Canadian Health Services Research Foundation Research Articles

Advancing in the institutionalization of Evidence-Informed Policy in Brazil

Abstract EVIPNet Brazil was launched in 2007, coordinated by the Ministry of Health. Its expansion has promoted the institutionalization of a national knowledge translation platform, and has also been active at the local level. Local Health Evidence Labs were implemented to institucionalize working groups linked to EVIPNet. In this multiple case study, we discuss the advances in the institutionalization of Evidence-Informed Policy-making in Brazil, based on a mapping of the Health Evidence Labs' institutional capacity to acquire, evaluate, adapt and apply evidence and analyzed organizational arrangements and implementation barriers. The coordinators of 15 responded to a self-assessment questionnaire from the Canadian Health Services Research Foundation. The main products reported are evidence briefs and deliberative dialogues focused on regional problems, training activities and different kinds of rapid responses. Health Evidence Labs have the resources to acquire and evaluate research evidence, but have a low capacity to adapt and apply evidence, indicating that they do not have all the factors (skills, structures, processes, and organizational culture) to promote and use research results in decision-making. The lower capacity to 'adapt' and 'apply' evidence may be related to low development of exchange process with external experts. Governance is joined between managers of the departments with technical bodies; the service provision occurs to attend internal and external demands; financing is public or utilizing public research calls. The implementation barriers described are the staff turnover, inadequate funding arragements for develop knowledge translation products, paid access to evidence databases, lack of a repository for their production, and lack of monitoring and evaluation. Brazil has improved in the institutionalization of evidence-informed policy but still some important barriers to achieve a complete national knowledge translation platform. Key messages Brazil has institutionalized evidence-informed policy from the structuring of EVIPNet Brazil Network. To achieve the network sustainability, it is vital to consider the alignment of organizational elements with an emphasis on governance, financing, and its monitoring.

Public Spending on Health Services and Policy Research in Canada: A Reflection on Thakkar and Sullivan Comment on "Public Spending on Health Service and Policy Research in Canada, the United Kingdom, and the United States: A Modest Proposal".

Vidhi Thakkar and Terrence Sullivan have done a careful and thought-provoking job in trying to establish comparable estimates of public spending on health services and policy research (HSPR) in Canada, the United Kingdom and the United States. Their main recommendation is a call for an international collaboration to develop common terms and categories of HSPR. This paper raises two additional questions that have an international comparative dimension: There is little doubt that public spending on HSPR represents more than the "tip of the iceberg," but how much more? And how do the countries fare on the uptake of HSPR by decision-makers? I have long speculated that probably as much or more is spent by provincial/territorial governments, regional health authorities, hospitals and other agencies on HSPR activities carried out by consultants in Canada than by the federal, provincial/territorial granting agencies. Support for this contention is provided in a paper by Penno and Gauld on spending on external consultancies by New Zealand’s District Health Boards (DHBs). Their estimate of the amount spent on consultancies in 2014/15 represents 80% of the amount spent on research by the Health Research Council of New Zealand in 2015. In terms of the uptake of research Jonathan Lomas pioneered the concept of linking researchers with decisionmakers when he became the founding Chief Executive Officer (CEO) of the Canadian Health Services Research Foundation (CHSRF) in 1997. An early assessment was promising, and it would be interesting to know if other countries have tried this. Most assessments of research uptake and impact are short-term in nature. It might be insightful to assess HSPR developments over the long term, such as prospective reimbursement through diagnosis related groups (DRGs) that has been evolving internationally for more 40+ years. In the short term the prospects for a major infusion of funding in HSPR in Canada are not promising, although there have been welcome investments in the Canadian Foundation for Healthcare Improvement (formerly CHSRF).

Call to action: Interprofessional mental health collaborative practice in rural and northern Canada.

Shared within health care is needed in rural and northern Canada where residents are challenged with greater social and health disparities. Compared to their urban counterparts, Canadians in these areas experience lower socioeconomic status; higher rates of disability; higher rates of unemployment; higher mortality rates; difficulty with transportation, thereby limiting access to essential health services; and higher rates of chronic illness (Barbopoulos & Clark, 2003; Canadian Institute for Health Informatics, 2006). Downsizing of hospitals in rural and northern areas is causing outmigration of health care services to centralized urban areas, forcing rural Canadians to travel greater distances to access health care services (Canadian Collaborative Mental Health Initiative [CCMHI], 2006). A lack of access to health care is frequently noted as a key issue facing rural and northern residents (Donato, 2015; Haggarty, Ryan-Nicholls, & Jarva, 2010; McIlwraith & Dyck, 2002; Ryan-Nicholls, 2004). Shortages of mental health professionals in rural, northern, and Aboriginal communities in Canada are well documented (Kulig & Williams, 2012; McIllwariath & Dyck, 2002; Pawlenko, 2005).Interprofessional mental health collaborative practice (IMHCP) is an emerging and vital response to meet the mental health-related demands in rural and northern Canada and is an enhancement of the current Canadian health practice of Interprofessional Practice (IPP; (CCMHI, 2006; Coffey & Anyinam, 2015; Commission on the Future of Health Care in Canada [CFHC], 2002; Haggarty et al., 2010; Heath et al., 2015). IPMHC involves developing and maintaining effective interprofessional working relationships with professionals, paraprofessionals, students, mental health consumShelley ers, families, and communities to ensure optimal health outcomes (Canadian Interprofessional Health Collaborative [CIHC], 2010). Effective collaboration requires individual professionals to reframe their views from the traditional 'we know best' mind-set to a holistic approach (CCMHI, 2006; Coffey & Anyinam, 2015; Petrie, 1976). Pearce and Sims (2001) define shared as leadership that emanates from members of teams, and not simply from the appointed leaders (p. 115). It is the authors' contention that psychology must fully embrace a shared role in IMHCP in rural and northern communities, not only within clinical practice but also within professional psychology associations and regulatory bodies. We discuss the opportunities and challenges this may create and how the scholarly literature can guide our next steps.BackgroundThe Romanow Report (CFHC, 2002) continues to be one of the most influential documents in modern health care delivery in Canada. Over the past decade, recommendations from this document have led to systemwide advances in IPP and interprofessional education (IPE). In response, provincial and territorial directives have been targeting collaborative practice as one of their priorities in streamlining quality health care (Canadian Health Services Research Foundation, 2011; Coffey & Anyinam, 2015; Health Professions Regulated Advisory Council [HPRAC], 2006; Province of Nova Scotia, 2014). IPP is now an explicit expectation within most standards of practice for self-regulated health care professions in Canada and is mandated by their respective regulatory bodies (Human Resources Professionals Association, 2015). National organisations specifically designed to promote awareness and education in this field, such as the CIHC (2010), are also emerging. As well, IPE is expanding within universities across Canada, supporting multimodal opportunities for clinical simulations in IPP (Church et al., 2010; Cornish et al., 2003; Curran et al., 2012; Dalhousie University, 2015a; Donato, 2015).Yet within rural and northern communities, there remain challenges with efficiently implementing IMHCP because these large, isolated geographic areas are being serviced by low numbers of health professionals representing a small number of disciplines. …

Translating research knowledge in dementia care organisations

To evaluate dementia care organisations' capacity to acquire, assess, adapt and apply dementia research. We used the Canadian Health Services Research Foundation's survey, 'Is research working for you?' by inviting the members of the New Zealand National Dementia Cooperative to participate in the online survey. A total of 146 (32%) members responded and indicated that, although the workforce had the skills to engage in research and implement evidence into practice, there was limited organisational support in terms of the time, resources and access to external support. We propose a number of strategies to improve knowledge translation in dementia care.

Australian research investigating the role of nurse practitioners: A view from implementation science

Summary The catalyst for the paper was a rapid review of the literature which identified Australian research on nurse practitioners. This paper reports on those studies investigating individual nurse practitioner roles, framed in terms of the implementation science literature and three stages of implementation: exploration and adoption of the role, initial implementation of the role, and full operation of the role. Database searching of the peer-reviewed literature was supplemented with searching relevant web sites. Most studies focused on certain aspects of the nurse practitioner role rather than undertaking a comprehensive evaluation. There was no consistency in the way the roles were described, making it difficult to compare what may be similar roles in different studies. The research generally treats the nurse practitioner role as the independent variable, rather than the care provided by the nurse practitioner. The concept of implementation fidelity was absent from all studies, except for one which addressed the issue indirectly. Many studies included little contextual information, making it difficult to judge the role of context in influencing both implementation and patient outcomes and establish plausible links between the activities of the nurse practitioners and patient outcomes. Based on the findings, a checklist is recommended for use in future studies which would enhance the ability to make judgements about implementing nurse practitioner models of care; facilitate comparison of similar roles and increase the capacity to make informed decisions about the prospects for wider implementation of nurse practitioner roles or models of care.

Review of Diagnosis-Related Group-Based Financing of Hospital Care.

Since the 1990s, diagnosis-related group (DRG)-based payment systems were gradually introduced in many countries. The main design characteristics of a DRG-based payment system are an exhaustive patient case classification system (ie, the system of diagnosis-related groupings) and the payment formula, which is based on the base rate multiplied by a relative cost weight specific for each DRG. Cases within the same DRG code group are expected to undergo similar clinical evolution. Consecutively, they should incur the costs of diagnostics and treatment within a predefined scale. Such predictability was proven in a number of cost-of-illness studies conducted on major prosperity diseases alongside clinical trials on efficiency. This was the case with risky pregnancies, chronic obstructive pulmonary disease, diabetes, depression, alcohol addiction, hepatitis, and cancer. This article presents experience of introduced DRG-based payments in countries of western and eastern Europe, Scandinavia, United States, Canada, and Australia. This article presents the results of few selected reviews and systematic reviews of the following evidence: published reports on health system reforms by World Health Organization, World Bank, Organization for Economic Co-operation and Development, Canadian Institute for Health Information, Canadian Health Services Research Foundation, and Centre for Health Economics University of York. Diverse payment systems have different strengths and weaknesses in relation to the various objectives. The advantages of the DRG payment system are reflected in the increased efficiency and transparency and reduced average length of stay. The disadvantage of DRG is creating financial incentives toward earlier hospital discharges. Occasionally, such polices are not in full accordance with the clinical benefit priorities.

A governance model for integrated primary/secondary care for the health-reforming first world - results of a systematic review.

BackgroundInternationally, key health care reform elements rely on improved integration of care between the primary and secondary sectors. The objective of this systematic review is to synthesise the existing published literature on elements of current integrated primary/secondary health care. These elements and how they have supported integrated healthcare governance are presented.MethodsA systematic review of peer-reviewed literature from PubMed, MEDLINE, CINAHL, the Cochrane Library, Informit Health Collection, the Primary Health Care Research and Information Service, the Canadian Health Services Research Foundation, European Foundation for Primary Care, European Forum for Primary Care, and Europa Sinapse was undertaken for the years 2006–2012. Relevant websites were also searched for grey literature. Papers were assessed by two assessors according to agreed inclusion criteria which were published in English, between 2006–2012, studies describing an integrated primary/secondary care model, and had reported outcomes in care quality, efficiency and/or satisfaction.ResultsTwenty-one studies met the inclusion criteria. All studies evaluated the process of integrated governance and service delivery structures, rather than the effectiveness of services. They included case reports and qualitative data analyses addressing policy change, business issues and issues of clinical integration. A thematic synthesis approach organising data according to themes identified ten elements needed for integrated primary/secondary health care governance across a regional setting including: joint planning; integrated information communication technology; change management; shared clinical priorities; incentives; population focus; measurement – using data as a quality improvement tool; continuing professional development supporting joint working; patient/community engagement; and, innovation.ConclusionsAll examples of successful primary/secondary care integration reported in the literature have focused on a combination of some, if not all, of the ten elements described in this paper, and there appears to be agreement that multiple elements are required to ensure successful and sustained integration efforts. Whilst no one model fits all systems these elements provide a focus for setting up integration initiatives which need to be flexible for adapting to local conditions and settings.

Linking Research to Action for Youth Violence Prevention: Community Capacity to Acquire, Assess, Adapt and Apply Research Evidence

Community-based organizations (CBOs) are important stakeholders in the health system, providing many valuable community-based programs and services. However, limited efforts have been made to encourage CBOs to incorporate research evidence into service provision, and their capacity to do so is not well understood. Therefore, the primary goal of this research was to examine CBOs' perceptions of: 1) the frequency of using research and other forms of evidence related to youth violence prevention, and 2) their capacity to acquire, assess, adapt and apply research evidence. CBOs involved in youth violence prevention completed a survey (n=35) and/or attended a focus group (n=16). Survey questions were adapted from the Canadian Health Services Research Foundation's "Is Research Working for You?" tool. CBOs' reported use of and capacity to acquire research evidence was high. CBOs reported possessing the structures, processes, and organizational culture needed to apply research evidence in decision-making. Assessing research evidence was a challenge for CBO staff, although many have external experts who can effectively do so. Generally, CBOs reported adequate capacity to adapt (i.e., synthesize, contextualize, and present) research evidence. Adapting research evidence for use in particular populations or geographical areas presented a considerable challenge. Although many barriers and socio-political complexities make linking research to action challenging, we found that CBOs generally feel competent and well equipped. Our findings support the viability of extending the push for evidence-based health care to community contexts so that the most effective programs and services for Canadians can be offered.

Using the Accreditation Canada Quality Worklife revalidated Model to predict healthy work environments

Background  The relevance of improving quality worklife in implementing healthy workplaces successfully has been demonstrated by both the Canadian Health Services Research Foundation and Accreditation Canada. In partnership with Accreditation Canada, this article focuses on two issues: the relationships between quality worklife and healthy work environment, and the prediction of healthy work environments using Accreditation Canada’s revalidated Quality Worklife Model. Methods  Using the 2008 and 2010 de-identified worklife data gathered among staff in organisations participating in the Qmentum accreditation program from all Canadian provinces (9,578 French speaking and 16,398 English-speaking respondents), this article attempts to demonstrate how the Quality Worklife revalidated Model predicts healthy work environments. The revalidation of the Quality Worklife Model was done using first principal component factor analysis (FA) with direct oblimin rotations (using SPSS 16.0), followed by a confirmatory factor analyses (using LISREL 8.80) on the French and the English samples. Furthermore, multivariate analyses of variance were conducted in order to detect mean differences between the different work environment groups linked to the psychological and physical consequences. Results  The results suggest that the healthy work environment group is associated with high work adjustment, good physical and mental health as well as low absenteeism and health-related presenteeism. On the other hand, the results suggest that the poor work environment group and to a less significant extent the subthreshold work environment is associated with low work adjustment, poor physical and mental health and high absenteeism and health-related presenteeism. Conclusion  The proposed model suggests that by categorising the Quality Worklife scores in three work environment groups based on a sample set of 11 quality worklife items, it becomes possible to predict employees’ risk of having poor work adjustment, poor mental and physical health, and poor work-related behaviours.

Chartbook: Shining a Light on the Quality of Healthcare in Canada

This paper provides a reflection on the findings of Canada's first-ever chartbook on the quality of healthcare in Canada. Quality of Healthcare in Canada: A Chartbook was published in 2010 by the Canadian Health Services Research Foundation in partnership with the Canadian Institute for Health Information and the Canadian Patient Safety Institute, and with support from Statistics Canada. This paper, by the chartbook authors (Sutherland and Leatherman) and colleagues (Law, Verma and Petersen), presents selected key findings and lessons from the chartbook and aims to serve as a catalyst for ideas and discussion in the papers that follow. The chartbook identified a lack of common language and indicators on quality across Canada's provinces and territories, underscoring the need to create and coordinate core measures. The Canadian chartbook and this issue of Healthcare Papers provide an update on the existing quality measures and the state of healthcare quality in Canada, and create the opportunity for jurisdictions to learn from one another and to contemplate the steps required to improve quality across the country.

How Long Can We Enjoy B-Player Status?

In the recent edition of Healthcare Papers (http://www. longwoods.com/publications/healthcarepapers/22856, Sutherland and colleagues reflect on their experiences developing a pan-Canadian picture of quality measurement (Sutherland and Leatherman 2010). Their review points out shortcomings, gaps and variations in how we measure and report on the performance of our healthcare system. The picture is not good. It is no better when we consider what the actual data say about the health system performance in Canada. On the basis of this chartbook – which is a useful compendium of quality data from multiple sources – one of us (T.S.) made this case clearly at the Canadian Health Services Research Foundation (CHSRF) CEO Forum in 2010: Canada gets a B grade. In the commentaries that follow, several authors raise – and seem to accept – this B grade.

How Long Can We Enjoy B-Player Status?

In the recent edition of Healthcare Papers (http://www. longwoods.com/publications/healthcarepapers/22856, Sutherland and colleagues reflect on their experiences developing a pan-Canadian picture of quality measurement (Sutherland and Leatherman 2010). Their review points out shortcomings, gaps and variations in how we measure and report on the performance of our healthcare system. The picture is not good. It is no better when we consider what the actual data say about the health system performance in Canada. On the basis of this chartbook – which is a useful compendium of quality data from multiple sources – one of us (T.S.) made this case clearly at the Canadian Health Services Research Foundation (CHSRF) CEO Forum in 2010: Canada gets a B grade. In the commentaries that follow, several authors raise – and seem to accept – this B grade.

Evaluating health inequity interventions: Applying a contextual (external) validity framework to programs funded by the Canadian Health Services Research Foundation

Including context in the measurement and evaluation of health in equity interventions is critical to understanding how events that occur in an intervention's environment might contribute to or impede its success. This study adapted and piloted a contextual validity assessment framework on a selection of health inequity-related programs funded by the Canadian Health Services Research Foundation (CHSRF) between 1998 and 2006. The two overarching objectives of this study were (1) to determine the relative amount and quality of attention given to conceptualizing, measuring and validating context within CHSRF funded research final reports related to health-inequity; and (2) to contribute evaluative evidence towards the incorporation of context into the assessment and measurement of health inequity interventions. The study found that of the 42/146 CHSRF programs and projects, judged to be related to health inequity 20 adequately reported on the conceptualization, measurement and validation of context. Amongst these health-inequity related project reports, greatest emphasis was placed on describing the socio-political and economical context over actually measuring and validating contextual evidence. Applying a contextual validity assessment framework was useful for distinguishing between the descriptive (conceptual) versus empirical (measurement and validation) inclusion of documented contextual evidence. Although contextual validity measurement frameworks needs further development, this study contributes insight into identifying funded research related to health inequities and preliminary criteria for assessing interventions targeted at specific populations and jurisdictions. This study also feeds a larger critical dialogue (albeit beyond the scope of this study) regarding the relevance and utility of using evaluative techniques for understanding how specific external conditions support or impede the successful implementation of health inequity interventions.

Re-imagining Healthcare: The Northwest Territories Transitions to an Integrated Chronic Disease Management Strategy

With the goal to improve healthcare services and delivery, Stanton Territorial Hospital in the Northwest Territories (NWT) invited the Canadian Health Services Research Foundation (CHSRF) to explore opportunities to collaborate in the redesign and improvement of the health system. This article describes the NWT’s efforts to transform its healthcare delivery to more appropriately care for people living with chronic diseases. It also sets the context for the initial meeting between the NWT and CHSRF and the collaborative journey that continues, with the bringing together of 40 health system managers, policy makers and clinicians, along with CHSRF staff and guest faculty, with a shared vision to redesign care to better meet the needs of people living with chronic diseases in the territory. In the NWT, chronic diseases account for approximately 70% of all deaths and half of all hospital admission days (Northwest Territories Department of Health and Social Services [DHSS] 2011b). As elsewhere, it is understood that healthcare services are not currently meeting population needs. Canadian health systems rank poorly in international comparisons that focus on the delivery of primary care, especially to those with multiple chronic conditions (Schoen et al. 2009). It is also well recognized in Canada that few healthcare systems are patient centred. In a recently commissioned CHSRF synthesis on transformation, professors Ross Baker and Jean-Louis Denis (2011) remarked, “Healthcare systems tend to reproduce their dominant logic and consequently neglect other areas where major care deficits persist.” In another CHSRF-commissioned synthesis on transformation, Professor Denis and colleagues (2011) noted that “a clear vision and a coherent set of strategies are required to transform the system and achieve better alignment between the care offered and the care the population needs today.” Such is the challenge for the NWT. In its recently released 2011–2016 strategic plan, DHSS (2011a) set a priority to “improve the health status of the population” through the development of a culturally appropriate chronic disease management model that tracks system quality outcome measures. With a senior leadership dedicated to improving the health status of its population as a key strategic priority and highly engaged throughout the change management process, the NWT is well positioned to improve healthcare services and delivery through transformation. CHSRF, in partnership with NWT leadership, intends to support the territory through its longer-term vision, to strategically reorient the health system for the benefit of all those living in the territory. We also hope that the lessons we learn here hold value for learning elsewhere.

Canadian Chief Executive Officers' Prescription for Higher Quality: More Clinical Engagement, Shared Accountability and Capacity Development

uality of Healthcare in Canada: A Chartbook, published by the Canadian Health Services Research Foundation (CHSRF) in 2010, showed that when compared with other developed countries, Canada ranks in the middle of the pack with respect to healthcare quality. How we can best achieve higher-quality care is a much-debated issue in Canada and in most modern healthcare systems – and there are many conflicting views. The historical guild of professionalism through selfregulating professional colleges remains intact, especially for issues of poor conduct or criminal behaviour. However, there is widespread evidence of errors of commission (e.g., wrong-sided surgery or medication error) and omission (e.g., under-managed care or infection caused by an absence of hand hygiene) and unacceptable variation in quality of care (CHSRF 2011). So beyond the regulatory bodies, important new organizational, managerial and legislative imperatives are emerging to improve quality. With the emergence of “accountable care organizations” in the United States and new legislation in several Canadian provinces promising greater attention to performance measurement and reporting, there is increasing movement toward enhancing accountability structures and mechanisms as a means of achieving higher-quality care. To promote further examination of accountability for quality, CHSRF, in partnership with the Association of Canadian Academic Healthcare Organizations, the Canadian Institute for Health Information and the Canadian Medical Association, chose Leadership Accountability in Canadian Healthcare: Creating the Momentum to Improve Quality as the theme of the fifth annual CEO Forum in Montreal on February 16, 2011. Over 150 leaders from various sectors of Canada’s healthcare system were in attendance at the forum. As part of the program, a polling exercise was conducted to gain participants’ perspectives on quality and to promote discussion.

Measurement of family health teams is underdeveloped

With regard to the news article by Collier,[1][1] innovators use evidence as the launch pad into uncharted territory. When innovations are evaluated, new evidence enables further innovation. The 2007 Canadian Health Services Research Foundation synthesis report on primary care teams states, “

Ethnic Disparities in Antipsychotic Drug Use in British Columbia: A Cross-Sectional Retrospective Study

Ethnic Disparities in Antipsychotic Drug Use in British Columbia: A Cross-Sectional Retrospective Study

Community capacity to acquire, assess, adapt, and apply research evidence: a survey of Ontario's HIV/AIDS sector

BackgroundCommunity-based organizations (CBOs) are important stakeholders in health systems and are increasingly called upon to use research evidence to inform their advocacy, program planning, and service delivery. To better support CBOs to find and use research evidence, we sought to assess the capacity of CBOs in the HIV/AIDS sector to acquire, assess, adapt, and apply research evidence in their work.MethodsWe invited executive directors of HIV/AIDS CBOs in Ontario, Canada (n = 51) to complete the Canadian Health Services Research Foundation's "Is Research Working for You?" survey.FindingsBased on responses from 25 organizations that collectively provide services to approximately 32,000 clients per year with 290 full-time equivalent staff, we found organizational capacity to acquire, assess, adapt, and apply research evidence to be low. CBO strengths include supporting a culture that rewards flexibility and quality improvement, exchanging information within their organization, and ensuring that their decision-making processes have a place for research. However, CBO Executive Directors indicated that they lacked the skills, time, resources, incentives, and links with experts to acquire research, assess its quality and reliability, and summarize it in a user-friendly way.ConclusionGiven the limited capacity to find and use research evidence, we recommend a capacity-building strategy for HIV/AIDS CBOs that focuses on providing the tools, resources, and skills needed to more consistently acquire, assess, adapt, and apply research evidence. Such a strategy may be appropriate in other sectors and jurisdictions as well given that CBO Executive Directors in the HIV/AIDS sector in Ontario report low capacity despite being in the enviable position of having stable government infrastructure in place to support them, benefiting from long-standing investment in capacity building, and being part of an active provincial network. CBOs in other sectors and jurisdictions that have fewer supports may have comparable or lower capacity. Future research should examine a larger sample of CBO Executive Directors from a range of sectors and jurisdictions.

Book Review: Epidemiology Mental Disorders in Canada: An Epidemiological Perspective

Mental Disorders in Canada: An Epidemiological Perspective John Cairney, David L Streiner, editors. Toronto (ON): University of Toronto Press; 2010. 432 p. CanS37.95 Reviewer rating: Good Epidemiology This edited volume was produced to celebrate contributions of late Alexander Leighton to field of psychiatric epidemiology in Canada. Leighton carried out Stirling County Study, initiating our modem approach to psychiatric epidemiology through community surveys. The aim of book is to provide a of research in psychiatric epidemiology in Canada1'5 and editors contend that no such review currently exists. This work certainly provides a single source for interested readers to capture major epidemiologic research that has been carried out over last 3 decades in Canada. These experts discuss both breakthroughs and blemishes of these previous works. For example, in terms of blemishes, 2002 Canadian Community Health Survey, Cycle 1.2: Mental Health and Weil-Being (CCHS 1 .2) is criticized for choosing to only partially code mental disorders from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, making it difficult to compare these results with other major surveys. Regarding breakthroughs, same CCHS 1.2 provides first pan-Canadian data on co-occurring mental disorders and substance use problems; specifically, 1 .7% or 435 000 people in Canada suffered from mood or anxiety disorders and substance use problems during 2002, year of survey. The contributors to volume are who's who of Canadian psychiatric epidemiology, including John Cairney, current president of Canadian Academy of Psychiatric Epidemiology; David Streiner, our Canadian guru on measurement and statistics; Roger Bland, executive medical director at Alberta Health Board; Paula Goering, Canadian Institutes of Health Research and Canadian Health Services Research Foundation Chair in health services research; and Isaac Sakinofsky, Canadian expert in epidemiology of suicide, to name but a few of distinguished contributors. The book is organized into 6 parts: context and theory; methodological issues; epidemiology of disorders; special topics, including prevalence of disorders in migrants and among criminal offenders; mental health care services, policy; and final thoughts. Several important issues are raised from this work. The first chapter by Streiner and Cairney gives an interesting brief history of psychiatric epidemiology; I was reading this as country was debating Conservative Government's decision to abolish mandatory long-form census. Streiner and Cairney recall sixth US census conducted in 1840 that attempted to count the insane at a national level. …

Nurse Executives’ Perceptions of the Executive Training for Research Application (EXTRA) Program

To improve the overall quality and effectiveness of the Canadian health care system through better decisions supported by research-based evidence (RBE), the Canadian Health Services Research Foundation (CHSRF) and partners have created the Executive Training for Research Application (EXTRA) program. To evaluate how nurse executive fellows perceive changes in their levels of knowledge of RBE and in their level of use of RBE following participation in the EXTRA program. Nurse executives in the first four cohorts of the program (2004-2007) completed a survey during their 2-year fellowship period. Statistically significant improvements were observed regarding nurse executives' perceived knowledge and use of RBE. According to the participants, the EXTRA fellowship contributes to their role and function in their organization by providing tools, learning, and access to resources and networking, which contributes to their credibility, leadership, and knowledge transfer skills. The EXTRA program has been structured to reduce barriers and to enhance the facilitators found in the literature on the implementation of evidence-based practices (EBP) in health care settings. Overall, nurse executives perceived that the benefits of participating in the EXTRA program were both individual and organizational.