Communication in disasters to support families with children with medical complexity and special healthcare needs: a rapid scoping review.

Disasters can disrupt normal healthcare processes, with serious effects on children who depend upon regular access to the health care system. Children with medical complexity (CMC) are especially at risk. These children have chronic medical conditions, and may depend on medical technology, like feeding tubes. Without clear, evidence-based processes to connect with healthcare teams, families may struggle to access the services and supports they need during disasters. There is limited research about this topic, which has been pushed forward in importance as a result of the COVID-19 pandemic. The authors therefore conducted a rapid scoping review on this topic, with the intention to inform policy processes. Both the peer-reviewed and gray literatures on disaster, CMC, and communication were searched in summer 2020 and spring 2021. Twenty six relevant articles were identified, from which four main themes were extracted: 1. Cooperative and collaborative planning. 2. Proactive outreach, engagement, and response. 3. Use of existing social networks to connect with families. 4. Return to usual routines. Based on this review, good practices appear to involve including families, professionals, other stakeholders, and children themselves in pre-disaster planning; service providers using proactive outreach at the outset of a crisis event; working with existing peer and neighborhood networks for support; employing multiple and two-way communication channels, including social media, to connect with families; re-establishing care processes as soon as possible, which may include virtual connections; addressing mental health issues as well as physical functioning; and prioritizing the resumption of daily routines. Above all, a well-established and ongoing relationship among children, their caregivers, and healthcare teams could reduce disruptions when disaster strikes.

Temperature-controlled spatiotemporally modulated phononic crystal for achieving nonreciprocal acoustic wave propagation.

We computationally investigate a method for spatiotemporally modulating a material's elastic properties, leveraging thermal dependence of elastic moduli, with the goal of inducing nonreciprocal propagation of acoustic waves. Acoustic wave propagation in an aluminum thin film subjected to spatiotemporal boundary heating from one side and constant cooling from the other side was simulated via the finite element method. Material property modulation patterns induced by the asymmetric boundary heating are found to be non-homogenous with depth. Despite these inhomogeneities, it will be shown that such thermoelasticity can still be used to achieve nonreciprocal acoustic wave propagation.

An unexpected transition to virtual care: family medicine residents' experience during the COVID-19 pandemic.

BACKGROUND: The global COVID-19 pandemic led to rapid changes in both medical care and medical education, particularly involving the rapid substitution of virtual solutions for traditional face-to-face appointments. There is a need for research into the effects and impacts of such changes. The objective of this article investigates the perspectives of Family Medicine Residents in one university program in order to understand the impact of this transition to virtual care and learning. METHODS: This is a qualitative focus group study. Four focus groups, stratified by site type (Rural = 1; Semi-Urban = 1; Urban = 2) were conducted, with a total of 25 participants. Participants were either first or second-year Residents in Family Medicine. Focus group recordings were analyzed thematically, based upon a five-level socio-ecological model (individual, family, organization, community, environment and policy context). RESULTS: Two main themes were identified: (1) Residents' experiences of Virtual Learning and Virtual Care, and (2) Living and Learning in Pandemic Times. In the first theme, Residents reported challenges both individually, in their family context, and in their training organizations. Of particular concern was the loss of hands-on experience with clinical skills such as conducting physical examinations. In the second theme, Residents reported disruption of self-care routines and family life. These Residents were unable to engage in the relationships outside of the workplace with their preceptors and peers which they had expected, and which play key roles in social support as well as in future decisions about practice location. CONCLUSIONS: While many patients appreciated virtual care, in the eyes of these Residents it is not the ideal modality for learning the practice of Family Medicine, and they awaited a return to normal times. Despite this, the pandemic has pointed out important ways in which residency training needs to adapt to an evolving world.

Utilizing IoT to design a relief supply chain network for the SARS-COV-2 pandemic.

The current universally challenging SARS-COV-2 pandemic has transcended all the social, logical, economic, and mortal boundaries regarding global operations. Although myriad global societies tried to address this issue, most of the employed efforts seem superficial and failed to deal with the problem, especially in the healthcare sector. On the other hand, the Internet of Things (IoT) has enabled healthcare system for both better understanding of the patient's condition and appropriate monitoring in a remote fashion. However, there has always been a gap for utilizing this approach on the healthcare system especially in agitated condition of the pandemics. Therefore, in this study, we develop two innovative approaches to design a relief supply chain network is by using IoT to address multiple suspected cases during a pandemic like the SARS-COV-2 outbreak. The first approach (prioritizing approach) minimizes the maximum ambulances response time, while the second approach (allocating approach) minimizes the total critical response time. Each approach is validated and investigated utilizing several test problems and a real case in Iran as well. A set of efficient meta-heuristics and hybrid ones is developed to optimize the proposed models. The proposed approaches have shown their versatility in various harsh SARS-COV-2 pandemic situations being dealt with by managers. Finally, we compare the two proposed approaches in terms of response time and route optimization using a real case study in Iran. Implementing the proposed IoT-based methodology in three consecutive weeks, the results showed 35.54% decrease in the number of confirmed cases.

Vocational experiences and career support opportunities among Canadian men with moderate and severe haemophilia.

AIM: The purpose of this research was to provide haemophilia treatment centres (HTCs) with guidance for the potential development of appropriate and timely interventions related to employment and vocational counselling and supports. METHODS: A multi-method approach was employed, where initial focus groups (n = 13) and review of the literature were used to construct a structured survey instrument (n = 75). RESULTS: Focus group participants made choices about employment with keen awareness of how their bleeding disorder might limit them physically; they described the role of social networks in career choices; and they wrestled with issues of disclosure. Among survey respondents, 47% per cent of respondents reported that haemophilia had a small negative impact, 27% felt that it had a moderate negative impact and 13% indicated that it had a very large negative impact. One-third of respondents had at some point received employment-related advice from a member of their haemophilia treatment centre team. Roughly two-thirds of respondents suggested that vocational advice would be "somewhat" or "very" useful at present. CONCLUSION: Canadian men with haemophilia continue to experience challenges related to employment and career development. There appears to be an opportunity for HTCs to incorporate additional supports on these topics into the range of services which they currently provide.

Why public health matters today more than ever: the convergence of health and social policy.

We argue that public health matters more today than ever because it is uniquely positioned as a meeting point or fulcrum between health care and social welfare policy perspectives on the social determinants of health. It combines a grounding in the sciences of biomedicine and epidemiology with the moral imperatives of social advocacy. Health cannot be delivered through health care policy alone and neither can social welfare policy ensure the well-being of all citizens on its own. Social policy is at a disadvantage because it does not engender universal consent the way health policy can. While the way that illness should be addressed is debated, it should be addressed to be not contested, as is social welfare for vulnerable populations. The convergence of health and social policy to address the social determinants of health means public health advocacy must explicitly leverage biomedicine to provide materialist and substantive arguments and social welfare to provide the normative and moral arguments. We conclude that a new model of public health advocacy or social lobbying is necessary to effectively raise concerns that health care-focused thinking will not, but with potential heft that social welfare, historically, has not been able to command.

The Qualitative Descriptive Approach in International Comparative Studies: Using Online Qualitative Surveys.

International comparative studies constitute a highly valuable contribution to public policy research. Analysing different policy designs offers not only a mean of knowing the phenomenon itself but also gives us insightful clues on how to improve existing practices. Although much of the work carried out in this realm relies on quantitative appraisal of the data contained in international databases or collected from institutional websites, countless topics may simply not be studied using this type of methodological design due to, for instance, the lack of reliable databases, sparse or diffuse sources of information, etc. Here then we discuss the use of the qualitative descriptive approach as a methodological tool to obtain data on how policies are structured. We propose the use of online qualitative surveys with key stakeholders from each relevant national context in order to retrieve the fundamental pieces of information on how a certain public policy is addressed there. Starting from Sandelowski's seminal paper on qualitative descriptive studies, we conduct a theoretical reflection on the current methodological proposition. We argue that a researcher engaged in this endeavour acts like a composite-sketch artist collecting pieces of information from witnesses in order to draw a valid depiction of reality. Furthermore, we discuss the most relevant aspects involving sampling, data collection and data analysis in this context. Overall, this methodological design has a great potential for allowing researchers to expand the international analysis of public policies to topics hitherto little appraised from this perspective.

Improving Physician Accountability through Primary Care Reform in Alberta.

Like other Canadian provinces and territories, Alberta has been attempting to reform primary care since the mid-1990s. Although initially these efforts were focused almost exclusively on the method of payment for physicians, since 2003, the focus of government policy has broadened to include other aspects of practice, including governance and accountability, improved continuity, the use of a team-based approach and the use of electronic information systems. Although significant progress has been made, Alberta continues to face challenges.

Past, present and future challenges in health care priority setting.

Purpose Current conditions have intensified the need for health systems to engage in the difficult task of priority setting. As the search for a "magic bullet" is replaced by an appreciation for the interplay between evidence, interests, culture, and outcomes, progress in relation to these dimensions requires assessment of achievements to date and identification of areas where knowledge and practice require attention most urgently. The paper aims to discuss these issues. Design/methodology/approach An international survey was administered to experts in the area of priority setting. The survey consisted of open-ended questions focusing on notable achievements, policy and practice challenges, and areas for future research in the discipline of priority setting. It was administered online between February and March of 2015. Findings "Decision-making frameworks" and "Engagement" were the two most frequently mentioned notable achievements. "Priority setting in practice" and "Awareness and education" were the two most frequently mentioned policy and practical challenges. "Priority setting in practice" and "Engagement" were the two most frequently mentioned areas in need of future research. Research limitations/implications Sampling bias toward more developed countries. Future study could use findings to create a more concise version to distribute more broadly. Practical implications Globally, these findings could be used as a platform for discussion and decision making related to policy, practice, and research in this area. Originality/value Whilst this study reaffirmed the continued importance of many longstanding themes in the priority setting literature, it is possible to also discern clear shifts in emphasis as the discipline progresses in response to new challenges.

Assessing and Improving Performance: A Longitudinal Evaluation of Priority Setting and Resource Allocation in a Canadian Health Region.

BACKGROUND: In order to meet the challenges presented by increasing demand and scarcity of resources, healthcare organizations are faced with difficult decisions related to resource allocation. Tools to facilitate evaluation and improvement of these processes could enable greater transparency and more optimal distribution of resources. METHODS: The Resource Allocation Performance Assessment Tool (RAPAT) was implemented in a healthcare organization in British Columbia, Canada. Recommendations for improvement were delivered, and a follow up evaluation exercise was conducted to assess the trajectory of the organization's priority setting and resource allocation (PSRA) process 2 years post the original evaluation. RESULTS: Implementation of RAPAT in the pilot organization identified strengths and weaknesses of the organization's PSRA process at the time of the original evaluation. Strengths included the use of criteria and evidence, an ability to reallocate resources, and the involvement of frontline staff in the process. Weaknesses included training, communication, and lack of program budgeting. Although the follow up revealed a regression from a more formal PSRA process, a legacy of explicit resource allocation was reported to be providing ongoing benefit for the organization. CONCLUSION: While past studies have taken a cross-sectional approach, this paper introduces the first longitudinal evaluation of PSRA in a healthcare organization. By including the strengths, weaknesses, and evolution of one organization's journey, the authors' intend that this paper will assist other healthcare leaders in meeting the challenges of allocating scarce resources.

Physician and parent barriers to the use of oral corticosteroids for the prevention of paediatric URTI-induced acute asthma exacerbations at home.

OBJECTIVES: Administration of oral corticosteroids at the onset of an upper respiratory tract infection (URTI) can be effective in the management of acute asthma exacerbations in children. This study was designed to identify barriers to parent-initiated implementation of clinical practice guideline-recommended use of oral corticosteroids for prophylaxis against severe asthma exacerbations in children. METHODS: Twenty-seven children who presented to BC Children's Hospital with URTI-induced asthma exacerbations were recruited. Parents received a filled prescription for a course of oral corticosteroids to be used at the earliest onset of their child's next URTI. Each family was contacted monthly over a 1-year period to inquire about URTI events, asthma symptoms, medication use and health care utilization. Focus groups were held with family physicians, paediatricians and parents; transcripts were analyzed qualitatively to identify key themes. RESULTS: Incidence of URTI events among participants was high (85%). Uptake of study medication was low; 44% used the medication as directed at their first URTI event. Eleven per cent of the patients who used the study medication also visited the emergency department for an exacerbation. Focus groups identified four main barriers to the effective use of parent-initiated oral corticosteroids: physician resistance and conflicting messages from providers; parent uncertainty about oral corticosteroids; multiple caregivers and relative ease of access to an emergency department. CONCLUSION: We have identified key barriers to the effective use of parent-administered oral corticosteroids as an asthma management strategy and gained important insights regarding the research that is required to enhance the applicability of the strategy.

High performance in healthcare priority setting and resource allocation: A literature- and case study-based framework in the Canadian context.

Priority setting and resource allocation, or PSRA, are key functions of executive teams in healthcare organizations. Yet decision-makers often base their choices on historical patterns of resource distribution or political pressures. Our aim was to provide leaders with guidance on how to improve PSRA practice, by creating organizational contexts which enable high performance. We carried out in-depth case studies of six Canadian healthcare organizations to obtain from healthcare leaders their understanding of the concept of high performance in PSRA and the factors which contribute to its achievement. Individual and group interviews were carried out (n = 62) with senior managers, middle managers and Board members. Site observations and document review were used to assist researchers in interpreting the interview data. Qualitative data were analyzed iteratively with the literature on empirical examples of PSRA practice, in order to develop a framework of high performance in PSRA. The framework consists of four domains - structures, processes, attitudes and behaviours, and outcomes - within which are 19 specific elements. The emergent themes derive from case studies in different kinds of health organizations (urban/rural, small/large) across Canada. The elements can serve as a checklist for 'high performance' in PSRA. This framework provides a means by which decision-makers in healthcare might assess their practice and identify key areas for improvement. The findings are likely generalizable, certainly within Canada but also across countries. This work constitutes, to our knowledge, the first attempt to present a full package of elements comprising high performance in health care PSRA.

The reallocation challenge: Containing Canadian medical care spending to invest in the social determinants of health.

We argue that Canadian provincial governments should contain medical care spending in order to invest more in the social determinants of health (SDH). Others have said this, many times. Doing it has not proven easy. We therefore emphasize the potential contribution of the priority-setting and resource allocation literature. This literature identifies formal tools and approaches that have built cultures of support for resource shifts, while providing pragmatic means for advancing efficiency and equity. Although reallocation towards SDH from other areas of the health care system is financially viable and supported by existing research, it will require new emphasis on the design of population health interventions that make reallocation politically expedient.

Fit for purpose? Introducing a rational priority setting approach into a community care setting.

Purpose - Program budgeting and marginal analysis (PBMA) is a priority setting approach that assists decision makers with allocating resources. Previous PBMA work establishes its efficacy and indicates that contextual factors complicate priority setting, which can hamper PBMA effectiveness. The purpose of this paper is to gain qualitative insight into PBMA effectiveness. Design/methodology/approach - A Canadian case study of PBMA implementation. Data consist of decision-maker interviews pre (n=20), post year-1 (n=12) and post year-2 (n=9) of PBMA to examine perceptions of baseline priority setting practice vis-à-vis desired practice, and perceptions of PBMA usability and acceptability. Findings - Fit emerged as a key theme in determining PBMA effectiveness. Fit herein refers to being of suitable quality and form to meet the intended purposes and needs of the end-users, and includes desirability, acceptability, and usability dimensions. Results confirm decision-maker desire for rational approaches like PBMA. However, most participants indicated that the timing of the exercise and the form in which PBMA was applied were not well-suited for this case study. Participant acceptance of and buy-in to PBMA changed during the study: a leadership change, limited organizational commitment, and concerns with organizational capacity were key barriers to PBMA adoption and thereby effectiveness. Practical implications - These findings suggest that a potential way-forward includes adding a contextual readiness/capacity assessment stage to PBMA, recognizing organizational complexity, and considering incremental adoption of PBMA's approach. Originality/value - These insights help us to better understand and work with priority setting conditions to advance evidence-informed decision making.

A Qualitative Evaluation of Program Budgeting and Marginal Analysis in a Canadian Pediatric Tertiary Care Institution.

BACKGROUND: Hospitals in Canada are being asked by governments to improve efficiency and do more with fewer resources. Healthcare decision makers are thus driven to find better ways to manage budgets and deliver on their mission. Formal processes of priority setting and resource allocation (PSRA) are one means to this end. OBJECTIVE: This paper reports an evaluation of one such approach, Program Budgeting and Marginal Analysis (PBMA), as applied at a children and women's tertiary care facility in Nova Scotia, Canada. A brief evaluation conducted immediately after the conclusion of the PBMA process was supplemented with a larger retrospective evaluation. METHODS: The retrospective evaluation included 26 face-to-face individual interviews with senior and middle managers who took part in PBMA. Interview transcripts were analyzed against a template consisting of 19 elements of structure, process, attitudes, and outcomes associated with high performance in PSRA. RESULTS: Respondents had a good experience with the implementation of PBMA, and considered it an improvement over past practice. Success was attributed to effective leadership, and substantial efforts to engage staff members. Understanding of economic and ethical principles of decision making was reportedly increased. Areas for improvement included ensuring that everyone participated in good faith, better communication of final results, and stronger follow-through to determine if anticipated changes and benefits in fact occurred. CONCLUSION: The evaluation framework employed here proved useful in assessing the quality of this resource allocation exercise. The results are directly useful to local decision makers, and the identified strengths and weaknesses are broadly consistent with those reported in studies of other organizations.

An evaluation tool for assessing performance in priority setting and resource allocation: multi-site application to identify strengths and weaknesses.

INTRODUCTION: An evaluation tool should help improve formal priority setting and resource allocation (PSRA) processes in Canada and elsewhere. These are crucial to maximizing value from limited resources. METHODS: On the basis of case studies, balanced scorecard development protocols and use-focused evaluation principles, an evaluation tool was developed based on an existing framework for high PSRA performance and implemented in two health care organizations in British Columbia, Canada. RESULTS: Implementation of the tool identified areas of strength, improvement and weakness in the pilot organizations' processes for PSRA including: communication, staff engagement and culture. Refinements were identified and incorporated into the tool for future application. CONCLUSION: This is the first documented multi-site application of such an evaluation tool. Broader dissemination should have use both in further refining the basis of the tool and in catalysing improved performance of PSRA practice.

Introducing New Priority Setting and Resource Allocation Processes in a Canadian Healthcare Organization: A Case Study Analysis Informed by Multiple Streams Theory.

BACKGROUND: In this article, we analyze one case instance of how proposals for change to the priority setting and resource allocation (PSRA) processes at a Canadian healthcare institution reached the decision agenda of the organization's senior leadership. We adopt key concepts from an established policy studies framework - Kingdon's multiple streams theory - to inform our analysis. METHODS: Twenty-six individual interviews were conducted at the IWK Health Centre in Halifax, NS, Canada. Participants were asked to reflect upon the reasons leading up to the implementation of a formal priority setting process - Program Budgeting and Marginal Analysis (PBMA) - in the 2012/2013 fiscal year. Responses were analyzed qualitatively using Kingdon's model as a template. RESULTS: The introduction of PBMA can be understood as the opening of a policy window. A problem stream - defined as lack of broad engagement and information sharing across service lines in past practice - converged with a known policy solution, PBMA, which addressed the identified problems and was perceived as easy to use and with an evidence-base from past applications across Canada and elsewhere. Conditions in the political realm allowed for this intervention to proceed, but also constrained its potential outcomes. CONCLUSION: Understanding in a theoretically-informed way how change occurs in healthcare management practices can provide useful lessons to researchers and decision-makers whose aim is to help health systems achieve the most effective use of available financial resources.

Reflecting on backward design for knowledge translation Comment on "A call for a backward design to knowledge translation".

In a recent Editorial for this journal, El-Jardali and Fadlallah proposed a new framework for Knowledge Translation (KT) in healthcare. Many such frameworks already exist; thus, new entrants to the field must be scrutinized in regard to their unique contributions to advancing understanding and practice. The El-Jardali and Fadlallah framework focuses on policy-level discussions, a relatively under-studied issue to date. Their framework usefully incorporates both priority setting questions at the front-end (which KT efforts get undertaken and which do not) as well as evaluation questions at the back-end (how do we show that more evidence-informed decisions are actually better ones?). Their framework also emphasizes capacity building among both decision-makers and researchers. This is an area worthy of additional attention, particularly because it is likely to be far more challenging than El-Jardali and Fadlallah allow.