Improving the quality of person-centred healthcare from the patient perspective: development of person-centred quality indicators.

Importance: International efforts are being made towards a person-centred care (PCC) model, but there are currently no standardised mechanisms to measure and monitor PCC at a healthcare system level. The use of metrics to measure PCC can help to drive the changes needed to improve the quality of healthcare that is person centred.

Objective: To develop and validate person-centred care quality indicators (PC-QIs) measuring PCC at a healthcare system level through a synthesis of the evidence and a person-centred consensus approach to ensure the PC-QIs reflect what matters most to people in their care.

Evidence-practice gaps in P2Y inhibitor use after hospitalisation for acute myocardial infarction: findings from a new population-level data linkage in Australia.

Background: P2Y inhibitor therapy is recommended for 12 months in patients hospitalised for acute myocardial infarction (AMI) unless the bleeding risk is high.

Aims: To describe real-world use of P2Y inhibitor therapy following AMI hospitalisation.

Methods: We used population-level linked hospital data to identify all patients discharged from a public hospital with a primary diagnosis of AMI between July 2011 and June 2013 in New South Wales and Victoria, Australia.

Evidence-Practice Gaps in Postdischarge Initiation With Oral Anticoagulants in Patients With Atrial Fibrillation.

Background Oral anticoagulant (OAC) therapy reduces the risk of stroke in people with atrial fibrillation (AF), and is considered best practice; however, there is little Australian evidence around the uptake of OACs in this population. Methods and Results We used linked hospital admissions, pharmaceutical dispensing claims, medical services, and mortality data for people in Australia's 2 most populous states (July 2010 to June 2015). Among OAC-naïve people hospitalized with AF, we estimated initiation of OAC therapy within 30 days of discharge, and persistence with therapy in the first year.

Does health system performance reporting stimulate change?

For numerous countries, including Canada, regular health system performance reporting has become increasingly routine if not mandated by legislation. In Canada, the health system performance reporting agenda includes multiple players at all levels from national organizations to provincial health (quality) councils and others. Canada, like many other countries, also participates in international health system performance reporting initiatives.

New Tools for Measuring and Improving Patient Safety in Canadian Hospitals.

The Canadian Institute for Health Information (CIHI) and the Canadian Patient Safety Institute (CPSI) have collaborated on a new measure of patient safety, along with a resource of evidence-informed practices. This measure captures four broad categories of harm in acute care hospitals, consisting of 31 clinical groups selected by clinicians. Analysis showed that harm was experienced in 1 of 18 hospital stays in Canada in 2014ߝ2015 and that no single category accounted for the majority of harmful events.

Systematic approach to evaluating and confirming the utility of a suite of national health system performance (HSP) indicators in Canada: a modified Delphi study.

Objectives: Evaluating an existing suite of health system performance (HSP) indicators for continued reporting using a systematic criteria-based assessment and national consensus conference.

Design: Modified Delphi approach with technical and leadership groups, an online survey of stakeholders and convening a national consensus conference.

Setting: A national health information steward, the Canadian Institute for Health Information (CIHI).

A Comparison of Administrative Data Versus Surveillance Data for Hospital-Associated Methicillin-Resistant Staphylococcus aureus Infections in Canadian Hospitals.

BACKGROUND In Canadian hospitals, clinical information is coded according to national coding standards and is routinely collected as administrative data. Administrative data may complement active surveillance programs by providing in-hospital MRSA infection data in a standardized and efficient manner, but only if infections are accurately captured. OBJECTIVE To assess the accuracy of administrative data regarding in-hospital bloodstream infections (BSIs) and all-body-site infections due to MRSA.

Palliative care coding practices in Canada since the introduction of guidelines and the HSMR indicator.

Objectives: This study examines palliative care (PC) coding practices since the introduction of a national coding standard and assesses a potential association with hospital standardised mortality ratio (HSMR) results.

Setting: Acute-care hospitals in Canada.

Participants: ∼16 million hospital discharges recorded in Canadian Institute for Health Information (CIHI)'s Discharge Abstract Database from April 2006 to March 2013.

New mental health indicators provide a snapshot on performance of the mental health system in Canada.

Although the general hospital remains an important place for stabilizing crises, most services for mental illnesses are provided in outpatient/community settings. In the absence of comprehensive data at the community level, data that are routinely collected from general hospitals can provide insights on the performance of mental health services for people living with mental illness or poor mental health. This article describes three new indicators that provide a snapshot on the performance of the mental health system in Canada: self-injury hospitalization rate, 30-day readmission rate for mental illness and percentage of patients with repeat hospitalizations for mental illness.

Babies admitted to NICU/ICU: province of birth and mode of delivery matter.

Neonatal intensive care units (NICUs) and intensive care units (ICUs) provide care for newborns in need of specialized medical attention. Across Canada, rates of NICU/ICU admission vary. Due to the high cost of monitoring and interventions these admissions cost more than general newborn stays - whether the newborn is in a specialized NICU or in an ICU in those facilities without specialized units for newborns.

Bariatric surgery in Canada: a focus on day surgery procedures.

Given the rise in obesity rates, increasing capacity for bariatric surgery has become a focus for some provincial planners. Four types of bariatric procedures are now performed in Canada; however, funding for the procedures varies by jurisdiction. This article provides an update to our previous article documenting the volume of in-patient bariatric procedures but focuses on the extent to which Canadians are increasingly receiving bariatric procedures in day surgery settings.

Falls among top reasons for transfers from continuing care to acute care hospitals in Canada.

There are limited data on the quality and safety of care for residents in continuing care settings. An analysis of the main reasons why residents, 75 and older, of continuing care facilities are transferred to acute care demonstrates that two of the top three reasons for transfers result from potentially avoidable events.

Thoracic cancer surgeries.

In 2005, Cancer Care Ontario (CCO) released Thoracic Surgical Oncology Standards. These standards were aimed at providing the best level of care for those undergoing thoracic surgery and encompass surgeon training, hospital ancillary services and minimum volume thresholds for surgeries of the lung and esophagus. The objective of the current study was to explore variations in thoracic cancer surgical volumes at the hospital level across Canada.

Unsentimental education: learning from the workers' compensation boards experience.

Hurley et al. document the rise of care provided by workers' compensation boards (WCBs) in Canada and suggest that they potentially represent the "proverbial canaries in the coal mine) for the publicly funded healthcare system. Given WCBs' potential draw on similar resources and their ability to purchase services through incentive-based funding, some may argue that these systems do indeed challenge our current understanding of equitable access under the public system.

Why healthcare renewal matters: lessons from diabetes.

In this commentary, we offer evidence about the burden of chronic conditions and use diabetes as a case study to reveal the gap between recommended and actual care in Canada. What we found through our research is cause for concern - namely, that the care that Canadians with diabetes receive is simply not good enough (an inconvenient truth) and that the country has tremendous untapped potential to prevent chronic illness and improve the quality of care (a convenient truth). Our work and the work of others help Canadians understand the benefits that will accrue to them from investments to close the gap between what we know and what we do.

Waits for surgery following hip fracture.

Almost all hip fracture patients undergo surgery to repair the fracture. Recent research suggests that timely repair is important for good outcomes following surgery. Patients who had surgical repair of a hip fracture in 2003-2004 were identified using hospitalization data collected by the Canadian Institute for Health Information.

Sex differences in hospital admissions from emergency departments in asthmatic adults: a population-based study.

Background: Women represent the majority of adult patients hospitalized for asthma. Analyzing the course of emergency department (ED) visits before hospital admission can help understanding of the mechanisms behind the excess of hospitalizations in women.

Objective: To investigate sex differences in hospital admission rates in adult patients with asthma visiting EDs in Ontario.

Missed opportunity: patients who leave emergency departments without being seen.

The rate of patients who visit emergency departments (EDs) but leave before being evaluated and treated is an important indicator of ED performance. This study examines patient- and hospital-level characteristics that may increase the risk of patients leaving EDs before being seen. The data are from the National Ambulatory Care Reporting System, an administrative database, and represent 4.

Bariatric surgery in Canada: obesity rates for Canadian adults are much higher today than in the past; however, rates of bariatric surgery, a treatment for high-risk severely obese individuals, have not risen in parallel.

Obesity rates for Canadian adults are much higher today than in the past, raising questions about how to achieve healthy weights and mitigate the associated health risks. While not a solution at the population level, bariatric surgery may be a treatment option for a relatively small proportion of obese individuals. In Canada, unlike in the United States, no consistent trend was evident in the use of this surgery between 1996-97 and 2003-04 across the five provinces for which comparable data were available.

Are there socio-economic differences in caesarean section rates in Canada?

Caesarean section rates have risen in recent years, sparking renewed debate about the circumstances under which such deliveries are being, and should be, performed. Some commentators suggest that increasing rates may, in part, be explained by women in higher-income brackets requesting elective caesareans (the so-called "too posh to push" hypothesis). After adjusting for maternal age, Canadian data do not support this theory.