Browsing by Author "Cunningham, Ceara"

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    Identifying cost-based quality and performance indicators for home care: a modified delphi method study
    (2024-07-24) Jajszczok, Max; Eastwood, Cathy A.; Lu, Mingshan; Cunningham, Ceara; Southern, Danielle A.; Quan, Hude
    Abstract Background This study, part of a multi-study program, aimed to identify a core set of cost-based quality and performance indicators using a modified Delphi research approach. Conceptually, this core set of cost-based indicators is intended for use within a broader health system performance framework for evaluating home care programming in Canada. Methods This study used findings from a recently published scoping review identifying 34 cost-focused home care program PQIs. A purposive and snowball technique was employed to recruit a national panel of system-level operational and content experts in home care. We collected data through progressive surveys and engagement sessions. In the first round of surveying, the panel scored each indicator on Importance, Actionable, and Interpretable criteria. The panel set the second round of ranking the remaining indicators’ consensus criteria. The panel ranked by importance their top five indicators from operational and system perspectives. Indicators selected by over 50% of the panel were accepted as consensus. Results We identified 13 panellists. 12 completed the first round which identified that 30 met the predetermined inclusion criteria. Eight completed the ranking exercise, with one of the eight completing one of two components. The second round resulted in three PQIs meeting the consensus criteria: one operational and two systems-policy-focused. The PQIs: “Average cost per day per home care client,” “Home care service cost (mean) per home care client 1y, 3y and 7y per health authority and provincially and nationally”, and “Home care funding as a percent of overall health care expenditures.” Conclusions The findings from this study offer a crucial foundation for assessing operational and health system outcomes. Notably, this research pioneers identifying key cost-based PQIs through a national expert panel and modified Delphi methodology. This study contributes to the literature on PQIs for home care and provides a basis for future research and practice. These selected PQIs should be applied to future research to test their applicability and validity within home care programming and outcomes. Researchers should apply these selected PQIs in future studies to evaluate their applicability and validity within home care programming and outcomes.
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    Impacts of Increased Home Care Investments on Health System Service Utilization
    (2024-07-24) Jajszczok, Max; Quan, Hude; Eastwood, Catherine A.; Lu, Mingshan; Cunningham, Ceara
    Introduction: A Canadian home care performance measurement framework does not exist. This research examined the impact of Federal and Provincial investments in home care programs in Alberta. We identified the need for financially focused home care system indicators, refined indicators through a modified Delphi approach, and applied selected indicators within the Alberta context. Methods: We conducted a three-phase multistage, mixed-methods study. 1.) Through a scoping review, we identified measures, frameworks and related evaluation tools specific to the IHI Quadruple Aim as applied to home care programs. 2.) We identified core financially focused measurement indicators using a modified Delphi process and a Content Analysis approach. 3.) We applied the newly identified indicators to Alberta Health Services data for home care clients from 2015 to 2020. The identified indicators were examined through trend analyses and a cost-effectiveness analysis economic evaluation. Results: In the first study, we reviewed 3,475 potential documents, leading to 105 articles for performance and quality indicator (PQI) extraction, identifying 829 unique PQIs. Under the IHI Quadruple Aim, 661 PQIs were Clinical Outcomes, 35 Healthcare Provider Satisfaction, 99 Patient Experience, and 34 Financial. In our second phase, 12 panellists comprised the first round and selected 30 PQIs. The second round, comprising eight panellists, resulted in consensus on three PQIs: “Average cost per day per home care client,” “Home care service cost per client over time,” and “Home care funding as a percentage of health care expenditures.” In our third phase, trend analyses identified that enhanced home care investments per client and overall expenditures in Alberta led to a decrease in acute care usage. Over five years, the model estimated a reduction of 346,200 patient days in acute care. An additional $240.3M in home care investments yielded a Cost Effectiveness Ratio of 694:1 in acute care beds days avoided. Conclusions: Our research identified and applied new cost-based indicators effectively portraying how targeted funding affects utilization, revealing that enhancing home care programs improves system cost-effectiveness. Policymakers are encouraged to incorporate these novel indicators into their measurement frameworks to gauge the effects of home care investments on the overall health system.
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    Strategies for improving physician documentation in the emergency department: a systematic review
    (2018-10-25) Lorenzetti, Diane L; Quan, Hude; Lucyk, Kelsey; Cunningham, Ceara; Hennessy, Deirdre; Jiang, Jason; Beck, Cynthia A
    Abstract Background Physician chart documentation can facilitate patient care decisions, reduce treatment errors, and inform health system planning and resource allocation activities. Although accurate and complete patient chart data supports quality and continuity of patient care, physician documentation often varies in terms of timeliness, legibility, clarity and completeness. While many educational and other approaches have been implemented in hospital settings, the extent to which these interventions can improve the quality of documentation in emergency departments (EDs) is unknown. Methods We conducted a systematic review to assess the effectiveness of approaches to improve ED physician documentation. Peer reviewed electronic databases, grey literature sources, and reference lists of included studies were searched to March 2015. Studies were included if they reported on outcomes associated with interventions designed to enhance the quality of physician documentation. Results Nineteen studies were identified that report on the effectiveness of interventions to improve physician documentation in EDs. Interventions included audit/feedback, dictation, education, facilitation, reminders, templates, and multi-interventions. While ten studies found that audit/feedback, dictation, pharmacist facilitation, reminders, templates, and multi-pronged approaches did improve the quality of physician documentation across multiple outcome measures, the remaining nine studies reported mixed results. Conclusions Promising approaches to improving physician documentation in emergency department settings include audit/feedback, reminders, templates, and multi-pronged education interventions. Future research should focus on exploring the impact of implementing these interventions in EDs with and without emergency medical record systems (EMRs), and investigating the potential of emerging technologies, including EMR-based machine-learning, to promote improvements in the quality of ED documentation.