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ResearchRapid Reviews

Rapid reviews are environmental scans or quick literature reviews on policy issues identified as urgent or emerging by NAO members.

Delivering Primary Care in Non-Traditional Healthcare Settings to Individuals Experiencing Homelessness

People experiencing homelessness (PEH) face multiple barriers to accessing primary care, over and above the pervasive problems of stigma and exclusion. This rapid review describes approaches to provide PEH with primary care services outside the mainstream health system, highlighting key features of promising and emerging initiatives from several countries.

Governance of COVID-19 Vaccine Data in Federations

Federations face unique challenges when organizing public health data across national and sub-national jurisdictions. These challenges are especially acute during a public health crisis such as the ongoing COVID-19 pandemic. This rapid review aims to draw lessons for Canada from other federations and a quasi-federation on the governance of COVID-19 vaccine data.

Public Reporting of Healthcare-Associated Infections in Three Canadian Provinces

Healthcare-associated infections (HAIs) are a major challenge for health systems globally. This rapid review assesses the state of HAI surveillance, monitoring, and reporting in three Canadian provinces: British Columbia, Manitoba, and Nova Scotia.

An International Review of Emergency Care Clinical Networks

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.

Coverage of Grey Area Services in Four Provincial/Territorial Health Insurance Programs

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.

Never Events in Acute Care: Policy Lessons from International Comparisons

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.

Peer Supports for Caregivers in Canada

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.

COVID-19 Case and Contact Management Strategies in Canada

Case and contact management is an essential component of a comprehensive public health response strategy in response to the ongoing COVID-19 pandemic. This rapid review describes the case and contact management strategies that have been deployed in jurisdictions across Canada.

Virtual Primary Care in Northern, Rural and Remote Canada

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.

COVID-19 Case and Contact Tracing: Policy Learning from International Comparisons

This rapid review surveys approaches taken by selected We sought to understand how six countries have been able to contain the COVID-19 pandemic and begin transitioning to more relaxed public health measures through the use of testing, case management, and contact tracing, with particular interest in the role of digital case and contact tracing tools.

Supporting Mental Health and Wellbeing Among Students in Higher Education

Young people in post-secondary institutions are actively expressing concern over their mental health and wellbeing, and increasingly seeking help. This rapid review describes current approaches and new initiatives in Canada and other OECD jurisdictions to support mental health in post-secondary settings, and identifies the role of governments in these efforts.

Public Management and Regulation of Contracted Health Services

Much debate surrounds the delivery of healthcare services in private, non-hospital settings centres around efficiency. This rapid review compares the experience of five provinces as they strive to enforce accountability between non-hospital facilities and provincial health insurance programs for the delivery of advanced diagnostic and surgical services.

Alternative Level of Care and Delayed Discharge: Lessons Learned from Abroad

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.

Innovations in Service Delivery for Institutional Care in Practically Managing Responsive Behaviours

People living with dementia sometimes exhibit “responsive behaviors” – agitation, aggression (including violence), and disturbances in mood, perception, and behaviour. This rapid review surveys and assesses emerging trends in non-pharmacological approaches to reducing responsive behaviors among people living with dementia in long-term care settings.

Using Technology to Support Home and Community Care in Rural Areas

An early pioneer in telehealth, Canada has long sought to deliver health care services and information to its underserved rural populations using information and communication technologies where possible. This rapid review identifies some best practices for using such technologies to support health care in rural communities.

Patient Safety Mandatory Reporting Legislation and Outcomes

Mandatory reporting legislation is key to monitoring patient safety incidents. This rapid review highlights a gap between the gathering of patient safety data and the ability of regulators, professionals, and other stakeholders to learn from such data to prevent future harm.

Adopting EMRs and Information Technology in Primary Care

While Electronic Medical Records (EMRs) and related information technologies have become a large component of high-performing health care systems, there remains very little progress in the Canadian context. This rapid review seeks to understand the outcomes associated with EMR use, the barriers towards implementations, and strategies for encouraging adoption.

Hospitals-As-Hubs: Integrated Care for Patients

Integrated models of care intend to improve the care experiences of people and providers as well as the outcomes of care for populations across the care continuum. This rapid review aims to understand the role that hospitals can play as lead integrators of care delivery models that span multiple sectors.

Dental Care Coverage for Older Adults in Seven Jurisdictions

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.

Strengthening Home and Community Care Services for Rural Populations

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.

Health System Performance of Northern Canada

This review compares Yukon’s performance with other northern regions, including: Labrador, Saguenay (QC), Côte-Nord (QC), Nord (QC), Nunavik (QC), Baie-James (QC), Northwestern (ON), Porcupine (ON), Thunder Bay (ON), Northern (MB), Mamawetan (SK), Keewatin (SK), Athasbasca (SK), North Zone (AB), Northwest (BC), North-Interior (BC), Northeast (BC), the Northwest Territories, Nunavut, and Yukon.

Care Closer to Home: Elements of High Performing Home and Community Healthcare Services

This rapid review summarises and assesses the review literature to identify key attributes that are associated with high-performing care provided closer to home. 

Accountable Care Organizations: Success Factors, Provider Perspectives and an Appraisal of the Evidence

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.

Waivers to Enable Innovation

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.

Province-Wide Services

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.

Accountable Care Organizations and the Canadian Context

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 Devices Regulation and Coverage in Five European Countries

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: Regulation and Coverage in New Zealand

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: Regulation and Coverage in Australia

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 Coverage: Ontario Compared to Other High-Income Jurisdictions

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: Regulation and Coverage in Canada 

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.

Healthcare Quality Councils: A Pan-Canadian Scan

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.

Primary Care Reforms in Ontario, Manitoba, Alberta, and the Northwest Territories

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.

Policy innovations in primary care across Canada

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.