Healthcare resource utilization and costs in stable patients with rheumatoid arthritis: Comparing nurse-led and rheumatologist-led models of care delivery.

OBJECTIVES: Having previously shown similar clinical outcomes, this study compared the healthcare resource utilization and direct costs in stable patients with RA followed in the nurse-led care (NLC) and rheumatologist-led care (RLC) models. METHODS: Previously collected clinical data were linked to data on practitioner claims, ambulatory care, and hospital discharges. Assessed resources included physician visits; emergency department (ED) visits; hospital admissions, and disease-modifying anti-rheumatic drugs (DMARDs). The mean per-patient resource utilization and cost (2020 Canadian dollars) over 1 year were compared between the groups using Wilcoxon rank-sum test. The mean per-patient cost of health services and total cost were also estimated using Generalized Linear Models (GLMs) accounting for the baseline differences between the groups. RESULTS: Overall, 244 patients were included. No differences in the number of visits to the ED or to general practice and internal medicine physicians and orthopedic surgeons were found. The NLC group had fewer hospitalizations than the RLC group (p-value=0.03). The mean cost of health services was not statistically different in NLC and RLC groups ($2275 vs. $3772, p-value=0.30). The RLC group included more patients on biologic DMARDs, contributing to a higher mean total cost than the NLC group ($9191 vs. $3056, p-value<0.01). The mean cost estimates with GLMs were consistent with the observed costs. CONCLUSIONS: A nurse-led model of care delivery for stable patients with RA was not associated with increases in healthcare resource utilization or cost as compared to RLC. NLC is one approach to meeting patient needs and better managing scarce healthcare resources.

Integrated People-Centred Care in Canada - Policies, Standards, and Implementation Tools to Improve Outcomes.

INTRODUCTION: Despite the national and international policy commitment to implement integrated health systems, there is an absence of national standards that support evidence-based design, implementation, and monitoring for improvement. Health Standards Organization (HSO)'s CAN/HSO 76000:2021 - Integrated People-Centred Health Systems (IPCHS) National Standard of Canada (NSC) has been developed to help close this gap. This manuscript outlines the policy context and the process taken to develop the IPCHS standard. DESCRIPTION: The IPCHS standard is built around 10 design principles with detailed, action-oriented criteria and guidance for policy makers and health system partners. The IPCHS standard was co-designed with a technical committee that included balanced representation of policy makers, health system decision-makers, Indigenous leaders, providers, patients, caregivers, and academics. Additional feedback was received from a diverse audience during two public review periods and targeted consultation via interviews. This qualitative feedback, combined with the evidence reviews completed by the technical committee, informed the final content of the IPCHS standard. DISCUSSION: The IPCHS standard was developed through a co-design process and complements existing frameworks by providing 66 detailed, action-oriented criteria, with specific guidance. The co-design process and consultations resulted in increased awareness and capacity among policy makers and health system partners. Supplementary tools are also in development to facilitate implementation and monitoring of progress and outcomes. This manuscript was developed in collaboration with technical committee members and HSO staff who led the targeted consultation and adoption of the IPCHS standard in six integrated care networks. CONCLUSION: Implementing integration strategies requires that we create and sustain a culture of continuous improvement and learning. Key lessons from the development process focused on the importance of co-design, embedding people-centred practices throughout the standard, formal yet iterative methodology inclusive of broad consultation, clear accountability for both policy makers and system partners, tools that support action and can be adapted to local context and level of integrated system maturity.

Nurse-Led Care for Stable Patients with Rheumatoid Arthritis: Quality of Care in Routine Practice Compared to the Traditional Rheumatologist-Led Model.

INTRODUCTION: This pragmatic non-inferiority study assessed quality of care within a nurse-led care (NLC) model for stable patients with rheumatoid arthritis (RA) compared to the traditional rheumatologist-led care (RLC) model. METHODS: Data were collected through a chart review. Baseline demographic and clinical characteristics were compared using Chi-square test and t test. The primary outcome measure was the percentage of patients being in remission or low disease activity (R/LDA) with the Disease Activity Score (DAS-28) ≤ 3.2 at 1-year follow-up. Process measures included the percentages of patients with chart documentation of (1) comorbidity screening; (2) education on flare management, and (3) vaccinations screening. Outcomes were summarized using descriptive statistics. RESULTS: Each group included 124 patients. At baseline, demographic and clinical characteristics were comparable between the groups for most variables. Exceptions were the median (Q1, Q3) Health Assessment Questionnaire Disability Index scores [0 (0, 0.25) in NLC and 0.38 (0, 0.88) in RLC, p = 0.01], and treatment patterns with 3% of NLC and 38% of RLC patients receiving a biologic agent, p = 0.01. NLC was non-inferior to RLC with 97% of NLC and 92% of RLC patients being in R/LDA at 1-year follow-up. Patients in the NLC group had better documentation across all process measures. CONCLUSIONS: This study provided real-world evidence that the evaluated NLC model providing protocolized follow-up care for stable patients with RA is effective to address patients' needs for ongoing disease monitoring, chronic disease management, education, and support.

Correction to: Family Integrated Care (FICare) in Level II Neonatal Intensive Care Units: study protocol for a cluster randomized controlled trial.

After publication of our article [1], the authors have reported mathematical errors made in the sample size calculation for this cluster randomized controlled trial (cRCT) (Benzies et al. 2017).

Using integrated technology to create quality care for older adults: a feasibility study.

PURPOSE: Slow changes in older adults' health status are often not detected until they escalate. Our aim was to understand if e-technology can enhance the safety and quality of older adult care by detecting changes in health status early. METHODS: E-technology was implemented with 30 seniors in an assisted living facility. We used wireless devices to monitor blood pressure, oxygen saturation, weight, and hydration. This 1-year feasibility study included: a readiness assessment, procuring devices, developing an alert software, training staff, and weekly monitoring for several months. RESULTS: Analysis of service utilization data showed no significant differences in number of emergency or hospital visits between the intervention and control group. Qualitative data suggested residents were satisfied with the e-technology. Among staff, several saw value in weekly monitoring, however staff emphasized the need for devices to be suitable for older adults. CONCLUSION: It is imperative that researchers work with facilities to ensure there is value-added in implementing new technology. Staff feedback helped fine-tune devices, training materials, and measurement process. It took longer than anticipated to procure suitable devices, set up the software, and recruit residents, thus limiting data collection. Future studies should dedicate more time to implementation and propose longer timelines.

Interprofessional Education for Internationally Educated Health Professionals: Pathways to Licensure.

In response to the shortage of healthcare professionals, the Canadian government has supported two innovative health workforce planning strategies: interprofessional education for interprofessional collaboration and recruiting internationally educated health professionals (IEHPs). Interprofessional collaboration is increasingly expected by Canadian-educated healthcare professionals; IEHPs must also be oriented to this practice model. An environmental scan and iterative assessments and evaluations informed the development of an online interprofessional competency toolkit aimed at training and assessing interprofessional collaboration for IEHPs. This paper outlines the complex licensure pathways for seven healthcare professions and confirms "collaboration" is a required competency, further validating the need for the toolkit.

Family Integrated Care (FICare) in Level II Neonatal Intensive Care Units: study protocol for a cluster randomized controlled trial.

BACKGROUND: Every year, about 15 million of the world's infants are born preterm (before 37 weeks gestation). In Alberta, the preterm birth rate was 8.7% in 2015, the second highest among Canadian provinces. Approximately 20% of preterm infants are born before 32 weeks gestation (early preterm), and require care in a Level III neonatal intensive care unit (NICU); 80% are born moderate (32 weeks and zero days [320/7] to 336/7 weeks) and late preterm (340/7 to 366/7 weeks), and require care in a Level II NICU. Preterm birth and experiences in the NICU disrupt early parent-infant relationships and induce parental psychosocial distress. Family Integrated Care (FICare) shows promise as a model of care in Level III NICUs. The purpose of this study is to evaluate length of stay, infant and maternal clinical outcomes, and costs following adaptation and implementation of FICare in Level II NICUs. METHODS: We will conduct a pragmatic, cluster randomized controlled trial (cRCT) in ten Alberta Level II NICUs allocated to one of two groups: FICare or standard care. The FICare Alberta model involves three theoretically-based, standardized components: information sharing, parenting education, and family support. Our sample size of 181 mother-infant dyads per group is based on the primary outcome of NICU length of stay, 80% participation, and 80% retention at follow-up. Secondary outcomes (e.g., infant clinical outcomes and maternal psychosocial distress) will be assessed shortly after admission to NICU, at discharge and 2 months corrected age. We will conduct economic analysis from two perspectives: the public healthcare payer and society. To understand the utility, acceptability, and impact of FICare, qualitative interviews will be conducted with a subset of mothers at the 2-month follow-up, and with hospital administrators and healthcare providers near the end of the study. DISCUSSION: Results of this pragmatic cRCT of FICare in Alberta Level II NICUs will inform policy decisions by providing evidence about the clinical effectiveness and costs of FICare. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02879799 . Registered on 27 May 2016. Protocol version: 9 June 2016; version 2.

Exploring Context and the Factors Shaping Team-Based Primary Healthcare Policies in Three Canadian Provinces: A Comparative Analysis.

This paper discusses findings from a high-level scan of the contextual factors and actors that influenced policies on team-based primary healthcare in three Canadian provinces: British Columbia, Alberta and Saskatchewan. The team searched diverse sources (e.g., news reports, press releases, discussion papers) for contextual information relevant to primary healthcare teams. We also conducted qualitative interviews with key health system informants from the three provinces. Data from documents and interviews were analyzed qualitatively using thematic analysis. We then wrote narrative summaries highlighting pivotal policy and local system events and the influence of actors and context. Our overall findings highlight the value of reviewing the context, relationships and power dynamics, which come together and create "policy windows" at different points in time. We observed physician-centric policy processes with some recent moves to rebalance power and be inclusive of other actors and perspectives. The context review also highlighted the significant influence of changes in political leadership and prioritization in driving policies on team-based care. While this existed in different degrees in the three provinces, the push and pull of political and professional power dynamics shaped Canadian provincial policies governing team-based care. If we are to move team-based primary healthcare forward in Canada, the provinces need to review the external factors and the complex set of relationships and trade-offs that underscore the policy process.

Interprofessional Competency Toolkit for Internationally Educated Health Professionals: Evaluation and Pilot Testing.

INTRODUCTION: Internationally Educated Health Professionals (IEHPs) constitute a major health care workforce in Canada. Interprofessional education is particularly important for IEHPs to integrate into the Canadian health care system. We designed an online interprofessional education curriculum for IEHPs. The curriculum is designed to cover the six interprofessional competency domains defined in the Canadian Interprofessional Health Collaborative National Interprofessional Competency Framework. In this article, we are presenting findings from the pilot testing of the curriculum with a cohort of IEHPs and educators. METHODS: We conducted surveys and interviews with IEHPs and educators from four provinces (British Columbia, Alberta, Saskatchewan, and Manitoba). We aimed to include seven healthcare professionals: licensed practical nurses, registered nurses, registered psychiatric nurses, pharmacists, physicians, occupational therapists, and physical therapists. We also used a pre- post- self-assessment tool and a set of reflective questions to measure the effectiveness of the curriculum. RESULTS: Thirty IEHPs and five educators reviewed the online curriculum and participated in this evaluation. Postintervention confidence scores for all items under the role clarification and patient-centered care domains increased significantly (P = <0.01) after module completion. The scores also increased for most questions in team functioning, collaborative leadership, and communication domains. The postassessment scores increased for only half of the questions in conflict management domains. Participants agreed with the appropriateness of the content in terms of language, scenarios, and cultural aspects covered in the online curriculum on interprofessional education. DISCUSSION: The content of the curriculum improved IEHPs' understanding of interprofessional collaboration in Canada. The interprofessional curriculum is a creative and useful resource to improve collaborative practice among internationally educated health professionals in Canada.

Advancing team-based primary health care: a comparative analysis of policies in western Canada.

BACKGROUND: We analyzed and compared primary health care (PHC) policies in British Columbia, Alberta and Saskatchewan to understand how they inform the design and implementation of team-based primary health care service delivery. The goal was to develop policy imperatives that can advance team-based PHC in Canada. METHODS: We conducted comparative case studies (n = 3). The policy analysis included: Context review: We reviewed relevant information (2007 to 2014) from databases and websites. Policy review and comparative analysis: We compared and contrasted publically available PHC policies. Key informant interviews: Key informants (n = 30) validated narratives prepared from the comparative analysis by offering contextual information on potential policy imperatives. Advisory group and roundtable: An expert advisory group guided this work and a key stakeholder roundtable event guided prioritization of policy imperatives. RESULTS: The concept of team-based PHC varies widely across and within the three provinces. We noted policy gaps related to team configuration, leadership, scope of practice, role clarity and financing of team-based care; few policies speak explicitly to monitoring and evaluation of team-based PHC. We prioritized four policy imperatives: (1) alignment of goals and policies at different system levels; (2) investment of resources for system change; (3) compensation models for all members of the team; and (4) accountability through collaborative practice metrics. CONCLUSIONS: Policies supporting team-based PHC have been slow to emerge, lacking a systematic and coordinated approach. Greater alignment with specific consideration of financing, reimbursement, implementation mechanisms and performance monitoring could accelerate systemic transformation by removing some well-known barriers to team-based care.

Interprofessional education for internationally educated health professionals: an environmental scan.

OBJECTIVE: The objective of this environmental scan was to identify Western Canadian interprofessional education (IPE) resources that currently exist for internationally educated health professionals (IEHPs). METHODOLOGY: A web-based search was conducted to identify learning resources meeting defined inclusion criteria with a particular focus on the resources available in the Western Canadian provinces. Information was extracted using a standardized template, and we contacted IEHP programs for additional information if necessary. Members of the research team reviewed preliminary findings, identified missing information from their respective provinces, and contacted organizations to fill in any gaps. RESULTS: The scan identified 26 learning resources for IEHPs in Western Canadian provinces and 15 in other provinces focused on support for IEHPs to meet their profession-specific licensing requirements and to acquire knowledge and competencies relevant to working in the Canadian health care system. Most learning resources, such as those found in bridging programs for IEHPs, included an orientation to the Canadian health care system, components of cultural competence, and at least one aspect of interprofessional competence (eg, communication skills). None of the 41 learning resources provided comprehensive training for IEHPs to cover the six interprofessional competency domains defined in the Canadian Interprofessional Health Collaborative (CIHC) National Interprofessional Competency Framework. CONCLUSION: The IEHPs learning resources in Western Canada do not cover all of the interprofessional competencies. This review points to the value of developing a comprehensive IPE curriculum, based on the six domains identified in the CIHC National Interprofessional Competency Framework.

Utilizing the physician assistant role: case study in an upper-extremity orthopedic surgical program.

BACKGROUND: Shortages with resources and inefficiencies with orthopedic services in Canada create opportunities for alternative staffing models and ways to use existing resources. Physician assistants (PAs) are a common provider used in specialty orthopedic services in the United States; however, Canada has limited experience with PAs. As part of a larger demonstration project, Alberta Health Services (AHS) implemented 1 PA position in an upper-extremity surgical program in Alberta, Canada, to demonstrate the role in 4 areas: preoperative, operative, postoperative and follow-up care. METHODS: A mixed-methods evaluation was conducted using semi-structured interviews (n = 38), health care provider (n = 28) and patient surveys (n = 47), and 2 years of clinic data on new patients. Data from a double operating room experiment detailed expected versus actual times for 3 phases of surgery (pre, during, post). RESULTS: Preoperatively, the PA prioritizes patient referrals for surgery and redirects patients to alternative care. In the second year with the PA in place, there was an increase in total new patients seen (113%). Postoperatively, the PA attended rounds on 5 surgeons' patients and handled follow-up care activities. Health care providers and patients reported that the PA provided excellent care. Findings from the operating room showed that the preparation time was greater than expected (38.6%), whereas the surgeon time (20.6%) and postsurgery time (37.2%) was less than expected. CONCLUSION: After 24 months the PA has become a valuable member of the health care team and works across the continuum of orthopedic care. The PA delivers quality care and improves system efficiencies.

CONTEXTE: Le manque de ressources et les inefficacités des services d'orthopédie au Canada créent des possibilités pour de nouveaux modèles de dotation et de mise à contribution des ressources existantes. Aux États-Unis, les adjoints au médecin sont des fournisseurs de soins courants dans les services spécialisés d'orthopédie comparativement au Canada qui en fait une utilisation limitée. Dans le cadre d'un grand projet de démonstration, Alberta Health Services (AHS) a créé un poste d'adjoint au médecin dans un programme de chirurgie des membres supérieurs en Alberta, au Canada, afin de démontrer le rôle de l'adjoint au médecin à 4 étapes des soins : préopératoire, opératoire, postopératoire et suivi. MÉTHODES: Une évaluation avec méthodes mixtes a été effectuée au moyen d'entrevues semi-structurées (n = 38), de sondages auprès de fournisseurs de soins (n = 28) et de patients (n = 47), et de données des nouveaux patients de la clinique sur 2 ans. Les données d'une expérience en salle d'opération double indiquaient le temps prévu et le temps réel de 3 étapes des chirurgies (pré, per et postopératoire). RÉSULTATS: À l'étape préopératoire, l'adjoint au médecin a établi la priorité des patients référés en chirurgie et redirigé les patients vers d'autres soins. Lors de la deuxième année de l'adjoint au médecin, nous avons observé une augmentation du nombre de nouveaux patients accueillis (113 %). À l'étape postopératoire, l'adjoint au médecin a participé aux tournées auprès des patients de 5 chirurgiens et s'est occupé des activités liées aux soins de suivi. Les fournisseurs de soins et les patients ont signalé l'excellence des soins de l'adjoint au médecin. Les résultats de la salle d'opération ont révélé un temps de préparation plus élevé que prévu (38,6 %), alors que le temps de chirurgie (20,6 %) et le temps postchirurgical (37,2 %) étaient inférieurs aux prévisions. CONCLUSION: Après 24 mois, l'adjoint au médecin est devenu un membre valorisé de l'équipe de soins qui travaille à toutes les étapes du continuum des soins orthopédiques. L'adjoint au médecin fournit des soins de qualité et améliore l'efficacité du système.

Indicators and Measurement Tools for Health Systems Integration: A Knowledge Synthesis.

BACKGROUND: Despite far reaching support for integrated care, conceptualizing and measuring integrated care remains challenging. This knowledge synthesis aimed to identify indicator domains and tools to measure progress towards integrated care. METHODS: We used an established framework and a Delphi survey with integration experts to identify relevant measurement domains. For each domain, we searched and reviewed the literature for relevant tools. FINDINGS: From 7,133 abstracts, we retrieved 114 unique tools. We found many quality tools to measure care coordination, patient engagement and team effectiveness/performance. In contrast, there were few tools in the domains of performance measurement and information systems, alignment of organizational goals and resource allocation. The search yielded 12 tools that measure overall integration or three or more indicator domains. DISCUSSION: Our findings highlight a continued gap in tools to measure foundational components that support integrated care. In the absence of such targeted tools, "overall integration" tools may be useful for a broad assessment of the overall state of a system. CONCLUSIONS: Continued progress towards integrated care depends on our ability to evaluate the success of strategies across different levels and context. This study has identified 114 tools that measure integrated care across 16 domains, supporting efforts towards a unified measurement framework.

Variability of staffing and staff mix across acute care units in Alberta, Canada.

BACKGROUND: The health workforce has a crucial position in healthcare, and effective distribution of the workforce is one of the critical areas for healthcare improvement. This requires a proper understanding of the allocation of healthcare providers including staffing levels and staffing variability within a healthcare system. High variability may imply significant differences in outcomes and greater opportunity to better distribute staffing and improve patient outcomes. The objective of this study was to examine staffing variation across acute care units in a large and integrated healthcare system. METHODS: We used survey and administrative data on full time equivalencies of Registered Nurses, Licensed Practical Nurses, Health Care Aides, and allied health staff for 287 acute care units to examine staffing levels across multiple unit types. We used a subsample of 157 units in a more detailed analysis of staffing levels and staff distribution. RESULTS: Results from the full sample indicate that staffing levels, particularly for Registered Nurses, vary substantially across unit types. Subsample analyses showed that the highest variation in staffing levels occurred in rural units, which also had higher average staffing for licensed practical nurses and allied health staff. Rural units had fewer Health Care Aides than did other units. The majority of units were staffed with a combination of all three nursing providers, but the most common arrangement in rural units was staffing of Registered Nurses and Licensed Practical Nurses only. We also found that units with the highest number Registered Nurses also tended to have higher numbers of other staff, particularly allied health providers. CONCLUSIONS: We observed significant variation in staffing levels and mix in acute care units. Some of the differences might be attributable to differences in patient needs and unit types. However, we also observed high variability in units with similar services and patient populations. As other research has shown that staffing is linked to differences in patient outcomes, there is an important opportunity to improve staffing for greater efficiency and higher quality care.

How best to structure interdisciplinary primary care teams: the study protocol for a systematic review with narrative framework synthesis.

BACKGROUND: Western publicly funded health care systems increasingly rely on interdisciplinary teams to support primary care delivery and management of chronic conditions. This knowledge synthesis focuses on what is known in the academic and grey literature about optimal structural characteristics of teams. Its goal is to assess which factors contribute to the effective functioning of interdisciplinary primary care teams and improved health system outcomes, with specific focus on (i) team structure contribution to team process, (ii) team process contribution to primary care goals, and (iii) team structure contribution to primary care goals. METHODS AND DESIGN: The systematic search of academic literature focuses on four chronic conditions and co-morbidities. Within this scope, qualitative and quantitative studies that assess the effects of team characteristics (funding, governance, organization) on care process and patient outcomes will be searched. Electronic databases (Ovid MEDLINE, Embase, CINAHL, PAIS, Web of Science) will be searched systematically. Online web-based searches will be supported by the Grey Matters Tool. Studies will be included, if they report on interdisciplinary primary care in publicly funded Western health systems, and address the relationships between team structure, process, and/or patient outcomes. Studies will be selected in a three-stage screening process (title/abstract/full text) by two independent reviewers in each stage. Study quality will be assessed using the Mixed Methods Assessment Tool. An a priori framework will be applied to data extraction, and a narrative framework approach is used for the synthesis. DISCUSSION: Using an integrated knowledge translation approach, an electronic decision support tool will be developed for decision makers. It will be searchable along two axes of inquiry: (i) what primary care goals are supported by specific team characteristics and (ii) how should teams be structured to support specific primary care goals? The results of this evidence review will contribute directly to the design of interdisciplinary primary care teams. The optimized design will support the goals of primary care, contributing to the improved health of populations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016041884.

Introduction of a team-based care model in a general medical unit.

BACKGROUND: Alberta Health Services is a provincial health authority responsible for healthcare for more than four million people. The organization recognized a need to change its care delivery model to make care more patient- and family-centred and use its health human resources more effectively by enhancing collaborative practice. A new care model including changes to how providers deliver care and skill mix changes to support the new processes was piloted on a medical unit in a large urban acute care hospital Evidence-based care processes were introduced, including an initial patient assessment and orientation, comfort rounds, bedside shift reports, patient whiteboards, Name Occupation Duty, rapid rounds, and team huddles. Small teams of nurses cared for a portion of patients on the unit. The model was intended to enhance safety and quality of care by allowing providers to work to full scope in a collaborative practice environment. METHODS: We evaluated the new model approximately one year after implementation using interviews with staff (n = 15), surveys of staff (n = 25 at baseline and at the final evaluation) and patients (n = 26 at baseline and 37 at the final evaluation), and administrative data pulled from organizational databases. RESULTS: Staff interviews revealed that overall, the new care processes and care teams worked quite well. Unit culture and collaboration were improved, as were role clarity, scope of practice, and patient care. Responses from staff surveys were also very positive, showing significant positive changes in most areas. Patient satisfaction surveys showed a few positive changes; scores overall were very high. Administrative data showed slight decreases in overall length of stay, 30-day readmissions, staff absenteeism, staff vacancies, and the overtime rate. We found no changes in unit length of stay, 30-day returns to emergency department, or nursing sensitive adverse events. CONCLUSIONS: Conclusions from the evaluation were positive, providing initial support for the idea of the collaborative practice model vision for adult medical units across Alberta. There were also a few positive effects on patient care suggesting that models such as this one could improve the organization's ability to deliver sustainable, high-quality, patient- and family-centred care without compromising quality.

Scope of practice review: providers for triage and assessment of spine-related disorders.

PURPOSE: This study explored which health care providers could be involved in centralized intake for patients with nonspecific low back pain to enhance access, continuity, and appropriateness of care. METHODS: We reviewed the scope of practice regulations for a range of health care providers. We also conducted telephone interviews with 17 individuals representing ten provincial colleges and regulatory bodies to further understand providers' legislated scopes of practice. Activities relevant to triaging and assessing patients with low back pain were mapped against professionals' scope of practice. RESULTS: Family physicians and nurse practitioners have the most comprehensive scopes and can complete all restricted activities for spine assessment and triage, while the scope of registered nurses and licensed practical nurses are progressively narrower. Chiropractors, occupational therapists, physiotherapists, and athletic therapists are considered experts in musculoskeletal assessments and appear best suited for musculoskeletal specific assessment and triage. Other providers may play a complementary role depending on the individual patient needs. CONCLUSION: These findings indicate that an interprofessional assessment and triage team that includes allied health professionals would be a feasible option to create a centralized intake model. Implementation of such teams would require removing barriers that currently prevent providers from delivering on their full scope of practice.

Interprofessional collaboration and integration as experienced by social workers in health care.

Interprofessional collaboration in health care is gaining popularity. This secondary analysis focuses on social workers' experiences on interprofessional teams. The data revealed that social workers perceived overall collaboration as positive. However, concerns were made apparent regarding not having the opportunity to work to full scope and a lack of understanding of social work ideology from other professionals. Both factors seem to impede integration of and collaboration with social workers on health care teams. This study confirms the need to encourage and support health care providers to more fully understand the foundation, role, and efficacy of social work on interprofessional teams.

Should Health Care Aides Assist With Medications in Long-Term Care?

Objective: The objective of the study was to determine whether health care aides (HCAs) could safely assist in medication administration in long-term care (LTC). Method: We obtained medication error reports from LTC facilities that involve HCAs in oral medication assistance and we analyzed Resident Assessment Instrument (RAI) data from these facilities. Standard ratings of error severity were "no apparent harm," "minimum harm," and "moderate harm." Results: We retrieved error reports from two LTC facilities with 220 errors reported by all health care providers including HCAs. HCAs were involved in 137 (63%) errors, licensed practical nurses (LPNs)/registered nurses (RNs) in 77 (35%), and pharmacy in four (2%). The analysis of error severity showed that HCAs were significantly less likely to cause errors of moderate severity than other nursing staff (2% vs. 7%, chi-square = 5.1, p value = .04). Conclusion: HCAs' assistance in oral medications in LTC facilities appears to be safe when provided under the medication assistance guidelines.

Development of key performance indicators to evaluate centralized intake for patients with osteoarthritis and rheumatoid arthritis.

INTRODUCTION: Centralized intake is integral to healthcare systems to support timely access to appropriate health services. The aim of this study was to develop key performance indicators (KPIs) to evaluate centralized intake systems for patients with osteoarthritis (OA) and rheumatoid arthritis (RA). METHODS: Phase 1 involved stakeholder meetings including healthcare providers, managers, researchers and patients to obtain input on candidate KPIs, aligned along six quality dimensions: appropriateness, accessibility, acceptability, efficiency, effectiveness, and safety. Phase 2 involved literature reviews to ensure KPIs were based on best practices and harmonized with existing measures. Phase 3 involved a three-round, online modified Delphi panel to finalize the KPIs. The panel consisted of two rounds of rating and a round of online and in-person discussions. KPIs rated as valid and important (≥7 on a 9-point Likert scale) were included in the final set. RESULTS: Twenty-five KPIs identified and substantiated during Phases 1 and 2 were submitted to 27 panellists including healthcare providers, managers, researchers, and patients in Phase 3. After the in-person meeting, three KPIs were removed and six were suggested. The final set includes 9 OA KPIs, 10 RA KPIs and 9 relating to centralized intake processes for both conditions. All 28 KPIs were rated as valid and important. CONCLUSIONS: Arthritis stakeholders have proposed 28 KPIs that should be used in quality improvement efforts when evaluating centralized intake for OA and RA. The KPIs measure five of the six dimensions of quality and are relevant to patients, practitioners and health systems.