioned care model by investigating its impacts (if any) on patient, system, and providers outcomes. Methods A repeated surveys study design with mixed methods in an outcome mapping framework was used to measure process and outcome indicators for patients and families, providers, and the system. Results Almost all outcomes at the patient and family, provider, and system level improved following the implementation of the model, and these effects were stronger on units where the model was more fully implemented. Conclusions The efforts of the province, DHAs and IWK to improve patient care through the new care model have been successful. This evaluation is unique in the broad range of indicators it incorporates. Comprehensive monitoring and evaluation of health system changes is critical to system effectiveness.
BMC Health Services Research, 2013
Background: Over the past decade, in the province of Quebec, Canada, the government has initiated two consecutive reforms. These have created a new type of primary healthcarefamily medicine groups (FMGs)and have established 95 geographically defined local health networks (LHNs) across the province. A key goal of these reforms was to improve collaboration among healthcare organizations. The objective of the paper is to analyze the impact of these reforms on the development of collaborations among primary healthcare practices and between these organisations and hospitals both within and outside administrative boundaries of the local health networks. Methods: We surveyed 297 primary healthcare practices in 23 LHNs in Quebec's two most populated regions (Montreal & Monteregie) in 2005 and 2010. We characterized collaborations by measuring primary healthcare practices' formal or informal arrangements among themselves or with hospitals for different activities. These collaborations were measured based on the percentage of clinics that identified at least one collaborative activity with another organization within or outside of their local health network. We created measures of collaboration for different types of primary healthcare practices: first-and second-generation FMGs, network clinics, local community services centres (CLSCs) and private medical clinics. We compared their situations in 2005 and in 2010 to observe their evolution. Results: Our results showed different patterns of evolution in inter-organizational collaboration among different types of primary healthcare practices. The local health network reform appears to have had an impact on territorializing collaborations firstly by significantly reducing collaborations outside LHNs areas for all types of primary healthcare practices, including new type of primary healthcare and CLSCs, and secondly by improving collaborations among healthcare organizations within LHNs areas for all organizations. This is with the exception of private medical clinics, where collaborations decreased both outside and within LHNs. Conclusion: Health system reforms aimed at creating geographically based networks influenced primary healthcare practices' both among themselves (horizontal collaborations) and with hospitals (vertical collaborations). There is evidence of increased collaborations within defined geographic areas, particularly among new type of primary healthcare.
Hospitalists And Care Transitions: The Divorce Of Inpatient And Outpatient Care
Health Affairs, 2008
We interviewed hospitalist and nonhospitalist respondents as part of the Community Tracking Study site visits to examine how the growing use of hospitalists has affected care delivery systems. The growth of hospitalist programs contributes to a loss of physicians' participation on hospital medical staffs, which increases the burden of coordination and blurs accountability for the quality of postdischarge care. Arrangements where companies and multispecialty medical groups employ hospitalists are more likely than others to establish routines for ensuring coordinated transitions upon hospital admission and discharge. Policymakers could support the development of guiding principles for care coordination, greater reliance on nonphysicians, and reintegration of inpatient and outpatient providers.
2019
Our review of literature reveals there has not been extensive, systematic research into intermediate tiers of the health service in England over the last seven decades. During this time, regions have continuously been a target for reform. There is no consensus among policy makers or commentators over where functions and responsibilities should be located. Differing views appear to have been shaped by different political strategies and policy trends. Organisational change has accelerated in recent years. Broadly speaking, operating within intractable tensions facing the health service, regions have progressively declined in their influence. Once responsible for the allocation of resources, their reduced role coincides with new forms of performance and financial management. Nevertheless, our review shows that longer-term strategic planning has usually occurred at an intermediate level. Through situating current changes in their historical and geographical context, a series of key them...