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Lee-Foon NK, Brown A, Reid RJ. Shifting gears: Creating equity informed leaders for effective learning health systems. Healthc Manage Forum 2024; 37:156-159. [PMID: 38189240 PMCID: PMC11044513 DOI: 10.1177/08404704231214510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Leadership is vital to a well-functioning and effective health system. This importance was underscored during the COVID-19 pandemic. As disparities in infection and mortality rates became pronounced, greater calls for equity-informed healthcare emerged. These calls led some leaders to use the Learning Health System (LHS) approach to quickly transform research into healthcare practice to mitigate inequities causing these rates. The LHS is a relatively new framework informed by many within and outside health systems, supported by decision-makers and financial arrangements and encouraged by a culture that fosters quick learning and improvements. Although studies indicate the LHS can enhance patients' health outcomes, scarce literature exists on health leaders' use and incorporation of equity into the LHS. This article begins addressing this gap by examining how equity can be incorporated into LHS activities and discussing ways leaders can ensure equity is considered and achieved in rapid learning cycles.
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Affiliation(s)
| | | | - Robert J. Reid
- Trillium Health Partners, Mississauga, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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Smith CL, Fisher G, Dharmayani PNA, Wijekulasuriya S, Ellis LA, Spanos S, Dammery G, Zurynski Y, Braithwaite J. Progress with the Learning Health System 2.0: a rapid review of Learning Health Systems' responses to pandemics and climate change. BMC Med 2024; 22:131. [PMID: 38519952 PMCID: PMC10960489 DOI: 10.1186/s12916-024-03345-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/23/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Pandemics and climate change each challenge health systems through increasing numbers and new types of patients. To adapt to these challenges, leading health systems have embraced a Learning Health System (LHS) approach, aiming to increase the efficiency with which data is translated into actionable knowledge. This rapid review sought to determine how these health systems have used LHS frameworks to both address the challenges posed by the COVID-19 pandemic and climate change, and to prepare for future disturbances, and thus transition towards the LHS2.0. METHODS Three databases (Embase, Scopus, and PubMed) were searched for peer-reviewed literature published in English in the five years to March 2023. Publications were included if they described a real-world LHS's response to one or more of the following: the COVID-19 pandemic, future pandemics, current climate events, future climate change events. Data were extracted and thematically analyzed using the five dimensions of the Institute of Medicine/Zurynski-Braithwaite's LHS framework: Science and Informatics, Patient-Clinician Partnerships, Continuous Learning Culture, Incentives, and Structure and Governance. RESULTS The search yielded 182 unique publications, four of which reported on LHSs and climate change. Backward citation tracking yielded 13 additional pandemic-related publications. None of the climate change-related papers met the inclusion criteria. Thirty-two publications were included after full-text review. Most were case studies (n = 12, 38%), narrative descriptions (n = 9, 28%) or empirical studies (n = 9, 28%). Science and Informatics (n = 31, 97%), Continuous Learning Culture (n = 26, 81%), Structure and Governance (n = 23, 72%) were the most frequently discussed LHS dimensions. Incentives (n = 21, 66%) and Patient-Clinician Partnerships (n = 18, 56%) received less attention. Twenty-nine papers (91%) discussed benefits or opportunities created by pandemics to furthering the development of an LHS, compared to 22 papers (69%) that discussed challenges. CONCLUSIONS An LHS 2.0 approach appears well-suited to responding to the rapidly changing and uncertain conditions of a pandemic, and, by extension, to preparing health systems for the effects of climate change. LHSs that embrace a continuous learning culture can inform patient care, public policy, and public messaging, and those that wisely use IT systems for decision-making can more readily enact surveillance systems for future pandemics and climate change-related events. TRIAL REGISTRATION PROSPERO pre-registration: CRD42023408896.
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Affiliation(s)
- Carolynn L Smith
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia.
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia.
| | - Georgia Fisher
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
| | - Putu Novi Arfirsta Dharmayani
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
| | - Shalini Wijekulasuriya
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
| | - Samantha Spanos
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
| | - Genevieve Dammery
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
| | - Yvonne Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
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Príncipe AS, Filho ASN, Machado BAS, Barbosa JDV, Winkler I, Ferreira CV. Decision Support Frameworks in Public Health Emergencies: A Systematic Review of Dynamic Models in Complex Contexts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6685. [PMID: 37681825 PMCID: PMC10487630 DOI: 10.3390/ijerph20176685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
Public health emergencies are extraordinary events of disease spread, with health, economic, and social consequences, which require coordinated actions by governments and society. This work aims to analyze scopes, application possibilities, challenges, and gaps of decision support frameworks in PHE management, using the components of the Health Emergency and Disaster Risk Management Framework (H-EDRM) and the Preparedness, Prevention, Response and Recovery Model (PPRR Model), providing guidelines for the development of new models. A systematic literature review was carried out using the Web of Science, Scopus, and Pubmed knowledge databases on studies published between 2016 and 2023, and thirty-six articles were selected. The outcomes show a concentration of frameworks on short-term emergency response operations, with a limited emphasis on the political and strategic components that drive actors and responsibilities. Management prioritizes monitoring, evaluation, and information management frameworks. However, the models need to overcome the challenges of multisectoral and interdisciplinary action, different levels of decisions and actors, data sharing, and development of common platforms of evidence for decisions fitted to the various emergencies.
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Affiliation(s)
| | - Aloísio S. N. Filho
- Department of Management and Industrial Technology, SENAI CIMATEC University Center, Salvador 41650-010, Brazil; (A.S.N.F.); (B.A.S.M.); (J.D.V.B.)
| | - Bruna A. S. Machado
- Department of Management and Industrial Technology, SENAI CIMATEC University Center, Salvador 41650-010, Brazil; (A.S.N.F.); (B.A.S.M.); (J.D.V.B.)
| | - Josiane D. V. Barbosa
- Department of Management and Industrial Technology, SENAI CIMATEC University Center, Salvador 41650-010, Brazil; (A.S.N.F.); (B.A.S.M.); (J.D.V.B.)
| | - Ingrid Winkler
- Department of Management and Industrial Technology, SENAI CIMATEC University Center, Salvador 41650-010, Brazil; (A.S.N.F.); (B.A.S.M.); (J.D.V.B.)
- Institute for Science, Innovation and Technology in Industry 4.0/INCITE INDUSTRIA 4.0, Salvador 41650-010, Brazil
| | - Cristiano V. Ferreira
- Technological Center of Joinville, Federal University of Santa Catarina, Joinville 89219-600, Brazil;
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Brody S, Loree S, Sampson M, Mensinkai S, Coffman J, Mueller MH, Askin N, Hamill C, Wilson E, McAteer MB, Staines H. Searching for evidence in public health emergencies: a white paper of best practices. J Med Libr Assoc 2023; 111:566-578. [PMID: 37312802 PMCID: PMC10259619 DOI: 10.5195/jmla.2023.1530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Objectives Information professionals have supported medical providers, administrators and decision-makers, and guideline creators in the COVID-19 response. Searching COVID-19 literature presented new challenges, including the volume and heterogeneity of literature and the proliferation of new information sources, and exposed existing issues in metadata and publishing. An expert panel developed best practices, including recommendations, elaborations, and examples, for searching during public health emergencies. Methods Project directors and advisors developed core elements from experience and literature. Experts, identified by affiliation with evidence synthesis groups, COVID-19 search experience, and nomination, responded to an online survey to reach consensus on core elements. Expert participants provided written responses to guiding questions. A synthesis of responses provided the foundation for focus group discussions. A writing group then drafted the best practices into a statement. Experts reviewed the statement prior to dissemination. Results Twelve information professionals contributed to best practice recommendations on six elements: core resources, search strategies, publication types, transparency and reproducibility, collaboration, and conducting research. Underlying principles across recommendations include timeliness, openness, balance, preparedness, and responsiveness. Conclusions The authors and experts anticipate the recommendations for searching for evidence during public health emergencies will help information specialists, librarians, evidence synthesis groups, researchers, and decision-makers respond to future public health emergencies, including but not limited to disease outbreaks. The recommendations complement existing guidance by addressing concerns specific to emergency response. The statement is intended as a living document. Future revisions should solicit input from a broader community and reflect conclusions of meta-research on COVID-19 and health emergencies.
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Affiliation(s)
- Stacy Brody
- , Reference & Instruction Librarian, Himmelfarb Health Sciences Library, George Washington University, School of Medicine and Health Sciences, Washington, DC, United States
| | - Sara Loree
- , Medical Library Manager, St. Luke's Health System, ID, United States
| | - Margaret Sampson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | | | - Jennifer Coffman
- , Science and Engineering Research Librarian, University of Virginia, Charlottesville, VA, United States
| | | | - Nicole Askin
- , WRHA Virtual Library, University of Manitoba, Winnipeg, MB, Canada
| | - Cheryl Hamill
- , South and East Metropolitan Health Services, Perth, Australia
| | - Emma Wilson
- , The University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, Scotland
| | - Mary Beth McAteer
- , Virginia Mason Medical Center, Jones Learning Center, Seattle, WA, United States
| | | | - Best Practices for Searching During Public Health Emergencies Working Group
- Cheryl Hamill, FALIA, AALIA (CP) Health, , 0000-0002-6069-1806, South and East Metropolitan Health Services, Perth, Australia; Maureen Dobbins, RN, PhD, 0000-0002-1968-6765, McMaster University, Canada; Amy M Claussen, MLIS, 0000-0003-3996-1055, University of Minnesota, United States; Kavita Umesh Kothari, MPH, 0000-0002-0759-5225, Health Information Consultant, Kobe, Japan; Caroline De Brún, PhD, 0000-0002-5185-0043, UK Health Security Agency, United Kingdom; Sarah Young, 0000-0002-8301-5106, Carnegie Mellon University, United States; Sarah E Neil-Sztramko, PhD, 0000-0002-9600-3403, McMaster University, Canada; Shaila Mensinkai, MA, MLIS, Librarian Reserve Corps, Canada; Emma Wilson, 0000-0002-8100-7508, The University of Edinburgh, Scotland; Robin M Featherstone MLIS, 0000-0003-2517-2258, CADTH Canadian Agency for Drugs and Technologies in Health (present affiliation); Cochrane Central Executive Team (sponsor), Toronto, Canada; Margaret Sampson, MLIS, PhD, AHIP, 0000-0003-2550-9893, Children's Hospital of Eastern Ontario Research Institute, Canada; Heather Staines, PhD, MA, 0000-0003-3876-1182, Delta Think, United States; Martha Knuth, MLIS, 0000-0003-4264-1642, Centers for Disease Control and Prevention, United States
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Groot G, Witham S, Badea A, Baer S, Dalidowicz M, Reeder B, Froh J, Carr T. Evaluating a learning health system initiative: Lessons learned during COVID-19 in Saskatchewan, Canada. Learn Health Syst 2022; 7:e10350. [PMID: 36714056 PMCID: PMC9874378 DOI: 10.1002/lrh2.10350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/20/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Evaluating a learning health system (LHS) encourages continuous system improvement and collaboration within the healthcare system. Although LHS is a widely accepted concept, there is little knowledge about evaluating an LHS. To explore the outputs and outcomes of an LHS model, we evaluated the COVID-19 Evidence Support Team (CEST) in Saskatchewan, Canada, an initiative to rapidly review scientific evidence about COVID-19 for decision-making. By evaluating this program during its formation, we explored how and to what extent the CEST initiative was used by stakeholders. An additional study aim was to understand how CEST could be applied as a functional LHS and the value of similar knowledge-to-action cycles. Methods Using a formative evaluation design, we conducted qualitative interviews with key informants (KIs) who were involved with COVID-19 response strategies in Saskatchewan. Transcripts were analyzed using reflexive thematic analysis to identify key themes. A program logic model was created to represent the inputs, activities, outputs, and outcomes of the CEST initiative. Results Interview data from 11 KIs were collated under three overarching categories: (1) outputs, (2) short-term outcomes, and (3) long-term outcomes from the CEST initiative. Overall, participants found the CEST initiative improved speed and access to reliable information, supported and influenced decision-making and public health strategies, leveraged partnerships, increased confidence and reassurance, and challenged misinformation. Themes relating to the long-term outcomes of the initiative included improving coordination, awareness, and using good judgment and planning to integrate CEST sustainably into the health system. Conclusion This formative evaluation demonstrated that CEST was a valued program and a promising LHS model for Saskatchewan. The future direction involves addressing program recommendations to implement this model as a functional LHS in Saskatchewan.
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Affiliation(s)
- Gary Groot
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSaskatchewanCanada
- Saskatchewan Health AuthorityRoyal University HospitalSaskatoonSaskatchewanCanada
| | - Stephanie Witham
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Andreea Badea
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Susan Baer
- Saskatchewan Health AuthorityHealth Sciences LibraryReginaSaskatchewanCanada
| | - Michelle Dalidowicz
- Saskatchewan Health AuthorityHealth Sciences LibraryReginaSaskatchewanCanada
| | - Bruce Reeder
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - John Froh
- Saskatchewan Health AuthorityRoyal University HospitalSaskatoonSaskatchewanCanada
| | - Tracey Carr
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSaskatchewanCanada
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Dewidar O, Kawala BA, Antequera A, Tricco AC, Tovey D, Straus S, Glover R, Tufte J, Magwood O, Smith M, Ooi CP, Dion A, Goetghebeur M, Reveiz L, Negrini S, Tugwell P, Petkovic J, Welch V. Methodological guidance for incorporating equity when informing rapid-policy and guideline development. J Clin Epidemiol 2022; 150:142-153. [PMID: 35863618 PMCID: PMC9359903 DOI: 10.1016/j.jclinepi.2022.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/30/2022] [Accepted: 07/12/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We provide guidance for considering equity in rapid reviews through examples of published COVID-19 rapid reviews. STUDY DESIGN AND SETTING This guidance was developed based on a series of methodological meetings, review of internationally renowned guidance such as the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for equity-focused systematic reviews (PRISMA-Equity) guideline. We identified Exemplar rapid reviews by searching COVID-19 databases and requesting examples from our team. RESULTS We proposed the following key steps: 1. involve relevant stakeholders with lived experience in the conduct and design of the review; 2. reflect on equity, inclusion and privilege in team values and composition; 3. develop research question to assess health inequities; 4. conduct searches in relevant disciplinary databases; 5. collect data and critically appraise recruitment, retention and attrition for populations experiencing inequities; 6. analyse evidence on equity; 7. evaluate the applicability of findings to populations experiencing inequities; and 8. adhere to reporting guidelines for communicating review findings. We illustrated these methods through rapid review examples. CONCLUSION Implementing this guidance could contribute to improving equity considerations in rapid reviews produced in public health emergencies, and help policymakers better understand the distributional impact of diseases on the population.
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Affiliation(s)
- Omar Dewidar
- Bruyère Research Institute, University of Ottawa, 85 Primrose Ave, Ottawa, Ontario K1R 6M1, Canada.
| | - Brenda Allen Kawala
- Section for Epidemiology and Social Medicine, Department of Public Health, Institute of Medicine-Master in Global Health, The Sahlgrenska Academy at University of Gothenburg, Box 414, SE-405 Gothenburg, Sweden
| | - Alba Antequera
- Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, Ontario M5B 1T8, Canada; Epidemiology Division, Dalla Lana School of Public Health & Institute of Health, Management, and Policy Evaluation, University of Toronto, 27 King's College Circle, Toronto, Ontario M5S 1A1, Canada; Queen's Collaboration for Health Care Quality, Joanna Briggs Institute Centre of Excellence, Queen's University, 92 Barrie Street, Room 214, Kingston, Ontario K7L 3N6, Canada
| | | | - Sharon Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, Ontario M5B 1T8, Canada
| | - Rebecca Glover
- Department of Health Services Research and Policy, Faculty of Public Health Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | | | - Olivia Magwood
- Bruyère Research Institute, University of Ottawa, 85 Primrose Ave, Ottawa, Ontario K1R 6M1, Canada; Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Thompson Hall, 25 University Private, Ottawa, ON, Canada K1N 7K4
| | - Maureen Smith
- Cochrane Consumer Executive, Ottawa, Ontario, Canada
| | - Cheow Peng Ooi
- Endocrine Unit, Department of Medicine, Universiti Putra Malaysia Faculty of Medicine and Health Sciences, 43400 Serdang, Selangor, Malaysia
| | - Anna Dion
- Centre for Implementation Research, Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Mireille Goetghebeur
- Unit Methods, Ethics and Participation, INESSS, National Institute for Excellence in Health and Social Services, Montréal, Québec, Canada
| | - Ludovic Reveiz
- Evidence and Intelligence for Action in Health Department, Incident Management System for the Covid-19 Response. Pan American Health Organization, 525 23rd St, Northwest, WA 20037-2895, USA
| | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Peter Tugwell
- Department of Medicine, and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Jennifer Petkovic
- Bruyère Research Institute, University of Ottawa, 85 Primrose Ave, Ottawa, Ontario K1R 6M1, Canada; WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Vivian Welch
- Bruyère Research Institute, University of Ottawa, 85 Primrose Ave, Ottawa, Ontario K1R 6M1, Canada; School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3, Canada
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