'Choosing Wisely': a growing international campaign.

Much attention has been paid to the inappropriate underuse of tests and treatments but until recently little attention has focused on the overuse that does not add value for patients and may even cause harm. Choosing Wisely is a campaign to engage physicians and patients in conversations about unnecessary tests, treatments and procedures. The campaign began in the United States in 2012, in Canada in 2014 and now many countries around the world are adapting the campaign and implementing it.

The incidence of adverse events among home care patients.

Objective: Incidence of adverse events (AEs) among home care patients and preventability ratings were estimated. Risk factors, AE types and factors associated with AEs were identified.

Design: This study used a stratified, randomized sample of home care patients discharged in the fiscal year 2004/05.

Disentangling the effects of disability and age on health service utilisation.

Purpose: This article examines two competing hypotheses for the impact of disability and age on health service utilisation in Canada: the double jeopardy and age-as-leveller hypotheses.

Method: The study uses a retrospective cohort design to examine the effect of age and disability on four aspects of health service utilisation: family doctor, medical specialist, hospital and homecare. The cohort was assembled from the longitudinal component of the National Population Health Survey.

Adverse events in community care: developing a research agenda.

Little is known about the extent to which adverse events compromise the quality of community care. This article describes the results of a consensus workshop in which 31 healthcare professionals were asked to identify and rank common adverse events and important research questions relating to community care. Workshop participants were decision-makers and healthcare providers with areas of expertise that included community and home care; acute and primary care; patient safety; medical errors; and health services policy, administration and research.

Another way to look at high service utilization: the contribution of disability.

Objectives: High users of health services are usually identified in terms of their health complications stemming from the coincidence of a number of chronic conditions. Instead, this analysis attempts to characterize high users in terms of disability, based on the belief that disability provides a more detailed and accurate representation of functional needs and health consequences. The study compares the characteristics of high users of health services among Canadian adults (aged 20-65) with those of low to moderate users and non-users.

What matters most in end-of-life care: perceptions of seriously ill patients and their family members.

Background: Initiatives to improve end-of-life care are hampered by our nascent understanding of what quality care means to patients and their families. The primary purpose of this study was to describe what seriously ill patients in hospital and their family members consider to be the key elements of quality end-of-life care.

Methods: After deriving a list of 28 elements related to quality end-of-life care from existing literature, focus groups with experts and interviews with patients, we administered a face-to-face questionnaire to older patients with advanced cancer and chronic end-stage medical disease and their family members in 5 hospitals across Canada to assess their perspectives on the importance.

End-of-life care in acute care hospitals in Canada: a quality finish?

Understanding patients' and family members' perspectives on the relative importance of elements of end-of-life (EOL) care and their satisfaction with those elements will help prioritize quality improvement initiatives. We administered a face-to-face questionnaire containing a selection of 28 elements of care to eligible inpatients with advanced lung, heart, or liver disease, or metastatic cancer, and available family caregivers (FCGs) in five tertiary care hospitals across Canada. 440 of 569 (78%) eligible patients and 160 of 176 (91%) FCGs participated.