Value agenda for heart failure in Ontario: Application of the Porter model.

Value in healthcare is a challenge that is faced all over the world; costs continue to rise despite efforts to increase quality and efficient healthcare delivery. Heart failure is a progressive chronic condition that has been demonstrated to benefit from close monitoring with positive effects on mortality and morbidity when well managed. This article will review the Porter model for value in healthcare by comparing the current state of heart failure management in Ontario, Canada, with the six key concepts of the value agenda. The Ontario quality-based procedure model has been implemented for heart failure management and will be applied against the Porter model to provide an increased understanding of how managers can think differently about patient outcomes. An examination as to how the quality and value of the treatment of this condition can be improved will be conducted using the principles of the value agenda.

Vitamin D deficiency as a risk factor for infection, sepsis and mortality in the critically ill: systematic review and meta-analysis.

INTRODUCTION: In Europe, vitamin D deficiency is highly prevalent varying between 40% and 60% in the healthy general adult population. The consequences of vitamin D deficiency for sepsis and outcome in critically ill patients remain controversial. We therefore systematically reviewed observational cohort studies on vitamin D deficiency in the intensive care unit. METHODS: Fourteen observational reports published from January 2000 to March 2014, retrieved from Pubmed and Embase, involving 9,715 critically ill patients and serum 25-hydroxyvitamin D3 (25 (OH)-D) concentrations, were meta-analysed. RESULTS: Levels of 25 (OH)-D less than 50 nmol/L were associated with increased rates of infection (risk ratio (RR) 1.49, 95% (confidence interval (CI) 1.12 to 1.99), P = 0.007), sepsis (RR 1.46, 95% (CI 1.27 to 1.68), P <0.001), 30-day mortality (RR 1.42, 95% (CI 1.00 to 2.02), P = 0.05), and in-hospital mortality (RR 1.79, 95% (CI 1.49 to 2.16), P <0.001). In a subgroup analysis of adjusted data including vitamin D deficiency as a risk factor for 30-day mortality the pooled RR was 1.76 (95% CI 1.37 to 2.26, P <0.001). CONCLUSIONS: This meta-analysis suggests that vitamin D deficiency increases susceptibility for severe infections and mortality of the critically ill.