Web-based patient access to personal health information is limited but increasing in Canada and i... more Web-based patient access to personal health information is limited but increasing in Canada and internationally. This exploratory study aimed to increase understanding of how Web-based access to laboratory test results in British Columbia (Canada), which has been broadly available since 2010, affects patients' experiences. In November 2013, we surveyed adults in British Columbia who had had a laboratory test in the previous 12 months. Using a retrospective cohort design, we compared reported wait-time for results, test result comprehension, and anxiety levels of "service users" who had Web-based access to their test results (n=2047) with those of a general population panel that did not have Web-based access (n=1245). The vast majority of service users (83.99%, 95% CI 82.31-85.67) said they received their results within "a few days", compared to just over a third of the comparison group (37.84%, 95% CI 34.96-40.73). Most in both groups said they understood their test results, but the rate was lower for service users than the comparison group (75.55%, 95% CI 73.58-77.49 vs 84.69%, 95% CI 82.59-86.81). There was no significant difference between groups in levels of reported anxiety after receiving test results. While most patients who received their laboratory test results online reported little anxiety after receiving their results and were satisfied with the service, there may be opportunities to improve comprehension of results.
In Ontario, clinical decision units (CDUs) were implemented as a pilot project in 2008 by the Min... more In Ontario, clinical decision units (CDUs) were implemented as a pilot project in 2008 by the Ministry of Health and Long-Term Care as part of its strategy to reduce emergency department (ED) waiting times. Our objective was to describe general characteristics of the program at each of the participating sites and to examine barriers and facilitators to integrating CDUs into practice. On-site small-group interviews were conducted in two phases with ED and hospital staff at participating sites, first at 8 to 12 weeks and again at 12 months postimplementation. Interview data were analyzed using the framework approach. Unstructured field notes and CDU clinical care protocols and documentation were also reviewed. The qualitative analysis identified 10 key themes related to integrating CDUs into EDs: shift in clinical and operational practice; administrative aspects of implementation; team building and stakeholder involvement; use of clinical care protocols; physical or virtual model of c...
The evaluation of emergency department (ED) quality of care is hampered by the absence of consens... more The evaluation of emergency department (ED) quality of care is hampered by the absence of consensus on appropriate measures. We sought to develop a consensus on a prioritized and parsimonious set of evidence-based quality of care indicators for EDs. The process was led by a nationally representative steering committee and expert panel (representatives from hospital administration, emergency medicine, health information, government, and provincial quality councils). A comprehensive review of the scientific literature was conducted to identify candidate indicators. The expert panel reviewed candidate indicators in a modified Delphi panel process using electronic surveys; final decisions on inclusion of indicators were made by the steering committee in a guided nominal group process with facilitated discussion. Indicators in the final set were ranked based on their priority for measurement. A gap analysis identified areas where future indicator development is needed. A feasibility stud...
Studies in health technology and informatics, 2015
This paper describes an approach which has been applied to value national outcomes of investments... more This paper describes an approach which has been applied to value national outcomes of investments by federal, provincial and territorial governments, clinicians and healthcare organizations in digital health. Hypotheses are used to develop a model, which is revised and populated based upon the available evidence. Quantitative national estimates and qualitative findings are produced and validated through structured peer review processes. This methodology has applied in four studies since 2008.
Recently, many Canadian emergency departments (EDs) have struggled with physician staffing shorta... more Recently, many Canadian emergency departments (EDs) have struggled with physician staffing shortages. In 2006, the Ontario Ministry of Health and Long-Term Care funded a brief "emergency medicine primer" (EMP) course for family physicians to upgrade or refresh skills, with the goal of increasing their ED work intensity. We sought to determine the effect of the EMP on the ED work intensity of family physicians. A retrospective longitudinal study was conducted of the ED work of 239 family physicians in the 2 years before and after a minimum of 6 months and up to 2 years from completing an EMP course in 2006 to 2008 compared to non-EMP physicians. ED work intensity was defined as the number of ED shifts per month and the number of ED patients seen per month. We conducted two analyses: a before and after comparison of all EMP physicians and a matched cohort analysis matching each EMP physician to four non-EMP physicians on sex, year of medical school graduation, rurality, and ...
Studies in health technology and informatics, 2013
Knowledge can be powerful in eliciting positive change when it is put into action. This is the be... more Knowledge can be powerful in eliciting positive change when it is put into action. This is the belief that drives knowledge translation. The University of Victoria (UVic) eHealth Observatory is focused on deriving knowledge from health information system (HIS) evaluation, which needs to be shared with HIS practitioners. Through an application of the Knowledge-to-Action Framework and the concept of a virtual community, we have established the virtual eHealth Benefits Evaluation Knowledge Translation (KT) Community. This paper describes the foundational elements of the KT Community and our overall KT strategy.
Unmet healthcare need should be rare in nations with a universally accessible publicly funded hea... more Unmet healthcare need should be rare in nations with a universally accessible publicly funded healthcare system such as Canada. This however is not the case. This study examines the extent to which predictors of such need are consistent with various paradigmatic approaches (e.g., structural-critical, social capital, social support, and lifestyle) that consider such issues. Analyses of data from a probability sample of 2536 urban residents in British Columbia specified the relationship of unmet need with socioeconomic issues such as income, gender, and housing tenure, community issues such as social networks and social support, and traditional lifestyle or behavioural risk factors. The structural-critical model concerned with socio-demographics provided the most parsimonious explanation for having an unmet healthcare need. Consistent with a structural-critical approach, gender was found to be a reliable predictor of having an unmet health need in each of the models tested. Increasing federal transfers to healthcare and providing childcare and other community supports that are of special value for women may help to reduce unmet healthcare need.
RESEARCH AND PRACTICE Objectives. We examined the effectiveness of community-level HIV preven... more RESEARCH AND PRACTICE Objectives. We examined the effectiveness of community-level HIV prevention programming for men who have sex with men.
Introduction HIV infection is increasingly characterized as a chronic condition that can be manag... more Introduction HIV infection is increasingly characterized as a chronic condition that can be managed through adherence to a healthy lifestyle, complex drug regimens, and regular treatment and monitoring. The location, quality, and/or affordability of a person's housing can be a significant determinant of his or her ability to meet these requirements. The objective of this systematic review is to inform program and policy development and future research by examining the available empirical evidence on the effects of housing status on health-related outcomes in people living with HIV/AIDS. Methods Electronic databases were searched from dates of inception through November 2005. A total of 29 studies met inclusion criteria for this review. Seventeen studies received a ''good'' or ''fair'' quality rating based on defined criteria. Results A significant positive association between increased housing stability and better health-related outcomes was noted in all studies examining housing status with outcomes of medication adherence (n = 9), utilization of health and social services (n = 5), and studies examining health status (n = 2) and HIV risk behaviours (n = 1). Conclusions Healthcare, support workers and public health policy should recognize the important impact of affordable and sustainable housing on the health of persons living with HIV.
Background: Rigorous evaluation of an intervention requires that its allocation be unbiased with ... more Background: Rigorous evaluation of an intervention requires that its allocation be unbiased with respect to confounders; this is especially difficult in complex, system-wide healthcare interventions. We developed a short survey instrument to identify factors for a minimization algorithm for the allocation of a hospitallevel intervention to reduce emergency department (ED) waiting times in Ontario, Canada.
Web-based patient access to personal health information is limited but increasing in Canada and i... more Web-based patient access to personal health information is limited but increasing in Canada and internationally. This exploratory study aimed to increase understanding of how Web-based access to laboratory test results in British Columbia (Canada), which has been broadly available since 2010, affects patients' experiences. In November 2013, we surveyed adults in British Columbia who had had a laboratory test in the previous 12 months. Using a retrospective cohort design, we compared reported wait-time for results, test result comprehension, and anxiety levels of "service users" who had Web-based access to their test results (n=2047) with those of a general population panel that did not have Web-based access (n=1245). The vast majority of service users (83.99%, 95% CI 82.31-85.67) said they received their results within "a few days", compared to just over a third of the comparison group (37.84%, 95% CI 34.96-40.73). Most in both groups said they understood their test results, but the rate was lower for service users than the comparison group (75.55%, 95% CI 73.58-77.49 vs 84.69%, 95% CI 82.59-86.81). There was no significant difference between groups in levels of reported anxiety after receiving test results. While most patients who received their laboratory test results online reported little anxiety after receiving their results and were satisfied with the service, there may be opportunities to improve comprehension of results.
In Ontario, clinical decision units (CDUs) were implemented as a pilot project in 2008 by the Min... more In Ontario, clinical decision units (CDUs) were implemented as a pilot project in 2008 by the Ministry of Health and Long-Term Care as part of its strategy to reduce emergency department (ED) waiting times. Our objective was to describe general characteristics of the program at each of the participating sites and to examine barriers and facilitators to integrating CDUs into practice. On-site small-group interviews were conducted in two phases with ED and hospital staff at participating sites, first at 8 to 12 weeks and again at 12 months postimplementation. Interview data were analyzed using the framework approach. Unstructured field notes and CDU clinical care protocols and documentation were also reviewed. The qualitative analysis identified 10 key themes related to integrating CDUs into EDs: shift in clinical and operational practice; administrative aspects of implementation; team building and stakeholder involvement; use of clinical care protocols; physical or virtual model of c...
The evaluation of emergency department (ED) quality of care is hampered by the absence of consens... more The evaluation of emergency department (ED) quality of care is hampered by the absence of consensus on appropriate measures. We sought to develop a consensus on a prioritized and parsimonious set of evidence-based quality of care indicators for EDs. The process was led by a nationally representative steering committee and expert panel (representatives from hospital administration, emergency medicine, health information, government, and provincial quality councils). A comprehensive review of the scientific literature was conducted to identify candidate indicators. The expert panel reviewed candidate indicators in a modified Delphi panel process using electronic surveys; final decisions on inclusion of indicators were made by the steering committee in a guided nominal group process with facilitated discussion. Indicators in the final set were ranked based on their priority for measurement. A gap analysis identified areas where future indicator development is needed. A feasibility stud...
Studies in health technology and informatics, 2015
This paper describes an approach which has been applied to value national outcomes of investments... more This paper describes an approach which has been applied to value national outcomes of investments by federal, provincial and territorial governments, clinicians and healthcare organizations in digital health. Hypotheses are used to develop a model, which is revised and populated based upon the available evidence. Quantitative national estimates and qualitative findings are produced and validated through structured peer review processes. This methodology has applied in four studies since 2008.
Recently, many Canadian emergency departments (EDs) have struggled with physician staffing shorta... more Recently, many Canadian emergency departments (EDs) have struggled with physician staffing shortages. In 2006, the Ontario Ministry of Health and Long-Term Care funded a brief "emergency medicine primer" (EMP) course for family physicians to upgrade or refresh skills, with the goal of increasing their ED work intensity. We sought to determine the effect of the EMP on the ED work intensity of family physicians. A retrospective longitudinal study was conducted of the ED work of 239 family physicians in the 2 years before and after a minimum of 6 months and up to 2 years from completing an EMP course in 2006 to 2008 compared to non-EMP physicians. ED work intensity was defined as the number of ED shifts per month and the number of ED patients seen per month. We conducted two analyses: a before and after comparison of all EMP physicians and a matched cohort analysis matching each EMP physician to four non-EMP physicians on sex, year of medical school graduation, rurality, and ...
Studies in health technology and informatics, 2013
Knowledge can be powerful in eliciting positive change when it is put into action. This is the be... more Knowledge can be powerful in eliciting positive change when it is put into action. This is the belief that drives knowledge translation. The University of Victoria (UVic) eHealth Observatory is focused on deriving knowledge from health information system (HIS) evaluation, which needs to be shared with HIS practitioners. Through an application of the Knowledge-to-Action Framework and the concept of a virtual community, we have established the virtual eHealth Benefits Evaluation Knowledge Translation (KT) Community. This paper describes the foundational elements of the KT Community and our overall KT strategy.
Unmet healthcare need should be rare in nations with a universally accessible publicly funded hea... more Unmet healthcare need should be rare in nations with a universally accessible publicly funded healthcare system such as Canada. This however is not the case. This study examines the extent to which predictors of such need are consistent with various paradigmatic approaches (e.g., structural-critical, social capital, social support, and lifestyle) that consider such issues. Analyses of data from a probability sample of 2536 urban residents in British Columbia specified the relationship of unmet need with socioeconomic issues such as income, gender, and housing tenure, community issues such as social networks and social support, and traditional lifestyle or behavioural risk factors. The structural-critical model concerned with socio-demographics provided the most parsimonious explanation for having an unmet healthcare need. Consistent with a structural-critical approach, gender was found to be a reliable predictor of having an unmet health need in each of the models tested. Increasing federal transfers to healthcare and providing childcare and other community supports that are of special value for women may help to reduce unmet healthcare need.
RESEARCH AND PRACTICE Objectives. We examined the effectiveness of community-level HIV preven... more RESEARCH AND PRACTICE Objectives. We examined the effectiveness of community-level HIV prevention programming for men who have sex with men.
Introduction HIV infection is increasingly characterized as a chronic condition that can be manag... more Introduction HIV infection is increasingly characterized as a chronic condition that can be managed through adherence to a healthy lifestyle, complex drug regimens, and regular treatment and monitoring. The location, quality, and/or affordability of a person's housing can be a significant determinant of his or her ability to meet these requirements. The objective of this systematic review is to inform program and policy development and future research by examining the available empirical evidence on the effects of housing status on health-related outcomes in people living with HIV/AIDS. Methods Electronic databases were searched from dates of inception through November 2005. A total of 29 studies met inclusion criteria for this review. Seventeen studies received a ''good'' or ''fair'' quality rating based on defined criteria. Results A significant positive association between increased housing stability and better health-related outcomes was noted in all studies examining housing status with outcomes of medication adherence (n = 9), utilization of health and social services (n = 5), and studies examining health status (n = 2) and HIV risk behaviours (n = 1). Conclusions Healthcare, support workers and public health policy should recognize the important impact of affordable and sustainable housing on the health of persons living with HIV.
Background: Rigorous evaluation of an intervention requires that its allocation be unbiased with ... more Background: Rigorous evaluation of an intervention requires that its allocation be unbiased with respect to confounders; this is especially difficult in complex, system-wide healthcare interventions. We developed a short survey instrument to identify factors for a minimization algorithm for the allocation of a hospitallevel intervention to reduce emergency department (ED) waiting times in Ontario, Canada.
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Papers by Chad Leaver