Calgary Regional Health Authority Research Articles

Understanding coordination of care from the consumer's perspective in a regional health system.

To understand and develop a model about the meaning of coordination to consumers who experienced a transition from acute care to home care. A qualitative, exploratory study using Grounded Theory. DATA SOURCES/ANALYSIS: Thirty-three consumers in the Calgary Regional Health Authority who had experienced the transition from an acute care hospital back into the community with home care support were interviewed. They were asked to describe their transition experience and what aspects of coordination were important to them. Interviews were recorded, transcribed, and analyzed using constant comparison. The coding and retrieval of information was facilitated by the computer software program Nud*ist. The resulting model has four components: (1) the meaning of coordination to consumers; (2) aspects of health care system support that are important for coordination; (3) elements that prepared consumers to return home; and (4) the components of a successful transition experience. Consumers appeared to play a crucial role in spanning organizational boundaries by participating in the coordination of their own care. Consumers must be included in health care decisions as recipients of services and major players in the transition processes related to their care. Health care providers need to ensure that consumers are prepared to carry out their coordination role and managers need to foster a culture that values the consumer "voice" in organizational processes.

Tuberculosis in Immigrants to Canada

Tuberculosis in Immigrants to Canada

Decreasing influenza impact in lodges: 1997-2000 Calgary Regional Health Authority.

Influenza causes high morbidity and hospitalization rates in residents of seniors lodges, I causing increased pressure on emergency departments and hospital beds every winter. This quasi-experimental study assessed the prevention of influenza outbreaks and their consequences in Calgary lodges. A multidisciplinary team worked to improve communication between health professionals, increase resident and staff immunization coverage, obtain weights and creatinines prior to influenza season, and facilitate amantadine prophylaxis during influenza A outbreaks. We had an increase in standing orders for amantadine and up to 56% of residents from one lodge had documented creatinine levels. Amantadine was administered to residents within two days of outbreak notification. Influenza morbidity in lodge outbreaks decreased from a rate of 37% to 9% over the three years and hospitalization rates decreased from 9% to 1%. We recommend that other regions consider a similar approach to decreasing influenza morbidity and hospitalization in lodge residents.

Decreasing Influenza Impact in Lodges: 1997–2000 Calgary Regional Health Authority

Influenza causes high morbidity and hospitalization rates in residents of seniors lodges, I causing increased pressure on emergency departments and hospital beds every winter. This quasi-experimental study assessed the prevention of influenza outbreaks and their consequences in Calgary lodges. A multidisciplinary team worked to improve communication between health professionals, increase resident and staff immunization coverage, obtain weights and creatinines prior to influenza season, and facilitate amantadine prophylaxis during influenza A outbreaks. We had an increase in standing orders for amantadine and up to 56% of residents from one lodge had documented creatinine levels. Amantadine was administered to residents within two days of outbreak notification. Influenza morbidity in lodge outbreaks decreased from a rate of 37% to 9% over the three years and hospitalization rates decreased from 9% to 1%. We recommend that other regions consider a similar approach to decreasing influenza morbidity and hospitalization in lodge residents.

Delegation: The Views of Case Managers

Care is provided under the direction of case managers within the Home Care Services division of the Calgary Regional Health Authority, Alberta, Canada. More than 90% of the case managers are registered nurses, with the other 10% being made up of physiotherapists and occupational therapists. Often, case managers delegate personal care and housekeeping to provider agency staff who have less professional education, whereas other tasks are given to family members, friends, and clients themselves. In light of the need to be cost-effective and yet for care to be delivered by the most appropriate provider, it is time to examine delegation by case managers.

Program Budgeting and Marginal Analysis: A Priority-Setting Framework for Canadian Regional Health Authorities

Health regions in Canada are responsible for meeting the needs of local populations with limited resources. However, relatively little attention has been given to this within-region resource allocation problem. An economic approach to needs assessment, namely program budgeting and marginal analysis, may be of benefit. Its potential for use in Canada is examined, in particular with examples from two Alberta health regions, the Calgary Regional Health Authority and the Chinook Health Region.

Telelearning in a partnership between a university faculty and a regional health authority: Benefits, challenges and strategies

The University of Calgary's Faculty of Medicine and the Calgary Regional Health Authority understand that telehealth is an evolving field requiring both academic enquiry and operational readiness. Both parties are committed to quality educational programmes--the Faculty through its commitment to excellence and the Authority with its charge to maintain and enhance such programmes. There are shared applications, multi-learner user groups, shared strategies to overcome distances and shared infrastructure--technologies, communication pathways and resources. Having embarked on a joint telelearning venture, we have learned a number of lessons. Central to progress has been an appreciation and respect for unique mandates, a spirit of trust and flexibility, an agreement on a set of principles, ongoing communication between and participation from the users and, at times, redirection. Questions being answered include the following. How well is this collaborative model working? How functional is it at this time of health reform and restructuring? Can one meet complementary telelearning goals within a faculty-health authority relationship? These all have implications for future success.

Abstracts of literature

Abstracts of literature

Enhancing Public Input Into Decision Making: Development of the Calgary Regional Health Authority Public Participation Framework

Public participation in shaping policy and decisions that affect health is receiving increased attention. In the health sector, an imbalance exists between theory and practice. This article describes the development of a framework to promote public and community participation in one urban health authority, including the components of the public participation framework of purpose, values, guiding principles, and expected outcomes. A list of participation activities within the authority was obtained by survey. These activities are presented in relation to the conceptual framework. The article concludes with a se

Qualitative Assessment of the Impact of Health Care Reform on the Availability of Clinicians for Preclinical Medical Instruction

Purpose: Over the past 5 years, Calgary clinicians experienced the restructuring of health care delivery and a move to a presentation-based curriculum at the University of Calgary. Course coordinators have noted increased difficulty in recruiting clinical lecturers at the preclinical undergraduate level. This study was designed to evaluate the relative importance of factors that may influence the time clinicians spend teaching at this level. Summary: This descriptive survey was conducted within the University of Calgary, Faculty of Medicine, a teaching institution affiliated with the Calgary Regional Health Authority, which is responsible for the delivery of health care within the City of Calgary. Basic scientists, residents, and adjunct medical professionals were excluded from a list of lecturers for the academic year 1996-97, leaving a target population of 386. Respondents were stratified according to university appointment, specialty, type of medical training, and hours taught in the 1996-97 academic year. Dependent variables included the financial constraints, time constraints, health care reform, changes in the undergraduate medical education curriculum, and lack of recognition on availability for teaching. Written comments were also categorized and analyzed according to the same variables. A response rate of 79% (n = 305) was achieved. Of the respondents, 52% agreed that recent reform has made it more difficult to teach; full-time faculty were less likely to agree compared to non-full-time faculty (60% vs. 44%; nonparametric median test, c2 = 6.18, p =. 046). Twice as many family physicians reported that financial constraint was a factor (66%) when compared to other specialists, whereas relatively few full-time faculty noted it to be a concern (12%) when compared to major part-time (43%) and non-full-time/major part-time appointees (66%; c2 = 23.4, p <. 0001). Clinicians reporting the most teaching hours (more than 30) were most likely to describe an increase in teaching hours (61%). Nonfaculty members were less aware of the recent curricular changes (73%); however, more family physicians felt that these changes had a positive impact on willingness to teach (10%) compared to surgical (8%) and nonsurgical specialists (9%; c2 = 6.07, p =. 048). Forty-five percent of respondents agreed that they would be more willing to teach if offered some form of recognition. Two thirds of written comments suggested that recognition should be nonmonetary (e.g., faculty promotion, acknowledgment). Conclusions: The experience at the University of Calgary suggests that availability of teachers for preclinical undergraduate medical education has diminished as a result of health care reform. Family physicians have been affected the most, and the clinical environment will make it even more difficult to involve this important group of teachers in undergraduate medical education.

Establishing standards for health care archives: a case study of the Calgary Regional Health Authority.

Due to recent restructuring of Alberta's health care system, many historically valuable records are at risk. However, Freedom and Information and Protection of Privacy legislation has created awareness of the need to care for both administrative and medical records of health care institutions, and standards for the maintenance of these records are evolving. The Calgary Regional Health Authority has established archives, records management, and access and privacy programs, and now has the opportunity to establish a serious medical research repository. The CRHA's experience proves the feasibility of preserving historical health care records for both medical and historical use.

The big bang approach to health reform: an update from the Calgary Regional Health Authority.

The big bang approach to health reform: an update from the Calgary Regional Health Authority.

Acceptance by the aga is the single best indicator of subsequent full publication of research

We studied publication rates and determinants of publication in GI-research. In particular, our concern was the possibility of publication bias, i.e. publication based on the statistical significance of study results. Methods. A random sample (n=l,000, stratified by study type) of all abstracts submitted to the 1992 to 1995 AGA-meetings, was followed up by a computerized literature search (Medline), as well as by postal questionnaires to abstract authors. In addition, abstracts were evaluated for study design features, statistical significance of study results, sample size, and research topic. Abstract evaluation was blinded with respect to acceptance, authors and origin. A quality score was assigned to all abstracts, based on completeness of reporting and measures undertaken to improve internal validity. High impact journals were defined as scientific impact factors (IF) > 5. Differences in publication were tested using log rank tests and Cox regression analysis. Results. Information is available on research presented in 232 abstracts submitted to the 1992-1994 meetings. Within the follow-up period of 3-5 years, 121 research projects (52%) were published in full, 63% of the subgroup of controlled clinical trials (CCT), 57% of basic science studies (BSS). Thirty percent of all abstracts were published within one year of the meeting. The majority of publications (60%) were in GI&Hepatology journals (71% of CCT publications, most frequently Dig Dis Sci, Am J Gastroenterol and Gastroenterology), followed by basic science journals (51% of BSS, most frequently Am J Physiol). Only 2% of all projects presented as abstracts were subsequently published in general medical journals, 19% of all publications were in high IF-journals, 98% were in English. Log ranks tests showed significantly better outcomes, when abstracts had been accepted for AGApresentation (p=.01). Also, outcome was dependent on study type, with CCT and BSS being more likely to be published than epidemiological or other research on humans (p=.03). With respect to topics, research on IBD had the highest publication rates (86%), research on upper GI-problems the lowest (43%), but overall, the research area was not a significant predictor (p=.l). There was no difference in publication rates, or in the percentage of high IF publications between North-American, Australian, and European research. However, although not statistically significant, countries other than these had markedly less overall publications (30% as compared to 54%, p=0.07), and none in high IF-journals. Statistical significance of study results and sample size could not be shown to influence publication rates, nor was the formal quality of the respective AGA abstract predictive. Cox regression analysis retained abstract acceptance as the only significant predictor of subsequent full publication (HR 1,9, CI 1.2-3.0). Preliminary results from the postal survey found lack of time or loss of interest the most frequent reasons for non publication. In 43% of unpublished projects, a manuscript had not or not yet been prepared. Conclusions: Acceptance for abstract presentation was found to be the only significant predictor of full publication of research projects initially submitted as abstracts to DDW meetings. There is, in addition, some evidence, that the country of origin, research type and research topic may be of importance. Bias based on the statistical significance of the study findings (publication bias) does not seem to be an issue. *Fellow of the German Academic Exchange Service (DAAD). Research funded by the Calgary Regional Health Authority (CRHA).

Calgary Regional Health Authority (CRHA) Department of Anaesthesia

Calgary Regional Health Authority (CRHA) Department of Anaesthesia