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A novel multi-criteria decision-making approach for prioritization of elective surgeries through formulation of “weighted MeNTS scoring system”. Heliyon 2022; 8:e10339. [PMID: 36090224 PMCID: PMC9449563 DOI: 10.1016/j.heliyon.2022.e10339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/30/2022] [Accepted: 08/12/2022] [Indexed: 11/22/2022] Open
Abstract
Background Publicly funded healthcare system has long non-manageable elective surgery waiting lists due to the non-existence of systematic mathematical modelling that can assess the relative priority of patients on elective surgery waiting lists thus denying the provision of surgical support to the patients with higher urgency. Mostly the patients of general surgery are entertain with highly subjective “time-honoured” methods that are inadequate to measure and compare the urgency of surgical procedure. Objective A methodology of assigning priorities to patients on elective surgery waiting lists has been presented in this paper using weighted criteria objectives. The objectives hve been chosen and assigned weights based on hospital conditions, and in consultation with the surgeons in hospital in Pakistan. Methods The proposed methodology presents two working contributions; first, a scoring mechanism based on MeNTS scoring system with weighted criterion that objectively translate the condition of patient prior to the surgical procedure; and second, a patient prioritization methodology to select patients for surgeries according to the corresponding scores. Detailed simulation results from actual patient data have been presented to evaluate the effectiveness of the proposed methodology, and its applicability and ease of use has been tested in real-time by surgeons while providing consultations to their patients. Results The proposed methodology outperforms the traditional “first-come-first-serve” methodology as there was a 30% reduction in average waiting time in elective surgery waiting lists (from 4.246 to 2.956 days) with 103 (90%) of patients being entertained before or within the unprioritized surgeries time span, with 94 patients having surgery within 1 day of being on waiting list (an increase of 47 patients). Moreover, transparency and equity were also found in the adaptation of this strategy to prioritize the elective surgery patients. Conclusions Prioritizing patients on elective surgery waiting lists is an important concern in surgical field. In most of the methodologies presented in earlier research, prioritization of patients for surgery is carried out subjectively. This study shows that the proposed technique has the potential to decrease the waiting times for patients on elective surgery waiting lists, as well as be presented as an objective methodology for preparing the elective surgery waiting lists to increase the transparency in waiting list.
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Marshall EG, Breton M, Green M, Edwards L, Ayn C, Smithman MA, Ryan Carson S, Ashcroft R, Bayoumi I, Burge F, Deslauriers V, Lawson B, Mathews M, McPherson C, Moritz LR, Nesto S, Stock D, Wong ST, Andrew M. CUP study: protocol for a comparative analysis of centralised waitlist effectiveness, policies and innovations for connecting unattached patients to primary care providers. BMJ Open 2022; 12:e049686. [PMID: 35256440 PMCID: PMC8905966 DOI: 10.1136/bmjopen-2021-049686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Access to a primary care provider is a key component of high-functioning healthcare systems. In Canada, 15% of patients do not have a regular primary care provider and are classified as 'unattached'. In an effort to link unattached patients with a provider, seven Canadian provinces implemented centralised waitlists (CWLs). The effectiveness of CWLs in attaching patients to regular primary care providers is unknown. Factors influencing CWLs effectiveness, particularly across jurisdictional contexts, have yet to be confirmed. METHODS AND ANALYSIS A mixed methods case study will be conducted across three Canadian provinces: Ontario, Québec and Nova Scotia. Quantitatively, CWL data will be linked to administrative and provider billing data to assess the rates of patient attachment over time and delay of attachment, stratified by demographics and compared with select indicators of health service utilisation. Qualitative interviews will be conducted with policymakers, patients, and primary care providers to elicit narratives regarding the administration, use, and access of CWLs. An analysis of policy documents will be used to identify contextual factors affecting CWL effectiveness. Stakeholder dialogues will be facilitated to uncover causal pathways and identify strategies for improving patient attachment to primary care. ETHICS AND DISSEMINATION Approval to conduct this study has been granted in Ontario (Queens University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board, file number 6028052; Western University Health Sciences Research Ethics Board, project 116591; University of Toronto Health Sciences Research Ethics Board, protocol number 40335), Québec (Centre intégré universitaire de santé et de services sociaux de l'Estrie, project number 2020-3446) and Nova Scotia (Nova Scotia Health Research Ethics Board, file number 1024979).
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Affiliation(s)
- Emily Gard Marshall
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mylaine Breton
- Department of Community Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
| | | | - Lynn Edwards
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Caitlyn Ayn
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mélanie Ann Smithman
- Centre de recherche Charles-LeMoyne, Université de Sherbrooke, Longueuil, Québec, Canada
| | | | | | | | - Frederick Burge
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Véronique Deslauriers
- Centre de recherche Charles-LeMoyne, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Beverley Lawson
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Lauren R Moritz
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sue Nesto
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Stock
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sabrina T Wong
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Melissa Andrew
- Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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3
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Breton M, Smithman MA, Kreindler SA, Jbilou J, Wong ST, Gard Marshall E, Sasseville M, Sutherland JM, Crooks VA, Shaw J, Contandriopoulos D, Brousselle A, Green M. Designing centralized waiting lists for attachment to a primary care provider: Considerations from a logic analysis. EVALUATION AND PROGRAM PLANNING 2021; 89:101962. [PMID: 34127272 DOI: 10.1016/j.evalprogplan.2021.101962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/22/2021] [Accepted: 05/08/2021] [Indexed: 06/12/2023]
Abstract
Access to a regular primary care provider is essential to quality care. In Canada, where 15 % of patients are unattached (i.e., without a regular provider), centralized waiting lists (CWLs) help attach patients to a primary care provider (family physician or nurse practitioner). Previous studies reveal mechanisms needed for CWLs to work, but focus mostly on CWLs for specialized health care. We aim to better understand how to design CWLs for unattached patients in primary care. In this study, a logic analysis compares empirical evidence from a qualitative case study of CWLs for unattached patients in seven Canadian provinces to programme theory derived from a realist review on CWLs. Data is analyzed using context-intervention-mechanism-outcome configurations. Results identify mechanisms involved in three components of CWL design: patient registration, patient prioritization, and patient assignment to a provider for attachment. CWL programme theory is revised to integrate mechanisms specific to primary care, where patients, rather than referring providers, are responsible for registering on the CWL, where prioritization must consider a broad range of conditions and characteristics, and where long-term acceptability of attachment is important. The study provides new insight into mechanisms that enable CWLs for unattached patients to work.
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Affiliation(s)
- Mylaine Breton
- Department of Community Health Sciences, Université de Sherbrooke, Canadian Research Chair in Clinical Governance on Primary Health Care, Longueuil, QC, Canada
| | | | - Sara A Kreindler
- Department of Community Health Sciences, Manitoba Research Chair in Health System Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Jalila Jbilou
- Centre de formation médicale du Nouveau-Brunswick and École de psychologie, Université de Moncton, Moncton, NB, Canada
| | - Sabrina T Wong
- School of Nursing and Centre for Health Services and Policy Research, University of British Columbia, BC Primary Care Sentinel Surveillance Network, Vancouver, BC, Canada
| | | | | | - Jason M Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, Michael Smith Foundation for Health Research, Vancouver, BC, Canada
| | - Valorie A Crooks
- Department of Geography, Simon Fraser University, Michael Smith Foundation for Health Research, Canada Research Chair in Health Service Geographies, Burnaby, BC, Canada
| | - Jay Shaw
- Institute for Health System Solutions and Virtual Care, Women's College Research Institute, Women's College Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Damien Contandriopoulos
- School of Nursing, University of Victoria, Research Chair Policies, Knowledge and Health (Pocosa/Politiques, Connaissances, Santé), Victoria, BC, Canada
| | - Astrid Brousselle
- School of Public Administration, University of Victoria, Victoria, BC, Canada
| | - Michael Green
- Departments of Family Medicine and Public Health Sciences, Queen's University, CTAQ Chair in Applied Health Economics/Health Policy, Centre for Health Services and Policy Research, Centre for Studies in Primary Care, Institute for Clinical Evaluative Sciences, Kingston, ON, Canada
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Doshmangir L, Pourasghar F, Sharghi R, Rezapour R, Gordeev VS. Developing a prioritisation framework for patients in need of coronary artery angiography. BMC Public Health 2021; 21:1997. [PMID: 34732170 PMCID: PMC8565640 DOI: 10.1186/s12889-021-12088-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effective waiting list management and comprehensive prioritisation can provide timely delivery of appropriate services to ensure that the patient needs are met and increase equity in the provision of health services. We developed a prioritisation framework for patients in need of coronary artery angiography (CAA). METHODS We used a multi-methods approach to elicit effective factors that affect CAA patient prioritisation. Qualitative data wase collected using semi-structured interviews with 15 experts. The final set of factors was selected using experts' consensus through modifed Delphi technique. The framework was finalised during expert panel meetings. RESULTS 212 effective factors were identified based on the literature review, interviews, and expert panel discussion of them, 37 factors were selected for modifed Delphi study. Following two rounds of Delphi discussions, seven final factors were selected and weighed by ten experts using pair-wise comparisons. The following weights were given: the severity of pain and symptoms (0.22), stress testing (0.18), background diseases (0.15), number of myocardial infarctions (0.15), waiting time (0.10), reduction of economic and social performance (0.12), and special conditions (0.08). CONCLUSION Clinical effective factors were important for CAA prioritisation framework. Using this framework can potentially lead to improved accountability and justice in the health system.
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Affiliation(s)
- Leila Doshmangir
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Faramarz Pourasghar
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rahim Sharghi
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ramin Rezapour
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vladimir Sergeevich Gordeev
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Radkhah N, Shabbidar S, Zarezadeh M, Safaeiyan A, Barzegar A. Effects of vitamin D supplementation on apolipoprotein A1 and B100 levels in adults: Systematic review and meta-analysis of controlled clinical trials. J Cardiovasc Thorac Res 2021; 13:190-197. [PMID: 34630965 PMCID: PMC8493225 DOI: 10.34172/jcvtr.2021.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/10/2021] [Indexed: 11/09/2022] Open
Abstract
Cardiovascular disease (CVD) is a leading cause of death around the world. According to the studies, apolipoproteins A1 and B100 play crucial role in CVD development and progression. Also, findings have indicated the positive role of vitamin D on these factors. Thus, we conducted the present meta-analysis of randomized controlled trials (RCTs) to demonstrate the impact of vitamin D supplementation on apolipoproteins A1 and B100 levels in adults. PubMed and Scopus databases and Google Scholar were searched up to 21 December 2020. Relevant articles were screened, extracted, and assessed for quality based on the Cochrane collaboration's risk of bias tool. Data analysis conducted by random-effect model and expressed by standardized mean difference (SMD). The heterogeneity between studies was assessed by I-squared (I2) test. Subgroups and sensitivity Analyses were also conducted. Seven RCTs were identified investigating the impact of vitamin D on Apo A1 levels and six on Apo B100 levels. The findings showed the insignificant effect of vitamin D supplementation on Apo A1 (SMD=0.26 mg/dL; 95% confidence interval (CI), -0.10, 0.61; P = 0.155) and Apo B100 (standardized mean difference (SMD)=-0.06 mg/dL; 95% CI, -0.24, 0.12; P = 0.530) in adults. There was a significant between-study heterogeneity in Apo A1 (I2=89.3%, P < 0.001) and Apo B100 (I2 = 57.1%, P = 0.030). However, significant increase in Apo A1 in daily dosage of vitamin D (SMD=0.56 mg/dL; 95% CI, 0.02, 1.11; P = 0.044) and ≤12 weeks of supplementation duration (SMD=0.71 mg/dL; 95% CI, 0.08, 1.34; P = 0.028) was observed. No significant effects of vitamin D on Apo A1 and Apo B100 levels after subgroup analysis by mean age, gender, study population, dosage and duration of study. Overall, daily vitamin D supplementation and ≤12 weeks of supplementation might have beneficial effects in increasing Apo A1 levels, however, future high-quality trials considering these a primary outcome are required.
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Affiliation(s)
- Nima Radkhah
- Department of Community Nutrition, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Shabbidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Meysam Zarezadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.,Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdolrasoul Safaeiyan
- Department of Vital Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Barzegar
- Department of Community Nutrition, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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Acuna JA, Zayas-Castro JL, Feijoo F, Sankaranarayanan S, Martinez R, Martinez DA. The Waiting Game - How Cooperation Between Public and Private Hospitals Can Help Reduce Waiting Lists. Health Care Manag Sci 2021; 25:100-125. [PMID: 34401992 PMCID: PMC8367652 DOI: 10.1007/s10729-021-09577-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/22/2021] [Indexed: 12/02/2022]
Abstract
Prolonged waiting to access health care is a primary concern for nations aiming for comprehensive effective care, due to its adverse effects on mortality, quality of life, and government approval. Here, we propose two novel bargaining frameworks to reduce waiting lists in two-tier health care systems with local and regional actors. In particular, we assess the impact of 1) trading patients on waiting lists among hospitals, the 2) introduction of the role of private hospitals in capturing unfulfilled demand, and the 3) hospitals’ willingness to share capacity on the system performance. We calibrated our models with 2008–2018 Chilean waiting list data. If hospitals trade unattended patients, our game-theoretic models indicate a potential reduction of waiting lists of up to 37%. However, when private hospitals are introduced into the system, we found a possible reduction of waiting lists of up to 60%. Further analyses revealed a trade-off between diagnosing unserved demand and the additional expense of using private hospitals as a back-up system. In summary, our game-theoretic frameworks of waiting list management in two-tier health systems suggest that public–private cooperation can be an effective mechanism to reduce waiting lists. Further empirical and prospective evaluations are needed.
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Affiliation(s)
- Jorge A Acuna
- Industrial and Management Systems Engineering, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL, 33620, USA.
| | - José L Zayas-Castro
- Industrial and Management Systems Engineering, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL, 33620, USA
| | - Felipe Feijoo
- School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | | | | | - Diego A Martinez
- School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile.,Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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7
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Barriers and facilitators for implementation of a patient prioritization tool in two specialized rehabilitation programs. JBI Evid Implement 2021; 19:149-161. [PMID: 33843768 DOI: 10.1097/xeb.0000000000000281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND AIMS Prioritization tools aim to manage access to care by ranking patients equitably in waiting lists based on determined criteria. Patient prioritization has been studied in a wide variety of clinical health services, including rehabilitation contexts. We created a web-based patient prioritization tool (PPT) with the participation of stakeholders in two rehabilitation programs, which we aim to implement into clinical practice. Successful implementation of such innovation can be influenced by a variety of determinants. The goal of this study was to explore facilitators and barriers to the implementation of a PPT in rehabilitation programs. METHODS We used two questionnaires and conducted two focus groups among service providers from two rehabilitation programs. We used descriptive statistics to report results of the questionnaires and qualitative content analysis based on the Consolidated Framework for Implementation Research. RESULTS Key facilitators are the flexibility and relative advantage of the tool to improve clinical practices and produce beneficial outcomes for patients. Main barriers are the lack of training, financial support and human resources to sustain the implementation process. CONCLUSION This is the first study that highlights organizational, individual and innovation levels facilitators and barriers for the implementation of a prioritization tool from service providers' perspective.
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Déry J, Ruiz A, Routhier F, Bélanger V, Côté A, Ait-Kadi D, Gagnon MP, Deslauriers S, Lopes Pecora AT, Redondo E, Allaire AS, Lamontagne ME. A systematic review of patient prioritization tools in non-emergency healthcare services. Syst Rev 2020; 9:227. [PMID: 33023666 PMCID: PMC7541289 DOI: 10.1186/s13643-020-01482-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/17/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient prioritization is a strategy used to manage access to healthcare services. Patient prioritization tools (PPT) contribute to supporting the prioritization decision process, and to its transparency and fairness. Patient prioritization tools can take various forms and are highly dependent on the particular context of application. Consequently, the sets of criteria change from one context to another, especially when used in non-emergency settings. This paper systematically synthesizes and analyzes the published evidence concerning the development and challenges related to the validation and implementation of PPTs in non-emergency settings. METHODS We conducted a systematic mixed studies review. We searched evidence in five databases to select articles based on eligibility criteria, and information of included articles was extracted using an extraction grid. The methodological quality of the studies was assessed by using the Mixed Methods Appraisal Tool. The article selection process, data extraction, and quality appraisal were performed by at least two reviewers independently. RESULTS We included 48 studies listing 34 different patient prioritization tools. Most of them are designed for managing access to elective surgeries in hospital settings. Two-thirds of the tools were investigated based on reliability or validity. Inconclusive results were found regarding the impact of PPTs on patient waiting times. Advantages associated with PPT use were found mostly in relationship to acceptability of the tools by clinicians and increased transparency and equity for patients. CONCLUSIONS This review describes the development and validation processes of PPTs used in non-urgent healthcare settings. Despite the large number of PPTs studied, implementation into clinical practice seems to be an open challenge. Based on the findings of this review, recommendations are proposed to develop, validate, and implement such tools in clinical settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018107205.
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Affiliation(s)
- Julien Déry
- Department of Rehabilitation, Université Laval, Québec, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Angel Ruiz
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada.,Faculty of Business Administration, Université Laval, Québec, Canada.,Centre interuniversitaire de recherche sur les réseaux d'entreprise, la logistique et le transport (CIRRELT), Université de Montréal, Montréal, Canada
| | - François Routhier
- Department of Rehabilitation, Université Laval, Québec, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Valérie Bélanger
- Centre interuniversitaire de recherche sur les réseaux d'entreprise, la logistique et le transport (CIRRELT), Université de Montréal, Montréal, Canada.,Department of Logistics and Operations Management, HEC Montréal, Montréal, Canada
| | - André Côté
- Faculty of Business Administration, Université Laval, Québec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Centre de recherche en gestion des services de santé, Université Laval, Québec, Canada
| | - Daoud Ait-Kadi
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada.,Centre interuniversitaire de recherche sur les réseaux d'entreprise, la logistique et le transport (CIRRELT), Université de Montréal, Montréal, Canada.,Department of Mechanical Engineering, Université Laval, Québec, Canada
| | - Marie-Pierre Gagnon
- Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Faculty of Nursing, Université Laval, Québec, Canada
| | - Simon Deslauriers
- Department of Rehabilitation, Université Laval, Québec, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Ana Tereza Lopes Pecora
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Eduardo Redondo
- Faculty of Business Administration, Université Laval, Québec, Canada.,Centre interuniversitaire de recherche sur les réseaux d'entreprise, la logistique et le transport (CIRRELT), Université de Montréal, Montréal, Canada
| | - Anne-Sophie Allaire
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Marie-Eve Lamontagne
- Department of Rehabilitation, Université Laval, Québec, Canada. .,Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada.
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Breton M, Smithman MA, Sasseville M, Kreindler SA, Sutherland JM, Beauséjour M, Green M, Marshall EG, Jbilou J, Shaw J, Brousselle A, Contandriopoulos D, Crooks VA, Wong ST. How the design and implementation of centralized waiting lists influence their use and effect on access to healthcare - A realist review. Health Policy 2020; 124:787-795. [PMID: 32553740 DOI: 10.1016/j.healthpol.2020.05.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/02/2020] [Accepted: 05/19/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT Many health systems have centralized waiting lists (CWLs), but there is limited evidence on CWL effectiveness and how to design and implement them. AIM To understand how CWLs' design and implementation influence their use and effect on access to healthcare. METHODS We conducted a realist review (n = 21 articles), extracting context-intervention-mechanism-outcome configurations to identify demi-regularities (i.e., recurring patterns of how CWLs work). RESULTS In implementing non-mandatory CWLs, acceptability to providers influences their uptake of the CWL. CWL eligibility criteria that are unclear or conflict with providers' role or judgement may result in inequities in patient registration. In CWLs that prioritize patients, providers must perceive the criteria as clear and appropriate to assess patients' level of need; otherwise, prioritization may be inconsistent. During patients' assignment to service providers, providers may select less-complex patients to obtain CWLs rewards or avoid penalties; or may select patients for other policies with stronger incentives, disregarding the established patient order and leading to inequities and limited effectiveness. CONCLUSION These findings highlight the need to consider provider behaviours in the four sequential CWL design components: CWL implementation, patient registration, patient prioritization and patient assignment to providers. Otherwise, CWLs may result in limited effects on access or lead to inequities in access to services.
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Affiliation(s)
- Mylaine Breton
- Department of Community Health Sciences, Université de Sherbrooke, Canadian Research Chair in Clinical Governance on Primary Health Care, Longueuil, QC, Canada.
| | | | - Martin Sasseville
- Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé - Université de Sherbrooke, Longueuil, QC, Canada
| | - Sara A Kreindler
- Department of Community Health Sciences, and Manitoba Research Chair in Health System Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, Michael Smith Foundation for Health Research, Vancouver, BC, Canada
| | - Marie Beauséjour
- Department of Community Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
| | - Michael Green
- Departments of Family Medicine and Public Health Sciences, Queen's University, Centre for Health Services and Policy Research, Centre for Studies in Primary Care, Institute for Clinical Evaluative Sciences, Kingston, ON, Canada
| | | | - Jalila Jbilou
- Centre de formation médicale du Nouveau-Brunswick and École de psychologie, Université de Moncton, Moncton, NB, Canada
| | - Jay Shaw
- Institute for Health System Solutions and Virtual Care, Women's College Research Institute, Women's College Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Astrid Brousselle
- School of Public Administration, University of Victoria, Victoria, BC, Canada
| | - Damien Contandriopoulos
- School of Nursing, University of Victoria, Research Chair Policies, Knowledge and Health (Pocosa/Politiques, Connaissances, Santé), Victoria, BC, Canada
| | - Valorie A Crooks
- Department of Geography, Simon Fraser University, Michael Smith Foundation for Health Research, Canada Research Chair in Health Service Geographies, Burnaby, BC, Canada
| | - Sabrina T Wong
- School of Nursing and Centre for Health Services and Policy Research, University of British Columbia, BC Primary Care Sentinel Surveillance Network, Vancouver, BC, Canada
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Smithman MA, Brousselle A, Touati N, Boivin A, Nour K, Dubois CA, Loignon C, Berbiche D, Breton M. Area deprivation and attachment to a general practitioner through centralized waiting lists: a cross-sectional study in Quebec, Canada. Int J Equity Health 2018; 17:176. [PMID: 30509274 PMCID: PMC6277998 DOI: 10.1186/s12939-018-0887-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 11/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Access to primary healthcare is an important social determinant of health and having a regular general practitioner (GP) has been shown to improve access. In Canada, socio-economically disadvantaged patients are more likely to be unattached (i.e. not have a regular GP). In the province of Quebec, where over 30% of the population is unattached, centralized waiting lists were implemented to help patients find a GP. Our objectives were to examine the association between social and material deprivation and 1) likelihood of attachment, and 2) wait time for attachment to a GP through centralized waiting lists. METHODS A cross-sectional study was conducted in five local health networks in Quebec, Canada, using clinical administrative data of patients attached to a GP between June 2013 and May 2015 (n = 24, 958 patients) and patients remaining on the waiting list as of May 2015 (n = 49, 901), using clinical administrative data. Social and material area deprivation indexes were used as proxies for patients' socio-economic status. Multiple regressions were carried out to assess the association between deprivation indexes and 1) likelihood of attachment to a GP and 2) wait time for attachment. Analyses controlled for sex, age, local health network and variables related to health needs. RESULTS Patients from materially medium, disadvantaged and very disadvantaged areas were underrepresented on the centralized waiting lists, while patients from socially disadvantaged and very disadvantaged areas were overrepresented. Patients from very materially advantaged and advantaged areas were less likely to be attached to a GP than patients from very disadvantaged areas. With the exception of patients from socially disadvantaged areas, all other categories of social deprivation were more likely to be attached to a GP compared to patients from very disadvantaged areas. We found a pro-rich gradient in wait time for attachment to a GP, with patients from more materially advantaged areas waiting less than those from disadvantaged areas. CONCLUSION Our findings suggest that there are socio-economic inequities in attachment to a GP through centralized waiting lists. Policy makers should take these findings into consideration to adjust centralized waiting list processes to avoid further exacerbation of health inequities.
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Affiliation(s)
- Mélanie Ann Smithman
- Centre de recherche Charles-Le Moyne - Saguenay Lac-St-Jean sur les innovations en santé, Université de Sherbrooke, Longueuil Campus, 150 Place Charles-Le Moyne, Suite 200, Longueuil, Quebec, J4K 0A8, Canada
| | - Astrid Brousselle
- School of Public Administration, University of Victoria, 3800 Finnerty Rd, Suite A302, Victoria, British Columbia, V8P 5C2, Canada
| | - Nassera Touati
- Centre de recherche sur la gouvernance, École nationale d'administration publique, 4750, Avenue Henri-Julien, Office 5117, Montreal, Quebec, H2T 3E5, Canada
| | - Antoine Boivin
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, 900 Rue Saint-Denis, Montreal, Quebec, H2X 0A9, Canada
| | - Kareen Nour
- Direction de santé publique, Centre intégré de santé et des services sociaux - Montérégie-Centre, 1255 rue Beauregard, Longueuil, Quebec, J4K 2M3, Canada
| | - Carl-Ardy Dubois
- Faculty of Nursing, Université de Montréal, 2375, chemin de la Côte Ste-Catherine, Office 5103, Montreal, Quebec, H3T 1A8, Canada
| | - Christine Loignon
- Centre de recherche Charles-Le Moyne - Saguenay Lac-St-Jean sur les innovations en santé, Université de Sherbrooke, Longueuil Campus, 150 Place Charles-Le Moyne, Suite 200, Longueuil, Quebec, J4K 0A8, Canada
| | - Djamal Berbiche
- Centre de recherche Charles-Le Moyne - Saguenay Lac-St-Jean sur les innovations en santé, Université de Sherbrooke, Longueuil Campus, 150 Place Charles-Le Moyne, Suite 200, Longueuil, Quebec, J4K 0A8, Canada
| | - Mylaine Breton
- Centre de recherche Charles-Le Moyne - Saguenay Lac-St-Jean sur les innovations en santé, Université de Sherbrooke, Longueuil Campus, 150 Place Charles-Le Moyne, Suite 200, Longueuil, Quebec, J4K 0A8, Canada.
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11
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Breton M, Wong ST, Smithman MA, Kreindler S, Jbilou J, Marshall E, Sutherland J, Brousselle A, Shaw J, Crooks VA, Contandriopoulos D, Sasseville M, Green M. Centralized Waiting Lists for Unattached Patients in Primary Care: Learning from an Intervention Implemented in Seven Canadian Provinces. ACTA ACUST UNITED AC 2018; 13:65-82. [PMID: 30052190 DOI: 10.12927/hcpol.2018.25555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction Centralized waiting lists (CWLs) are one solution to reduce the problematic number of patients without a regular primary care provider. This article describes different models of CWLs for unattached patients implemented in seven Canadian provinces and identifies common issues in the implementation of these CWLs. Methods Logic models of each province's intervention were built after a grey literature review, 42 semi-structured interviews and a validation process with key stakeholders were performed. Results Our analysis across provinces showed variability and common features in the design of CWLs such as same main objective to attach patients to a primary care provider; implementation as a province-wide program with the exception of British Columbia; management at a regional level in most provinces; voluntary participation for providers except in two provinces where it was mandatory for providers to attach CWL patients; fairly similar registration process across the provinces; some forms of prioritization of patients either using simple criteria or assessing for vulnerability was performed in most provinces except New Brunswick. Conclusion Despite their differences in design, CWLs implemented in seven Canadian provinces face common issues and challenges regarding provider capacity to address the demand for attachment, barriers to the attachment of more vulnerable and complex patients as well as non-standardized approaches to evaluating their effectiveness. Sharing experiences across provinces as CWLs were being implemented would have fostered learning and could have helped avoid facing similar challenges.
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Affiliation(s)
- Mylaine Breton
- Associate Professor, Department of Community Health Sciences, Université de Sherbrooke; Chairwoman, Canadian Research Chair in Clinical Governance on Primary Health Care, Longueuil, QC
| | - Sabrina T Wong
- Professor, School of Nursing and Centre for Health Services and Policy Research, University of British Columbia; Co-Director, BC Primary Care Sentinel Surveillance Network, Vancouver, BC
| | | | - Sara Kreindler
- Assistant Professor, Department of Community Health Sciences, University of Manitoba; Manitoba Research Chair in Health System Innovation and Community Health Sciences, Winnipeg, MB
| | - Jalila Jbilou
- Professor and Researcher, Centre de formation médicale du Nouveau-Brunswick and École de psychologie, Université de Moncton, Moncton, NB
| | - Emily Marshall
- Associate Professor, Department of Family Medicine, Dalhousie University, Halifax, NS
| | - Jason Sutherland
- Associate Professor, Centre for Health Services and Policy Research, University of British Columbia; Scholar, Michael Smith Foundation for Health Research, Vancouver, BC
| | - Astrid Brousselle
- Director and Professor, School of Public Administration, University of Victoria, Victoria, BC
| | - Jay Shaw
- Scientist, Institute for Health System Solutions and Virtual Care, Women's College Research Institute, Women's College Hospital; Assistant Professor, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Valorie A Crooks
- Professor, Department of Geography, Simon Fraser University; Scholar, Michael Smith Foundation for Health Research; Canada Research Chair in Health Service Geographies, Burnaby, BC
| | - Damien Contandriopoulos
- Professor, School of Nursing, University of Victoria; Chairman, Research Chair Policies, Knowledge and Health (Pocosa/Politiques, Connaissances, Santé), Victoria, BC
| | - Martin Sasseville
- Research professional, Centre de recherche - Hôpital Charles-Le Moyne - Université de Sherbrooke, Longueuil, QC
| | - Michael Green
- Associate Professor, Departments of Family Medicine and Public Health Sciences, Queen's University; CTAQ Chair in Applied Health Economics/Health Policy; Director, Centre for Health Services and Policy Research; Associate Director, Centre for Studies in Primary Care; Adjunct Scientist, Institute for Clinical Evaluative Sciences, Kingston, ON
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12
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Hunter RJ, Buckley N, Fitzgerald EL, MacCormick AD, Eglinton TW. General Surgery Prioritization Tool: a pilot study. ANZ J Surg 2018; 88:1279-1283. [PMID: 30117634 DOI: 10.1111/ans.14703] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 04/21/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The prioritization of elective surgical wait-lists remains a contentious issue. Multiple new tools and systems have been developed to attempt to reliably prioritize patients. This study pilots one such system, the General Surgery Prioritization Tool and compares it to the existing triage system of clinical judgement. The aim was to determine if the new tool reflects clinical judgement. Secondary aims were to assess for any bias in its application to different patient groups or its application by different scorers. METHOD A cohort of 392 patients was identified who were wait-listed for non-cancer elective surgery between July 2015 and February 2016. The General Surgery Prioritization Tool was applied after traditional prioritization using clinical judgement. The scores produced by the new tool were compared to the clinical judgement categories. Differences in scores based on gender, ethnicity, age, surgical condition and surgeon were then analysed. RESULTS There was statistically significant correlation in the new tool scores with traditional triage groups (P < 0.0001). There were no statistically significant differences in mean scores attributable to gender, age or ethnicity. There were minimal differences in mean scores between common surgical conditions. Except for one outlier the mean scores were consistent across 17 surgeons. CONCLUSION This pilot study has found the General Surgery Prioritization Tool to reflect clinical judgement and to be generalizable by age, gender, ethnicity and prioritizing surgeon. The tool is at least as clinically reliable as traditional methods in the triage for elective general surgery with the advantage of being a more explicit process.
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Affiliation(s)
- Rachel J Hunter
- Department of General Surgery, Canterbury District Health Board, Christchurch, New Zealand
| | - Nicholas Buckley
- Department of General Surgery, Canterbury District Health Board, Christchurch, New Zealand
| | - Eve L Fitzgerald
- Department of General Surgery, Canterbury District Health Board, Christchurch, New Zealand
| | - Andrew D MacCormick
- Counties Manakau District Health Board, The University of Auckland, Auckland, New Zealand
| | - Tim W Eglinton
- Canterbury District Health Board, University of Otago, Dunedin, New Zealand
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13
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Developing a universal tool for the prioritization of patients waiting for elective surgery. Health Policy 2013; 113:118-26. [DOI: 10.1016/j.healthpol.2013.07.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 06/07/2013] [Accepted: 07/04/2013] [Indexed: 11/17/2022]
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14
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Varagunam M, Hutchings A, Neuburger J, Black N. Impact on hospital performance of introducing routine patient reported outcome measures in surgery. J Health Serv Res Policy 2013; 19:77-84. [DOI: 10.1177/1355819613506187] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To determine the impact of introducing patient reported outcome measures (PROMs) on the selection of patients for surgery and on outcome for four elective operations (hip replacement, knee replacement, varicose vein surgery and groin hernia repair). Methods Patient-level data from the National PROMs programme for England from April 2009 to March 2012 were analysed to determine the extent of change in mean preoperative scores and mean adjusted postoperative scores using disease-specific and generic PROMs assessed using standardized effect sizes (SESs). Variation between providers was determined by intra-class correlation coefficients for each time period. Consistency in outlier ratings was tested using weighted Kappa statistics. Results There was little apparent impact. Preoperative severity increased slightly for two procedures only: varicose vein surgery (SES disease-specific PROM 0.10; generic PROM −0.07) and to a lesser extent for hip replacement (SES disease-specific PROM −0.03). There was little inter-provider variation and it did not change significantly over time. There were also slight improvements in outcomes for hip and knee replacement (SES for disease-specific and generic PROMs 0.03) though not for hernia repair and a slight worsening for varicose vein surgery. The extent of variation in performance between providers was unchanged. The proportion of providers deemed to be outliers did not change over time. There was only moderate consistency in those providers deemed to be outliers for hip and knee replacement (Kappa 0.31–0.47) and it was even weaker for the other two procedures. Although 35% of providers of hip replacement were outliers in at least one year, only 6% were consistently outliers. Such inconsistency may be partly due to regression to the mean. Conclusions The minimal impact that the routine use and feedback of PROMs had on provider behaviour during the initial years suggests that more attention needs to be paid to how results are communicated and to the provision of advice as to what action may be taken.
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Affiliation(s)
- Mira Varagunam
- Research Fellow in Statistics, London School of Hygiene & Tropical Medicine, UK
| | - Andrew Hutchings
- Lecturer in Health Services Research, Health Services Research Unit, UK
| | - Jenny Neuburger
- Lecturer in Medical Statistics, London School of Hygiene & Tropical Medicine, UK
| | - Nick Black
- Professor of Health Services Research, Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, UK
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16
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Derrett S, Cousins K, Gauld R. A messy reality: an analysis of New Zealand's elective surgery scoring system via media sources, 2000-2006. Int J Health Plann Manage 2012; 28:48-62. [PMID: 22815091 PMCID: PMC3617466 DOI: 10.1002/hpm.2127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Waiting lists for elective procedures are a characteristic feature of tax-funded universal health systems. New Zealand has gained a reputation for its 'booking system' for waiting list management, introduced in the early-1990s. The New Zealand system uses criteria to 'score' and then 'book' qualifying patients for surgery. This article aims to (i) describe key issues focused on by the media, (ii) identify local strategies and (iii) present evidence of variation. Newspaper sources were searched (2000-2006). A total of 1199 booking system stories were identified. Findings demonstrate, from a national system perspective, the extraordinarily difficult nature of maintaining overall control and coordination. Equity and national consistency are affected when hospitals respond to local pressure by reducing access to elective treatment. Findings suggest that central government probably needs to be closely involved in local-level management and policy adjustments; that through the study period, the New Zealand system appears to have been largely out of the control of government; and that governments elsewhere may need to be cautious when considering developing similar systems. Developing and implementing scoring and booking systems may always be a 'messy reality' with unintended consequences and throwing regional differences in service management and access into stark relief.
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Affiliation(s)
- Sarah Derrett
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
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17
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Gillett WR, Peek JC, Herbison GP. Development of clinical priority access criteria for assisted reproduction and its evaluation on 1386 infertile couples in New Zealand. Hum Reprod 2011; 27:131-41. [DOI: 10.1093/humrep/der372] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Kaukonen P, Salmelin RK, Luoma I, Puura K, Rutanen M, Pukuri T, Tamminen T. Child psychiatry in the Finnish health care reform: National criteria for treatment access. Health Policy 2010; 96:20-7. [DOI: 10.1016/j.healthpol.2009.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 12/10/2009] [Accepted: 12/10/2009] [Indexed: 10/19/2022]
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Dew K, Stubbe M, Macdonald L, Dowell A, Plumridge E. The (non) use of prioritisation protocols by surgeons. SOCIOLOGY OF HEALTH & ILLNESS 2010; 32:545-562. [PMID: 20163563 DOI: 10.1111/j.1467-9566.2009.01229.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Priority setting and rationing is a dominant feature of contemporary health policy. In New Zealand, clinical priority assessment criteria (CPAC) tools have been developed to make access to elective surgery more equitable and efficient. Research was undertaken to identify how surgeons used these tools in the consultation. Forty-seven consultations with 15 different surgeons have to date been video- and audio-recorded. There were no instances where CPAC tools were explicitly used in the consultation. Drawing on the methodology of conversation analysis and the concept of news delivery as developed by Maynard, this paper argues that the delivery of diagnoses and treatment plans can usefully be seen in part as the delivery of bad or good news. Using three case studies to illustrate the argument, it is suggested that the interactional work required in the delivery of such news challenges the ability of clinicians to use protocols such as CPAC. The analysis sheds light on important consultation processes that need to be more carefully considered when designing interventions to influence clinician behaviour. In order to influence the behaviour of clinicians to achieve policy goals, greater attention needs to be paid to the interactional demands of the consultation process.
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Affiliation(s)
- Kevin Dew
- Sociology Programme, Victoria University of Wellington, Wellington 6140, New Zealand.
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Dew K. Public health and the cult of humanity: a neglected Durkheimian concept. SOCIOLOGY OF HEALTH & ILLNESS 2007; 29:100-14. [PMID: 17286708 DOI: 10.1111/j.1467-9566.2007.00521.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Public health researchers have used a number of concepts derived from the work of Durkheim, such as anomie and social capital. One concept that has not been deployed in public health discourses is that of the cult of humanity - Durkheim's religion in a society organised around organic solidarity. This paper discusses Durkheim's views on religion and science, and the cult of humanity. The cult of humanity is characterised as having humanity at the centre of worship and combining elements of religion and science. Medicine and complementary therapies are identified as possible candidates to fulfil the role of the cult of humanity, but the institution of public health seems to be a particularly apt candidate. The paper concludes by discussing the way in which this analysis provides insight into the dual advocacy and academic functions of public health, the tension between individual choice and constraint and the buffering role of public health in relation to other social institutions.
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Affiliation(s)
- Kevin Dew
- Public Health, University of Otago, Wellington, New Zealand.
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Abstract
OBJECTIVE This paper uses an economic model to compare three methods for stimulating quality improvement: payment incentives, competition for patients, and emphasis on professional ethics. DESIGN Use an economic model to simulate the impact on quality distortions (risk selection) of differences in payment incentives, competition for patients, and emphasis on professional ethics. SETTING Health care policymakers in many countries seek to use incentives and competition to spur quality improvement. However, strong incentives often promote risk selection: insurers and providers financially benefit from distorting quality to attract profitable patients. RESULTS The analysis suggests that intense competition for patients and strong financial rewards for cost control can exacerbate quality distortions and compromise social solidarity. CONCLUSIONS Carefully regulated competition and mixed forms of provider payment (risk sharing) appear to be the best options. Moreover, designing competition, regulation, payment, and other forms of health policy to promote suppliers' professional ethics can help society to reap the quality and efficiency benefits of competition and incentives without sacrificing social solidarity.
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Affiliation(s)
- Karen Eggleston
- Department of Economics, Tufts University, Medford, MA 02155, USA.
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