How Canada Compares: Engagement of Seniors in Chronic Condition Management in 11 Countries.

Patient engagement is a growing movement that emphasizes the collaboration between patients and their healthcare providers. Patient engagement in chronic condition management is important because its success relies on patients preventing and acting on symptoms outside of their doctor's office. For many chronic conditions, seniors are often affected more than other age groups. Here we highlight how Canadian seniors are engaged in their management of chronic conditions compared to seniors in 10 peer countries. Although more Canadian seniors reported feeling engaged by their regular doctors than the international average, there is room for improvement.

Care and Outcomes of Patients With Cancer Admitted to the Hospital on Weekends and Holidays: A Retrospective Cohort Study.

BACKGROUND: Patients admitted to the hospital on weekends experience worse outcomes than those admitted on weekdays. Patients with cancer may be especially vulnerable to the effects of weekend care. Our objective was to compare the care and outcomes of patients with cancer admitted urgently to the hospital on weekends and holidays versus those of patients with cancer admitted at other times. MATERIALS AND METHODS: This was a retrospective study of all adult patients with cancer having an urgent hospitalization in Canada from 2010 to 2013. Patients admitted to hospital on weekends/holidays were compared with those admitted on weekdays. The primary outcome was 7-day in-hospital mortality. We also compared performance of procedures in the first 2 days of hospital admission and admission to critical care after the first 24 hours. RESULTS: 290,471 hospital admissions were included. Patients admitted to hospital on weekends/holidays had an increased risk of 7-day in-hospital mortality (4.8% vs 4.3%; adjusted odds ratio [OR], 1.13; 95% CI, 1.08-1.17), corresponding to 137 excess deaths per year compared with the weekday group. This risk persisted after restricting the analysis to patients arriving by ambulance (7.1% vs 6.4%; adjusted OR, 1.11; 95% CI, 1.04-1.18). Among those who had procedures in the first 4 days of admission, fewer weekend/holiday-admitted patients had them performed in the first 2 days, for 8 of 9 common procedure groups. There was no difference in critical care admission risk after the first 24 hours. CONCLUSIONS: Patients with cancer admitted to the hospital on weekends/holidays experience higher mortality relative to patients admitted on weekdays. This may result from different care processes for weekend/holiday patients, including delayed procedures. Future research is needed to identify key outcome-driving procedures, and ensure timely access to these on all days of the week.

Physician Follow-up after Hospital Discharge in Alberta and Saskatchewan.

The period immediately after discharge from hospital can potentially be high risk and a vulnerable transition point for patients. This analysis from the Canadian Institute for Health Information assessed adherence to best practices for patient follow-up in the community after hospitalization in Alberta and Saskatchewan. For three selected conditions - acute myocardial infarction, heart failure and chronic obstructive pulmonary disease - the majority of patients (77-92%) saw a physician within a month of their discharge. However, fewer patients saw a physician within the first week (35-56%).

Quality of care: international comparisons of Canadian provinces.

There is increasing interest in comparing Canada's health system internationally to enhance accountability, promote benchmarking and increase mutual learning. The Canadian Institute for Health Information (CIHI) developed an interactive web display using data from the Organization for Economic Co-operation and Development, CIHI and Statistics Canada.

Estimating surge in COVID-19 cases, hospital resources and PPE demand with the interactive and locally-informed COVID-19 Health System Capacity Planning Tool.

Introduction: The COVID-19 pandemic revealed an urgent need for analytic tools to help health system leaders plan for surges in hospital capacity. Our objective was to develop a practical and locally informed Tool to help explore the effects of public health interventions on SARS-CoV-2 transmission and create scenarios to project potential surges in hospital admissions and resource demand. Methods: Our Excel-based Tool uses a modified S(usceptible)-E(xposed)-I(nfected)-R(emoved) model with vaccination to simulate the potential spread of COVID-19 cases in the community and subsequent demand for hospitalizations, intensive care unit beds, ventilators, health care workers, and personal protective equipment. With over 40+ customizable parameters, planners can adapt the Tool to their jurisdiction and changes in the pandemic. Results: We showcase the Tool using data for Ontario, Canada. Using healthcare utilization data to fit hospitalizations and ICU cases, we illustrate how public health interventions influenced the COVID-19 reproduction number and case counts. We also demonstrate the Tool's ability to project a potential epidemic trajectory and subsequent demand for hospital resources. Using local data, we built three planning scenarios for Ontario for a 3-month period. Our worst-case scenario accurately projected the surge in critical care demand that overwhelmed hospital capacity in Ontario during Spring 2021. Conclusions: Our Tool can help different levels of health authorities plan their response to the pandemic. The main differentiators between this Tool and other existing tools include its ease of use, ability to build scenarios, and that it provides immediate outcomes that are ready to share with executive decision makers. The Tool is used by provincial health ministries, public health departments, and hospitals to make operational decisions and communicate possible scenarios to the public. The Tool provides educational value for the healthcare community and can be adapted for existing and emerging diseases.

The Determinants of the Technical Efficiency of Acute Inpatient Care in Canada.

OBJECTIVE: To evaluate the technical efficiency of acute inpatient care at the pan-Canadian level and to explore the factors associated with inefficiency-why hospitals are not on their production frontier. DATA SOURCES/STUDY SETTING: Canadian Management Information System (MIS) database (CMDB) and Discharge Abstract Database (DAD) for the fiscal year of 2012-2013. STUDY DESIGN: We use a nonparametric approach (data envelopment analysis) applied to three peer groups (teaching, large, and medium hospitals, focusing on their acute inpatient care only). The double bootstrap procedure (Simar and Wilson 2007) is adopted in the regression. DATA COLLECTION/EXTRACTION METHODS: Information on inpatient episodes of care (number and quality of outcomes) was extracted from the DAD. The cost of the inpatient care was extracted from the CMDB. PRINCIPAL FINDINGS: On average, acute hospitals in Canada are operating at about 75 percent efficiency, and this could thus potentially increase their level of outcomes (quantity and quality) by addressing inefficiencies. In some cases, such as for teaching hospitals, the factors significantly correlated with efficiency scores were not related to management but to the social composition of the caseload. In contrast, for large and medium nonteaching hospitals, efficiency related more to the ability to discharge patients to postacute care facilities. The efficiency of medium hospitals is also positively related to treating more clinically noncomplex patients. CONCLUSIONS: The main drivers of efficiency of acute inpatient care vary by hospital peer groups. Thus, the results provide different policy and managerial implications for teaching, large, and medium hospitals to achieve efficiency gains.