[Development of quality of care indicators to support chronic disease management]. / Élaboration d'indicateurs de qualité pour soutenir la gestion des maladies chroniques.

INTRODUCTION: This article presents the results of a project conducted by the Institut national d'excellence en santé et en services sociaux of Québec to develop quality of care indicators for the management of six chronic illnesses. METHODS: Indicators were identified through literature searches and analysis of clinical practice guidelines (CPGs). Interdisciplinary expert panels assessed their validity and the strength of the evidence on which they were based. Representatives of patients (N = 19) and professionals (N = 29) were consulted on their relevance and acceptability. Indicators were categorized according to the Chronic Care Model (CCM). RESULTS: A total of 164 indicators were developed, 126 specific to the illnesses under study and 38 on processes and outcomes generic to the CCM. There was convergence between patients and professionals on the relevance of a majority of indicators. Professionals expressed concerns on the indicators measured by means of patient surveys that they considered to be too subjective. DISCUSSION: The importance given to CPGs as the main source of indicators resulted in a great number of indicators of the technical quality ofcare. Using the CCM contributed to a broader perspective of quality. The consultation process identified some of the concerns of professionals about indicator measurement, thusguidingfuture implementation initiatives.

Health technology assessment in Canada.

Canada's health system is a unique combination of public financing and private provision. With the significant government role in financing health services, health technology assessment (HTA) has found a ready audience as a form of policy research. In addition, Canada has been a leader in HTA and is entering a phase of deepening and maturation of HTA activities. The relative absence of dramatic change in the overall health system, coupled with public faith in the Canadian approach has been favorable to HTA's development in Canada. Emerging issues, beyond the demographic and economic pressures facing all Organisation for Economic Co-operation and Development health systems, include the convergence of assessment modalities and organizations for drug and nondrug technologies, increasing public concerns about the viability of Canada's approach to healthcare services, and the transition of HTA from an activity targeting macro-level policy makers to a management tool for healthcare facilities and providers.

The challenge of promoting integration: conceptualization, implementation, and assessment of a pilot care delivery model for patients with type 2 diabetes.

BACKGROUND: The Côte-des-Neiges diabetes pilot project strove to conceptualize, implement, and assess an integrated health care system for Type 2 diabetes. Using a disease management and population-based approach, a multidisciplinary team sought to (1). organize health care in an integrative framework, (2). promote behavior changes in patients to foster self-care, (3). introduce tools to allow family physicians to modify their practices, and (4). encourage local community action to support patients and providers. METHODS: Information from a needs assessment helped guide the development of the care model, which was implemented over a 1-year period. A preliminary assessment was undertaken using qualitative methods. Data were collected through in-depth interviews, focus groups, participant observation, and document analysis. RESULTS: (1). Physicians and patients appreciated having access to a multidisciplinary team and related services, and personalized communication was preferred to computerized links. (2). Patients also perceived the benefit of individualized assessment and self-care educational sessions allowing them to participate in their illness management. (3). A diabetes care flow sheet altered the management strategies of physicians. (4). Limited time prevented full development of networking efforts to promote community mobilization. CONCLUSIONS: Approaches to chronic diseases such as diabetes require integrative health care strategies to support patients and providers in their community. In spite of time constraints, patients perceived the value of education with increasing involvement in their illness, physicians reported changes in their practice, and steps were initiated to mobilize community resources.

Sharing empirical knowledge to improve breastfeeding promotion and support: description of a research dissemination project.

BACKGROUND: Effective transfer of research findings to health care settings is a shared priority among researchers, clinicians, and decision makers. A multidisciplinary, multi-method investigation conducted in 2001 that explored breastfeeding practices and support within a large immigrant community in Montreal, Quebec, Canada, bore numerous implications for practice. Peer-reviewed funding was subsequently granted to support dissemination of these findings to relevant stakeholders. METHOD: Key steps in implementing this research dissemination project included (1) identifying and attracting target audiences from hospitals, community health settings, and government agencies; (2) tailoring tools for communication of research findings to the various needs of audiences; (3) designing interactive workshops to facilitate knowledge uptake; and (4) integrating the project outcomes within a government-sponsored regional breastfeeding committee for longer-term impact. FINDINGS: Despite organizational challenges, more than 90 health care providers, decision makers, and breastfeeding support volunteers participated in the project workshops. Through feedback loops, the dissemination activities contributed new layers of understanding to the original research findings. The activities also engaged audience members to identify more effective breastfeeding support interventions and led to the adoption of breastfeeding support priorities shared by hospital, community, and government stakeholders. CONCLUSION: This dissemination project provided unique opportunities for researchers and stakeholders to share in the interpretation of research findings and to strategically plan for future interventions to promote and support breastfeeding within ethnically diverse communities. Further research dissemination work should continue to be theoretically grounded, include systematic, long-term assessment of dissemination outcomes, and be adequately financed throughout.