A More Nuanced Discussion Required.

Williams and colleagues make a valuable contribution to the home care policy literature, however, their arguments are not always convincing. Missing is a more nuanced discussion of research showing that even when governments provide more supportive services for older adults, families continue to provide care, and a discussion of alternative forms of caring that may arise in the future such as care from siblings and non-married older adults helping one another. Drawing on research pointing to several countries that offer caregivers a range of services would also have been helpful.

Incentive-Based Primary Care: Cost and Utilization Analysis.

Context: In its fee-for-service funding model for primary care, British Columbia, Canada, introduced incentive payments to general practitioners as pay for performance for providing enhanced, guidelines-based care to patients with chronic conditions. Evaluation of the program was conducted at the health care system level.

Objective: To examine the impact of the incentive payments on annual health care costs and hospital utilization patterns in British Columbia.

Family physicians enhance end-of-life care: evaluation of a new continuing medical education learning module in British Columbia.

Background: The Practice Support Program (PSP) is an innovative peer-to-peer continuing medical education (CME) program that offers full-service family physicians/general practitioners (GPs) in British Columbia (BC), Canada, post-graduate training on a variety of topics. We present the evaluation findings from the PSP learning module on enhancing end-of-life (EOL) care within primary care.

Methods: Pen-and-paper surveys were administered to participants three times: at the beginning of the first training session (n = 608; 69.

Financial implications of the continuity of primary care.

Background: The objective of this study was to assess the financial implications of the continuity of care, for patients with high care needs, by examining the cost of government-funded health care services in British Columbia, Canada.

Methods: Using British Columbia Ministry of Health administrative databases for fiscal year 2010-2011 and generalized linear models, we estimated cost ratios for 10 cost-related predictor variables, including patients' attachment to the practice. Patients were selected and divided into groups on the basis of their Resource Utilization Band (RUB) and placement in provincial registries for 8 chronic conditions (1,619,941 patients).

RISQy business (Relationships, Incentives, Supports, and Quality): evolution of the British Columbia Model of Primary Care (patient-centered medical home).

In 2002, the British Columbia Ministry of Health and the British Columbia Medical Association (now Doctors of BC) came together to form the British Columbia General Practice Services Committee to bring about transformative change in primary care in British Columbia, Canada. This committee's approach to primary care was to respond to an operational problem--the decline of family practice in British Columbia--with an operational solution--assist general practitioners to provide better care by introducing new incentive fees into the fee-for-service payment schedule, and by providing additional training to general practitioners. This may be referred to as a "soft power" approach, which can be summarized in the abbreviation RISQ: focus on Relationships; provide Incentives for general practitioners to spend more time with their patients and provide guidelines-based care; Support general practitioners by developing learning modules to improve their practices; and, through the incentive payments and learning modules, provide better Quality care to patients and improved satisfaction to physicians.

Mental health practice and attitudes of family physicians can be changed!

Objectives: An adult mental health module was developed in British Columbia to increase the use of evidence-based screening and cognitive behavioral self-management tools as well as medications that fit within busy family physician time constraints and payment systems. Aims were to enhance family physician skills, comfort, and confidence in diagnosing and treating mental health patients using the lens of depression; to improve patient experience and partnership; to increase use of action or care plans; and to increase mental health literacy and comfort of medical office assistants.

Methods: The British Columbia Practice Support Program delivered the module using the Plan-Do-Study-Act cycle for learning improvement.

Integrated models of care delivery for the frail elderly: international perspectives.

Introduction: Interest is growing in integrated systems of care for the frail elderly. Few such systems have been both documented and evaluated in a rigorous manner. The present article provides an international review of such systems.

An evidence-based policy prescription for an aging population.

In this paper, the authors provide a policy prescription for Canada's aging population. They question the appropriateness of predictions about the lack of sustainability of our healthcare system. The authors note that aging per se will only have a modest impact on future healthcare costs, and that other factors such as increased medical interventions, changes in technology and increases in overall service use will be the main cost drivers.

Transforming family practice in British Columbia: the General Practice Services Committee.

Objective: To describe a new approach to primary care reform developed in British Columbia (BC) under the leadership of the General Practice Services Committee (GPSC). COMPOSITION OF THE COMMITTEE: The GPSC is a joint committee of the BC Ministry of Health Services, the BC Medical Association, and the Society of General Practitioners of BC. Representatives of BC's health authorities also attend as guests.

Time for a paradigm shift: managing smarter by moving from data and information to knowledge and wisdom in healthcare decision-making.

Senior decision-makers in the Canadian healthcare system have to continuously make significant, and complex, policy and program decisions. However, it appears that, often, the evidence they have available is fairly simple descriptive information, collected for operational purposes. Trying to solve complex problems with fairly simple data may lead to suboptimal decisions.

Increasing value for money in the Canadian healthcare system: new findings on the contribution of primary care services.

This article presents a major new finding in regard to the value for money of primary care services. It was found that the more higher-care-needs patients were attached to a primary care practice, the lower the costs were for the overall healthcare system (for the total of medical services, hospital services and drugs). The majority of the cost reductions stemmed from decreases in the costs of hospital services.

Evaluation of healthcare services: asking the right questions to develop new policy and program-relevant knowledge for decision-making.

This article presents a framework for thinking about the key questions that need to be answered to develop new policy and program-relevant knowledge that can be used to make more informed decisions. It is a primer for administrators, policy makers and others about how to identify the knowledge they need to make decisions regarding new or existing programs. The article covers three related dimensions in evaluation: types of evaluations, key domains of inquiry and generic research questions.

Costs of end-of-life care: findings from the province of Saskatchewan.

As part of the Health Care Use at the End-of-Life in Western Canada Study, the Western Office of the Canadian Institute for Health Information (CIHI) collaborated with the ministries or departments of health in British Columbia, Alberta, Saskatchewan and Manitoba to characterize selected aspects of healthcare at the end of life. In-depth supplementary studies were also conducted for each of the four western provinces. Saskatchewan focused its analysis on healthcare costs in the two years before death.

Increasing value for money in the Canadian healthcare system: new findings and the case for integrated care for seniors.

Given the recent economic climate and increasing costs in the Canadian healthcare system, we must ensure that we are getting the best value for money possible. This article presents new findings and a broad weight of evidence to make the case that it is possible to obtain better value for money in our healthcare system by adopting models of integrated care delivery for seniors and others with ongoing care needs.

Organizing healthcare delivery systems for persons with ongoing care needs and their families: a best practices framework.

How systems of care delivery are structured can have a major impact on their relative efficiency and on the quality of care provided to individuals. As the population continues to age, as more people are able to continue to live with disabilities or chronic conditions, and as demands continue from consumers and lobby groups to allow individuals to be more fully integrated into customary Canadian life, pressures to deal with the needs of persons with ongoing care requirements will only continue to mount.

Who cares and how much? The imputed economic contribution to the Canadian healthcare system of middle-aged and older unpaid caregivers providing care to the elderly.

Canadians provide significant amounts of unpaid care to elderly family members and friends with long-term health problems. While some information is available on the nature of the tasks unpaid caregivers perform, and the amounts of time they spend on these tasks, the contribution of unpaid caregivers is often hidden. (It is recognized that some caregiving may be for short periods of time or may entail matters better described as "help" or "assistance," such as providing transportation.

Providing care and support for an aging population: briefing notes on key policy issues.

The Canadian Initiative on Frailty and Aging was initiated with the overall goals of furthering understanding of the causes, trajectory and implications of frailty and improving the lives of older persons at risk of frailty. This paper presents the current research on key policy issues related to the frail elderly.

A comparative analysis of costs to government for home care and long-term residential care services, standardized for client care needs.

This paper reports on the results of analyses using administrative data from British Columbia for 10 years from fiscal 1987/1988 to 1996/1997, inclusive, to examine the comparative costs to government of long-term home care and residential care services. The analyses used administrative data for hospital care, physician care, drugs, and home care and residential long-term care. Direct comparisons for cost and utilization data were possible, as the same care-level classification system is used in BC for home care and residential care clients.

Comparative costs of home care and residential care.

Purpose: This paper reports on Canadian research that examined the cost effectiveness of home care for seniors as a substitute for long-term institutional services.

Design And Methods: Two Canadian cities were included in the research: Victoria, British Columbia, and Winnipeg, Manitoba. The research computes the costs of formal care and informal care in both settings and ensures comparable groups of clients in both settings by comparing individuals at the same level of care.

Rationing home care resources: how discharged seniors cope.

Rationing home care services has become a common strategy used by state/provincial governments to control escalating health care costs, particularly at a time when very little new funding has been re-directed to the home care sector. Across British Columbia, Regional Health Authorities had implemented service reforms that call for the discharge of higher functioning clients from home support service. This paper describes the coping strategies of 137 senior clients who were discharged from home support services and from the Continuing Care Program in the Simon Fraser Health Region located in British Columbia, Canada.

Economic evaluation of a geriatric day hospital: cost-benefit analysis based on functional autonomy changes.

Objective: to investigate whether the benefits related to a geriatric day hospital programme exceeded the costs, using a cost-benefit analysis based on changes in functional autonomy.

Design: a quasi-experimental design with a historical cohort as comparison group.

Setting: the geriatric day hospital programme at the Sherbrooke Geriatric University Institute in the Province of Quebec, Canada.