Healthcare quarterly (Toronto, Ont.)最新文献

Equitable healthcare is needed to improve population health outcomes. However, a lack of comprehensive analytical tools and data impedes efforts to monitor and improve equity in care. Measures often do not include stratified statistics, providing insufficient information about variations in access, quality or outcomes across population subgroups. Measures that are equity-sensitive leverage disaggregated data to detect differences in care among population groups and across institutions, serving as one mechanism toward identifying and tracking healthcare inequities across the care continuum. This report presents a framework to assess measures for equity sensitivity that may be used across diverse settings.

The province of Ontario has seen significant growth in the waitlists for both pediatric surgery and pediatric endoscopy. Due to long-standing resource constraints exacerbated by the COVID-19 pandemic, the surgical waitlist at a pediatric tertiary hospital in Toronto had risen to over 6,500 patients by April 2023, with 65% beyond nationally validated wait time targets (out-of-window). A regional Surgical and Endoscopy Community Partnerships program was developed with five partner hospital sites to build capacity and decentralize pediatric surgical care by transferring select low-acuity patients, primarily targeting the longest-waiting cases, from the pediatric tertiary hospital waitlists to partner hospitals closer to their homes. Each of the partner hospitals had pre-existing pediatric surgical programs and the necessary infrastructure and staffing to support the referred patients. Between April 2023 and March 2024, this program transitioned more than 650 pediatric cases to partner hospitals, reducing the waitlist by approximately 10%. Early program success has demonstrated that an integrated system-wide approach to the provision of pediatric surgical care is a viable model for future surgical care delivery.

Quality does not exist in a vacuum. It is shaped by the sweeping societal changes and forces that affect the way people work and live, industries and economies operate, and how technology is used. When context changes, the ways in which we think about healthcare, quality and leadership need to change as well. This is the final article in a series that sets out a bold and multi-dimensional view of quality that is built around the themes of human centricity, trust, resilience, sustainability and prosperity. As themes are explored, specific shifts required to move us toward Quality 5.0 are described, ways of measuring and monitoring progress are proposed and a new set of leadership competencies for the future is presented. Together with the previous five articles in this series, this article is meant to inspire change that improves outcomes at individual, community and system levels.

Canada's healthcare system faces mounting crises, from dementia to homecare shortages, yet responses remain mired in stakeholder consultation. Some experts now call for a "Manhattan Project" approach. However, the Manhattan Project's centralized wartime model is incompatible with Canada's federated healthcare system. A better template is DARPA - the Defense Advanced Research Projects Agency - which enables rapid, parallel experimentation across distributed jurisdictions. A Canadian healthcare DARPA would require leadership willing to abandon consensus, protection for failure, compressed timelines and, crucially, reallocation of existing resources rather than new bureaucracy. This model replaces inertia with iteration, creating mechanisms that learn faster than disease spreads.

This paper describes a framework that engages diverse leaders and decision-makers across Canada's federal, provincial and territorial jurisdictions to build collaboration that overcomes the silos and competition among jurisdictions during healthcare supply disruptions. The collaboration model proposes to address the challenge of fragmented and competitive approaches among Canadian jurisdictions to source and manage supply shortages, which increases the risk of harm for both patients and the healthcare workforce. Empirical evidence of outcomes and effectiveness of collaborative engagement across jurisdictions is presented to demonstrate the potential for a "Whole Canada" approach to coordinating management of supply disruptions and strategies that mitigating the risk of supply disruptions for patients and health system capacity to deliver care. Simulations were used to pilot the framework, focusing on supply management strategies that reach across Canadian jurisdictions to mitigate risks of supply shortages to ensure that all Canadians have access to safe and sustainable healthcare services.

Artificial intelligence (AI) presents opportunities and challenges in post-discharge psychiatric care. Leveraging structured data and machine learning, the Centre for Addiction and Mental Health aims to predict adverse outcomes, including readmissions, among patients recently discharged from psychiatric units. By identifying high-risk individuals, AI can guide referrals to resource-intensive outpatient clinics, enhancing continuity of care and improving outcomes. A governance framework addressing ethics, transparency and fairness underpins the development and implementation process. The study emphasizes using interpretable AI models over black-box systems to foster trust and clinical utility, aligning AI advancements with ethical mental health practices.

Eating disorders are serious, complex conditions that place a significant burden on health systems, individuals and families. Even before the COVID-19 pandemic, hospitalizations for eating disorders in Ontario were rising and characterized by longer hospital stays, greater medical complexity and increasing admissions among young male adults. Using linked ICES data, our work shows that the pandemic was associated with a disproportionate increase in these existing trends, with emergency department visits and hospitalizations among adolescents rising well above expected levels and remaining elevated through 2023; in contrast, young adult rates have largely returned to baseline. These patterns highlight the unique vulnerabilities of adolescents. We discuss the ongoing challenges of limited workforce capacity, long wait times and fragmented services, and propose solutions informed by Ontario Health's Eating Disorders quality standard. Coordinated, multidisciplinary and measurement-driven approaches, co-designed with patients and caregivers, are essential to build a resilient, equitable system capable of meeting the complex needs of this population.

This study examines the role of clinicians during supply chain disruptions and the impact of these disruptions on their capacity to deliver care to patients. Clinician leaders (physicians, nurses, pharmacists and regional health authority leaders) from seven Canadian provinces (Ontario, Alberta, British Columbia, Nova Scotia, Newfoundland and Labrador, Quebec and Manitoba) participated in co-design sessions to identify strategies to integrate frontline clinical expertise into supply chain management. A workgroup led by two clinician leaders (a physician and a nurse) defined the challenges of supply disruptions for clinicians (individuals delivering clinical care to patients, such as physicians, nurses and pharmacists) and identified the structural barriers that limit clinician participation in managing supply disruptions and in adapting care delivery through alternative care pathways and resource allocation. This paper presents a set of actionable clinician-led strategies to engage clinicians in supply chain management to ensure that clinician expertise informs supply management decisions and enables safe and quality patient care that is accessible when and where needed. Strategies include designating agencies responsible for clinician communication during supply shortages, building bilateral communication channels linking clinicians and system leaders, implementing standardized communication protocols to engage the workforce in supply chain management and mobilizing clinical expertise to inform supply disruption decisions.

Healthcare faces distinct challenges in adopting artificial intelligence (AI) that are rarely seen in other industries. This paper highlights key pain points within Canada's public health systems that call for change through the implementation of digital technologies and AI-powered tools. The implementation of these innovative tools can transform health systems by improving productivity, administrative efficiencies and financial savings. Given the tremendous opportunity for AI to help healthcare systems, we propose a strategic approach for leaders in public healthcare systems to effectively implement AI tools in healthcare through a developed implementation framework. Implications are provided for academics and practitioners.

The digital world holds great power to transform knowledge. Digital health technology is emerging as an important asset globally to address the growing need for mental health and substance use management, and Canadians are supportive of incorporating it as part of the healthcare system (Canada Health Infoway 2023). The World Health Organization recognizes the power of digital health solutions to not only ensure sustainability of the health system but also to enhance access, quality and efficiency (WHO 2024). Countries such as Estonia, Australia, Denmark, Norway and Singapore are leading the way with nationwide, government-coordinated systems. In Canada, clear policies and strategies vary across provinces and territories, but early efforts are underway nationally to build a consolidated foundation required to support digital health. The Canadian Institute for Health Information is developing a Pan-Canadian Health Data Content Framework that will be connected to the Shared Pan-Canadian Interoperability Roadmap through Canada Health Infoway. It will provide standardized ways to integrate and share data across platforms, with health information accessible across all jurisdictions and organizations.