Healthcare Management Forum

The COVID-19 pandemic resulted in a rapid adoption of virtual care. Virtual care existed before the pandemic for specific conditions and circumstances. Health Technology Assessment (HTA) of virtual care evaluated clinical and cost-effectiveness to inform decisions about the optimal use prior to the pandemic but the necessary implementation of virtual care during the pandemic meant HTA was not feasible prior to adoption. The questions for HTA no longer focused on clinical or cost-effectiveness and focused on implementation considerations. Health technology assessment post-adoption of virtual care included questions such as the appropriate medical conditions for virtual care, training, billing, patient and clinician perspectives and experiences, and equity of access. Moving forward, it is important for HTA organizations to identify new and emerging virtual care technologies, explore early and other types of evidence, assess the potential impact on the healthcare system, and explore the operational considerations.

Public health data have demonstrated disproportionate COVID-19 morbidity and mortality among racialized populations. However, limited hospital data may prevent research into racial disproportionality among inpatients. We conducted a retrospective cross-sectional study of patients admitted with or without COVID-19 to an Ontario tertiary hospital between March and October 2020 to determine the percentage of inpatients with a formal race or ethnicity assessment in their medical record. The COVID-19 group included inpatients with concurrent COVID-19 positivity; the reference group included a random sample of General Medicine inpatients without COVID-19. We reviewed 80 patients with COVID-19 and 80 patients without COVID-19. Formal ethnicity assessments were recorded among 44% of the COVID-19 group and 49% of the reference group. Race and ethnicity data collection was less than 50% among inpatients with and without COVID-19 in one Ontario hospital. Adequate data collection is necessary to study racial health disparities in the hospital setting.

The pandemic has accelerated the move to virtual care. This has included remote monitoring and implementation of technologies that allow for patient care at home and assisted living for ageing in place. Technologies are available to help consumers to maintain their health and wellness. However, challenges associated with implementing virtual care remain. In this article, we describe some of these challenges, along with the need to develop new models for promoting effective and sustainable virtual care. This includes the need for integration of institutional efforts (eg, government and hospital) with emerging access to commercially available home technologies supplied to patients and citizens. The authors argue that consideration of a personal digital ecosystem and its relation to institutional digital health ecosystems is critical. The authors suggest virtual care be considered in the combined context of the person and healthcare system. Implications for future research directions for virtual care are discussed.

The number of Older Adults (OAs) in Ontario will double in two decades. The COVID-19 pandemic demonstrated that the model of subsidized Long-Term Care (LTC) homes does not reflect the care needs of OAs. Many nations have implemented LTC models as a continuum of care for OAs promoting independent home/community living. These models help delay admission to LTC homes and achieve a higher quality-of-life for OAs. Current financial pressure on the healthcare system and inadequacies of LTC homes necessitate a broader social welfare policy. One viable option for sustainable LTC is implementing Ontario’s mandatory public long-term care insurance policy.

Transitions to and from primary care are a time of concern, especially for patients with chronic conditions and complex care needs. The Edmonton Southside Primary Care Network (ESPCN) developed a process for nurses to ensure timely post-discharge follow-up calls and physician appointments after hospitalization, assessing readmission risk with LACE and Clinical Frailty scores. Over 84% of eligible high-risk discharges received follow-up within 14 days. Of 7,400 index discharges, 1,464 had an emergency department revisit and 725 patients were readmitted within 30 days. Overall, ESPCN rates of readmission (9.8%) and rates of Family Practice Sensitive Conditions (FPSC) (5.7%) were significantly lower than national and provincial rates. FPSC rates for high-risk patients were significantly lower than low- or medium-risk groups. Consistent processes that support nursing involvement enable primary care teams to focus on those with highest risk for adverse outcomes and support patients to access the most appropriate place for the care they need.

Telemedicine modalities for patient care have seen significant global uptake during the COVID-19 pandemic. This study aimed to bibliometrically evaluate the evolution and current landscape of telemedicine literature in Canada. The Scopus database was searched to identify telemedicine publications for which the first or last author had a Canadian institutional affiliation. Study selection and data abstraction were conducted by two pairs of independent reviewers. Between 1976 and January 2021, 810 of 3,620 retrieved citations were telemedicine publications originating from Canada, including 29 randomized controlled trials and 6 systematic reviews. The annual publication output increased substantially from 1/year in 1976 to 80/year in 2020. Based on author keyword analysis, the most frequently investigated disciplines or disease entities were primary care, COVID-19, telepsychiatry, heart failure, and mental health. The insights this study provides will aid scientists, policy makers, and other stakeholders in identifying opportunities for future investigation and clinical application.

This article presents an overview of the effects of the COVID-19 pandemic on the adoption and diffusion of technologies including within healthcare. Consumer technologies have been rapidly applied to mitigate negative health impacts such as social isolation, or to monitor the health and function of family members separated by quarantine. As the lines between consumer technologies and professional health technologies blur, there is an opportunity to examine the outcomes of accessible and familiar technologies used by consumers. The rapid diffusion of technology uptake challenges traditional frameworks that describe technology acceptance and adoption. There is an opportunity to understand the impact of experience of use and involuntariness on technology diffusion. Beyond the onset of the pandemic, the management of post-COVID syndrome, which some see as the next public health crisis, is an opportunity to accelerate the diffusion of home monitoring technologies already benefiting people living with other chronic health conditions.

This is the first paper describing the unit level champion role in order to implement the Collaborative Care framework as an evidence-based practice in the province of Alberta. The clear selection criteria of Unit Lead, funding (.2 FTE) that allows for the dedication of the role, support with various education, coaching from the project management team, and community of practices were suggested as important factors for successful utilization of Unit Leads to implement quality improvement initiatives in a large scale. Future initiatives may consider using a peer-leader champion as a change agent who is committed to the change initiative, credible and personally connected to the unit staff, possesses knowledge about the organizational culture, and develops a unit-tailored strategy via performance monitoring data to fully implement an evidence-based practice for quality care.

Telemedicine via videoconferencing rapidly deployed during the COVID-19 pandemic reduces contact and opportunity for virus transmission, with Quadruple Aim benefits of improved population health and associated cost avoidance of COVID-related illness. Patient experience of telemedicine has generally been positive, but widespread use of videoconferencing outside of healthcare has brought growing recognition of associated mental fatigue. Experience in telepsychiatry shows attending to non-verbal communication and maintaining empathic rapport requires increased mental effort, making provider experience more sensitive to cumulative fatigue effects. Since empathy and therapeutic alliance are foundational to all physician-patient relationships, these telepsychiatry findings have implications for telehealth generally. Health leaders and providers planning for sustainable incorporation of videoconferencing into ongoing healthcare delivery should consider the potential for unintended negative effects on provider experience and burnout.

The implementation of Person-Centred Care (PCC) by primary care teams is complex. Framed through the Quadruple Aim, successful healthcare system redesigns result in improved health outcomes of individuals and populations, reduce costs, and ensure an engaged and productive workforce. However, how can primary care teams achieve the Quadruple Aim? This article provides a learning and performance framework to support PCC through a Team-Based Care (TBC) ecosystem approach. We developed our approach using action research to improve TBC orientations, workshops, and consultations for teams and their leaders in Urgent Primary Care Centres and Primary Care Networks in Canada. This paper provides a synthesis of our experience in the context of the relevant evidence. We aim to share our efforts and acknowledge that our experience is still ongoing and complemented by ongoing improvement activities by others in the TBC ecosystem.

Artificial Intelligence (AI) is becoming increasingly common in healthcare and has potential to improve the efficiency and quality of healthcare services. As the utility of AI expands, medical-legal questions arise regarding the possible legal implications of incorporating AI into clinical practice. Particularly, the unique black box nature of AI brings distinct challenges. There is limited guidance addressing liability when AI is used in clinical practice, and traditional legal principles present limitations when applied to novel uses of AI. Comprehensive solutions to address the challenges of AI have not been well established in North America. As AI continues to evolve in healthcare, appropriate guidance from professional regulatory bodies may help the medical field realize AI’s utility and encourage its safe use. As the options for AI in medicine evolve, physicians and health leaders would be prudent to consider the evolving medical-legal context regarding use of AI in clinical practices and facilities.

Healthcare organizations face significant ethical complexity when developing policies related to the sexual activities of clients within their facilities. On one hand, admission to healthcare facilities should not require clients to abstain from all sexual activity. On the other hand, clients’ sexual activities within facilities have implications for other people, and many clients may be at risk of sexual mistreatment. In response, organizations may be tempted to approach their clients’ decisions about sexual activity on the model of decisions about medical treatment. In this article, we argue that this approach is more ethically problematic than it may first appear. We review asymmetries between the decisional contexts of medical treatment and sexual activity and argue that those asymmetries generate ethical issues for any policy that treats clients’ decisions about sex as analogous to decisions about treatment. We also offer suggestions for the development of ethically justifiable policies related to client sexuality.