Ontario’s plan for personal support workers
Quality
Money matters: does ‘pay-for-performance’ improve quality?
In Ontario, new ways of paying doctors have been introduced in an attempt to improve the quality of their services. One approach is pay-for-performance, which pays doctors for meeting certain treatment goals. However, there is little high quality evidence that pay-for-performance improves the quality of care, and it appears to have had limited impact in …
Does more care mean better care?
A recent study found that Ontario hospitals that used more resources and spent more money had better outcomes for acutely ill patients than hospitals that used fewer resources. These findings go against a previous study that looked at the same question in the United States and found that more resources didn’t impact outcomes. A better …
Medication shortages: how Ontario came to rely on one manufacturer
Concerns about quality and a fire at a Sandoz plant in Quebec exacerbated the current drug shortage in Canada. Many are asking why the shutdown of a single facility could threaten the nation’s supply of vital prescription medications. While federal and provincial governments have been eager to play the blame game, a shared sense of …
Alberta driving quality improvement through clinical leadership
Alberta is introducing Strategic Clinical Networks in areas such as mental health and addictions, cancer care, diabetes, obesity and nutrition. These networks are meant to lead clinical practices province-wide, and improve the quality of care, outcomes and costs of health care services. This is an ambitious undertaking which may contain some lessons for Ontario. Alberta’s …
Controversies about Community Care Access Centres and home care
Shortened hospital lengths of stay, and a growing number of people living with chronic diseases has meant that more Ontarians than ever are receiving health care services in their homes. In 2010, the Ontario Auditor General raised concerns about the quality and value of home care services, some of which remain outstanding. Resolving these issues …
Managing conflicts of interest in research
There have been a number of recent reports of conflicts of interest in medical research. There are at least two types of conflicts of interest – financial conflicts, where researchers stand to gain financially from their work; and intellectual conflicts, where researchers stand to gain professionally. Ensuring that all conflicts of interest are declared and …
Who controls how patient information is shared in Ontario?
Ontario’s Information and Privacy Commissioner recently ordered Cancer Care Ontario to stop sending paper copies of screening reports containing personal health information to physicians. However, a massive amount of personal health information is mailed or faxed every day in Ontario. The implications of this order to information sharing and transfer across the health care …
Interpreting randomized trial evidence around mammography
The Canadian Task Force on Preventive Health Care recently released recommendations about screening for breast cancer. These recommendations have been criticized by some because they emphasize the results of randomized trials. This article explores the advantages and limitations of randomized trial evidence regarding screening mammography. The recent recommendations by the Canadian Task Force on Preventive …
The mammography controversy
In medical journals, doctors and scientists continue to debate the relative benefits and harms of breast cancer screening for women who are at average risk of developing breast cancer. This debate is not always reflected in screening programs, most of which strongly recommend mammography to average risk women within a certain age bracket. Some experts …
Should health care workers be required to get the flu vaccine?
Each year several thousand Canadians die from influenza. Vaccinating health care workers against flu reduces transmission and would protect patients who are most vulnerable. However, only about 40% of hospital staff in Ontario were vaccinated last winter. Is it time for Ontario to make the flu vaccine mandatory for health care workers? Explaining the influenza …
Hospital accreditation and quality improvement
Hospital accreditation is a process that assesses a hospital’s performance against a set of standards. This process is done differently across provinces and countries. In Canada, most hospitals go through an accreditation process conducted by Accreditation Canada. The accreditation process could be more transparent and provide more information to the public about the quality of …
Why does the government appoint hospital supervisors?
In August 2011, a supervisor was appointed at the Niagara Health System to “restore public confidence” in the hospital. The Ontario Public Hospitals Act allows the government to appoint a supervisor to take over the administration of a hospital if it is considered in the public interest to do so. While appointing a supervisor happens …
Making sense of Ontario’s fee codes
Most of Ontario’s doctors bill the Ontario Health Insurance Plan for their services on a “fee for service” basis. The amount doctors are paid for each service is established through negotiations between the Ontario Ministry of Health and Long-Term Care and the Ontario Medical Association. Although fees are reviewed every few years, there is disagreement about …
Improving access to trauma care in Ontario
An integrated, coordinated system of trauma care has been shown to reduce injury-related deaths by improving timely access to specialized care There is, however, wide variation in how long it takes to get a severely injured patient to a trauma centre in Ontario. Trauma systems improve by systematically assessing performance and outcomes. Ontario does not …
Accessing trauma care in Ontario
Every year nearly 5,000 Ontarians are injured through trauma and require specialized trauma care, which has been proven to save lives. Many Ontarians think that they can access specialized trauma care at their local emergency department. This is not true. Timely access to specialized trauma care does not always occur in Ontario. Melanie Carter was …
The risks of emergency department overcrowding
Each year one in five Ontarians visits one of the province’s 163 emergency departments. A recent study has shown that those who present to emergency departments when waiting times are longer have worse outcomes. Since 2008, Ontario has spent a lot of money and effort to reduce waiting times and improve the quality of care …
LHINs and the governance of Ontario’s health care system
In many provinces across Canada the authority and governance of health care has been moved to regional authorities, based on the belief that local authorities can better integrate and coordinate services, and contain costs. Ontario created 14 Local Health Integration Networks (LHINs) in 2006, with the mandate to plan, fund and integrate health care services …
Why isn’t there a system of integrated maternity care in Ontario?
Midwives provide high quality care for normal, low risk pregnancy and child birth, but provide this care to relatively few women in Ontario. The demand for midwifery services is outstripping capacity. The philosophy and actual practice of care provided by midwives and obstetricians is different. Obstetricians deliver many more babies, but obstetrician-led care is more …
How should hospital doctors be paid?
Doctors are a significant portion of the costs for the health care system. In 2009, almost a quarter of Ontario’s health care budget was spent on paying doctors. Most doctors who work in hospitals are not paid by the hospital directly, but by the Ontario Health Insurance Plan, which pays doctors for each procedure and clinical service. …