The Long-term Effects of Maternal Employment on Daughters’ Later Labour Force Participation and Earnings

This paper investigates the long-term effects of maternal labour force participation on daughters’ later labour force participation and earnings. The majority of the existing work in this area investigates how current maternal labour force participation affects current child outcomes, including scholastic, behavioural and health outcomes. The Longitudinal Administrative Databank (LAD), a 20 percent random sample of Canadian tax filers provides a unique opportunity to link information regarding a mother’s labour force participation from the birth of a daughter onward, to the daughter’s own labour force participation in later years. We find that maternal employment is correlated with both an increased likelihood of working and increased earnings, but that no long term effects remain once unobserved heterogeneity is addressed. These findings call into question the growing concern that a large body of research has raised regarding the negative impacts of maternal employment on child outcomesmaternal employment, earnings, labour force participation

The ‘Trendiness’ of Sleep: An Empirical Investigation into the Cyclical Nature of Sleep Time

Using Canadian time use data, we exploit exogenous variation in local unemployment rates to investigate the cyclical nature of sleep time and show that for both men and women, sleep time decreases when the economy is doing relatively better. Our results suggest that in a recession Canadians sleep an average of 2 hours and 34 minutes more per week, or 22 minutes more per day. Given the importance of even small changes in sleep time on measures of cognitive functioning such as reaction time and concentration, our findings may help explain the countercyclical nature of mortality. Further, as we find that sleep is affected by the same economic variables (notably the unemployment rate) that affect market work time, our results also contribute to the limited literature that shows that sleep time should not be treated as exogenously determined, but, like any other resource, determined by its relative cost.Business Cycles, Sleep.

The ‘Trendiness’ of Sleep: An Empirical Investigation into the Cyclical Nature of Sleep Time

Using Canadian time use data, we exploit exogenous variation in local unemployment rates to investigate the cyclical nature of sleep time and show that for both men and women, sleep time decreases when the economy is doing relatively better. Our results suggest that in a recession Canadians sleep an average of 2 hours and 34 minutes more per week, or 22 minutes more per day. Given the importance of even small changes in sleep time on measures of cognitive functioning such as reaction time and concentration, our findings may help explain the countercyclical nature of mortality. Further, as we find that sleep is affected by the same economic variables (notably the unemployment rate) that affect market work time, our results also contribute to the limited literature that shows that sleep time should not be treated as exogenously determined, but, like any other resource, determined by its relative cost. Pierre Brochu is an Assistant Professor in the Department of Economics at the University of Ottawa. He received his B.A. and M.A. from the University of Toronto and his Ph.D. from the University of British Columbia. His research interests include labour economics, applied health economics and applied econometrics. His research has mainly focused on the employee-employer relationship; more specifically, job security and job stability

Improved delivery of cardiovascular care (IDOCC) through outreach facilitation: study protocol and implementation details of a cluster randomized controlled trial in primary care

Abstract Background There is a need to find innovative approaches for translating best practices for chronic disease care into daily primary care practice routines. Primary care plays a crucial role in the prevention and management of cardiovascular disease. There is, however, a substantive care gap, and many challenges exist in implementing evidence-based care. The Improved Delivery of Cardiovascular Care (IDOCC) project is a pragmatic trial designed to improve the delivery of evidence-based care for the prevention and management of cardiovascular disease in primary care practices using practice outreach facilitation. Methods The IDOCC project is a stepped-wedge cluster randomized control trial in which Practice Outreach Facilitators work with primary care practices to improve cardiovascular disease prevention and management for patients at highest risk. Primary care practices in a large health region in Eastern Ontario, Canada, were eligible to participate. The intervention consists of regular monthly meetings with the Practice Outreach Facilitator over a one- to two-year period. Starting with audit and feedback, consensus building, and goal setting, the practices are supported in changing practice behavior by incorporating chronic care model elements. These elements include (a) evidence-based decision support for providers, (b) delivery system redesign for practices, (c) enhanced self-management support tools provided to practices to help them engage patients, and (d) increased community resource linkages for practices to enhance referral of patients. The primary outcome is a composite score measured at the level of the patient to represent each practice's adherence to evidence-based guidelines for cardiovascular care. Qualitative analysis of the Practice Outreach Facilitators' written narratives of their ongoing practice interactions will be done. These textual analyses will add further insight into understanding critical factors impacting project implementation. Discussion This pragmatic, stepped-wedge randomized controlled trial with both quantitative and process evaluations demonstrates innovative methods of implementing large-scale quality improvement and evidence-based approaches to care delivery. This is the first Canadian study to examine the impact of a large-scale multifaceted cardiovascular quality-improvement program in primary care. It is anticipated that through the evaluation of IDOCC, we will demonstrate an effective, practical, and sustainable means of improving the cardiovascular health of patients across Canada. Trial Registration ClinicalTrials.gov: NCT0057480

Patient, informal caregiver and care provider acceptance of a hospital in the home program in Ontario, Canada

<p>Abstract</p> <p>Background</p> <p>Hospital in the home programs have been implemented in several countries and have been shown to be safe substitutions (alternatives) to in-patient hospitalization. These programs may offer a solution to the increasing demands made on tertiary care facilities and to surge capacity. We investigated the acceptance of this type of care provision with nurse practitioners as the designated principal home care providers in a family medicine program in a large Canadian urban setting.</p> <p>Methods</p> <p>Patients requiring hospitalization to the family medicine service ward, for any diagnosis, who met selection criteria, were invited to enter the hospital in the home program as an alternative to admission. Participants in the hospital in the home program, their caregivers, and the physicians responsible for their care were surveyed about their perceptions of the program. Nurse practitioners, who provided care, were surveyed and interviewed.</p> <p>Results</p> <p>Ten percent (104) of admissions to the ward were screened, and 37 patients participated in 44 home hospital admissions. Twenty nine patient, 17 caregiver and 38 provider surveys were completed. Most patients (88%–100%) and caregivers (92%–100%) reported high satisfaction levels with various aspects of health service delivery. However, a significant proportion in both groups stated that they would select to be treated in-hospital should the need arise again. This was usually due to fears about the safety of the program. Physicians (98%–100%) and nurse practitioners also rated the program highly. The program had virtually no negative impact on the physician workload. However nurse practitioners felt that the program did not utilize their full expertise.</p> <p>Conclusion</p> <p>Provision of hospital level care in the home is well received by patients, their caregivers and health care providers. As a new program, investment in patient education about program safety may be necessary to ensure its long term success. A small proportion of hospital admissions were screened for this program. Appropriate dissemination of program information to family physicians should help buy-in and participation. Nurse practitioners' skills may not be optimally utilized in this setting.</p

Practice facilitation for improving cardiovascular care: secondary evaluation of a stepped wedge cluster randomized controlled trial using population-based administrative data

Abstract Background Practice facilitation (PF), a multifaceted approach in which facilitators (external health care professionals) help family physicians to improve their adoption of best practices, has been highly successful. Improved Delivery of Cardiovascular Care (IDOCC) was an innovative PF trial designed to improve evidence-based care for people who have, or are at risk of, cardiovascular disease (CVD). The intervention was found to be ineffective as assessed by a patient-level composite score based on chart reviews from a subsample of patients (N = 5292). Here, we used population-based administrative data to examine IDOCC’s effect on CVD-related hospitalizations. Methods IDOCC used a pragmatic, stepped wedge cluster randomized controlled design involving primary care providers recruited across Eastern Ontario, Canada. IDOCC’s effect on CVD-related hospitalizations was assessed in the 2 years of active intervention and post-intervention years. Marginal and mixed-effects regression analyses were used to account for the study design and to control for patient, physician, and practice characteristics. Secondary and subgroup analyses investigated robustness. Results Our sample included 262,996 patient/year observations representing 54,085 unique patients who had, or were at risk of, CVD, from 70 practices. There was a strong decreasing secular trend in CVD-related hospitalizations but no statistically significant effect of IDOCC. Relative to patients in the control condition, patients in the intervention condition were estimated to have 4 % lower odds of CVD-related hospitalizations (adjOR = 0.96, 99 % CI 0.83 to 1.11). The nonsignificant result persisted across robustness analyses. Conclusions Clinical outcomes from administrative databases were examined to form a more complete picture of the (in)effectiveness of a large-scale quality improvement intervention. IDOCC did not have a significant effect on CVD hospitalizations, suggesting that the results from the primary composite adherence score analysis were neither due to choice of outcome nor relatively short follow-up period. Trial registration ClinicalTrials.gov NCT00574808 , registered on 14 December 2007

Choosing a Model for eConsult Specialist Remuneration: Factors to Consider

Electronic consultation (eConsult) is an innovative solution that allows specialists and primary care providers to communicate electronically, improving access to specialist care. Understanding the cost implications of different remuneration models available to pay specialists is of critical importance as adoption of these services continues to increase. We used data collected through the Champlain BASE (Building Access to Specialists through eConsultation) eConsult service to simulate the cost implications of different remuneration models in Canada. The prorated hourly rate model averaged $45.72 CAD (Canadian Dollar) per eConsult while the prorated hourly rate with incentive averaged$51.90 CAD per eConsult, and the fee for service cost $60.50 CAD per eConsult. Paying all specialty groups to block three hours per week for eConsults averaged$337.44 CAD per eConsult and paying for 1-h blocks averaged $133.41 CAD per eConsult. As the remuneration of specialists is the largest cost driver of an established eConsult service, our findings can inform policymakers considering the implementation of eConsult or wishing to further develop an existing service

Improving access to specialists in remote communities: a cross-sectional study and cost analysis of the use of eConsult in Nunavut

Background: Residents of remote communities face inequities in access to specialists, excessive wait times, and poorly coordinated care. The Champlain BASETM (Building Access to Specialists through eConsultation) service facilitates asynchronous communication between primary care providers (PCP) and specialists. The service was extended to several PCPs in Nunavut in 2014. Objective: To (1) describe the use of eConsult services in Nunavut, and (2) conduct a costing evaluation. Design: A cross-sectional study and cost analysis of all eConsult cases submitted between August 2014 and April 2016. Results: PCPs from Nunavut submitted 165 eConsult cases. The most popular specialties were dermatology (16%), cardiology (8%), endocrinology (7%), otolaryngology (7%), and obstetrics/gynaecology (7%). Specialists provided a response in a median of 0.9 days (IQR=0.3–3.0, range=0.01–15.02). In 35% of cases, PCPs were able to avoid the face-to-face specialist visits they had originally planned for their patients. Total savings associated with eConsult in Nunavut are estimated at $180,552.73 or$1,100.93 per eConsult. Conclusions: The eConsult service provided patients in Nunavut’s remote communities with prompt access to specialist advice. The service’s chief advantage in Canada’s northern communities is its ability to offer electronic access to a breadth of specialties far greater than could be supported locally. Our findings suggest that a territory-wide adoption of eConsult would generate enormous savings

The trendiness of sleep: An empirical investigation into the cyclical nature of sleep time

Abstract Using Canadian time use data, we exploit exogenous variation in local unemployment Résumé En utilisant des données canadiennes sur l&apos;utilisation du temps, nous exploitons les variations exogènes des taux de chômage locaux afin d&apos;étudier la nature cyclique du temps de sommeil et montrons que le temps de sommeil des hommes et des femmes diminue lorsque l&apos;économie fait relativement mieux. Nos résultats suggèrent que, lors d&apos;une récession, les Canadiens dorment en moyenne 2 heures et 34 minutes de plus par semaine ou 22 minutes de plus par jour. Étant donné l&apos;importance de l&apos;effet de changements de temps de sommeil sur des mesures de fonctionnement cognitif telles que le temps de réaction et de