HealthcarePapers
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This commentary by Victorian Order of Nurses Canada, written in response to "Getting What We Pay For? The Value-for-Money Challenge," by McGrail, Zierler and Ip, answers four key questions about Canada's home and community care sector: (1) What are our objectives? (2) Where do we achieve good value now? (3) Where and why are we failing? and (4) What will help us do better? We conclude that although the home and community care sector offers great promise in meeting the evolving health and social needs of Canadians, it is not living up to its potential. We propose the development of a national, integrated approach to home and community care to help Canadians remain healthy and independent in their homes. This would represent a wise financial investment for governments and would contribute to the long-term health of Canadians.
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Hutchison makes a number of important observations about primary healthcare renewal in Canada. This commentary on his paper examines some of the forces driving policy change in primary health, particularly concerns about increasing demand. While I agree with Hutchison that incremental change is more likely than radical reform, I argue that it may be time to fundamentally rethink the role of primary healthcare.
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The Canadian Institute for Health Information began publishing hospital standardized mortality ratio (HSMR) data for select Canadian hospitals in November 2007. This paper describes the experience of the Winnipeg Regional Health Authority in assessing the validity of the HSMR through statistical analysis, coding definitions and chart audits. We found a lack of empirical evidence supporting the use of the HSMR in measuring reductions in preventable deaths. ⋯ The results of our chart audit show that the HSMR is not a sensitive measure of adverse events as defined by "unexpected death" in the Canadian Adverse Events Study. It should not be viewed as an important indicator of patient safety or quality of care. We discuss the cumulative sum statistic as an alternative to the HSMR in monitoring in-hospital mortality.
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Solving the obesity crisis has less to do with post-partisanship and more to do with increasing public support for strong public policy initiatives that will make the healthy choice the easy choice. The government has an important role in mitigating the toxic food environment created by food manufacturers and restaurant chains. Progress to date has occurred on the state level. With greater public support in a new political environment, national progress may be possible in the foreseeable future.