How Timid or Bold Are Ministries of Health and Provincial Health Authorities in Canada in Planning for Healthcare Quality?

Introduction: World Health Organization (WHO) guidelines recommend countries set quality plans for their health systems with clear priorities, indicators and targets. This paper examines whether Canada's federal, provincial and territorial governments are applying these principles.

Methods: We evaluated plans from 2010 to 2019 for 14 ministries of health and four health authorities in provinces with a single authority against a rubric that considered the existence of indicators, baselines, targets, time frames and progress reports.

Diabetes prevalence and complication rates: In individual First Nations communities in the Sioux Lookout region of Ontario.

Objective: To test the feasibility of reporting diabetes indicators at a regional and community level in order to provide feedback to local leaders on health system performance.

Design: Analysis of administrative data from hospital discharges and physician billings.

Setting: Sioux Lookout region of Ontario.

Big cities and bright lights: rural- and northern-trained physicians in urban practice.

Introduction: Rural medical education is increasing in popularity in Canada. This study examines why some family physicians who completed their residency training in northern Ontario decided to practise in urban centres.

Methods: We used a qualitative research method.

Graduates of northern Ontario family medicine residency programs practise where they train.

Objective: To examine where graduates of the Northeastern Ontario Family Medicine (NOFM) residency program in Sudbury and the Family Medicine North (FMN) program in Thunder Bay practise after graduation, using cross-sectional and longitudinal analyses.

Methods: Data from the Scott's Medical Database were examined. All physicians who graduated from NOFM and FMN between 1993 and 2002 were included in this analysis.

Finding the right balance between evidence for judgment and evidence for quality improvement.

"Evidence for judgment" asks whether healthcare practitioners did what they were supposed to do. "Evidence for improvement" asks whether quality is improving due to the deliberate efforts of managers and care providers. The former describes the gap between optimal and actual care, examines peer-to-peer comparisons, is retrospective and often measured only at a single point in time, and identifies problems but not necessarily solutions.

A rural CT scanner: evaluating the effect on local health care.

Objective: The first small rural hospital in Ontario to propose a computed tomography (CT) scanner was in Walkerton, a town 160 km north of London. The Ontario Ministry of Health approved the proposal as a pilot project to evaluate the effect on local health care of a rural scanner. This evaluation study had 3 parts: a survey of physicians, a survey of patients, and an analysis of population CT scanning rates.

Duration of rural training during residency: rural family physicians prefer 6 months.

Objective: To determine whether rural family physicians thought they had received enough months of rural exposure during family medicine residency, how many months of rural exposure those who were satisfied with their training had had, and how many months of rural exposure those who were not satisfied with their training wanted.

Design: Mailed survey.

Setting: Rural Canada.

Canadian rural family medicine training programs: growth and variation in recruitment.

Objective: To document the proliferation of rural family medicine residency programs and to note differences in design as they affect rural recruitment.

Design: Descriptive study using semistructured telephone interviews.

Setting: All family medicine residency programs in Canada in 2002.

Factors influencing family physicians to enter rural practice: does rural or urban background make a difference?

Objective: To examine where rural physicians grew up, when during their training they became interested in rural medicine, factors influencing their decision to practise rural medicine, and differences in these measures according to rural or urban upbringing.

Design: Mailed survey.

Setting: Rural Canada.

Quality councils as catalysts and leaders in quality improvement: the experience of the health quality council in Saskatchewan.

Quality councils are an increasingly common phenomenon in Canada. The Health Quality Council in Saskatchewan, the largest such council in Canada, is similar to other councils in that it reports publicly on quality of care, but it differs in that it has an explicit, central role to support quality improvement activities. The HQC strives to gain buy-in and cooperation from provider groups, even those identified as having suboptimal care, by offering them quality improvement training, measurement tools, information about best practices and advice from experts in change management, group psychology, process redesign and operations research.

Time trends and geographic disparities in acute complications of diabetes in Ontario, Canada.

Objective: This study examines whether acute diabetes complication rates have fallen in recent years and whether geographic factors influence these trends.

Research Design And Methods: A population-based time-trend analysis of acute complications of diabetes was conducted using linked administrative and census data from Ontario, Canada. The study population included all adults identified through a province-wide electronic diabetes registry between 1994 and 1999 (n = 577,659).

Quality of care of international and Canadian medical graduates in acute myocardial infarction.

Background: International medical graduates (IMGs) make up a substantial proportion of the physician workforce and play an important role in the care of patients with acute myocardial infarction (AMI). There are concerns that IMGs may provide inferior medical care compared with locally trained medical graduates, but that has not been established.

Methods: We performed a retrospective cohort study of linked administrative databases containing health care claims of physicians' service payments, hospital discharge abstracts, and patients' vital status.

Canadian Cardiovascular Society Consensus Conference 2002: Management of heart disease in the elderly patient.

Cardiovascular disease is a major health issue for the elderly patient. Many diagnostic, therapeutic and ethical issues are specific for the the older adult with heart disease. The Canadian Cardiovascular Society 2002 Consensus Conference provides recommendations for the most frequently encountered cardiac problems in the elderly patient.

Factors influencing participation in obstetrics by obstetrician-gynecologists.

Objective: To examine factors affecting participation in obstetrics among obstetrician-gynecologists and changes in participation over time.

Methods: Using physician billings from Ontario, Canada, from 1992/1993 to 2001/2002, we examined the impact of physician age, gender, practice location, and years of practice on participation in obstetrics with multiple logistic regression and repeated measures analyses. We also examined differences in practice patterns between obstetrics providers and nonproviders using linear and log-linear regressions.

Chronic migraineurs: an important subgroup of patients who visit emergency departments frequently.

Study Objective: We examine whether patients with frequent migraines represent a distinct subgroup of patients who visit emergency departments (EDs) frequently.

Methods: This population-based, cross-sectional study used fiscal year 1998 physician billing data from Ontario, Canada. "Frequent ED visitors" were individuals with at least 12 ED visits per year and were classified as either "frequent migraineurs" (> or =50% of ED visits for migraine) and "other frequent ED visitors.

Patient, physician, and community factors affecting referrals to specialists in Ontario, Canada: a population-based, multi-level modelling approach.

Question Addressed: This population-based study examines the factors affecting referrals by primary care physicians (PCPs) to specialists.

Materials And Methods: Multilevel Poisson models were used to test the impact of patient, physician and community-level variables on the referral rate (the number of office-based specialist referrals per patient by the patient's customary PCP in fiscal year 1997/98). Patients from each of 6972 PCPs with sufficient data in Ontario were examined.

Geography and service supply do not explain socioeconomic gradients in angiography use after acute myocardial infarction.

Background: Socioeconomic status appears to be an important predictor of coronary angiography use after acute myocardial infarction. One potential explanation for this is that patients with lower socioeconomic status live in neighbourhoods near nonteaching hospitals that have no catheterization capacity, few specialists and lower volumes of patients with acute myocardial infarction. This study was conducted to determine whether the impact of socioeconomic status on angiography use would be lessened by considering variations in the supply of services.

Frequent users of emergency departments. Do they also use family physicians' services?

Objective: To determine whether frequent users of emergency department (ED) services use more or fewer primary care services than other ED patients.

Design: Population-based, observational, cross-sectional study.

Setting: Province of Ontario in 1997-1998.

The declining comprehensiveness of primary care.

Background: Recent studies suggest that comprehensiveness of primary care has declined steadily over the past decade. This study tracks the participation rates of general practitioners and family physicians in 6 nonoffice settings across Ontario and examines among which types of physicians this decline in comprehensiveness has occurred.

Methods: Billing (claims) records were used to determine the proportions of fee-for-service general practitioners and family physicians who provided emergency, inpatient, nursing home, house call, anesthesia or obstetrical services from 1989/90 to 1999/2000.