Diversion of hospital admissions from the emergency department using an interprofessional team: a propensity score analysis.

Purpose: To examine if an ED interprofessional team ("ED1Team") could safely decrease hospital admissions among older persons.

Methods: This single-center, retrospective, propensity score matched study was performed at a single ED during a control (December 2/2018-March 31/2019) and intervention (December 2/2019-March 31/2020) period. The intervention was assessed by the ED1Team, which could include an occupational therapist, physiotherapist, and social worker.

Visitor Restrictions During the COVID-19 Pandemic and Increased Falls With Harm at a Canadian Hospital: An Exploratory Study.

Background: Falls with harms (FWH) in hospitalized patients increase costs and lengths of stay. The COVID-19 pandemic has resulted in more FWH. Additionally, the COVID-19 pandemic has resulted in increased patients in isolation with fewer visitors.

Introduction of Group Electronic Monitoring of Hand Hygiene on Inpatient Units: A Multicenter Cluster Randomized Quality Improvement Study.

Background: The current approach to measuring hand hygiene (HH) relies on human auditors who capture <1% of HH opportunities and rapidly become recognized by staff, resulting in inflation in performance. Group electronic monitoring is a validated method of measuring HH adherence, but data demonstrating the clinical impact of this technology are lacking.

Methods: A stepped-wedge cluster randomized quality improvement study was performed on 26 inpatient medical and surgical units across 5 acute care hospitals in Ontario, Canada.

The use of a self-check-in kiosk for early patient identification and queuing in the emergency department.

Objective: Delays in triage processes in the emergency department (ED) can compromise patient safety. The aim of this study was to provide proof-of-concept that a self-check-in kiosk could decrease the time needed to identify ambulatory patients arriving in the ED. We compared the use of a novel automated self-check-in kiosk to identify patients on ED arrival to routine nurse-initiated patient identification.

Characteristics of physicians and patients who join team-based primary care practices: evidence from Quebec's Family Medicine Groups.

Purpose: New models of delivering primary care are being implemented in various countries. In Quebec, Family Medicine Groups (FMGs) are a team-based approach to enhance access to, and coordination of, care. We examined whether physicians' and patients' characteristics predicted their participation in this new model of primary care.

Marginal structural models for skewed outcomes: identifying causal relationships in health care utilization.

Evaluating the impacts of clinical or policy interventions on health care utilization requires addressing methodological challenges for causal inference while also analyzing highly skewed data. We examine the impact of registering with a Family Medicine Group, an integrated primary care model in Quebec, on hospitalization and emergency department visits using propensity scores to adjust for baseline characteristics and marginal structural models to account for time-varying exposures. We also evaluate the performance of different marginal structural generalized linear models in the presence of highly skewed data and conduct a simulation study to determine the robustness of alternative generalized linear models to distributional model mis-specification.

Innovative and diverse strategies toward primary health care reform: lessons learned from the Canadian experience.

Introduction: In the last decade, Canadian provincial and territorial health systems have taken diverse approaches to strengthening primary care delivery. Although the Canadian and US systems differ in significant ways, important commonalities include the organization of care delivery, core principles guiding primary care reform, and some degree of provincial/state autonomy. This suggests that Canadian experiences, which employed a variety of tools, strategies, and policies, may be informative for US efforts to improve primary care.

Primary health care in Canada: systems in motion.

Context: During the 1980s and 1990s, innovations in the organization, funding, and delivery of primary health care in Canada were at the periphery of the system rather than at its core. In the early 2000s, a new policy environment emerged.

Methods: This policy analysis examines primary health care reform efforts in Canada during the last decade, drawing on descriptive information from published and gray literature and from a series of semistructured interviews with informed observers of primary health care in Canada.