10 February 2010

Healthcare corner #6 - General effectiveness measurement and current controversies

missed class last week because i had a cold :( but i didnt miss anything in terms of content on the canadian health system. and this week was about effectiveness, in general, so it was still light on canadian-specific info.

so, effectiveness is "the degree to which attainable improvements in health are, in fact, attained." and it appears that there isnt really a mapped out system to collect, monitor, maintain, or report on large scale/national level effectiveness. this may be due to the fact that it would be too costly, time consuming, and/or statistically confusing (because the federal government only sends funds to the provinces who then create separate and specific health care systems for their citizens).

but, there is data availability on the smaller scale. provinces, regional health authorities (RHAs), hospitals, doctors, and research scientists may (and do) collect, maintain, and report on statistics that help them guide health policy and monitor the outcomes of the health system.

here are some policy strategies available to help improve the effectiveness of a health system:
1. medical practice guidelines, such as the canadian task force on preventive health care, are produced by summarizing research findings to suggest best practices for doctors and hospitals (fyi, there is also a u.s. version of this type of site).

2. health planning and reporting. there is no large canadian version of this, but, for example there is a u.s. version that uses the national medicare patient database to report on. its called the dartmouth atlas of health care (my friend meg mentioned this in an earlier comment). for a more palatable "regular person" synthesis of some of their data try this new york times graphic.

3. routine population health reporting, such as the health indicators project, supplies data on general health outcomes for the country and provinces (c-sections rates, rates of heart attacks/stroke/etc).

4. systematic review libraries, such as the cochrane collaboration (summarizes individual medical research studies into one review per topic to find out what really works and what doesnt) and the campbell collaboration (summarizes individual social policy studies into one review per topic to find out what really works and what doesnt).

while these sites are more for the medical/scientific community, they do produce a very short summary blurb to help most regular people get the gist of the results. if you are interested, you can browse the topics on, for example, the cochrane site and find things like "how well do birth control pills work to treat facial acne?"
some current canadian health controversies in the news, for your reading pleasure:
- scandal...the premier of newfoundland/labrador went to u.s. for heart surgery.

- yikes, pelvic exams! my coworker told me about this globe and mail article exposing a frequent canadian medical practice of letting medical students practice pelvic exams on women who are knocked out under general anesthesia for surgery such as hysterectomies, tubal ligation, etc. these women are not consented for this pelvic exam and arent told it was done to them afterward. awesome. glad to see in the article that at least the u.s. doesnt do this.

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