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Biomedical subjects

Adalsteinn D Brown

Publications and source records attributed to Adalsteinn D Brown.

At least 19 recordsLinked to original sources
PubMed2006

Factors that influence cancer patients' overall perceptions of the quality of care.

OBJECTIVE: This study outlines predictors of cancer patients' overall perceptions of the quality of care. DESIGN AND SETTING: Our sample included 2790 patients who received cancer care services during 2004 in 15 comprehensive cancer programmes across Ontario, Canada. Patients were classified into three groups: those receiving both chemotherapy and radiotherapy (n = 752), those receiving only chemotherapy (n = 1044), and those receiving only radiotherapy (n = 994). An ordinal logistic regression model for each patient group was performed to determine which variables most affected the probabilities of the patients' overall evaluations of the quality of care. Potential control variables were patients' age, sex, type of cancer, self-assessed health, and who completed the survey. RESULTS: Among seven common predictors of the overall quality perception across the three models, four should be of particular interest because patients perceived them as relatively problematic aspects of care. These are 'was informed about follow-up care after completing treatment', 'knew next step in care', 'knew who to go to with questions', and 'providers were aware of test results'. These predictors explained between 25 and 34% of the variance (depending on the model) of the overall perception of quality. The explanatory power of these predictors did not change across sex and age group. 'Self-assessed health' was the only control variable that remained in all three models. CONCLUSIONS: From a practical perspective, improvement efforts are best focused on factors that are strong predictors as well as on those for which there is a low score. Thus, on the basis of this study, practitioners' improvement efforts might be constructively focused on the four predictors mentioned above.

Adolescent↗
PubMed2006

Pay-for-performance in publicly financed healthcare: some international experience and considerations for Canada.

Recent reports in the United States and Canada provide evidence that healthcare systems routinely fail to deliver safe and high-quality healthcare services. Governments and other healthcare payers have begun to experiment with pay-for-performance programs that offer healthcare providers and organizations financial incentives for quality. The purpose of this paper is (1) to provide an overview of the design of major pay-for-performance programs in the United States, the United Kingdom, and Australia, with specific focus on government-sponsored programs, and (2) to articulate some considerations for potential implementation of pay-for-performance in Canada.

Australia↗
PubMed2006

Financial benchmarks for Ontario hospitals.

Since the inception of the Hospital Reports in 1998, researchers have focused on three separate but related problems--how to measure performance; how to evaluate performance; and how to transfer knowledge about excellent performance to the field. This article describes a method to address the second problem--how to evaluate performance by benchmarking two indicators of financial performance and condition through three years of recent data for Ontario hospitals.

Benchmarking↗
PubMed2006

Accountability: unpacking the suitcase.

"Accountability" is the suitcase word in Canadian healthcare. As policy-makers, managers, researchers and providers, we pack accountability with meaning, carry it around with us and open it up to explain everything from the quality of our relationships with and expectations of one another, to our requirements for more transparency in the use of resources, to our diagnosis of problems and remedies for improving our healthcare system.

Canada↗
PubMed2006

Remembering Peter Drucker: inspiring the quality revolution in healthcare.

The authors review the late Peter Drucker's most significant writings, especially as they pertain to contemporary quality improvement principles in healthcare. In order to determine Drucker's most influential works, the authors conducted an empirical review of his impact by examining academic citations to his work and ideas.

Health Services Administration↗
PubMed2005

Development of a set of strategy-based system-level cancer care performance indicators in Ontario, Canada.

OBJECTIVES: To develop a set of scientifically sound and managerially useful system-level cancer care performance indicators for public reporting in Ontario, Canada. IMPLEMENTATION: Using a modified Delphi panel method, comprising a systematic literature review and multiple rounds of structured feedback from 34 experts, the Cancer Quality Council of Ontario developed a set of quality indicators spanning cancer prevention through to end-of-life care. To be useful to decision-makers and providers, indicator selection criteria included a clear focus on the cancer system, relevance to a diversity of cancer providers, a strong link to the mission and strategic objectives of the cancer system, clear directionality of indicator results, presence of targets and/or benchmarks, feasibility of populating the indicator, and credibility of the measure as an indicator of quality. To ensure that the selected indicators would measure progress over time against specific and widely accepted goals, we created a strategy map based on the five strategic objectives of the Ontario cancer system: (i) to improve the measurement and reporting of cancer quality, (ii) to increase the use of evidence and innovation in decision-making, (iii) to improve access to cancer services and reduce waiting times, (iv) to increase efficiency across the system, (v) to reduce the burden of cancer. An analysis of the mean indicator ratings by experts, and the strategy mapping exercise resulted in the identification of 36 indicators deemed suitable for routine performance measurement of the Ontario cancer system. LESSONS LEARNED: The resulting instrument incorporates a credible evidence basis for performance measurement aligned to the five strategic goals for the Ontario cancer system. It represents the integrating of a management culture, focused on the implementation of a new strategic direction for the cancer system, with the underlying evidence-based culture of clinicians.

Benchmarking↗
PubMed2005

Developing an efficient model to select emergency department patient satisfaction improvement strategies.

STUDY OBJECTIVE: Patient satisfaction is an important performance measure for emergency departments (EDs), but the most efficient ways of improving satisfaction are unclear. This study uses optimization techniques to identify the best possible combination of predictors of overall patient satisfaction to help guide improvement efforts. METHODS: The results of a satisfaction survey from 20,500 patients who visited 123 EDs were used to develop ordinal logistic regression models for overall quality of care, overall medical treatment, willingness to recommend the ED to others, and willingness to return to the same ED. Originally, 68,981 surveys were mailed, and 20,916 were returned, representing an overall response rate of 30.3%. We then incorporated these regressions into an optimization model to select the most efficient combination of predictors necessary to increase the 4 overall satisfaction measures by 5%. A sensitivity analysis was also conducted to explore differences across hospital peer groups and regions. RESULTS: Results differ slightly for each of the 4 overall satisfaction measures. However, 4 predictors were common to all of these measures: "perceived waiting time to receive treatment," "courtesy of the nursing staff," "courtesy of the physicians," and "thoroughness of the physicians." The selected predictors were not necessarily the strongest predictors identified through regression models. The optimization model suggests that most of these predictors must be improved by 15% to increase the overall satisfaction measures by 5%. CONCLUSION: This study introduces the use of optimization techniques to study ED patient satisfaction and highlights an opportunity to apply this technique to widely collected data to help inform hospitals' improvement strategies. The results suggest that hospitals should focus most of their improvement efforts on the 4 predictors mentioned above.

Adolescent↗
PubMed2005

Development of ovarian cancer surgery quality indicators using a modified Delphi approach.

OBJECTIVE: Little performance measurement has been undertaken in the area of oncology, particularly for surgery which is a pivotal event in the continuum of cancer care. This work was conducted to develop indicators of quality ovarian cancer surgery using a modified three-step Delphi approach. METHODS: A multidisciplinary panel, comprised of surgical and methodologic co-chairs, nine surgeons, one medical oncologist, one radiation oncologist, a nurse, and a pathologist, reviewed potential indicators extracted from the medical literature through two consecutive rounds of rating followed by consensus discussion. The panel then prioritized the indicators selected in the previous two rounds. RESULTS: Of 33 possible indicators that emerged from 41 selected articles, 14 were prioritized by the panel as benchmarks for assessing the quality of surgical care. The 14 indicators represent three levels of measurement (provincial/regional, hospital, individual provider) across several phases of care (diagnosis, surgery, pathology, and adjuvant therapy), as well as broad measures of access and outcomes. Some of the indicators selected by the panel were also recommended as standards of care by national initiatives in other countries. CONCLUSIONS: A systematic evidence- and consensus-based approach was used to develop quality indicators of ovarian cancer care, with a focus on pre-, peri-, and postoperative care as well as outcomes, that are applicable in any jurisdiction.

Consensus↗
PubMed2005

Making performance reports work.

Public performance reporting is an increasingly common health policy tool to support accountability and quality improvement but there are few formal evaluations of this trend. In this review, we suggest that performance reporting may be an effective way to support improvements in performance when it is directed towards groups of providers rather than individuals and that there is enough evidence to support the use and further development of public performance reporting. However, the true impact of performance reporting depends on the policy context around reporting including clarity of strategy, incentives, and support for performance improvement.

Hospitals↗
PubMed2005

Acute care hospital strategic priorities: perceptions of challenges, control, competition and collaboration in Ontario's evolving healthcare system.

To explore the current and pending strategic agenda of Ontario hospitals (the largest consumers of the provincial healthcare budget), a survey of Ontario acute care hospital CEOs was conducted in January 2004. The survey, with an 82% response rate, identifies 29 strategic priorities under seven key strategic themes consistent across different hospital types. These themes include (1) human resources cultivation, (2) service integration and partnerships, (3) consumer engagement, (4) corporate governance and management, (5) organizational efficiency and redesign, (6) improved information use for decision-making, (7) patient care management. The extent to which an individual hospital's control over strategic resolutions is perceived may affect multilevel strategic priority-setting and action-planning. In addition to supporting ongoing development of meaningful performance measures and information critical to strategic decision-making, this study's findings may facilitate a better understanding of hospitals' key resource commitments, the extent of competition and collaboration for key resources, the perceived degree of individual control over strategic issue resolution and where systemic resolutions may be required.

Attitude of Health Personnel↗
PubMed2005

Development of prostate cancer quality indicators: a modified Delphi approach.

OBJECTIVES: There is evidence of variation in both the processes and outcomes of prostate cancer care, resulting in possible harm to patients and increased costs to the health system. Care could be improved by first identifying critical, measurable indicators that correlate with quality of care. This work was conducted to develop indicators of prostate cancer care using a modified three-step Delphi approach. METHODS: A 17-member multidisciplinary panel reviewed potential indicators extracted from the medical literature through two consecutive rounds of rating followed by consensus discussion. The panel then prioritized the indicators selected in the previous two rounds. RESULTS: Of 31 possible indicators that emerged from 49 reviewed articles, 11 were prioritized by the panel as benchmarks for assessing the quality of surgical care for prostate cancer. The 11 indicators represent three levels of measurement (regional, hospital, individual provider) across several phases of care (diagnosis, surgery, pathology, and follow-up), as well as broad measures of outcomes. CONCLUSION: A systematic evidence- and consensus-based approach was used to develop quality indicators of prostate cancer care, with a focus on pre-, peri- and post-operative care as well as outcomes. Some of the indicators selected by the panel were also recommended by a similarly structured panel process. These indicators can be used by individual providers and organizations to monitor the quality of their services, and develop interventions to address any variations.

Delphi Technique↗
PubMed2005

Development of quality indicators for colorectal cancer surgery, using a 3-step modified Delphi approach.

BACKGROUND: Little performance measurement has been undertaken in the area of oncology, particularly for surgery, which is a pivotal event in the continuum of cancer care. This work was conducted to develop indicators of quality for colorectal cancer surgery, using a 3-step modified Delphi approach. METHODS: A multidisciplinary panel, comprising surgical and methodological co-chairs, 9 surgeons, a medical oncologist, a radiation oncologist, a nurse and a pathologist, reviewed potential indicators extracted from the medical literature through 2 consecutive rounds of rating followed by consensus discussion. The panel then prioritized the indicators selected in the previous 2 rounds. RESULTS: Of 45 possible indicators that emerged from 30 selected articles, 15 were prioritized by the panel as benchmarks for assessing the quality of surgical care. The 15 indicators represent 3 levels of measurement (provincial/regional, hospital, individual provider) across several phases of care (diagnosis, surgery, adjuvant therapy, pathology and follow-up), as well as broad measures of access and outcome. The indicators selected by the panel were more often supported by evidence than those that were discarded. CONCLUSIONS: This project represents a unique initiative, and the results may be applicable to colorectal cancer surgery in any jurisdiction.

Benchmarking↗
PubMed2004

Disease adaptation may have decreased quality-of-life responsiveness in patients with chronic progressive neurological disorders.

OBJECTIVE: We hypothesized that disease adaptation could be measured in chronic progressive neurological disorders (CPND) through paired longitudinal comparisons of quality of life (QOL) and health status (HS) and of the mental health (MH) and physical health (PH) domains of QOL instruments. STUDY DESIGN AND SETTING: We identified 193 quantitative studies of QOL and HS in a systematic review of episodic (END) and chronic progressive (CPND) neurological disorders. Effect size or other responsiveness measures were analyzed in 31 studies that included paired longitudinal comparisons of QOL-HS, MH-PH, or both. Responsiveness means were compared using the paired-sample t-test or sign test. RESULTS: In 12 paired comparisons, QOL responsiveness was significantly lower than HS (P=.05, sign test). In 53 paired MH-PH effect-size comparisons, MH responsiveness was lower than PH (P=.02, t=2.48, paired sample). Significantly lower MH responsiveness was observed in 28 paired CPND comparisons (P < .01, t=3.86, paired sample) but not in 25 paired END comparisons (P=.50, t=0.68, paired sample). CONCLUSION: Lower responsiveness of QOL in CPND may be related to disease adaptation. Further prospective studies are needed to confirm our findings and to investigate the importance of disease adaptation in the evaluation of neurological disease and in health resource allocation.

Adaptation, Psychological↗
PubMedDate not supplied

Performance measurement in women's health: the Women's Health Report, Hospital Report 2001 series, a Canadian experience.

The Women's Health Report was a preliminary study that formed part of the Hospital Report 2001 Series; an evaluation of hospital performance in the province of Ontario using a balanced scorecard framework. The Report reflects the importance of including a women's health perspective in the evaluation of health system performance and the need for increased accountability for equity in access to, and delivery of, care. This paper outlines the methodology that was used to develop the Women's Health Report and highlights important findings from this early stage in the development of performance measurement for hospital care for women in Canada.

Evaluation Studies as Topic↗
PubMedDate not supplied

Crossing the strategic synapse: aligning hospital strategy with shared system priorities in ontario, Canada.

The dominant system-level strategic priorities facing Ontario hospitals were elicited and validated. Researchers employed a multi-stage survey and focus group process to solicit the opinions of senior hospital managers and other healthcare stakeholders. Four shared, system-level priorities emerged: (i) improved clinical and staff recruitment; (ii) stronger inter-hospital partnership and vertical integration along the continuum of care; (iii) improved patient safety; and (iv) the implementation of decision support systems. A subsequent CEO validation survey showed strong endorsement of these system priorities. The authors conclude that a survey, focus group, and validation process can reveal shared system priorities and can highlight emergent organizational strategies designed to resolve them. This process, in which a hospital learns of the priorities facing other hospitals in a system, is a potentially useful managerial tool to promote "strategic synapse"-whereby management can adjust internal organizational strategy and local scorecards to align with shared system priorities.

Continuity of Patient Care↗