A categorisation of problems and solutions to improve patient referrals from primary to specialty care.

Background: Improving access to specialty care has been identified as a critical issue in the delivery of health services, especially given an increasing burden of chronic disease. Identifying and addressing problems that impact access to specialty care for patients referred to speciality care for non-emergent procedures and how these deficiencies can be managed via health system delivery interventions is important to improve care for patients with chronic conditions. However, the primary-specialty care interface is complex and may be impacted by a variety of potential health services delivery deficiencies; with an equal range of interventions developed to correct them.

Complex intervention modelling should capture the dynamics of adaptation.

Background: Complexity has been linked to health interventions in two ways: first as a property of the intervention, and secondly as a property of the system into which the intervention is implemented. The former recognizes that interventions may consist of multiple components that act both independently and interdependently, making it difficult to identify the components or combinations of components (and their contexts) that are important mechanisms of change. The latter recognizes that interventions are implemented in complex adaptive systems comprised of intelligent agents who modify their behaviour (including any actions required to implement the intervention) in an effort to improve outcomes relative to their own perspective and objectives.

Development of key performance indicators to evaluate centralized intake for patients with osteoarthritis and rheumatoid arthritis.

Introduction: Centralized intake is integral to healthcare systems to support timely access to appropriate health services. The aim of this study was to develop key performance indicators (KPIs) to evaluate centralized intake systems for patients with osteoarthritis (OA) and rheumatoid arthritis (RA).

Methods: Phase 1 involved stakeholder meetings including healthcare providers, managers, researchers and patients to obtain input on candidate KPIs, aligned along six quality dimensions: appropriateness, accessibility, acceptability, efficiency, effectiveness, and safety.

Sex allocation and dispersal in a heterogeneous two-patch environment.

We investigate the evolution of sex allocation and dispersal in a two-habitat environment using a game theoretic analysis. One habitat is of better quality than the other and increased habitat quality influences the competitive ability of offspring in a sex-specific manner. Unlike previous work, we allow incomplete mixing of the population during mating.