Synthèses de recherche des IRSC - Détails

Synthèses de recherche des IRSC - Détails
Chercheur principal désigné Titre du projet Résumé du projet Établissement Montant total du projet (des IRSC et des partenaires)
Dr. Linda LI Knowledge management in health care communities: Identifying, describing, and evaluating the use of communities of practice for knowledge exchange and creation among health care professional and decision makers Abstract Not Available University of British Columbia 84 646 $
Dr. Brenda WILSON A review of approaches to considering social, ethical, and legal issues in health technology assessment Health care services have social, ethical, or legal effects in addition to the clinical effects they are designed to produce. However, there is currently no consensus on how policy makers can best consider these broader concerns when they evaluate health services. In this study, we will use reviews of past research and other literature to examine these issues in detail. For example, we will identify and critically assess the options for incorporating social, ethical, and legal considerations into the evaluation of health services, and we will examine whether and how such issues have been incorporated in past evaluations. We will use two practical examples from the area of genetic screening, to help us focus our research: newborn screening programs for cystic fibrosis (CF) and prenatal screening programs for haemoglobinopathies (haemoglobinopathies include conditions such as sickle cell anemia and thalassemia). Newborn screening for CF is designed to identify and begin early treatment for infants with CF. Prenatal screening for haemoglobinopathies is designed to identify couples who may carry these conditions, and then offer them options, including diagnostic tests for the fetus and the opportunity to terminate an affected pregnancy. Social, ethical, and legal concerns have been raised for both programs (e.g., for newborn CF screening, the identification of infants who carry CF but will not develop the disease is controversial; for prenatal haemoglobinopathy screening, issues of discrimination and of equal access to care have been raised). The goal of our study will be to make recommendations that give health service evaluators and policy makers more insight into complex social, ethical, and legal issues, particularly for genetic screening. Ultimately, the aim is for decisions about health care to be based on the best available evidence. University of Ottawa/Université d'Ottawa 83 943 $
Dr. Samuel SHORTT Managing to ensure patient safety in primary care: A synthesis of research evidence on the United Kingdom experience with clinical governance Recent research in Canada and abroad has shown that medical errors are a very significant cause of death or illness in hospitals. Even though most formal care takes place at the primary care level, very little is known about errors in this environment since the delivery of primary care by thousands of independent practitioners makes estimates of rates very difficult. However, a number of small studies from various venues suggest that errors in primary care are common and often serious. As an alternative to documenting specific errors and targeting interventions to prevent them, in 1998 the United Kingdom introduced the concept of clinical governance designed to elevate the quality of care so as to eliminate those organizational or provider characteristics that combine to create error. Primary Care Groups (PCGs) are required to implement a comprehensive program of quality improvement, including audits, evidence-based protocols, and bench marking. Our study intends to determine whether this approach might offer a model for Canadian health policy. It will systematically review the literature on clinical governance and will seek key informant opinion from government and health care providers in Canada and the UK. The results of this study will yield a description and evaluation of clinical governance as a quality assurance strategy in primary care. It will specify facilitators to implementation, barriers to success, and outcomes documented where the approach has been evaluated. Queen's University (Kingston, Ontario) 64 985 $
Dr. Samuel SHORTT Access to primary care for the homeless: A synthesis of research evidence on effective practices In Canada, tens of thousands of persons are said to be homeless. Many of such individuals have health problems, common among which are: HIV/AIDS, tuberculosis, mental illness, substance abuse, trauma, premature death and a variety of chronic diseases including diabetes and hypertension. Unfortunately they face many significant barriers to accessing needed health services, such as lack of health entitlement documents or the need to place securing food and safety ahead of medical care. This may lead to inappropriate service utilization including a high rate of emergency department use and more frequent hospital admissions with longer stays than the general population. Barriers also cause homeless persons to forego some types of services, especially preventive care. Several suggestive approaches to encourage the more effective provision of primary care for the homeless population have been described such as: multi-disciplinary service integration at a single venue; outreach programs, especially for persons living outside shelters; and case management to create a continuous and supportive link between a client and a service agency. Our study is intended to inform health policy formation by synthesizing the literature on the most effective methods to provide primary care to the homeless. We will also seek key informant opinion from government, health care providers, and NGOs. For the initiatives identified we will identify facilitators to implementation, barriers to success, and documented outcomes. Results will be widely disseminated to the public, key stakeholders, governments, and other researchers. Queen's University (Kingston, Ontario) 64 900 $
Prof. Boris SOBOLEV The utility of instruments for reporting waiting times for elective surgery and associated risks: A systematic review In recent years, the state of health care has ranked among the primary concerns of Canadians. In particular, there is great concern regarding waiting lists for necessary medical services. It is well recognized that currently there are no validated standards by which surgical waiting times are measured or reported, or in fact any standardized mechanisms for transferring the information on access to care into practices of health system management. This research will synthesize information about wait lists for elective surgery that is already available in the scientific literature. All of the relevant data from multiple studies will then be re-analyzed in order to examine the utility of existing instruments for reporting wait-list performance. This information will be communicated to health system managers and policy makers who are responsible for developing a consistent and fair mechanism for surgical wait lists and timely health care delivery. The input of the Ministry of Health Services, chief medical and nursing officers, health service delivery administrators, and surgeons through a knowledge translation process will ensure that the research synthesis is presented in a format useful to health system managers and policy makers. University of British Columbia 85 000 $
Docteure Marie-Pascale POMEY Organizational determinants of waiting time management for health services - A policy review and synthesis While most of the focus on waiting times in Canada has been at the provincial and federal levels, the role of regional and local health authorities and hospitals has often been ignored or downplayed; despite the fact that their is direct responsibility to initiate and implement policies and strategies to ensure timely access to health services. The objectives of this research are to: 1) Conduct a systematic review of the scholarly and grey literature that focuses on the measurement and management of waiting times; 2) Synthesize the gathered information in order to identify the policy and organizational determinants that are associated with the management of waiting times to be able to develop a model; 3) Test the relevancy of the model through interviews with key policy and decision-makers involved in the management of waiting lists in three currently problematic areas: urgent care (heart surgery), elective surgery (orthopaedics), and diagnostic services (MRIs) ; 4) Identify gaps in learning for future research. The results of this research will provide valuable information to decision-makers, managers and researchers regarding key factors associated with the successful management of waiting times. University of Ottawa/Université d'Ottawa 75 956 $
Dr. Craig MITTON Public involvement in health care priority setting: A scoping review Health care decision makers are caught between the public, which wants its increasing health care service demands answered promptly and competently, and the government, which tries to limit health care funding growth so as to keep budgets balanced without tax increases. The solution from health care decision makers has been to try to get more results from every dollar spent. This search for ever-increasing efficiencies revolves around the allocation of funding where it will have the maximum impact.
Research has been carried out on resource allocation processes to assist decision makers in this quest. However, this research has by and large neglected the way in which decision makers should appropriately incorporate preferences and values from the public. Fortunately, there is a related field of research - public participation in health care decision making - from which we can draw to address this important issue. This research project proposes to conduct a scoping review of the literature on public participation in health care decision making to identify research that can guide decision makers incorporating public information when facing resource allocation decisions.		 University of British Columbia 70 000 $
Dr. Esther SUTER Health services integration definitions, processes and impact - a research synthesis Changes in demographics and increasing health care costs demand that we find new ways to deliver health services. New models focus on better integration of services for clients. However, there is a need to establish if these new models improve delivery of care. This Research Synthesis will summarize the literature on integrated health services. The focus will be on definitions, how these services are planned, and what the benefits are. We will also review services for vulnerable populations such as children and youth, seniors, aboriginal populations, the mentally ill, and immigrant women. The review of the literature, and analysis and interpretation of the findings will be conducted according to current accepted standards for this type of work.
The completed review will be of use for health services planners, managers and decision-makers and will assist them to improve current health services. It will also help them with planning of new services that deliver better outcomes such as continuity of care, in particular for vulnerable populations.		 Calgary Health Region 69 410 $
Dr. Jean GRENIER Intégration de la psychologie en médecine et en soins primaires Cette recherche tend à confirmer l`hypothèse que l`intégration de la psychologie est essentielle à la prestation de services de qualité, efficaces et efficients en soins de santé primaires. Pour ce faire, il s'agira d'une part, de clarifier le rôle et les contributions importantes de la psychologie à l'intérieur des soins primaires. D'autre part, il s'agira aussi de mettre à la disposition des décideurs les meilleures données pour faciliter leurs prises de décisions quant aux initiatives d'interdisciplinarité pour l'amélioration de la qualité des soins de santé primaires au Canada. Les objectifs susmentionnés seront atteints par l'entremise : 1) d'une synthèse approfondie des connaissances actuelles canadiennes et internationales sur les avantages d'intégrer la psychologie clinique et de la santé aux soins primaires ainsi que sur les modèles existants d'intégration ; 2) la proposition de modèles d'intégration qui seraient les mieux adaptés au système de santé canadien ; 3) la présentation d'informations nécessaires aux institutions académiques et professionnelles pour réviser les objectifs de formation et développer des stratégies d'enseignement qui prépareront les futurs médecins et psychologues à la collaboration et à l'interdisciplinarité. University of Ottawa/Université d'Ottawa 68 516 $
Dr. Sharon STRAUS Mapping interventions for care co-ordination Coordination of care is a goal that health care organizations around the world are attempting to achieve. Indeed, the Romanow Report on the Future of Health Care in Canada identified integrated, coordinated care as a priority. However, there is no widely agreed typology for coordinated care, nor is there a catalogue of the scope of potential interventions. This proposal describes a scoping review and research synthesis to meet this identified gap and it directly addresses the need for workforce planning and timely access to quality of care. The results of this work will inform health researchers, funders and policy makers about what is currently understood about achieving coordinated care and will provide a catalogue of various interventions and their effectiveness. It will serve to guide future priorities for research including the completion of both primary studies and systematic reviews. University of Calgary 68 968 $
Dr. Steven MORGAN Best practices in drug coverage policy: International approaches to balancing evidence, ethics, and economics Evidence concerning the effects of drug products is generated, reviewed, and appraised with much greater frequency than evidence concerning coverage policies. Our purpose is to synthesize evidence about drug coverage policies that are being considered for wide/wider implementation in Canada. The time and budget allotted to this RFA necessitates focus. After receiving input on topic selection from federal, provincial, and territorial decision makers, and from representatives of the private insurance industry, we chose to focus on formulary-based coverage policies, including:
  • Listing decisions / scope of positive lists
  • Tiered co-payments / reference based pricing
  • Special authority listings / limited use policies
We will answer "does it work?" by assessing impact on access to medicines, health outcomes, trends in drug costs, and distributions of financial burdens. We will employ rigorous and systematic methods to identifying, appraising, and synthesizing evidence of these effects. To assist in the translation of evidence to the Canadian environment we will also answer "will it work here?" We will extract data from studies to determine whether certain factors are necessary for, or associated with, favourable outcomes. Investigated factors will include population served, the system of drug financing, and decision-making process (governance, evidentiary support, and public participation). Combined with a review of formulary-based coverage policies in five comparator countries, this study will illustrate of international best practices in drug funding and resource allocation, as requested in the RFA.		 University of British Columbia 70 000 $
Dr. William GHALI A Scoping Review of Methodological and Applied Issues Relating to Health System Report Cards Recent health policy reports such as the Romanow Report, the Kirby Report, and the provincially-solicited Mazankowski Report in Alberta have identified the importance of system accountability for quality in health care delivery and service provision. To that end, each of these reports have pointed to the need for routine reporting on health system quality, and have recommended that mechanisms be in place for the routine reporting of data relating to health system performance and quality. This scoping review will strive to identify the scope of existing published evidence on best practices relating to the production, reporting, and dissemination of health system report cards, as well as the specific clinical areas for which such report cards currently exist in Canada. Furthermore, we will review the evidence relating to the efficacy (or effectivness) of report cards as a tool for improving either outcomes or processes of care. A combination of peer-reviewed published literature and grey literature will be assessed for this scoping review, and a template for scoping reviews from the Centre for Reviews and Dissemination at the University of York (UK) will be used to guide our work. University of Calgary 64 660 $
Dr. Douglas MARTIN Toward a framework for resource allocation: A review of the state of knowledge The aim of this initiative is to capture and synthesize current knowledge related to "Sustainable financing, funding and ethical resource allocation" and disseminate knowledge to policy makers and scholars. The research will involve a comprehensive review of international and national English language literature between 1991 and 2006. The information from articles will be synthesized using data abstraction forms and evaluated by a team of experienced researchers. Findings from the literature synthesis will be disseminated to policy makers, health care managers and scholars across Canada through journal articles, international conferences, email listserves and an executive course co-sponsored by the University of Toronto's Joint Centre for Bioethics and Rotman School of Business and Harvard University. The research will benefit policy makers and practitioners in the development of guidance for decision making and an agenda for future studies. University of Toronto 63 000 $
Dr. Michael MACENTEE A scoping review and research synthesis on the organisation and delivery of oral health services in long-term care facilities There is limited accountability for the current poor oral health among frail elders, and conflicting opinions and research reports on the cause of this problem. To date, there has not been a systematic exploration or evidence-based summary of the knowledge available for evaluating the organization, regulation, delivery, and outcome of oral healthcare programs in LTC facilities. Consequently most policy and managerial decisions relating to dentistry in this setting are ill-informed. The results of our review and synthesis of research evidence will help to clarify much of the uncertainty associated with oral health-related services in LTC. They will identify concerns that need additional research and help to assign priorities for research funds. In addition, the contact with participants interested in LTC will help to establish an active network of researchers, clinicians and other participants interested in dental geriatrics, and promote interdisciplinary care for this growing segment of the population. Our findings should provide guidance and possible solutions for policy-makers, administrators and health professionals responsible for the health of frail elders in our society. University of British Columbia 68 402 $
Dr. Elizabeth MCGIBBON Inequities in access to health services for rural African Canadian and aboriginal populations in Canada: A scoping review There are substantial inequalities in the health status of Canadians, particularly in relation to race, social class, and gender. Consequently, there is an urgent need to address inequities in access to health services. Little detailed information exists about the nature and scope of these inequities in access, particularly in rural areas and in relation to Aboriginal and Black Canadians.
The overall goal of the project is to determine the size and nature of the literature regarding barriers in access to health services for rural Aboriginal and Black Canadians. This information will be essential for change twoards increased access and increased well being of Aboriginal and Black Canadians. Methods will include: 1) standard techniques such as data base searches; 2) identification of other sources of data; and 3) innovative methods which will include stakeholders from the community, health service administrators and providers and policy makers. The results will be shared with each group of stakeholders. One of the strengths of the study is its innovative methods for inclusion of the above stakeholders in the gathering and exchange of the research results and their dissemination across Canada.		 St. Francis Xavier University (Nova Scotia) 69 486 $
Docteur Jean-Louis DENIS In search of performance: Governance and accountability models and strategies for new organizational forms and innovative mandates in health care settings Recent reforms in health care systems have often relied on the implementation of new organizational forms and the introduction of innovative mandates. New organizational forms are defined in term of formal or virtual rearrangements of resources like the creation of local health networks, integrated delivery health systems, clinical networks and community alliance or partnerships for health. Innovative mandates referred to the transformation of the mission of health care organizations by the incorporation of new responsibility like population health and the integration of care and services. The emergence and implementation of new organizational forms and innovative mandates required the renewal of governance and accountability models and strategies. The purpose of this project is to synthesize the existing knowledge regarding governance and accountability models and strategies related to the transformation of health care systems and organizations. Université de Montréal 62 036 $
Docteure Marie-Pierre GAGNON Interventions efficaces pour une intégration optimale des technologies de l'information et des communications dans la pratique des professionnels de la santé. Synthèse des connaissances Les pratiques fondées sur les preuves scientifiques demeurent encore peu adoptées. Parmi les moyens permettant aux professionnels de la santé d'améliorer leur pratique, les technologies de l'information et des communications (TIC) constituent des outils efficaces d'acquisition et d'intégration des connaissances. Les TIC regroupent un ensemble d'outils pouvant favoriser de meilleures pratiques, que ce soit par la formation et le développement professionnel, la recherche ou le soutien aux prises de décisions cliniques. L'intégration des TIC dans la pratique des professionnels de la santé constitue une opportunité afin d'améliorer la qualité des soins en permettant, notamment, une meilleure gestion de l'information, un accès facilité aux services et une amélioration de la continuité des soins. Cependant, en dépit de plus en plus de preuves relatives à l'efficacité de ces outils pour soutenir les pratiques, l'adoption des TIC à des fins cliniques ou éducatives par les différents professionnels de la santé demeure limitée. Les facteurs humains et organisationnels ont été identifiés comme principales barrières à l'adoption des TIC par les cliniciens. Jusqu'à présent, un certain nombre d'interventions a été réalisé en vue de faciliter l'intégration des TIC dans les pratiques professionnelles, mais l'efficacité de celles-ci et les conditions facilitant leur succès demeurent méconnues. Cette synthèse veut répondre au besoin de connaissances sur les processus permettant l'intégration des TIC dans les pratiques des professionnels de la santé et des barrières pouvant limiter celle-ci. Une revue systématique, comprenant une évaluation de la qualité des études et une analyse basée sur des critères explicites, permettra d'examiner la littérature sur l'adoption des TIC par les professionnels et de dégager les effets de différentes interventions sur les pratiques et les indicateurs de santé. Hôpital Saint-François d'Assise (Québec) 69 625 $
Dr. Amy SALMON Beyond plain language: Exploring strategies for community-driven knowledge translation led by and for women with addictions Women with addictions in Vancouver's Downtown Eastside frequently report that the results of research conducted on substance use, addiction, harm reduction and related health issues are not being effectively communicated within their community. Knowledge synthesis and translation activities are typically targeted to clinician, service provider, and policy audiences and do not actively involve women with substance use problems themselves. There is a pressing need to identify knowledge synthesis processes that support health information exchange that reflects the realities of women's lives and their concerns. This study will develop a model for community-driven knowledge synthesis and translation to create relevant health information resources by, with, and for women with addictions. Four community-based, peer-driven organizations for women who use drugs will be active partners in all stages of the study: Vancouver Area Network of Drug Users, Magdalene Recovery Society, BC Association of People on Methadone and San Francisco SafeHouse. This study will not only produce knowledge synthesis resources, but will also enhance long-term research ready partnerships with substance-using women and the community organizations that serve them, providing the foundation for identifying knowledge gaps and community needs to drive future research. BC Women's Hospital (Vancouver) 80 000 $
Dr. Howard SCHACHTER Strengthening the Science of Knowledge Translation in Child and Youth Mental Health: Synthesizing the Evidence One current problem within healthcare is that scientific knowledge with the potential to improve the health care and outcomes for children, youth or adults is not being put consistently or quickly enough into the hands of those who are in a position to bring about these beneficial effects. Individuals with the capacity to make these changes include health professionals or organizations, who make available or provide the care described by this scientific knowledge, as well as potential recipients of this care, who could be empowered by this knowledge to influence (decisions about) their own health and healthcare.
In order to remedy this problem, scientific efforts have been made to assess the effectiveness of strategies to communicate currently available scientific knowledge to improve healthcare and its outcomes. Audiences have included those who make available or deliver healthcare, as well as those who may receive it.
However, at present there is no conclusive understanding of the possible, beneficial impact of similar endeavors, which are intended specifically to improve the mental healthcare and outcomes for children and youth. One significant reason for this gap in understanding is that, to date, no systematic and scientifically rigorous attempts have been made specifically to identify, bring together, and determine the value of the currently available scientific knowledge concerning the effectiveness of efforts to improve the mental healthcare and outcomes for children and youth. Our work will be undertaken to achieve this unrealized goal.
A high quality systematic review of the scientific evidence will be conducted. We will then adopt specific strategies to effectively communicate the findings obtained from our project to those individuals and organizations with the capacity to improve the mental healthcare and outcomes for children and youth.		 Children's Hospital of Eastern Ontario (Ottawa)/Centre hospitalier pour enfants de l'est de l'Ontario 74 365 $
Dr. Heather STUART Improving Worker Mental Health Through Stigma Reduction Workers with mental health problems often face considerable workplace stigma and discrimination. Their autonomy may be limited, supervision increased, job security placed in jeopardy, advancement restricted, and social support from workmates withdrawn. To overcome treatment barriers, and reduce workplace disability, organizations must be proactive in identifying and managing mental health problems among their workers. This research will synthesize the published evaluation literature pertaining to stigma reduction in order to develop a toolkit of best principles and practices that could be applied to Canadian workplaces. The review will include programs that target mental health literacy (such as improved symptom recognition, treatments, and treatment availability) as well as programs that target changes in illness attitudes or behaviours (such as programs designed to promote greater appreciation of mental health or those promoting better management of mental health related problems, either at the personal or organizational levels). We will include evaluations that have used both quasi-experimental and experimental designs and conduct a standardized quality assessment of each study. We will concentrate our efforts on studies published in the last 25 years, as these will be most relevant to current business practices, but will also include older classic studies if they appear to be particularly relevant or informative.
Our second objective will be to identify and describe selected case examples of organizations that have successfully implemented mental health promotion programs in order to illustrate how best principles and practices pertaining to stigma reduction can be translated into specific workplace initiatives designed to improve worker mental health. Illustrative cases will be identified with the assistance of our business partner.		 Queen's University 71 714 $
Dr. Mark TAYLOR Determining Acceptable Waiting Times for the Surgical Treatment of Solid Organ Malignancies - A Systematic Review People with cancer should have the surgery they need in a timely fashion, since survival may depend on the amount of cancer present when surgery is done. However, for most types of cancer we do not know how long it is safe to wait. For most patients diagnosed with cancer, the initial and often sole treatment is surgery. A review of waiting times for cancer patients treated by surgery is important for developing Canadian benchmarks.
The aim of this review is to provide a complete picture of the evidence for and the use of benchmarks in Canada and abroad. The methods and tools used in this study will provide a defined approach for summarizing benchmark wait times. In addition, the study will suggest future areas of research for informed policy-making in the public health care system.		 St. Boniface General Hospital, Winnipeg 99 280 $
Dr. Bassam MASRI Priority Criteria for Hip and Knee Replacement: Addressing Health Service Wait Times for Surgery The purpose of this study is to identify the best practices for prioritizing patients, by severity and need, on a surgical wait list for hip or knee replacement. The problem is that presently there is no prioritization of patients on the B.C. wait list. Furthermore, there is no policy in place for the use of evidence-based benchmarks for medically acceptable wait times for patients who require total joint replacement or revision. No valid or reliable means are presently used to assess the priority of patients for surgery, rendering it difficult to manage a rapidly increasing surgical wait list to ensure that patients with the highest urgency are served first. A system is required that focuses on improvement in assessment, timeliness, and consistent expectations of wait time according to urgency and equal access to health care in Canada. We will conduct a critical review of existing research and examine the entire up-to-date wait list for hip/knee replacement surgery in BC, and conduct a comparative analysis with wait times in other provinces. We will identify what initiatives have been used to improve access to care, and design strategies to improve access and monitor the effect through recommending priority areas for research and evidence based pilot studies. University of British Columbia 100 000 $
Dr. Marcy WINGET Moving evidence to application: A three province cancer collaborative This proposal is a collaboration between the cancer agencies of Alberta, Saskatchewan, and Manitoba in response to the request for applications (RFA) from Canadian Institutes of Health Research (CIHR): Toward Canadian Benchmarks for Health Services Wait Times : Evidence, Application and Research Priorities. The First Minister's Meeting held September 13 -15, 2004 identified waiting times as a key provincial and federal priority, and one that forms the basis of the 'Deal for a Decade'. Health Canada has published a number of reports that recognize the lack of standardization in waiting lists across the country. The complexity of the cancer care trajectory and the breadth of stakeholders, each with distinct information needs, has made the collection and standardized reporting of cancer-specific wait time measures difficult. Lack of standardization compromises the validity of comparisons between agencies and measurements of compliance with benchmarks. We propose to review the definitions and metrics for reporting wait times data used in cancer care, examine the feasibility of their implementation in the Canadian setting, and make recommendations for future steps with respect to both future research needs and steps towards standardization that can be taken more immediately. We will account for the diversity of stakeholders needs and the multi-modal nature of cancer treatment in this evaluation process. Alberta Cancer Board (Edmonton) 100 000 $
Dr. William HODGE A systematic review of waiting times and outcomes for sight restoration The annual economic burden of visual impairment and blindness in Canada is estimated close to $1 billion. Cataract and age-related macular degeneration are the two most vision-threatening diseases. Statistics Canada has predicted that the portion of persons aging 50 or above will reach 41.3% of the total Canadian population by the year 2026. Population aging could lead to higher prevalence of age-related eye conditions, and this might be further aggravated by the fact that the ophthalmologist population in Canada is aging as well. In result, the waiting list of seeing a general ophthalmologist or for specific ophthalmology treatments grows longer. Timely access to eye healthcare and how patients are affected by these times; therefore, becomes an important clinical question. Patient quality of life is affected, and in some cases, a successful visual outcome may depend upon timely access to service. Nevertheless, most eye surgery is elective, and a "reasonable" waiting time allows healthcare resources to be utilized in other sectors of the healthcare field. Previous health services studies have encompassed average wait times of different ophthalmology treatments and wait list priorities. The aim of this systematic review is to critically appraise and summarize current evidence concerning the wait times for vision healthcare services, and associated patients' outcomes relating to sight restoration. The results of this review will be communicated to the Provincial/Territorial Deputy Ministers of Health via the CIHR. University of Ottawa/Université d'Ottawa 87 749 $
Prof. Paul MOAYYEDI An evidence-based assessment of appropriate waiting times for gastrointestinal cancers One in four Canadians will die from cancer and this is projected to increase with time. Most cancers can be cured if detected early enough so it is important that patients with suspected cancer are seen as early as possible. Canadians are rightly proud of their Provincial Health Care system but waiting times are a problem and these vary between provinces. We intend to review the published evidence and use the experience of other countries with similar health care systems to obtain objective information in the following areas:
  1. What clinical features should be used to decide patients have a higher chance of having cancer?
  2. What is the evidence that increased waiting time leads to a worst prognosis from cancer.
  3. What is the maximum time patients with suspected cancer feel they should have to wait before seeing the appropriate specialist and getting the relevant tests.
 McMaster University 86 008 $
Dr. Thomas NOSEWORTHY Towards establishing evidence-based benchmarks for acceptable waiting times for joint replacement surgery Not Available University of Calgary 99 047 $
Dr. Thomas NOSEWORTHY Sight restoration: benchmark waiting times for cataract removal and corneal transplantation Not Available University of Calgary 99 047 $
Dr. William MACKILLOP Toward Canadian benchmarks for waiting times for radiotherapy for cancer: Synthesizing the evidence and establishing research priorities Waiting lists for cancer treatment are a major concern to patients, doctors and the general public. Radiotherapy is an effective form of treatment that is required in about 50% of patients with cancer. Waiting lists for radiotherapy have been a widespread problem in Canada for the last 15 years. The development of effective solutions to this problem has been hampered by lack agreement about how long it is safe for patients to wait for radiotherapy. There is some evidence that delays in starting RT may make the treatment less effective but that information has never been carefully compiled and analyzed. There are currently no evidence-based, national guidelines that define acceptable waiting times for RT in Canada. We propose first to gather and synthesize the relevant information and then translate it into guidelines for acceptable waiting times for RT. In interpreting the evidence, we plan to engage a broad range of stakeholders, including patients and the public as well as health professionals, health system managers and policy makers Queen's University (Kingston, Ontario) 99 997 $
Dr. Anne KLASSEN Towards evaluation of an integrated services system for children and youth with disabilities: A systematic review Children and youth with disabilities (CYD) such as autism, Down syndrome and cerebral palsy require ongoing involvement from health, social, and educational services to manage the underlying medical condition and its complications, support their safe and full participation in activities with peers, family members and society, and prevent or minimize physical and mental health problems for them and family members. There has traditionally been little in the way of integration, coordination or collaboration among the service agencies involved. We are working towards an evidence base needed to improve services through integration and systematic evaluation, but currently there is no system in place to monitor the quality of care received by CYD. Much work is required to identify the key data elements needed to create indicators, and to develop valid and reliable measures that will enable researchers, program planners and managers to track which services are delivered, how well they are delivered from a system perspective, as well as the relationship between process variables and important CYD outcomes.
In this project, we will conduct a systematic literature review to generate a comprehensive list of published and unpublished child-specific quality indicators that can be used to collect data across service sectors. The results of this review will be used to guide relevant data collection across agencies as we move towards more integrated services, and to measure and evaluate the efficiency and effectiveness of a more integrated system at the individual and system levels.		 McMaster University 98 598 $
Prof. Nancy ROSS Neighbourhood health effects: A systematic review of research evidence and place-based policy prescriptions Two key priorities in Canadian Population and Public Health research are understanding and addressing the impacts of physical and social environments on health and analyzing and reducing health disparities. These are not unrelated priorities if we consider that some neighbourhood environments might be a source of health disparities by placing their populations at risk for what may be a wide variety of adverse health outcomes. Neighbourhoods are 'upstream' in the pathways behind health disparities and they set the context for the span of income and educational possibilities, the norms and behaviours accepted, the types of health care facilities available, and the types of jobs available to their residents. We will conduct a systematic review of the neighbourhoods and health literature which has four objectives:
  1. To elucidate and synthesize both the size (magnitude of health effects attributable to neighbourhood context) and scope (across population groups) of neighbourhood effects across the three country contexts;
  2. To assess the types of health outcomes (health status, mental health, health behaviours, mortality) that are most directly related to neighbourhood conditions and to specify outcome and sub-population specific pathways between neighbourhood properties and health;
  3. To establish a typology of methodologies and recommend best practices for measuring neighbourhood and measuring neighbourhood characteristics; and,
  4. To suggest a place-based multi-sectoral policy response that is proportional in size and scope to the degree of neighbourhood effects on health.
As Canada begins to set public health goals including the reduction of health disparities, the primary aim of this synthesis is to inform the policy debate in Canada on the role of neighbourhood conditions in the production of human health and health disparities.		 McGill University/Université McGill 72 100 $
Madame Marie-France RAYNAULT Synthèse de recherche portant sur les interventions de santé publique visant à réduire les inégalités sociales de santé La recherche sur les inégalités sociales de santé a connu un essor intéressant ces dernières années au Canada. Les autorités de santé publique et les intervenants régionaux et locaux sont maintenant très sensibilisés aux impacts négatifs de la pauvreté et des autres inégalités sociales sur la santé des populations. Les solutions à ces problèmes sont néanmoins complexes et peuvent sembler hors de portée des professionnels qui ont à appliquer les programmes d'intervention en promotion de la santé.
Nous faisons l`hypothèse que les politiques macrosociales qui se sont avérées utiles pour réduire les inégalités sociales s'inscrivent dans une architecture de politiques qui ont aussi leur pendant régional et local et que les interventions de santé publique se doivent de participer à cet effort sociétal de façon éclairée. Le projet vise à étudier les politiques et programmes dans les pays qui ont réussi à réduire les inégalités sociales, à synthétiser cette information à l'usage des gestionnaires locaux et à développer une pratique d'échanges sur les implications locales de ces grandes politiques.		 Université de Montréal 84 165 $
Dr. Lois JACKSON A scoping review and research synthesis of community-level interventions that modify social environments and influence health Social conditions in communities have been shown to be a better predictor of health than health care or individual lifestyles. Therefore policies and programs that seek to improve social conditions can be expected to have a great impact on health of the community. In order to know which policies and programs might be the most effective in improving health, it is necessary to look at the effects that changes in policies and programs have had in the past. Once it is known which programs and policies are most effective and under what conditions, policy makers, health care practitioners, and community organizations can plan interventions with more confidence that they will be effective.
The Atlantic Centre for Health Promotion Research has assembled a dynamic team of researchers and end-users of research to determine 1) which interventions in the social environments of communities are most effective and 2) areas in which more research evidence is needed to determine the effectiveness. The results of the study will be distributed widely through summary briefing documents, oral presentations, distribution of the full report, and publication in a peer-reviewed journal.		 Dalhousie University (Nova Scotia) 99 950 $
Dr. Robert TEASELL Research synthesis to determine the appropriate application of effective interventions for stroke rehabilitation within the Canadian health care system Stroke is the fourth leading cause of death in Canada and a leading cause of disability. Recently published reviews of the research evidence, including a major, comprehensive synthesis by the applicants and their collaborators (www.ebrsr.com), have identified effective rehabilitation interventions that significantly improve function, ability to perform activities of daily living, help prevent secondary disability, and facilitate the return home and to active community participation. However, in the current Canadian health care system, scientific knowledge about best practices is not applied systematically or expeditiously to rehabilitative services. This application proposes to produce a synthesis of literature and environmental scan to identify the barriers and opportunities for implementing effective interventions for stroke rehabilitation within the public health care system in Canada. Various qualitative and quantitative methods will be used to answer the research questions posed: literature synthesis, document analysis, key informant interviews and analyses of administrative data. The intent is to clarify the role for stroke rehabilitation in the continuum of care as well as the resources needed to support this role. St. Joseph's Health Care (London, Ontario) 85 000 $
Dr. Lucie BROSSEAU Increasing public access to clinical practice guidelines for rheumatoid arthritis and osteoarthritis Rheumatoid arthritis (RA) and osteoarthritis (OA) affect a significant proportion of the population in Canada. Funding pressures in the health care system have created an urgent need for accurate, up-to-date clinical guidelines that describe the most effective and efficient treatments. The current project consists of two distinct phases. In phase I, the effectiveness of treatment strategies for RA and OA that can be independently self-managed by patients themselves will be systematically reviewed and they include: 1) use of assistive devices, 2) conservation of energy/sleeping enhancement, 3) TENS, 4) splinting and orthotics, 5) therapeutic exercise, and 6) thermotherapy. The systematic identification, critical appraisal and synthesis of the best available evidence will serve as a basis for formulating Evidence-based Clinical Practice Guidelines (EBCPGs), which will be translated into lay words to facilitate communication with the general public. In phase II, the effectiveness of press media and an interactive educational training program for patients will be tested for their potential to promote the dissemination and implementation of the EBCPGs. University of Ottawa/Université d'Ottawa 99 983 $
Dr. Marcia HILLS Assessing the effectiveness of inter-sectoral community efforts to promote health and reduce health disparities By conducting a systematic review of the effectiveness of community efforts to reduce health disparities, this research will offer focused information on a neglected area of research: complex community health interventions to reduce health disparities. Furthermore, it will utilize a method of review synthesis, which takes into account the influence of complex, contextual factors, such as the impact of the social and physical environment on health and the production of health disparities. This proposal responds directly to two research priorities identified by the CIHR IPPH: understanding and addressing the impacts of physical and social environments on health; and, analyzing and reducing health disparities. It has the following objectives: 1) to inform policy-makers, researchers and practitioners of the best available evidence concerning effective practice in community efforts to reduce health disparities; 2) to enhance collaborative relationships between researchers and policy-makers in the development, conduct and use of systematic reviews to inform policy on reducing health disparities; and, 3) to test the coherence, practicality and scientific value of the realist synthesis methodology for conducting systematic reviews of complex health interventions. University of Victoria (British Columbia) 91 119 $
Monsieur Paul BERNARD A scoping review of the literature about the effects of place on social inequalities of health Researchers and policy-makers now acknowledge the role of neighbourhood social and material environment in producing and maintaining social inequalities in health. However, still remains the task of understanding what characteristics of the neighbourhood environment matter for mortality and morbidity. To contribute in fostering knowledge about this issue, we will review the empirical studies that examined the association between neighbourhood characteristics and health outcomes. Neighbourhood characteristics hypothesized to influence health and health behaviour are: 1)attributes of the physical environment such as pollution, graffiti, litter and garbage, etc 2) attributes of the institutional environment such as schools, medical care, public transportations, etc 3)attributes of the economic environment such as supermarkets, fast-food restaurants, bars, etc 4) attributes of the social environment such as violence, trust, social organizations, etc. A group of policy-makers will be involved throughout the project, discussing our results, making explicit their needs, and sharing their considerable stock of knowledge. This knowledge transfer between researches and policymakers will inform the design of policies and interventions to tackle social inequalities in health. Université de Montréal 70 080 $
Dr. Tanya HORSLEY A systematic review of waiting times for cardiac services and procedures The most important issue in cardiac disease both in terms of morbidity and mortality, and access and wait times is coronary angiography and revascularization for both stable out-patient exertional angina and for acute coronary syndromes (ACS). Cardiac services are expected to increase in both volume and services needed over the next two decades. The Canadian Institute for Health Information (CIHI) recently (March 2006) reported that ''the number of angioplasty and bypass surgeries had a combined increase of 51% over five years between 1997-1998 and 2002-2003, amounting to almost 22,000 more surgeries over this period''. This fact makes understanding evidence based benchmarks for cardiac services and procedures, and the impact of these wait times on patient outcomes, a high priority in our country. Children's Hospital of Eastern Ontario (Ottawa)/Centre hospitalier pour enfants de l'est de l'Ontario 92 974 $
Dr. Alison NICCOLS A meta-analysis of integrated treatment programs for substance-using women and their children: Effectiveness and moderators of treatment outcome Numerous programs for substance-using women and their children have been developed and implemented in recent years. The quality of treatment evaluations has been variable and many studies involve small samples, making it difficult to determine effectiveness in general and of specific programs. Further, knowing a treatment is effective is not enough to provide researchers and clinicians with information about what types of programs are best and which clients are likely to benefit from treatment. Therefore, we will conduct a meta-analysis to synthesize existing research. Meta-analytic techniques allow the results of studies with small sample sizes to be combined, which increases statistical power to detect treatment effects and to identify factors that moderate treatment. We also will examine important feasibility factors that can impact uptake of recommended clinical practices. To our knowledge, this meta-analysis would be the first systematic quantitative review of studies evaluating the impact of integrated treatment programs on substance-using women and their chidren. It will assist in determining the impact of treatment, the program, client, and study characteristics that may moderate this impact, and program feasibility and implementation issues. The results of this meta-analysis will contribute to knowledge in the field, inform priorities and directions for future research, assist in development of best practice guidelines, and inform public policy and program funding decisions, thereby improving the health and well-being of substance-using women and their children. McMaster University 99 904 $
Dr. Lori ROSS An evidence-based algorithm to quantify risk-benefit decision-making for use of antidepressant medication during pregnancy and lactation The treatment of depression during the perinatal period is of paramount importance given the consequences on mother, baby and family unit. Recent studies have reported adverse sequlae associated with fetal/neonatal exposure to both antidepressant medication and untreated maternal depression. As such, there is incredible potential for knowledge translation in this area to improve uptake of appropriate treatment. The current study seeks to synthesize the existing research evidence to determine the variables needing consideration in order to make an informed decision. Systematic literature reviews of all published evidence relevant to treatment with antidepressant medications will be conducted. Stakeholders will be involved at the outset to advise the research team on all aspects of the project. End-users and international experts will be surveyed to identify gaps in the existing literature. The synthesized knowledge will be summarized into a preliminary synopsis that will be readily accessible to mental health providers, researchers, funding agencies, policy makers and consumers considering antidepressant treatment. This study will provide the groundwork for future development of treatment algorithms to assist in determining whether or not to use antidepressant medication in treating a depressive episode during pregnancy or while breast feeding. Women's College Hospital (Toronto) 98 097 $
Dr. Peter DODEK Scoping and systematic review of non-invasive mechanical ventilation: Laying the groundwork for development of clinical practice guidelines Mechanical ventilation through an endotracheal tube is perhaps the most common intervention used in critical care. Non-invasive ventilation delivered by an external mask is a relatively new form of mechanical ventilation that has been shown to decrease the need for endotracheal intubation and in some studies, to improve survival. There are numerous published studies of this modality in a variety of populations and settings but there are few if any syntheses of these studies. The purpose of this scoping and systematic review is to conduct a systematic literature search of published work related to non-invasive ventilation, to critically appraise studies that are found, to develop systematic reviews on this topic, including the use of meta-analyses where appropriate, and to identify future research opportunities. These products will then be used as the foundation for development of evidence-based clinical practice guidelines for the use of non-invasive ventilation. The audience for this work includes ICU clinicians (physicians, nurses, respiratory therapists), ICU managers, and hospital administrators. University of British Columbia 52 663 $
Dr. Ann CRANNEY Research syntheses of driving in individuals with arthritis As more Canadians get older, the number of people with arthritis will increase. Arthritis causes physical limitations resulting in difficulties with activities like driving. The ability to drive is important for older adults with arthritis as it allows them to maintain their mobility and independence. However, the association between the physical limitations due to arthritis and a person's driving performance is not clear. As well, health care providers are uncertain how to deal with driving concerns in arthritis patients. In order to develop tools to assist both health care providers and arthritis patients, a thorough review of the driving literature relevant to arthritis is required. We will conduct a literature review to examine the effect of arthritis on driving performance and identify/evaluate existing driving resources developed for people with arthritis. Ultimately, the results of this review will be used to develop recommendations and tools to assist the health care provider and arthritis patient to optimize safe driving and independence. In addition, the research findings will be used to identify key areas that require further study. Consumers with arthritis, health care providers and policy makers will help us define the scope of this review, interpret the results and put them into practice. Ottawa Health Research Institute/L'Institut de recherche en Santé d'Ottawa 62 454 $
Dr. Paul MASOTTI Adverse events in Canadian home care: A scoping review International and Canadian attention has been drawn to the high rate of Adverse Events with significant consequences for hospitalized patients. A smaller body of literature suggests problems are also found in the delivery of primary care. Unfortunately,the published documentation on the occurrence of Adverse Events in homecare, particularly the Canadian experience, is less comprehensive.
As part of an overall goal of understanding what is known about adverse events (prevalence, types, policy, indicators and consequences) in the delivery of home care services, we will conduct a 'Scoping Review' of Canadian and international literature to discover and synthesize knowledge and identify gaps in evidence where primary research is needed and timely. We will address available information in both the published and grey literature (government and organization websites and available papers/reports). We will also conduct key informant interviews with decision makers in Canadian home care organizations and provincial health policy units. This study will be conducted by members of a new collaborative research program/relationship between the Centre for Health Services and Policy Research - Queen's University and the Executive Directors of three Ontario Community Care Access Centres.		 Queen's University (Kingston, Ontario) 98 076 $
Dr. Julian LITTLE Development of optimal methods for synthesizing evidence on gene-disease associations and related interactions As a result of the Human Genome Project and related advances in technologies for laboratory analysis of variation in large numbers of genes in large numbers of people, there has been a tremendous increase in the numbers of studies of the effects of genetic variation on human health. In addition to laboratory analysis, this type of investigation requires careful statistical analysis and interpretation. Because a large number of variants of genes can be studied, there is potential for false leads based on the results of single studies. In addition, experience with the investigation of the relationships between environmental factors and human health and disease, and with clinical trials, has shown that a number of biases can distort the results of studies. The consequence of such distortion is that the information on which decisions about methods to prevent disease or manage it is incorrect, and that limited resources for prevention and health care are not used effectively. We propose to apply methods that have led to improvements in the quality of evidence from clinical trials and from diagnostic tests to studies of genetic variation and health. In this project, we plan to select a large sample of such studies and, using information abstracted from them studies, investigate whether there are any systematic relationships between aspects of study methods and the results obtained. University of Ottawa/Université d'Ottawa 97 607 $
Dr. Annie SAWKA Strategies for prevention of hip fracture in elderly nursing home residents As Canadians are getting older, more and more seniors are living their final years of life in nursing homes. Elderly nursing home residents have a high risk of hip fracture (4% risk per year). Hip fractures can result in loss of life, severe pain, loss of ability to walk, and worsening quality of life. The cost to the taxpayer for hospital care of a hip fracture experienced by a nursing home resident is roughly nine to sixteen thousand dollars. It is important to identify strategies to decrease the risk of hip fracture in elderly nursing home residents. We plan to perform a series of reviews examining data from clinical trials of interventions for prevention of hip fracture in elderly nursing home residents. We will examine data on nutritional therapies (including supplements), drug therapies (including hormonal therapies), behavior modification strategies (including exercise programs, physiotherapy and others), and combinations of these strategies. We will combine results of analyses and estimate the costs of implementation and the cost savings in hospital care of hip fractures that could be expected with implementation of effective strategies. This research will help physicians and health policy makers understand which strategies may work and at what cost in preventing hip fracture in elderly nursing home residents and encourage funding of such programs by government. University Health Network (Toronto) 89 000 $
Dr. Linda LI From aches and pains to timely treatment: What drives people with arthritis to seek information and treatment? People with arthritis often need a combination of pharmacological and non-drug treatments over the course of the disease; however, some opt to delay seeking effective treatment or decide against treatment altogether. This project aims to synthesize the literature on individual, social and cultural determinants that influence people's practice of information-seeking and treatment-seeking (i.e., help-seeking) in the management of osteoarthritis and inflammatory arthritis. We will conduct a comprehensive literature search using databases from health, behavioural and social sciences, extract this information and categorize it by type and stage of arthritis. We will also summarize the literature regarding people's experiences with and management of arthritis. Findings from this project, combined with current knowledge on health professional and system-related factors around the delivery of arthritis care, can be used to guide the development of interventions to facilitate people's informed and appropriate use of effective treatments. Upon study completion, a panel of arthritis stakeholders will be invited to a workshop, where they will be briefed on the findings and invited to discuss gaps and the future direction of research, clinical practice and health services delivery. Further, we will assemble project teams, with representatives from stakeholder groups, to develop local-friendly interventions that facilitate early and appropriate arthritis care. University of British Columbia 99 964 $
Dr. David MOHER The Ottawa research synthesis training and mentorship program: developing a national capacity strategy Thousands of articles and books reporting the results of research studies on health and health care are published every year. To synthesize this information, scientists use systematic reviews ,a highly organized summary, make this sea of published information manageable for, and useful to doctors and administrators in health regions and government. The University of Ottawa has developed and used research synthesis education programs for doctors and administrators at the local, provincial, national and international level. The purpose of this training program is to teach two cohorts of health service and/or policy professionals in 15 days over one year how to better evaluate and use research synthesis to help make decisions in their professional settings. Participants will explore what synthesis is, how to synthesize a variety of study designs, and how different types of synthesis have been applied to real world health care problems. Participants will perform their own synthesis under the mentorship of course faculty. The entire program will last 2 years, graduating two classes of health service professionals. Children's Hospital of Eastern Ontario (Ottawa)/Centre hospitalier pour enfants de l'est de l'Ontario 147 312 $
Dr. Marcy WINGET Database linkage to identify and quantify use of key health services from pre-diagnosis to treatment and time between services for colorectal cancer patients The proposed study is a population-based evaluation of health services utilization and timeliness to care for colorectal cancer patients. Utilization of major care steps that range from pre-diagnostis to treatment will be identified and time between care steps quantified. Taking colorectal cancer as an exemplary case, we will: 1) identify steps in colorectal cancer patient trajectories using medical records and administrative data sources, 2) quantify and evaluate time between care steps, and 3) develop methodology for achieving (1) and (2) using administrative data only so that the framework can be implemented for routine evaluation. Data will be linked from databases housed by several agencies and abstracted from medical and electronic health records. Data elements will be identified that are needed to capture the key health services defined by standards of care for colorectal cancer screening, diagnostic tests, and treatment. Multiple stakeholders will be involved to maximize usefulness of results to better-enable evaluation of and improve timely access to quality health care. Discovering the patient trajectories and time spent between each "care step" will form a concrete basis for: 1) identification of areas within the care system that need to be changed, 2) provide insight into best ways to make the changes, 3) identification of areas to best put resources, 4) identification of the types of resources needed, and 5) provide substantive baseline data by which future changes to health care systems can be evaluated. Alberta Cancer Board (Edmonton) 97 600 $
Dr. Gary TEARY Flow Matters: Using Operations Research to understand and improve the flow of medicine patients in the Saskatoon Health Region Concerns about long waits in hospitals exist throughout Canada. Media stories and anecdotal evidence suggest that overcrowding, gridlock and process bottlenecks are creating persistent problems for health care facilities.
This research project will investigate the flow of medicine patients from Emergency Departments to inpatient bed units in the Saskatoon Health Region. By continuing our efforts to build capacity in Operations Research (OR), we will be able to accurately map patient flows, identify points in the care process that can cause an increase in waiting time, and test various improvement strategies. Moreover, we plan to study the reasons why wait times for specific processes are particularly long. We want to grasp the source of variability in patient flows and use OR analysis to understand how much slack capacity is needed in the system in order to have it operate more efficiently.
We may be able to apply specific improvement strategies from other industries. Airlines, for example, use arrival slots for airplanes so they can better schedule incoming traffic. We could use the notion of "discharge slots" to orchestrate inpatient discharges, rather than having such events occur at random times throughout a day. By being more aware of downstream discharges, one may be able to better manage incoming arrivals to inpatient units and create a more synchronized system.
Our research will ultimately improve the health delivery system by enabling the removal of inefficiencies. Hospital staff expertise will be used to identify process improvement opportunities. Successful application of our approaches could contribute to shortened patient length of stay, thus leading to more satisfied patients. Better staff communication and teamwork, as a result of improved flow, would lead to enhanced staff morale. We are confident that our analysis can contribute to the more seamless movement of patients throughout the health care system.		 University of Saskatchewan 97 485 $
Dr. Mark HARRISON Change in Objective Functional Tests While Waiting for Total Joint Replacement The increasing demand for total joint replacement continues to exceed the available resources, impacting wait list times for both specialist orthopedic consultations and joint replacement surgery. The decline in health status while patients wait for total joint replacement has not been assessed with objective measures of physical function, cardiovascular health and psychological status, rather subjective measures and questionnaires are commonly utilized to stratify patients on the wait list. This study aims to objectively measure the physical, physiological and psychological decline in health status while waiting for total joint replacement, and correlate these measures with current stratification techniques like the Western Canada Wait List Hip and Knee Prioritization Tool. This information will allow the development of improved patient stratification techniques, and the identification of suitable pre-operative programs such as exercise, weight loss, and / or counseling to improve patients' health status while waiting for surgery. Queen's University (Kingston, Ontario) 89 692 $
Dr. William HODGE An Investigation of the Relationship Between Cataract Surgery Wait Times and Rates of Surgery Timely access to health care services is a very important issue to Canadians, and provincial governments are currently taking steps to reduce waiting times for "priority" services such as cataract surgery. As measures of access to health services, wait times are easy to interpret and highly relevant to the public, however it is very difficult for health researchers and policy makers to define and accurately measure wait times. Rate of surgery is an alternative outcome that could be used to measure access to cataract surgery. The purpose of this study is to investigate the relationship between cataract surgery wait times and rates of surgery. We aim to determine if, and how, these measures are correlated using information from several secondary health databases in Ontario. We will examine how well rate of surgery predicts surgical wait time, and explore the effects of variables such as age, cataract severity, health district, etc on this relationship. Should rate of surgery prove to be reliably predictive of wait time in the case of cataract surgery, there is potential for the use of this outcome to be applied in other health care fields. University of Ottawa/Université d'Ottawa 71 666 $
Prof. Boris SOBOLEV Mapping the delivery of cardiac surgical care in four BC hospitals and developing a taxonomy of peri-operative processes Why is the provision of healthcare so hard to improve? Waits, delays, and cancellations negatively impact patients and their families, care providers and hospital operations despite the effort and resources directed at solving these problems. We believe that at least part of the difficulty is a limited understanding of how changes in organization, management and policy affect the delivery of healthcare services. We argue that a new interdisciplinary framework, which links health services research, operations research, and computer sciences, is required.
To address this, we are proposing a pilot project to identify the processes that contribute to variation in wait times for coronary artery bypass surgery. The aim of this project is to gain a better understanding of the organization and management of cardiac surgical care used in hospitals across BC. We will focus on coronary bypass surgery because the procedure is well-structured in terms of clinical and managerial activities involved and, thus, is amenable to study and improvement. The significance of the proposal rests on integrating a new method for evaluation of access to health care into efforts to enhance quality, organization, and delivery of hospital care in Canada.		 University of British Columbia 99 820 $
Prof. Boris SOBOLEV Research synthesis of approaches to patient-flow simulation in surgical care Despite a variety of approaches, little research is available on the appropriateness of modeling techniques when the goal is to assess the impact of changes in organization, management and policy on waits during the peri-operative process. As a result, few health systems have used simulations for re-engineering surgical care delivery. In order to inform decision makers by providing the information currently available, we are proposing to perform a research synthesis of the literature on the methods for simulation of patient flow in surgical care. We will focus on patient flow in surgical care because the peri-operative process is well-structured in terms of clinical and managerial activities involved and, thus, is amenable to study and improvement. The anticipated value of the results includes new methods to evaluate policy and management alternatives, and the integration of this new methodology into existing efforts to improve patient flow. University of British Columbia 85 000 $
Dr. Elizabeth BADLEY Alternative Role of Physiotherapists in Improving Access to Total Joint Replacement Waiting times for total joint replacement (TJR) for arthritis is a continuing concern in Canada as the number of people with arthritis increases with the aging of the population. To reduce wait times for surgery, it is important to correctly identify the people that need orthopaedic surgery, and that people who are not yet surgical candidates have access to interim care. New models of care using other health professionals such as physical therapists (PTs) are evolving as a result of these issues in access. The purpose of this research is to: a) synthesize the literature related to models of care for arthritis using health professionals in expanded clinical roles and b) to evaluate the pilot project using PTs in an orthopedic clinic to triage patients to surgery and to provide arthritis management support for patients not yet needing total joint replacement surgery (i.e. non-surgical patients). This study will add to our understanding of the impact of implementing alternative models of care to improve access to orthopaedic services in a Canadian context and provide the necessary information to implement a therapist mediated intervention for more comprehensive care of non-surgical patients. Toronto Western Research Institute (Toronto) 98 250 $
Dr. Marcello TONELLI Research synthesis: evidence-based management of waiting lists for kidney transplantation. The objective of our research program is to synthesize available information that helps to define 1) which patients should be placed on waiting lists for kidney transplantation and 2) how patients should be investigated and managed after placement on the waiting list to ensure that those who are no longer good candidates for transplantation are removed from the list. This information is needed to devise strategies which increase appropriate access to kidney transplantation. This information will help improve equitable and timely access to kidney transplantation, a potentially life-saving treatment for kidney failure. University of Alberta 88 292 $
Dr. Thomas NOSEWORTHY Operations Research in Queue Management: Development of Scheduling Systems for Hip and Knee Replacement Surgery In the transportation and banking industries, industrial engineers have brought their knowledge and skills to bear in managing access, line-ups and long waiting times for services. Despite such knowledge in queue management, very little of this expertise has been utilized in managing the line-ups for surgical services such as hip and knee replacement. This research proposes to carry out three related bodies of work: (1) A comprehensive literature review to broaden understanding of where and how queue managment is being used for scheduled services in health care. (2) An environmental scan to determine what industrial engineering techniques are currently used in Canada for queue management for scheduled (elective) health services. (3) A pilot project to build and introduce a scheduling system for hip and knee replacement, using arrival and service rate data and modelling, in one Canadian region. This formative work will inform broader activities in multiple regions aimed at developing scheduling systems for joint replacement. Such systems will offer certainty to patients seeking care, by assigning an explicit date upon which they can expect to receive services. The development of a scheduling system will use the tools and techniques known to industrial engineers and will be able to be exploited for this purpose in other geographical areas and for other interventions. The ultimate intention is to build a tool kit for queue management, which permits analysis, modelling and formulation of scheduling systems. University of Calgary 100 000 $