Les Vertesi | PubMed Health

PubMed2006

Mixing the oil with the water: pay-for-performance in Canadian healthcare.

Public health systems in other countries have been experimenting with pay mechanisms that specifically target improvements in productivity and quality. The potential gains are huge, but actual results are less certain, since they rely on a detailed and strategic understanding of local incentives. Canada is a slow joiner for reasons that are rarely discussed, but that may be related to some fundamental issues that make our existing payment mechanisms incompatible with pay-for-performance (P4P). As the international community sets new standards for both quality and productivity in healthcare, Canadians will find it increasingly difficult to stay with their existing pay mechanisms, safe as they may seem to us at the moment. The transition, which will not be easy, will force us to take a hard look at some of the values we take for granted.

Canada↗

PubMed2004

Romanow versus Kirby: resolving the differences.

In their paper on the Romanow and Kirby reports, Chodos and MacLeod make an impassioned attempt to bridge the divide between two landmark reports that are often painted as polar opposites on the private/public aspect of healthcare delivery. Their attempt to reconcile the differences and achieve "a degree of consensus" is well worthwhile, and the resulting discussion informative. But in the end, can the differences really be reduced to semantics that can be bridged with a little common sense, or do they represent two fundamentally different views of how things work?

Canada↗

PubMed2002

Relative importance of designation and accreditation of trauma centers during evolution of a regional trauma system.

BACKGROUND: Improved survival after injury has been demonstrated with trauma system implementation and designation of trauma centers. Local designating health authorities or national verification (United States) or accreditation (Canada) programs audit trauma center performance. The relative importance of designation versus accreditation with respect to improved outcomes is not clear. The purpose of this study was to measure outcomes within a single regional trauma system after designation of trauma centers and to compare outcomes in the one accredited center to the nonaccredited centers. METHODS: Data from three trauma centers were studied. All were large, university-affiliated regional medical centers, integrated into a regional trauma system and served by a single ambulance service. The study period was 1992 to 1999, immediately after trauma center designation in 1991. The British Columbia Trauma Registry was used to identify trauma patients, mechanism of injury, length of stay, case mix, case volume, acuity, pediatric caseload, and proportion of transfers at each center. A questionnaire was circulated to each hospital to determine the level of institutional support and programmatic development for trauma. The Trauma Registry was used to calculate z scores (TRISS methodology) for each center and TRISS-adjusted mortality odds ratios between institutions. Differences in covariables were controlled for in subgroup analysis. RESULTS: Two centers (hospitals A and C) had a high trauma caseload; one (hospital B) had a small and diminishing caseload. Only one center (hospital A) developed a trauma program consistent with Canadian accreditation criteria; z scores for center A were consistently better than at hospital B or C and survival odds ratios were significant. This finding applied to the total trauma population, blunt adult trauma patients (whether or not transfers and hip fracture patients were excluded), and in the more severely injured blunt trauma subgroups. There were no differences between hospitals for the relatively small number of patients with penetrating trauma. CONCLUSION: Differences between hospitals were apparent from the outset of the trauma system. However, designation as a trauma center does not appear to necessarily improve survival in large regional medical centers. Development of a trauma program and commitment to meeting national guidelines through the accreditation process does appear to be associated with improved outcome after injury.

Accreditation↗