Ontario's Program Research Articles

Development and Implementation of EVAR Follow-Up Guidelines: A Quality Improvement Project Through the IDEAS Ontario Program

Life-long imaging follow-up is essential to the safe and appropriate management of patients who undergo endovascular aneurysm repair (EVAR). Adherence to surveillance guidelines is known to be poor, and EVAR does not protect against death with future aneurysm rupture. Our objective was to improve post-EVAR follow-up imaging to >90%. We examined compliance to EVAR follow-up in a cohort of patients with grafts implanted between August 2010 and December 2012. Using quality improvement tools learned through the IDEAS Ontario (Improving and Driving Excellence Across Sectors) advanced curriculum, we developed a process map to identify barriers and areas of potential improvement. We implemented a number of initiatives to address what we had identified and used a PDSA (Plan-Do-Study-Act) cycle to evaluate the impact of our initiatives. After an audit of the 176 EVARS performed, we identified that 39% of our patients had inadequate follow-up. We identified a number of factors for improvement, including consensus of follow-up protocol among the surgeons, a tracking system for the patients, and improving patient education. We achieved consensus with the surgeons, variable buy-in (0%-98%) of the tracking system, and found that 50% of our patients did not know they required long-term follow-up. Human factor analysis figured prominently in the barriers to achieving unified success. We were able to achieve 100% imaging follow-up during the course of the program. We performed a systematic analysis of a widely documented problem and developed change ideas that we implemented within our division. By the end of the course, we had achieved our goal. Quality improvement is an ongoing cycle requiring constant re-engagement and buy-in and is becoming the standard of care and will significantly impact future program funding.

Staffing Model for Radiation Therapists in Ontario

PurposeThe Cancer Care Ontario's (CCO) Radiation Program Leadership tasked the Radiation Therapy Professional Advisory Committee (RTPAC) to develop a radiation therapist (RT) staffing model to support current radiation therapy practice. BackgroundA 1999 RT staffing model was outdated. Limitations included: (1) the inability to keep pace with advanced treatment planning and/or delivery techniques, (2) the exclusion of staffing for brachytherapy and orthovoltage, and (3) the omission of vital patient safety activities that are required to support clinical practices. MethodsThe RTPAC used a comprehensive scientific methodology to develop the new staffing model. A thorough literature review was completed, and an evidence-based model was developed. A unique creativity tool, the simplex process, was used to identify all the RTs' domains of practice that are integral for professional practice. All domains identified were included in the recommended staffing model. ResultsThe staffing model recommends basing the number of RTs on equipment and associated clinical activities. The following staffing numbers are recommended: (1) linear accelerators: 4 full-time equivalent (FTEs) RTs per 10-hour day, (2) brachytherapy: 3 FTEs/8-hour day, (3) orthovoltage: 3 FTEs/8-hour day, (4) CT simulator: 3 FTEs/8-hour day and 4 FTEs/10-hour day, (5) dosimetry: 1 FTE/325 courses per year, (6) radiation oncology systems support and technology development implementation: 1 FTE/4 linear accelerator, (7) administration and education: 1 manager, 1 FTE supervisor/30 staff, 1 FTE professional practice leader/8 linear accelerators, 1 FTE staff educator/8 linear accelerators, 1 FTE undergraduate educator/8–10 students, and (8) additional 20% FTEs of the total for vacation, sick time, maternity leaves, and other leaves. ConclusionsThe recommended staffing model is now more suitable for today's radiation therapy profession by addressing the domains of practice and clinical activities. Further research includes monitoring performance indicators annually to ensure that the staffing model is current. These indicators include wait times, access to care, radiation incidents, technological advances, and the quality of work-life of RTs.

Ontario’s Full-Day Kindergarten and Report Cards: Honouring Children’s Learning and Development through Reflective Evaluation Practices

The Ontario Full Day Kindergarten (FDK) program, now in its fifth year, celebrates children’s intentionality and natural curiosity about the world. Consequently, a report card is needed to support the vision for the new full-day early learning program in Ontario. A preliminary review of the report cards reveals that expectations/outcomes have been categorized and quantified. The scales being used vary considerably from school board to school board and these variations include: using numeric scales of achievement (Levels 1-4); providing descriptors for a specific skill set (i.e. emerging, developing at expected level, beyond expected level); or evaluating progress based on frequency (i.e. sometimes evident, always evident, not yet evident). Additionally, although reports should include next steps for the Early Learning–Kindergarten team, as well as next steps for the parents to assist them in supporting their child’s learning (Ontario Ministry of Education, 2010), our preliminary review reveals that while this information is sometimes communicated variably or informally, it is only periodically included in completed report cards. The overall focus of the new FDK program is on developing children’s problem solving and metacognitive skills (encouraging children to think about their thinking). In addition, the goal is for children to develop self-motivation and self-regulation so that they can become self-directed, lifelong learners. A new report card is needed to embrace this new vision for full-day learning which is based on child directedness and inquiry. In this article we: a) present the background on the inception of the Full-Day Kindergarten program in Ontario; b) share insights and evaluative methods from the Reggio Emilia approach of pedagogical documentation for reporting growth and learning of four and five year olds in an attempt to inform our practices in Ontario; and c) present a standardized provincial Kindergarten report card that is aligned to Pascal’s vision for full day early learning.

Advancing Telephone Focus Groups Method Through the Use of Webinar

Telephone focus groups have been increasingly popular in public health research and evaluation. One of the main concerns of telephone focus groups is the lack of nonverbal cues among participants, which could limit group interactions and dynamics during the focus group discussion. To overcome this limitation, we supplemented telephone focus groups with webinar technology in a recent evaluation of a provincial public health program in Ontario, Canada. In this article, we share the methods used and our experiences in conducting telephone focus groups supplemented with webinar technology, including advantages and challenges. Our experience will inform other researchers who may consider using telephone focus groups with webinars in future research and evaluation.

A spot of bother: Why varicella vaccine programs matter.

To evaluate Ontario's provincial varicella vaccination program through analysis of aggregate varicella cases in order to determine whether there has been a decrease in reportable disease burden; and to assess varicella vaccine adverse events following immunization (AEFIs). Aggregate varicella cases (1993-2013) were extracted from the reportable disease databases. Pre-program (1993-2004) and post-program (2007-2013) periods were chosen according to implementation of the publicly funded vaccination program. AEFIs following administration of varicella vaccines (2010-2013) were also extracted. Reporting rates were calculated using net doses distributed as the denominator. Serious AEFIs were defined using World Health Organization standards. The incidence of aggregate varicella reports decreased significantly over the study period (from 311.4 to 22.2 cases per 100,000 population in 1993 and 2013, respectively). Incidence also decreased significantly in all age groups between the pre- and the post-program periods with a shift in age distribution towards older individuals in the post-program period. A total of 162 AEFIs following varicella vaccine were reported between 2010 and 2013 for an annualized reporting rate of 14.6 per 100,000 doses distributed. The most common events were rash (37.3%), including eight reports of varicella-like rash (0.7 per 100,000 doses distributed). Ten serious events were reported (0.9 per 100,000 doses distributed), and all vaccine recipients recovered. Significant reductions in varicella disease incidence and low AEFI reporting rates were observed with the introduction of the publicly funded varicella vaccine program in Ontario. Continued surveillance is indicated to further assess trends in varicella disease and vaccine safety.

Making the Grade through the Front Door: Evaluation and Innovation in a Registered Practical Nurse to Bachelor of Science in Nursing Program

Background: Education of nurses from a diploma to a degree is a global phenomenon. However, bridging is often seen as a ‘backdoor’ route to becoming a Registered Nurse and very little evaluation data exists to challenge this notion. Objectives: This research project was undertaken to explore student characteristics, academic performance, outcomes, and experiences in an RPN-to-BScN Bridging Program. Design: A mixed method design was employed. Student admission and registrarial data were examined in relation to student characteristics and academic performance. Secondary data analysis was conducted on focus group interviews with 110 students that explored their perceptions of the impact of the program on their lives. Setting: Data was collected through University databases and face to face focus groups. Participants: Admission and registrarial data for all students admitted to a nursing bridging program in Ontario, Canada, from 2005-2011 were analyzed. Participants in the qualitative focus group interviews included 110 students across all years of the program. Methods: Descriptive and analytical statistics provide insight into student performance and characteristics. Qualitative data analysis was conducted using NVivo 9 with multi-member teams. Results: Data analysis reveals important insights into student academic performance, including exploration of relevant variables such as ongoing and cumulative GPA, entrance GPA, and program completion. Qualitative analysis provides insight into how studying in the program affects students’ lives. Conclusions: RPN-to-BScN education is not a “back door” to a nursing degree. Rather, it is a front door, as rigorous and as personally and professionally transformative as we expect a 4-year BScN Degree to be.

Knowledge change associated with participation in prenatal education programs in Ontario: A cohort study.

The primary objective was to examine how participation in prenatal programs delivered by Ontario public health units influences pregnant women's pregnancy-related knowledge. Secondary objectives were to examine the socio-demographic characteristics of women participating in these programs and assess program satisfaction. A cohort study was conducted of 511 adult pregnant women who were registered for a prenatal program within one of seven Ontario public health units. Participants completed a pre-program survey, which examined socio-demographic and pregnancy characteristics, and baseline pregnancyrelated knowledge. After finishing the program, participants completed a post-program survey investigating pregnancy-related knowledge and program satisfaction. Pregnancy-related knowledge was assessed using the Healthy Pregnancies Knowledge Survey, which captures knowledge within three subtopic areas: healthy pregnancies, healthy lifestyles and breastfeeding. Participants demonstrated a significant increase in mean knowledge scores, both overall and across each subtopic area. Most participants reported that their program satisfied their questions either mostly or very well across all content areas examined. This study is the first large-scale effort to examine the ability of prenatal programs offered through Ontario public health units to influence clients' pregnancy-related knowledge. These findings contribute to the evidence base for prenatal education program planning.

Teacher Candidates’ Involvement with Reading Interventions in High Needs Schools: Wrestling with the Everyday

The demands on new teachers as they enter the teaching profession are extensive and deep-rooted. This article provides insight into how faculty within a teacher education program in Ontario, Canada considered one service program emphasis and how it shed light into the everyday world of teacher candidates as they wrestled with the everyday activity of trying to support struggling readers. We identify this process of forging relationships and developing professional skills as we examine the experiences and reflections of teacher candidates as they journey through their involvement with the program. As such, we take Dorothy Smith’s (2005) perspective that the everyday world is problematic. Those things which we take for granted, and assume to be obvious, or have been assumed by reading research to be normative, are not necessarily so.

Renewable energy, subsidies, and the WTO: Where has the ‘green’ gone?

Faced with the energy transition imperative, governments have to decide about public policies to promote renewable electrical energy production and to protect domestic power generation equipment industries. These policies can generate trade frictions. For example, in the Canadian renewable energy dispute the EU and Japan claimed that Feed in Tariff (FIT) programs in Ontario constitute discriminatory subsidies because of a local content requirement (LCR) clause that is incompatible with World Trade Organization obligations. This paper investigates this issue using an international quality differentiated duopoly model in which power generation equipment producers compete on price. FIT programs including those with a LCR are compared for their impacts on trade, profits, amount of renewable electricity produced, and welfare. When sales are taken into account, the results confirm discrimination. However, introducing a difference in the quality of the power generation equipment produced on both sides of the border has a moderating effect on the results. Finally, the results enable discussion of the question of whether environmental protection can be a reason for subsidizing renewable energy producers in light of the SCM Agreement.

By Sleight of Neoliberal Logics: Street Youth, Workfare, and the Everyday Tactics of Survival in London, Ontario, Canada

AbstractBased on 14 months of ethnographic fieldwork with street youths in a mid‐sized city in Ontario, Canada, this paper centers on the ways some street youths are engaging in partial accommodation and selective resistance to Ontario's workfare program; Ontario Works (OW). Owing to its neoliberal reconceptualization in the mid 1990's OW “participants”—in order to receive social assistance—must engage in a documentable effort to pursue employment, practical education or skills‐development leading to entry into the labor market. However, many of my informants are unable or unwilling to seek low‐wage, precarious work; the only form of work available to them. Through creative interpretation and manipulation of OW rules, I argue that street youth challenge the redefinition of the morality of poverty through OW's neoliberal policies and discursive strategies, and refashion a moral economy based on survival and making do. Their alternative moral economy reveals the limits of the state's reach and effort to domesticate marginalized youths.

The role of the practice facilitators in Ontario primary healthcare quality improvement.

BackgroundPractice facilitation is a key component of quality improvement in primary healthcare. Studies have reported the effectiveness of practice facilitation in improving quality management and care delivery. However, little has been published about practice facilitators’ training, facilitation activities, and their perceived role in quality improvement in primary healthcare. This study examined practice facilitators’ training and the perceptions of the practice facilitator role in a provincial primary healthcare learning collaborative quality improvement initiative in Ontario, Canada.MethodDescriptive and qualitative methods were used to outline the practice facilitator training as well as to look into the experiences and perceptions of practice facilitators and primary healthcare teams regarding the practice facilitation role in quality improvement. Data collection included training artifacts, activity logs, self-reflection reports, and semi-structured interviews with practice facilitators and primary healthcare participants. Reflections and interviews were analyzed to identify the role of the practice facilitators from their own experience, and from the perspective of the participants. Descriptive statistics were used to learn about categories of facilitation activities undertaken and frequency of these activities.ResultsSixteen practice facilitators and seven family healthcare teams participated in the study. Practice facilitators received a two-day intensive training workshop and continued training. Their time was spent mostly working directly with participating teams, continued learning and training, communications and administration. They served as coaches, resource providers, enablers and motivators. Participating teams expressed satisfaction with the practice facilitator role, although they had hoped this position would provide onsite and hands-on support in conducting activities of quality improvement at the practice level.ConclusionsPractice facilitators played a crucial role in the implementation of quality improvement in Ontario’s learning collaborative program. The practice facilitator role is perceived to be that of a coach, enabler and motivator. This study suggests that the practice facilitator successfully supported participating teams to undertake quality improvement activities in primary healthcare settings.

Economic Evaluation of Community-Based HIV Prevention Programs in Ontario: Evidence of Effectiveness in Reducing HIV Infections and Health Care Costs.

Investments in community-based HIV prevention programs in Ontario over the past two and a half decades are assumed to have had an impact on the HIV epidemic, but they have never been systematically evaluated. To help close this knowledge gap, we conducted a macro-level evaluation of investment in Ontario HIV prevention programs from the payer perspective. Our results showed that, from 1987 to 2011, province-wide community-based programs helped to avert a total of 16,672 HIV infections, saving Ontario’s health care system approximately $6.5 billion Canadian dollars (range 4.8–7.5B). We also showed that these community-based HIV programs were cost-saving: from 2005 to 2011, every dollar invested in these programs saved about $5. This study is an important first step in understanding the impact of investing in community-based HIV prevention programs in Ontario and recognizing the impact that these programs have had in reducing HIV infections and health care costs.

Evaluation of Sampling and Testing Efficiencies of Plum pox virus Eradication Programs in Pennsylvania and Ontario.

Plum pox virus (PPV) was first detected in the United States in Pennsylvania in 1999 and in Ontario, Canada in 2000. Following a 10-year survey and eradication program, PPV was officially declared eradicated in Pennsylvania in 2009. Although incidence of PPV was greatly reduced from 2000 to 2008, PPV remains present in Ontario. The objective of this study was to compare how the Pennsylvania and Ontario PPV eradication programs affected the probability of detecting PPV at the leaf, scaffold, tree, and Prunus orchard block scales. A simulation model was developed to evaluate the sampling and testing efficiency of the two programs. At the tree scale, the Pennsylvania sampling and detection protocols had a detection efficiency of 71.8% compared with 40.5% for the Ontario program. Several components in the Pennsylvania and Ontario PPV eradication programs affected PPV detection efficiency. A stratified (by tree scaffold) random sampling design did not improve PPV detection efficiency in either program, compared with a simple random sampling design to select leaves for enzyme-linked immunosorbent assay (ELISA) testing. Detection efficiency for both programs increased with sample size but gains in detection efficiency diminished as sample size increased. There was good agreement (between the commercial ELISA kit used in Pennsylvania and the kit used in Ontario) at the leaf and scaffold scales but not the tree scale. Based on simulation modeling, the Pennsylvania PPV eradication program required that >2 PPV-positive trees must be present within a Prunus block to achieve a 95% probability of correctly detecting PPV at the block scale, whereas the Ontario program required >5 PPV-positive trees within a block to achieve 95% probability of detection. The results from this study have important implications with regard to the efficiency of the two eradication programs to detect PPV-positive trees.

Seniors managing multiple medications: using mixed methods to view the home care safety lens.

BackgroundPatient safety is a national and international priority with medication safety earmarked as both a prevalent and high-risk area of concern. To date, medication safety research has focused overwhelmingly on institutional based care provided by paid healthcare professionals, which often has little applicability to the home care setting. This critical gap in our current understanding of medication safety in the home care sector is particularly evident with the elderly who often manage more than one chronic illness and a complex palette of medications, along with other care needs. This study addresses the medication management issues faced by seniors with chronic illnesses, their family, caregivers, and paid providers within Canadian publicly funded home care programs in Alberta (AB), Ontario (ON), Quebec (QC) and Nova Scotia (NS).MethodsInformed by a socio-ecological perspective, this study utilized Interpretive Description (ID) methodology and participatory photographic methods to capture and analyze a range of visual and textual data. Three successive phases of data collection and analysis were conducted in a concurrent, iterative fashion in eight urban and/or rural households in each province. A total of 94 participants (i.e., seniors receiving home care services, their family/caregivers, and paid providers) were interviewed individually. In addition, 69 providers took part in focus groups. Analysis was iterative and concurrent with data collection in that each interview was compared with subsequent interviews for converging as well as diverging patterns.ResultsSix patterns were identified that provide a rich portrayal of the complexity of medication management safety in home care: vulnerabilities that impact the safe management and storage of medication, sustaining adequate supports, degrees of shared accountability for care, systems of variable effectiveness, poly-literacy required to navigate the system, and systemic challenges to maintaining medication safety in the home.ConclusionsThere is a need for policy makers, health system leaders, care providers, researchers, and educators to work with home care clients and caregivers on three key messages for improvement: adapt care delivery models to the home care landscape; develop a palette of user-centered tools to support medication safety in the home; and strengthen health systems integration.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1193-5) contains supplementary material, which is available to authorized users.

PIN34 - Cost-Utility analysis of three types of Influenza Vaccines (Trivalent, Trivalent High dose and quadrivalent) in adults aged 65 and Older Under Universal Influenza Immunization Program (UIIP) In Ontario, Canada

PIN34 - Cost-Utility analysis of three types of Influenza Vaccines (Trivalent, Trivalent High dose and quadrivalent) in adults aged 65 and Older Under Universal Influenza Immunization Program (UIIP) In Ontario, Canada

Impact of Eradication Programs on the Temporal and Spatial Dynamics of Plum pox virus on Prunus spp. in Pennsylvania and Ontario, Canada.

The goals of this research were to quantify the impacts of the Pennsylvania and Ontario Plum pox virus (PPV) eradication programs on the spatial and temporal dynamics of PPV epidemics on Prunus spp. The incidence of PPV-positive trees detected over time decreased in both Pennsylvania (-ln 0.85 units per year) and Ontario (-ln 0.51 units per year); however, PPV incidence per year decreased only 60% as fast in Ontario as in Pennsylvania. Marked point pattern analysis revealed that PPV-positive Prunus blocks in Pennsylvania were clustered for distances of 0.7 to 4.3 km, whereas PPV-positive blocks in Ontario were clustered for distances of 1.0 to 25.0 km. Multiyear spatiotemporal analyses revealed that the locations of PPV-positive blocks detected were spatially dependent upon the locations of PPV-positive blocks detected during the previous year. In Pennsylvania, between 2002 and 2006, distances to 95% of newly detected PPV-positive blocks occurred within 10 and 20 km from the previous year's PPV-positive blocks. In Ontario, 95% of new PPV-positive blocks occurred within 500 to 900 m from PPV-positive blocks detected the previous year. Until 2011, the PPV eradication policy for Prunus blocks in Ontario was triggered by a threshold incidence or PPV-positive tests for three consecutive years. Although the Ontario program was highly successful in reducing PPV incidence from 2001 to 2008, PPV was not eradicated. This study provides important quantitative information concerning the impact of PPV eradication programs on the spatial and temporal dynamics of PPV epidemics in Pennsylvania and Ontario. The analyses employed in this study may help to improve the effectiveness of present and future PPV eradication programs.

A new Canadian interdisciplinary Ph.D. in computational sciences

In response to growing demands of society for experts trained in computational skills applied to various domains, the School of Computer Science at the University of Guelph is creating a new approach to doctoral studies called an interdisciplinary Ph.D. in computational sciences. The program is designed to appeal to candidates with strong backgrounds in either computer science or an application discipline who are not necessarily seeking a traditional academic career. Thesis based, it features minimal course requirements and short duration, with the student’s research directed by co-advisors from computer science and the application discipline. The degree program’s rationale and special characteristics are described. Related programs in Ontario and reception of this innovative proposal at the institutional level are discussed.

The development of vaccination perspectives among chiropractic, naturopathic and medical students: a case study of professional enculturation.

An important influence on parents' decisions about pediatric vaccination (children under 6years of age) is the attitude of their health care providers, including complementary and alternative medicine (CAM) providers. Very limited qualitative research exists, however, on how attitudes towards vaccination develop among healthcare professionals in-training. We explored perspective development among three groups of students: medical, chiropractic, and naturopathic. We conducted focus group sessions with participants from each year of study at three different healthcare training programs in Ontario, Canada. Semi-structured and open-ended questions were used to elicit dynamic interaction among participants and explore how they constructed their attitudes toward vaccination at the beginning and part way through their professional training. Analyses of verbatim transcripts of audiotaped interviews were conducted both inductively and deductively using questions structured by existing literature on learning, professional socialization and interprofessional relations. We found five major themes and each theme was illustrated with representative quotes. Numerous unexpected insights emerged within these themes, including students' general open-mindedness towards pediatric vaccination at the beginning of their training; the powerful influence of both formal education and informal socialization; uncritical acceptance of the vaccination views of senior or respected professionals; students' preference for multiple perspectives rather than one-sided, didactic instruction; the absence of explicit socio-cultural tensions among professions; and how divergences among professional students' perspectives result from differing emphases with respect to lifestyle, individual choice, public health and epidemiological factors-rather than disagreement concerning the biomedical evidence. This last finding implies that their different perspectives on pediatric vaccination may be complementary rather than irreconcilable. Our findings should be considered by developers of professional and interprofessional educational curricula and public health officials formulating policy on pediatric vaccination.

Successfully Attaining a Dietetic Internship Position in Ontario on the First Attempt: A Descriptive Survey

We explored the characteristics of Ontario-based dietetic internship program applicants who were successful upon their first application attempt, and we made comparisons between those who were successful and unsuccessful on their first internship application attempt. A 32-item online survey was distributed to graduates from nutrition programs in Ontario and to members of the Dietitians of Canada Student Network, Toronto Home Economics Association, and Ontario Home Economists in Business. Data from a previous study examining the characteristics of unsuccessful internship applicants were obtained from the authors to compare the two groups. Respondents (n = 76) were mostly female (97%), 20-25 years of age (67%), and had a previous degree (46%). Compared with those who were unsuccessful on their first internship application attempt, those who were successful had a significantly higher mean cGPA (3.69 ± 0.39 vs. 3.35 ± 0.41), were more likely to have a prior degree (46% vs. 29%), spent more time preparing their internship application package, and perceived their internship application packages to be stronger. Despite some differences, most applicants met the minimum cGPA requirement outlined by internship programs in Ontario. More internship opportunities can help increase the diversity and human potential in the dietetic profession.

Use of Compassionate Supply of Antiretroviral Drugs to Avoid Treatment Interruptions or Delayed Treatment Initiation among HIV-Positive Patients Living in Ontario: A Retrospective Review

Without a national pharmacare plan in Canada, HIV-infected patients across the nation differ in their ability to obtain essential HIV therapy. Despite the fact there are public insurance programs in Ontario, patients are unable to access medication. The authors described how frequently patients in their urban clinic could not access medications and why they required a compassionate supply of HIV drugs, with the goals of minimizing treatment delays and avoiding interruptions.The authors conducted a retrospective review and collected information about demographic characteristics, current drug insurance and the challenges encountered.Over one year, the authors provided 2,886 days of free HIV drugs to 42 patients who were predominantly citizens or permanent residents of Canada (88%). The most common obstacles were associated with the Trillium Drug Program and the total value of all drugs supplied was $134,860.This study suggests that Ontario's catastrophic drug insurance plan leaves some patients with significant gaps in drug coverage.