Selected Research Projects
Determinants of Quality in Ontario LTC Homes (2011-2012)
Walter P. Wodchis (PI), Tim Burns (Co-PI; MOHLTC), Ben Chan (Co-P; HQO)
Ontario is active in both regulatory and Quality Improvement (QI) approaches to improving the quality of LTC. The provincial government enacted the Long-Term Care Homes Act, 2007 that came into full force July 1, 2010. Health Quality Ontario (HQO) has initiated a QI initiative called Residents First. They have also started Public Reporting of LTC quality outcomes. It is predicted that Homes will make changes in response to these three initiatives, an impact first felt by staff and resulting in improved resident outcomes. A research partnership, among the Seniors Health Research Transfer Network (SHRTN), the Ontario Association for Non-Profit Homes and Services for Seniors (OANHSS), the Ontario Long Term Care Association (OLTCA), the Ontario Association of Residents’ Councils (OARC), Concerned Friends of Ontario Citizens in Care Facilities, HQO and researchers at the University of Toronto, will embark on a province-wide research project to explore the impacts of these new initiatives. The project, funded by CIHR and HQO, is called “The Determinants of Quality in Ontario LTC Homes”. All homes will be asked to outline how they are dealing with the new initiatives.
Data collection, including administrator and staff surveys, will take place between November 2011 and February 2012. For more information, see the Determinants of Quality in Ontario LTC Homes (2011-2012) web page.
Does CIHR Team Grant in Community Care and Health Human Resources
Raisa Deber (Co-PI), A Paul Williams (Co-PI) and colleagues. 2006-2011.
The research agenda of this five-year CIHR Team Grant of $2.5 million addresses the need for better evidence concerning two key elements affecting and being affected by, the shift of care between hospitals and home/community. Both have been dientified as of high priority, nationally and internationally.
Theme 1 - Community Care of the Team Grant, addresses the demand side, with a focus on applying the 'balance of care' (BoC) model developed by our international research partner (David Challis) to examine: the extent to which individuals with high care needs who might otherwise be institutionalized can be care for in the community; and the costs and consequences of various car emodels for patients, providers, and health care systems. These models have clear implications for access, quality, and cost, as well as for service integration and the mix of services (and service providers) needed to provide care.
Theme 2 - Health Human Resources, addresses the supply and employment shifts of health professionals, with particular emphasis on: the sub-sectors in which these providers work; the factors affecting the likelihood that they will continue working in their profession; differences by sub-sector in retention ("stickiness") and what workers do; and their training and educational needs.
The research findings from both themes will be integrated in Theme 3 - Cross-Jurisdictional, Integrative Policy Analysis, which will focus on the extent to which policy, funding, regulatory, and institutional differences affect policy implementation, and the implications for patients, providers, and the health care system.
The Team Grant has assembled an interdisciplilnary group of researchers, community partners, and collaborators, organized to provide an infrastructure to allow cost-effective sharing of resources across Projects. The Team Grant also assists in developing research capacity among our partners and students, and promote research and knowledge transfer in home and community care. We also use the extensive networks of our research team and research partners (in Canada and the UK) to communicate our results to policy-makers, providers, and consumers at local, provincial, national and international levels.
Does "Value-Based Purchasing" Improve Care?
Mark Dobrow (Co-PI), Louise Lemieux-Charles (Co-PI), Paul Ritvo, David Urbach and Walter Wodchis. 2006-2009.
Value-based purchasing (VBP) is a recent trend linking quality improvement to clinical accountability through a system of incentives, such as:
- pay-for-reporting: rewarding providers who track health information
- pay-for participation: rewarding providers who participate in evidence-based measurement and reporting programs
- pay-for-performance: rewarding providers who provide care that is consistent with evidence-based measures
Can VBP help to alter clinical behaviour and improve the quality of care? Should resources be invested in developing this type of incentive system? Past quality improvement approaches, such as total quality management and continuous quality improvement, have demonstrated only limited success, and the impact of VBP is largely unknown.
This CIHR-funded study is examining the impact of VBP on quality of care in the
Assessing an e-Health Intervention for Adolescents with Scoliosis
James Wright (PI), Cameron Hetherington, Doina Lupea, David Nicholas, Joyce Nyhof-Young and Andrew Willan. 2006-2009.
This CIHR-funded study is exploring the use of the internet to provide social support, knowledge and coping skills for adolescents with scoliosis. Working with adolescents and their families, the investigators will develop and assess an evidence-based website with peer support for adolescents who are about to undergo surgery.
Focus groups with adolescents and their families will be held to identify information needs and website preferences and the website will be evaluated by adolescents for its impact on coping, knowledge and social support. The researchers hope to contribute both to enhanced health outcomes for these patients and to the development of future e-health interventions for children undergoing other major surgical procedures.
Determining Trends in Nurse Transitions across Sectors
Audrey Laporte (PI), Andrea Baumann, Jennifer Blythe, Raisa Deber and Linda O’Brien-Pallas. 2006-2009.
Building on previous CIHR-funded research of nursing retention and turnover in
Previous analysis of the longitudinal dataset showed that nursing shortages and retention vary across care sector. In Stage 1 of this follow-up study, data will be added from the most recent year (2004) and differences between full-and part-time employment will be examined. Is part-time work related to child-bearing or retirement age, or does it reflect a trend in the casualization of nursing labour? In Stage 2, a stratified random sample of 1,968 nurses will by surveyed in collaboration with the College of Nurses of Ontario. Advanced dynamic panel data analytic techniques will be used to analyse individual, job, employer and workplace level factors affecting a) nurse willingness to stay in nursing; b) nurse willingenss to stay in or leave particular sectors of nursing; and c) the number of hours nurses choose to work.
Building Knowledge and Skills for Effective Leadership for Change in Primary Care
Jan Barnsley (Co-PI), Ross Baker (Co-PI), Yves Talbot (Co-PI), Austin Zubin, Louise Barton, Whitney Berta, Louise Lemieux-Charles, Brian Gamble, Peter Norton, Monica Riutort, William Sibbald and Tina Smith. 2005-2007
A new IHPME primary care study is about to be launched with a grant of $564,000 from the Ontario Ministry of Health and Long-Term Care Primary Health Care Transition Fund. Investigators in this project will create a leadership development project based on an action-learning model. Project participants will learn and apply best practices in four areas critical to the advancement of primary care: information management, work redesign, collaboration and integration, and performance improvement. Participants will be teams of primary care practitioners and staff from a variety of Ontario practices. They will participate in three learning sessions with faculty and experts, test and evaluate local changes to improve their practices, and share their learning with other participants. To validate the four areas of critical knowledge an assessment of practitioner's needs, identification of existing best practices and review of the scholarly literature will be conducted The project will be evaluated in terms of individual learning and changes in practice. Materials developed through this project will be disseminated electronically and through conference presentations.
Aging, Social Capital and Health Services Utilization
Audrey Laporte (PI) and Eric Nauenberg. 2007
Staffing in BC Long-Term Care Facilities: 1995-2005
Margaret McGregor (PI) and Whitney Berta. 2007.
This is a retrospective, longitudinal study of staffing in BC long-term care facilities. Residential care policy in BC has led to a decline in the availability of long-term care beds and more restrictive admission criteria. The impact of these changes is unknown. This study, funded by CIHR, has three aims:
- to analyze changes in staffing levels and expertise in BC long-term care facilities from 1995-2005;
- to analyze differences in staffing levels and expertise in publicly funded for-profit and not-for-profit facilities; and
- to assess the feasibility of linking staffing data with health outcome data.
While US studies have shown that not-for-profit facilities have higher staffing levels and better care outcomes than for-profit facilities, there is little Canadian data on staffing levels, facility type and care outcomes. In addition to understanding the impact of policy on care in BC, this study will lay the groundwork for future research linking staffing data and outcome data.
Primary Care Practice Management and Performance Indicators Project
Jan Barnsley (PI), Whitney Berta, Jeff Bloom, Rhonda Cockerill, Liisa Jaakkimainen, Raymond Pong, Yves Talbot and Eugene Vayda
2000-2006.
This study identifies and evaluates indicators by which physicians can monitor the quality of their practice.The goal of the project is to develop tools and processes that can be used by family physicians and nurse practitioners, in both urban and rural settings, to identify ways to improve the provision of health care to patients and the management of family practice.The research team has completed phase one and two of the study, which involved the selection and testing of primary care performance indicators. It isnowengaged in phase 3, assessing the clinical and practice management performanceof family practices and providing feedback to physicians and nurse practitioners.
Operational Efficiencies of Long Term Care Facilities in Canada
Whitney Berta (Co-PI), Audrey Laporte (Co-PI), Geoff Anderson and Vivian Valdmanis.
This study investigates the relationships between inputs (and their costs) and operational efficiency, and what factors determine efficiency. As the proportion of the Canadian population which is elderly increases over the next few decades, the demand for institutional LTC is expected to increase beyond the system's current capacity. Unrealized service efficiencies may mitigate some of the effects of aging baby boomers on health expenditures. However, realizing these efficiencies is contingent upon identifying what the determinants of operational efficiency are, and how they are related to service quality.
The objectives of this study are tomeasure the operational efficiency of each LTC facility relative to the 'best performance' standard identified amongst facilities across Canada andidentify resident-, facility- and environment-level factors most closely associated with observed facility operational efficiency. Results will provide decision-makers with information about which organizational structures and factors are most closely associated with greater efficiency. As such the findings can be used to inform improved decision-making and policy planning related to the provision of funds and allocation of resources to LTC facilities.
Cost and Quality of Variations in Ambulatory and Home-Based Palliative Care
Peter Coyte, Denise Guerriere, and Audrey Laporte
Restructuring health care has resulted in an increasing emphasis on the provision of ambulatory and home-based end-of-life care. In spite of this trend, very little is known about the societal costs and quality of care in this setting. The purposes of this study are to assess the societal costs, satisfaction and quality of home-based palliative care and examine the factors that account for variations over the course of the palliative care trajectory, from admission to death. Family caregivers will be recruited from Regional Palliative Care Programs in Toronto, Edmonton, and Calgary. Study findings will assist in the formulation of palliative care health planning and resource allocation initiatives.
Determinants and Outcomes of Privately and Publicly Financed Home-Based Nursing
Peter Coyte, Denise Guerriere, Patricia McKeever and Ada Wong.
Launched in the Fall of 2003, this study will assess determinants of publicly and privately financed home-based nursing and personal support service utilization. Determinants such as socio-economic status, amount of informal caregiving, and geographic location of residence will be considered. The relationship between publicly and privately financed home-based nursing and personal support services and the quality of care, as well as the costs to the system and to care recipients will also be evaluated. A greater appreciation of home-based nursing and personal support services is necessary for practitioners, health service managers, and policy decision makers to ensure that care recipients and their families receive efficient, effective, equitable, and quality care. Decision-making around the allocation of resources in a financially constrained environment may be facilitated through an accurate depiction of the home care context where nursing and personal support services are provided and received.
Canadian Adverse Events Study
G. Ross Baker (Co-PI), Peter Norton (Co-PI) and colleagues.
This study is the first to map the extent and nature of adverse events which occur in Canadian hospitals. An adverse event is defined as any unintended injury or complication resulting in death, disability or prolonged hospital stay caused by health care management rather than the patient's underlying condition. A total of 3,745 charts were reviewed across 20 hospitals in five provinces according to criteria known to be associated with adverse events. Study results found that the Canadian adverse events rate was 7.5 per hundred patient admissions. Nearly 37 per cent of errors were found to be preventable. Few adverse events resulted in permanent disability (5%) or death (1.6%).
Findings were published in the May 25 edition of the Canadian Medical Association Journal and the full-text article is available here: The Canadian Adverse Events Study: the incidence of adverse events in hospital patients in Canada .