Browsing by Author "Lucyk, Kelsey"

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    A History of the Social Determinants of Health in Canada through the Lens of the Canadian Public Health Association, 1910-2010: Implications for Present and Future Population Health in Canada
    (2017) Lucyk, Kelsey; McLaren, Lindsay; Stahnisch, Frank W.
    The 2008 final report of the WHO’s Commission on Social Determinants of Health (SDOH) marked a watershed in the history of the SDOH for bringing together decades of evidence and theory on the social causes of illness from the diverse health research landscape. Yet, a rich history predates this and other contributions (e.g., 1974 Lalonde Report) that are widely credited as the start of the SDOH approach. This history is revealed through casting the contemporary interpretive lens of the SDOH onto the past. I gained a nuanced understanding of the emergence and evolution of the SDOH in Canada by analyzing the archives of the Canadian Public Health Association (CPHA) from 1910 to 2010. I applied a social history and critical public health perspective while exploring this data using methods of thematic content analysis. To situate my findings with relevance to the contemporary landscape of population and public health (PPH), I complemented my analysis of archival sources with that of published and grey SDOH literature, print news articles, and oral history interviews with PPH leaders. My findings show that as a way of thinking, the SDOH approach is complex and diffuse. This, coupled with the inherently political nature of the SDOH, presents challenges in terms of communicating key messages of the SDOH to decision-makers and the public. Additionally, the history of the SDOH is non-linear and changes alongside social, economic, and political events. Economic recession and growth, for example, at times brought more and less urgency to act on the SDOH within the Canadian PPH community. However, despite that ebb and flow, the foundations of health equity and social justice have remained firm throughout the history of the SDOH. These foundations, combined with the growth and increasing disciplinary coherence of PPH, suggest that action on the SDOH will remain a core commitment of PPH.
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    Administrative health data in Canada: lessons from history
    (BioMed Central, 2015-08-19) Lucyk, Kelsey; Lu, Mingshan; Sajobi, Tolulope; Quan, Hude
    BACKGROUND: Health decision-making requires evidence from high-quality data. As one example, the Discharge Abstract Database (DAD) compiles data from the majority of Canadian hospitals to form one of the most comprehensive and highly regarded administrative databases available for health research, internationally. However, despite the success of this and other administrative health data resources, little is known about their history or the factors that have led to their success. The purpose of this paper is to provide an historical overview of administrative data for health research in Canada to contribute to the institutional memory of this field. METHODS: We conducted a qualitative content analysis of approximately 20 key sources to construct an historical narrative of administrative health data in Canada. Specifically, we searched for content related to key events, individuals, challenges, and successes in this field over time. RESULTS AND DISCUSSION: In Canada, administrative data for health research has developed in tangent with provincial research centres. Interestingly, the lessons learned from this history align with the original recommendations of the 1964 Royal Commission on Health Services: (1) standardization, and (2) centralization of data resources, that is (3) facilitated through governmental financial support. CONCLUSIONS: The overview history provided here illustrates the need for longstanding partnerships between government and academia, for classification and standardization are time-consuming and ever-evolving processes. This paper will be of interest to those who work with administrative health data, and also for countries that are looking to build or improve upon their use of administrative health data for decision-making.
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    Barriers to data quality resulting from the process of coding health information to administrative data: a qualitative study
    (2017-11-22) Lucyk, Kelsey; Tang, Karen; Quan, Hude
    Abstract Background Administrative health data are increasingly used for research and surveillance to inform decision-making because of its large sample sizes, geographic coverage, comprehensivity, and possibility for longitudinal follow-up. Within Canadian provinces, individuals are assigned unique personal health numbers that allow for linkage of administrative health records in that jurisdiction. It is therefore necessary to ensure that these data are of high quality, and that chart information is accurately coded to meet this end. Our objective is to explore the potential barriers that exist for high quality data coding through qualitative inquiry into the roles and responsibilities of medical chart coders. Methods We conducted semi-structured interviews with 28 medical chart coders from Alberta, Canada. We used thematic analysis and open-coded each transcript to understand the process of administrative health data generation and identify barriers to its quality. Results The process of generating administrative health data is highly complex and involves a diverse workforce. As such, there are multiple points in this process that introduce challenges for high quality data. For coders, the main barriers to data quality occurred around chart documentation, variability in the interpretation of chart information, and high quota expectations. Conclusions This study illustrates the complex nature of barriers to high quality coding, in the context of administrative data generation. The findings from this study may be of use to data users, researchers, and decision-makers who wish to better understand the limitations of their data or pursue interventions to improve data quality.
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    ‘Growing Pains’: An historical analysis of population mental health in Kitimat, British Columbia, 1950-2010
    (2013-09-23) Lucyk, Kelsey; Stahnisch, Frank
    The relationship between economic change and mental health in resource-based communities has been largely unexplored. This historical case study examines how mental health was understood alongside changing economic circumstances in the resource-based community of Kitimat, British Columbia. A content analysis of archival documents and eight qualitative interviews with long-term residents revealed that understandings of mental health shifted according to local economic circumstances. Specifically, during times of economic growth the socially ideal family unit was seen as a way to achieve mental health. Conversely, during times of economic downturn residents were preoccupied with issues like housing or unemployment, which they identified as essential to their mental health. Overall, residents’ understandings of mental health aligned with holistic or biomedical perspectives, and sometimes both. Considering the recent state of economic development in Kitimat, and its inevitable downturn—common to other resource-based communities—this study offers important insight into the implications for mental health.
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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.
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    The association between influenza vaccination and socioeconomic status in high income countries varies by the measure used: a systematic review
    (2019-07-17) Lucyk, Kelsey; Simmonds, Kimberley A; Lorenzetti, Diane L; Drews, Steven J; Svenson, Lawrence W; Russell, Margaret L
    Abstract Background The purpose of this paper is to systematically review the literature on the relationship between socioeconomic status (SES) and influenza immunization and to examine how certain measures of SES may influence interpretations of this relationship. Methods We conducted a systematic review of existing peer-reviewed literature to evaluate the above relationship in the general population. Electronic databases (MEDLINE and EMBASE) were searched from January 2012 to May 2017 to identify English-language studies relevant to this review. Studies were included where influenza vaccination was explicitly reported as the dependent variable and SES as the independent variable. We limited our review to measures of SES that focus on education, income, social class, occupation, and deprivation. Studies that measured SES using other variables (e.g., race, ethnicity, geographic location, rural or urban status, or insurance status) were excluded. Studies were also excluded if they did not report on the human population or did not analyze original data. The population of interest included all age groups, levels of health status, and sociodemographic backgrounds. The review was also limited to World Bank high-income countries. Two authors independently screened full-text articles after obtaining a Kappa score of K = 0.867. The methodological quality of manuscripts was assessed using the appraisal tools developed by the Joanna Briggs Institute. Results were qualitatively reported and synthesized. Results Of the 42 articles included in this review, 52.4% (n = 22) found that higher levels of SES resulted in higher levels of influenza vaccination; 4.5% (n = 2) reported a negative association; and 14.3% (n = 6) found no association. Just over a quarter (26.2%, n = 12) of articles reported mixed results. Conclusions There was consistently a relationship between SES and influenza immunization, which varied according to how SES was measured. It is recommended that authors be explicit in defining the SES concept they are trying to capture and that they utilize multiple measures of SES (e.g., education, income, class).