Strong primary care systems can contribute to improved health outcomes, health equity, and more efficient health systems. This rapid review draws lessons from three promising models of team-based primary care in place in Canada—nurse practitioner-led clinics, community health centres, and collaborative emergency centres—that have the potential to improve access to care in rural, remote, and northern communities.

Clinical networks have become increasingly widespread to promote innovation, knowledge creation and exchange, and collaboration. Emergency care clinical networks (ECCNs) are specifically oriented to support emergency care providers working in emergency settings. This rapid review explores the prevalence and characteristics of 32 ECCNs worldwide to identify and share promising practices that may ultimately enhance the effectiveness of these networks to improve care delivery and strengthen health systems.

Provincial and territorial (PT) health systems in Canada provide comparable universal health coverage (UHC) for hospital, medical, diagnostic, and inpatient prescriptions to their populations. Some medical services fall on the boundary, however, in what could be called the “grey area” of UHC services. This rapid review describes how four PT governments—BC, NWT, ON, and PEI—provide their residents with the grey areas of medical transportation services, post-operative rehabilitation services, assistive reproductive technology services, and virtual physician visits.

Patient safety incidents are estimated to be the third-leading cause of death in Canada among the highest in the OECD. This rapid review describes and assesses the policy interventions aimed at reducing “retained foreign object” incidents and other never events in England, Ireland, and New Zealand to identify policy lessons of interest to Canadian decision makers.

Caregivers are increasingly recognized as the backbone of healthcare systems, providing much of community-based chronic disease and long-term care – a demand that will continue to rise as populations age. In response limitations in healthcare and social care institutions, online peer-based caregiver support systems have emerged enabling caregivers to share information, skill development, emotional support, and even caregiving duties. This rapid review characterizes the landscape of peer support for caregivers and identifies the key features and approaches that may be most effective in optimizing these initiatives.

In Canada, the effective use of virtual care is perhaps nowhere more urgent than in northern, rural, and remote communities. While these jurisdictions have taken major steps to further develop and implement new virtual care services, our understanding of the key features involved in providing accessible, efficient, and satisfying virtual care is limited. This rapid review contributes to discussions of where, how, and in what way emerging virtual care approaches could be used to improve the quality and access to primary care in these often-underserved communities.

The Canadian health system is struggling to find effective approaches to getting patients who no longer require acute treatment – which uses limited and expensive inpatient resources – out of the hospital. This rapid review profiles approaches by other countries to tackle unnecessary prolonged stays, highlighting those that have successfully transferred people out of hospitals into community-based settings.

While Canadians enjoy financial protection against the cost of hospital and physician services, there are some notable gaps in coverage, such as for oral health care. This rapid review describes several approaches to dental care coverage, with a focus on older adults (individuals 65 years and older), in seven comparable jurisdictions: Canada (Alberta),
Australia (New South Wales), England, France, Italy, Germany, and Sweden.

This rapid review describes home and community care interventions being delivered to rural populations, report their associated outcomes, and to highlight evidence-informed “best practices” for delivering care to rural communities. We also looked to Sweden, Intermountain healthcare in the United States, and Australia to identify any unique approaches or lessons to be learned for implementing and delivering home and community support services to rural and remote populations.

This rapid review updates the previous rapid review (no. 9) and sets out to address three broad objectives:

1. To identify the key factors and mechanisms involved in ACOs that have demonstrated success.
2. To consider lessons learned from the perspectives of providers working in ACOs.
3. To conduct an appraisal of the evaluative literature.

The report concludes with discussing implications for Ontario the Ontario context.

This report examines the experiences of the U.S., U.K., and France with respect to the use of regulatory waivers or administrative agreements. This report summarizes the experience of regulatory permissiveness as a way to offer time-limited leniency from statutory or regulatory requirements to implement innovative programs and delivery models. It concludes with lessons learned for the Ontario context.

This rapid review describes the current landscape of province-wide services in Canada, including the following two, often distinct, categories of services: 1) health and clinical services; and (2) shared back-office administrative services, including information technology, payroll and some human resources (HR) functions. We aim to shed light on the approaches provincial governments have taken to centralize health services and administrative functions in provincial arm’s-length organizations.

This rapid review intended to address three broad objectives:

1. To characterize public ACOs, in particular their approach to shared savings and financial risk, accountability and monitoring, as well as funding and incentive mechanisms
2. To synthesize the results of evaluations of ACOs conducted between 2015-2018 in the US
3. To explore initiatives across Canada with respect to implementing ACO-like models based on criteria identified in objective one.

Assistive technologies or devices have been defined as any piece of equipment or products that are used to maintain or improve an individual’s functional capabilities. Coverage of assistive technologies (ATs) has been shaped by two different policy regimes—disability policy and health policy. However, high-income jurisdictions have varying approaches to coverage for assistive technologies with differences in the eligibility, types of devices covered, and cost-sharing approaches. These rapid reviews compare coverage policies in eight countries (Australia, Canada, Germany, Italy, the Netherlands, New Zealand, Norway, the United Kingdom) for four categories of ATs. The following rapid reviews involve an in-depth assessment of programs within each jurisdiction using a common definition of ATs and a core set of questions. In more broadly drawn universal health coverage (UHC) systems, such as the five western European countries, ATs tend to be part of UHC although patient contributions are also common albeit based on different rationales. In the more narrowly drawn UHC systems in Canada, Australia, and New Zealand, ATs tend to be part of separate extended health benefit programs and are accompanied by user fees and access restrictions. All systems have reasonably strict rules on eligibility for coverage in terms of proving disability although they vary in the requirement on the permanence of the disability.

Assistive technologies or devices have been defined as any piece of equipment or products that are used to maintain or improve an individual’s functional capabilities. Coverage of assistive technologies (ATs) has been shaped by two different policy regimes—disability policy and health policy. However, high-income jurisdictions have varying approaches to coverage for assistive technologies with differences in the eligibility, types of devices covered, and cost-sharing approaches. These rapid reviews compare coverage policies in eight countries (Australia, Canada, Germany, Italy, the Netherlands, New Zealand, Norway, the United Kingdom) for four categories of ATs. The following rapid reviews involve an in-depth assessment of programs within each jurisdiction using a common definition of ATs and a core set of questions. In more broadly drawn universal health coverage (UHC) systems, such as the five western European countries, ATs tend to be part of UHC although patient contributions are also common albeit based on different rationales. In the more narrowly drawn UHC systems in Canada, Australia, and New Zealand, ATs tend to be part of separate extended health benefit programs and are accompanied by user fees and access restrictions. All systems have reasonably strict rules on eligibility for coverage in terms of proving disability although they vary in the requirement on the permanence of the disability.

Assistive technologies or devices have been defined as any piece of equipment or products that are used to maintain or improve an individual’s functional capabilities. Coverage of assistive technologies (ATs) has been shaped by two different policy regimes—disability policy and health policy. However, high-income jurisdictions have varying approaches to coverage for assistive technologies with differences in the eligibility, types of devices covered, and cost-sharing approaches. These rapid reviews compare coverage policies in eight countries (Australia, Canada, Germany, Italy, the Netherlands, New Zealand, Norway, the United Kingdom) for four categories of ATs. The following rapid reviews involve an in-depth assessment of programs within each jurisdiction using a common definition of ATs and a core set of questions. In more broadly drawn universal health coverage (UHC) systems, such as the five western European countries, ATs tend to be part of UHC although patient contributions are also common albeit based on different rationales. In the more narrowly drawn UHC systems in Canada, Australia, and New Zealand, ATs tend to be part of separate extended health benefit programs and are accompanied by user fees and access restrictions. All systems have reasonably strict rules on eligibility for coverage in terms of proving disability although they vary in the requirement on the permanence of the disability.

Assistive technologies or devices have been defined as any piece of equipment or products that are used to maintain or improve an individual’s functional capabilities. Coverage of assistive technologies (ATs) has been shaped by two different policy regimes—disability policy and health policy. However, high-income jurisdictions have varying approaches to coverage for assistive technologies with differences in the eligibility, types of devices covered, and cost-sharing approaches. These rapid reviews compare coverage policies in eight countries (Australia, Canada, Germany, Italy, the Netherlands, New Zealand, Norway, the United Kingdom) for four categories of ATs. The following rapid reviews involve an in-depth assessment of programs within each jurisdiction using a common definition of ATs and a core set of questions. In more broadly drawn universal health coverage (UHC) systems, such as the five western European countries, ATs tend to be part of UHC although patient contributions are also common albeit based on different rationales. In the more narrowly drawn UHC systems in Canada, Australia, and New Zealand, ATs tend to be part of separate extended health benefit programs and are accompanied by user fees and access restrictions. All systems have reasonably strict rules on eligibility for coverage in terms of proving disability although they vary in the requirement on the permanence of the disability.

Assistive devices aim to provide individuals with tools that can support the management of their health and social needs. These devices are often used to support hospital discharge, maintain independence in the home, and to support active participation at home, work, and in the community. Given that the proportion of older adults in Canada is growing (Statistics Canada, 2014) and assistive devices usage increases with age (Statistics Canada, 2015), we can expect increased pressure for public funding and/or provision of assistive devices. Despite the acknowledged value of having access to assistive devices, the degree to which provinces and territories (P/T) publicly support such access varies. How decisions are made are then a result of two imperatives: the first a consequence of the democratic process where decisions are made on the basis of unique interest group pressures, politics and historical policies within individual jurisdictions; the second on the basis more technocrat recommendations through deliberate processes (e.g. health technology assessments) based on clinical and cost effectiveness analyses. This review looks to identify all Canadian jurisdictions that offer publicly supported assistive devices programs and to identify program characteristics, including: program mandates, eligibility criteria, types of devices included/excluded, how decisions to include/exclude are made, the funding mechanisms used (private insurance, user fees, public insurance, a mix), and how the funding approaches are decided.

The public sector in Canada arrived late to the quality improvement (QI) movement compared to the United States and United Kingdom. In 2002, both the Kirby and Romanow Reports called for greater accountability for quality of care. following the Romanow Report’s recommendation for a pan-Canadian council to regularly assess health system performance, including QI, the 2003 First Ministers’ Accord on Health Care Renewal established the Health Council of Canada. Fifteen years later, the Health Council of Canada is no longer operating[1] but five provincial quality councils have been established. There is no shared definition of healthcare QI in Canada. Quality improvement has been described as a strategic philosophy or culture focused on systematically embedding quality into daily practice. Forging a common language and shared direction is necessary if Canada is to achieve equitable, quality healthcare for all its citizens. This is particularly relevant in today’s era, marked by the United Nations Declaration on the Rights of Indigenous Peoples, the Truth and Reconciliation Commission’s Calls to Action, and the health disparities that exist between Indigenous and non-Indigenous peoples living in Canada. With this rapid review, we provide a broad understanding of quality councils and QI activities throughout Canada—their structural features, mandates, and roles. We also identify complementarities as well as suggest some potential opportunities for collaboration across jurisdictional lines.

[1] The Health Council of Canada ceased operations in 2014.

A previous rapid review of all 13 provincial/territorial jurisdictions in Canada identified Ontario, Manitoba, Alberta, and the Northwest Territories as being the most innovative in pursuing primary care reform over the last decade (Peckham, Ho, & Marchildon, 2018). The purpose of the present rapid review was to explore these jurisdictions in greater depth. We rely on available public indicators and expert advice to determine how jurisdictions have improved access to after-hours care; worked to offer a broader scope of services through access to interdisciplinary teams; and improved communication and coordination through information technology and electronic medical records (EMRs) accessible to health and social service providers as well as patients and caregivers.

This review explores the state of primary care reform across Canada with an aim to elicit jurisdictions that have progressed primary care most innovatively through the last decade. To do this we use six criteria that are identified as necessary components for more effective and efficient primary care systems:

1. Development of new models of primary care facilitating access to interprofessional teams
2. Introduction of tight patient rostering to contain costs, and improve accountability and continuity of care
3. Requirement that primary care practices provide patients with a comprehensive range of after-hour (24/7) primary care services
4. Effective investment in, and use of, information communications technology accessible to both patients and providers
5. Changes in primary care physician remuneration to encourage greater continuity and quality of care
6. Health system organization changes producing health system alignment for greater physician accountability to patients and health systems

Four jurisdictions (Alberta, Manitoba, Ontario, and the Northwest Territories) were identified to have initiated the most ambitious efforts towards primary care reforms and are worthy of deeper study.