UPDATE: Consistency of Home Care Personnel Under Managed Competition: A Case Study from Ontario (Shortened Version Presented at the Knowledge to Wisdom Conference)

Measuring Consistency of Personnel in Home care: Current Challenges and Findings Consistency of personnel is important to ensuring continuity of care for home care clients. It is particularly important to those clients who are at high risk for adverse effects when provider changes occur. Information about the extent to which clients experience consistency of personnel is difficult to collect in Ontario. It resides with individual provider agencies rather than with the Community Care Access Centres (CCACs) that arrange service delivery. We will present findings from the Continuity of Care in Home Care study which obtained information directly from service provider agencies on the number of providers that 500 CCAC clients saw. These clients received either nursing or homemaking services or both. Factors linked with the mean number of providers experienced by a client and with the total number of providers experienced by a client during up to a year of service delivery will be highlighted. Factors affecting the frequency of provider changes will be discussed along with the implications of our findings for clients, service providers, agencies and policy makers.home care services, adults, Ontario, health personnel, consistency of services, providers

Theories of participation in health care decision making: Case studies of four communities in Ontario, Canada

SIGLEAvailable from British Library Document Supply Centre-DSC:DX207768 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

HSO Performance: A Critical Appraisal of Current Research

This document reviews the findings of studies of the clinical and economic performance of Ontario’s Health Service Organizations and makes recommendations for further evaluation. The tentative conclusions regarding HSO performance indicate that: 1. The HSO program in total and some HSOs individually have lower rates of hospitalization of their patients. 2. The use of ambulatory care by HSO and FFS patients is about the same. 3. HSO physicians manager greater patient loads. 4. HSOs employ more non-physician health personnel. 5. Some HSOs provide higher quality of care. 6. Some HSOs are better structured to deliver preventive services to their patients. 7. HSO physicians are more likely to believe their method of remuneration favours the delivery of preventive services. 8. HSO patients are less satisfied with their care. These conclusions are tentative because there are several methodological problems with the studies on which they are based: eg. The estimation of the true size of a practice, the self-selection of patients and providers, and the calculation of costs (particularly for hospital care). As well, the existing evaluations involve few centres and there are many differences among the centres. Hence generalizations of the findings to the wider population of providers may be invalid. It appears that although payment mechanisms can affect the cost and quality of health care, the differences within modalities are as great or greater than the differences between modalities. Factors, other than payment mechanism which have been found to affect the quality or cost of health care include: group practice, peer review, other financial incentives, other organizational determinants (eg. Institutional links), the use of non-physician providers, and the provider selection process. An important step in evaluation is to set out the core objectives of the program under evaluation. Primary objects might include shifting physicians to non-FFS practice, reducing hospital utilization, enhancing disease prevention and health promotion activities, promoting better maintenance care for chronic illness, and enhancing the health status of the population. Once the primary objectives are clearly specified measureable targets may be selected. To guide the development of the HSO program it is important to identify other practice features associated with better performance rather than simply study the effects of payment mechanism alone.

Understanding the Role of Values in Health Policy Decision-Making From the Perspective of Policy-Makers and Stakeholders: A Multiple-Case Embedded Study in Chile and Colombia

Background: Chile and Colombia are examples of Latin American countries with health systems shaped by similar values. Recently, both countries have crafted policies to regulate the participation of private for-profit insurance companies in their health systems, but through very different mechanisms. This study asks: what values are important in the decision-making processes that crafted these policies? And how and why are they used?Methods: An embedded multiple-case study design was carried out for 2 specific decisions in each country: (1) in Chile, the development of the Universal Plan of Explicit Entitlements - AUGE/GES - and mandating universal coverage of treatments for high-cost diseases; and (2) in Colombia, the declaration of health as a fundamental right and a mechanism to explicitly exclude technologies that cannot be publicly funded. We interviewed key informants involved in one or more of the decisions and/or in the policy analysis and development process that contributed to the eventual decision. The data analysis involved a constant comparative approach and thematic analysis for each case study. Results: From the 40 individuals who were invited, 28 key informants participated. A tension between 2 important values was identified for each decision (eg, solidarity vs. individualism for the AUGE/GES plan in Chile; human dignity vs. sustainability for the declaration of the right to health in Colombia). Policy-makers used values in the decision-making process to frame problems in meaningful ways, to guide policy development, as a pragmatic instrument to make decisions, and as a way to legitimize decisions. In Chile, values such as individualism and free choice were incorporated in decision-making because attaining private health insurance was seen as an indicator of improved personal economic status. In Colombia, human dignity was incorporated as the core value because the Constitutional Court asserted its importance in its use of judicial activism as a check on the power of the executive and legislative branches.Conclusion: There is an opportunity to open further exploration of the role of values in different health decisions, political sectors besides health, and even other jurisdictions

Ptsd Symptoms Across Pregnancy And Early Postpartum Among Women With Lifetime Ptsd Diagnosis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/122410/1/da22465.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/122410/2/da22465_am.pd

Will it make a difference if I showed up and share? A citizen’s perspective on improving public involvement processes for health system decisionmaking

Introduction: Health policy decision-makers are grappling with increasingly complex and ethically controversial decisions at a time when citizens are demanding more involvement in these decision processes. Objectives: To assess and revise a set of guiding principles for the design of public involvement processes generated from a synthesis of public participation design and evaluation frameworks that can be used to inform the design and evaluation of future public participation processes in the health sector. Methods: Six focus groups held in five Canadian provinces comprising citizens with considerable experience of public participation processes. Results and discussion: Our findings suggest that citizen participants are highly critical of, and discerning about, their public participation experiences. Yet, they are optimistic and determined to contribute in meaningful ways to future public policy processes. They are clear about where improvements are needed and give top priority to what information is shared, and how, among participants and decision-makers. The views of experienced citizens mapped well onto most of the prior principles of public involvement with a few modifications. First, participants gave greater emphasis to the content and balance of information for the purposes of building trust and credibility between citizens and decision-makers. Second, participants viewed themselves, as well as decision-makers, as sources of information to be shared through the consultation process. Finally, participants stressed the importance of getting the information and communication principles right over addressing all other principles

A framework for explaining the role of values in health policy decision-making in Latin America : a critical interpretive synthesis

Abstract: Background: Although values underpin the goals pursued in health systems, including how health systems benefit the population, it is often not clear how values are incorporated into policy decision-making about health systems. The challenge is to encompass social/citizen values, health system goals, and financial realities and to incorporate them into the policy-making process. This is a challenge for all health systems and of particular importance for Latin American (LA) countries. Our objective was to understand how and under what conditions societal values inform decisions about health system financing in LA countries. Methods: A critical interpretive synthesis approach was utilised for this work. We searched 17 databases in December 2016 to identify articles written in English, Spanish or Portuguese that focus on values that inform the policy process for health system financing in LA countries at the macro and meso levels. Two reviewers independently screened records and assessed them for inclusion. One researcher conceptually mapped the included articles, created structured summaries of key findings from each, and selected a purposive sample of articles to thematically synthesise the results across the domains of agenda-setting/prioritisation, policy development and implementation. Results: We identified 5925 references, included 199 papers, and synthesised 68 papers. We identified 116 values and developed a framework to explain how values have been used to inform policy decisions about financing in LA countries. This framework has four categories – (1) goal-related values (i.e. guiding principles of the health system); (2) technical values (those incorporated into the instruments adopted by policy-makers to ensure a sustainable and efficient health system); (3) governance values (those applied in the policy process to ensure a transparent and accountable process of decision-making); and (4) situational values (a broad category of values that represent competing strategies to make decisions in the health systems, their influence varying according to the four factors)..

Enhancing Bioproducts in Seaweeds via Sustainable Aquaculture: Antioxidant and Sun-Protection Compounds

Marine macroalgae are considered an untapped source of healthy natural metabolites and their market demand is rapidly increasing. Intertidal macroalgae present chemical defense mechanisms that enable them to thrive under changing environmental conditions. These intracellular chemicals include compounds that can be used for human benefit. The aim of this study was to test cultivation protocols that direct seaweed metabolic responses to enhance the production of target antioxidant and photoprotective biomaterials. We present an original integrated multi-trophic aquaculture (IMTA) design, based on a two-phase cultivation plan, in which three seaweed species were initially fed by fish effluents, and subsequently exposed to various abiotic stresses, namely, high irradiance, nutrient starvation, and high salinity. The combined effect of the IMTA’s high nutrient concentrations and/or followed by the abiotic stressors enhanced the seaweeds’ content of mycosporine-like amino acids (MAAs) by 2.3-fold, phenolic compounds by 1.4-fold, and their antioxidant capacity by 1.8-fold. The Sun Protection Factor (SPF) rose by 2.7-fold, and the chlorophyll and phycobiliprotein synthesis was stimulated dramatically by an order of magnitude. Our integrated cultivation system design offers a sustainable approach, with the potential to be adopted by emerging industries for food and health applicationsPartial funding for open access charge: Universidad de Málag

Members of Minority and Underserved Communities Set Priorities for Health Research

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146820/1/milq12354.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146820/2/milq12354_am.pd

Alternatives to project-specific consent for access to personal information for health research: Insights from a public dialogue

<p>Abstract</p> <p>Background</p> <p>The role of consent for research use of health information is contentious. Most discussion has focused on when project-specific consent may be waived but, recently, a broader range of consent options has been entertained, including broad opt-in for multiple studies with restrictions and notification with opt-out. We sought to elicit public values in this matter and to work toward an agreement about a common approach to consent for use of personal information for health research through deliberative public dialogues.</p> <p>Methods</p> <p>We conducted seven day-long public dialogues, involving 98 participants across Canada. Immediately before and after each dialogue, participants completed a fixed-response questionnaire rating individuals' support for 3 approaches to consent in the abstract and their consent choices for 5 health research scenarios using personal information. They also rated how confident different safeguards made them feel that their information was being used responsibly.</p> <p>Results</p> <p>Broad opt-in consent for use of personal information garnered the greatest support in the abstract. When presented with specific research scenarios, no one approach to consent predominated. When profit was introduced into the scenarios, consent choices shifted toward greater control over use. Despite lively and constructive dialogues, and considerable shifting in opinion at the individual level, at the end of the day, there was no substantive aggregate movement in opinion. Personal controls were among the most commonly cited approaches to improving people's confidence in the responsible use of their information for research.</p> <p>Conclusion</p> <p>Because no one approach to consent satisfied even a simple majority of dialogue participants and the importance placed on personal controls, a mechanism should be developed for documenting consent choice for different types of research, including ways for individuals to check who has accessed their medical record for purposes other than clinical care. This could be done, for example, through a web-based patient portal to their electronic health record. Researchers and policy makers should continue to engage the public to promote greater public understanding of the research process and to look for feasible alternatives to existing approaches to project-specific consent for observational research.</p