Recherche sur les services humains de la santé
The Centre for Rural and Northern Research (CRaNHR) at Laurentian University conducts interdisciplinary research on health equity issues, including health human services. CRaNHR has a strong history of collaboration, innovation, and exploration surrounding health human services in rural, northern, and remote regions.
Our current and completed research projects in Health Human Services are outlined below. For more information, see NOSM Integrated Impact Investigations.
Current Research Streams
A Pragmatic Effectiveness-Implementation Trial
To Evaluate a Hospital-to-Home Transitional Care Intervention Compared to Usual Care for Older Adults with Multiple Chronic Conditions and Depression Community Assets Supporting Transitions (CAST) Research Study
Principal Investigator: Dr. Maureen Markle-Reid (McMaster)
Co-Principal Investigator: Dr. Carrier McAiney (McMaster)
Local Principal Investigator: Dr. Diana Urajnik (CRaNHR, Laurentian University)
Research Assistant: Julia Russell (CRaNHR, Laurentian University)
Few older adults diagnosed with depression receive adequate treatment, despite the fact that it is one of the most common mental health conditions affecting this population. Transitioning from hospital to home is a risk factor for depression, particularly in older adults who have multiple health problems and few social supports.
The aim of this study is to determine the effects and costs of a hospital-to-home support program for older adults with multiple chronic conditions (MCC) and symptoms of depression. A pragmatic randomized controlled trial design will be used to compare patients receiving the intervention plus usual care to a usual care-only control group. The overall goal is to improve health outcomes in older adults with depressive symptoms and other health problems. This study is being undertaken at multiple locations throughout Ontario, of which Sudbury is one site.
Considering Context: Supporting decision making in rural, northern and remote health care systems.
Principal Investigators: S. Bornstein (CHRSP, Memorial University), A.P. Gauthier (CRaNRH, Laurentian University), M. Doupe (Rady Faculty of Health Sciences, University of Manitoba), and R. Fransoo (Rady Faculty of Health Sciences, University of Manitoba)
Research Coordinator: M.G. French (CRaNHR, Laurentian University)
This five-year innovative partnered integrated knowledge translation (iKT) program will develop, test, implement, and evaluate a suite of approaches to the synthesis and contextualization of health evidence to facilitate the timely delivery and uptake of appropriate decision support products for health systems in rural Canadian communities, including those with Francophone, First Nations, Métis, Innu and Inuit populations. Researchers will organize a three-province program (NL, ON, and MB) of contextualized knowledge synthesis and translation, and prepare for the expansion of the collaboration into other Canadian regions and jurisdictions.
Combining approaches used in NL’s Contextualized Health Research Synthesis Program (CHRSP) with those developed by similar collaborations between researchers and knowledge users in Northern ON and Southern Manitoba, the project will undertake experiments and studies to develop the best ways to help teams in these three provinces to work together on products that are specifically tailored for the needs and contexts of each province’s health system while optimizing engagement and inclusiveness and maximizing the use of limited financial and human resources. This innovative research will help to uncover the common as well as the diverse challenges facing rural Canadian health systems. (Funded by CIHR 2018).
Northern and Rural Family Physicians in Ontario: Who Are They and What Do They Do?
Investigators: E.F. Wenghofer, P.E. Timony and J.C. Hogenbirk
This study has two main research objectives. The first is to establish scope of practice profiles and to explore scope of practice changes over time for the following sub-populations of physicians in Ontario: rural and northern physicians; Francophone physicians; and graduates of the Northern Ontario School of Medicine (NOSM). The second objective is to conduct research on the impact of the admission of medical school applicants with rural upbringing and medical training for northern and rural practice on the physician’s choice of practice location and scope of practice.
To achieve both objectives, the study will use annual registration data from the College of Physicians and Surgeons of Ontario (CPSO) merged with tracking study data to conduct a geographic analysis of physician demographics and practice characteristics (e.g., age, gender, certification, specialty, location of education, scope of practice) for all Ontario. Results should be useful to the CPSO for regulatory purposes involving scope of practice and to the Ontario Ministry of Health and Long-Term Care regarding health workforce planning.
The contribution of the Northern Ontario School of Medicine (NOSM) to the number of physicians and surgeons practicing in Northern Ontario
Investigators: E.F. Wenghofer, J.C. Hogenbirk, and P.E. Timony
The objective is to determine changes over time in the intra-provincial migration patterns of physicians and physician demographics, with a focus on Northern Ontario; and the contribution of NOSM to the pool of physicians and surgeons in Northern Ontario. Using historical data (2000 – 2016) from the College of Physicians and Surgeons of Ontario (CPSO), we will conduct a geographic and temporal analysis of physician demographics and practice characteristics (e.g., age, gender, certification, specialty, location of education) for all Ontario. Results should be useful to the Ontario Ministry of Health and Long-Term Care regarding health workforce planning.
The Priority Assistance to Transition Home (PATH) Program Study
Principal Investigator: Dr. Diana Urajnik
Co- Investigators: Oxana Mian and Julia Russell
Hospitalization rates in the North have consistently been higher than the rest of Ontario. Frequent hospitalizations result in multiple transitions between home and urgent care. There is ample evidence that older adults undergoing care transitions are extremely vulnerable, and if not cared for properly the risk for re-admission to hospital increases significantly, along with other negative health outcomes.
The Priority Assistance to Transition Home (PATH) program was implemented in the North East Local Health Integration Network under the Home At Last provincial model. The goals of the program are to reduce barriers to discharge to ensure the shorter length of stay, to reduce emergency department (ED) wait times, to ensure a smooth transition home following an ED visit or hospital stay, and to provide appropriate supports to settle the person in their home. This evaluation will explore the PATH program and its’ impact on the hospital to home care transitions. The project is a collaborative effort involving the Canadian Red Cross (of Sudbury), The Friends (of Parry Sound), and CRaNHR.
A Needs Assessment of Men's Mental Health and Suicide Prevention Services for Men in Northern Ontario
Investigators: E. Neufeld, T. Smith, M. McLelland, and B. Ward
There is a growing recognition that mental health issues among men need greater attention. The gender paradox in mental health research demonstrates the discordant relationship between men's high rate of suicide and low rates of depression relative to women. Our overall goal is to improve our understanding of men's mental health needs and access to mental health services, including suicide risk and prevention, in two North East communities.
The main objective is to identify and examine mental health services and providers in the Sudbury and North Bay regions. By identifying the needs of the community against the services provided within the regions, gaps in services and overlapping or duplicate services in men's mental health care can be identified. This information can directly influence the integration and collaboration of mental health care providers in the North East region, including decisions around policy and mental health care delivery that specifically targets (i) men and (ii) suicide prevention. All service providers identified in the needs assessment will be provided with a summary of the research results to further stimulate collaboration around community strengths and areas for improvement in men’s mental health and suicide prevention.
The Principal and Co-Investigators represent Laurentian University, Nipissing University, Health Sciences North and the North Bay Regional Health Centre. This initiative between the four partner institutes will support a new foundational program of health services research in mental health and suicide prevention among men; a priority research area recently identified by CIHR. The results of this research will form the basis of a regional needs assessment in the North East, and stimulate further interest, collaboration, and mental health research from the NEAHSN partners over the long term. Our hope is to inform the future development of intervention studies and health outcomes research for men’s mental health in the North. (funding from the North Bay Regional Health Centre, Collaborative Mental Health Research Fund).
Engaging Communities in Setting Priorities for Home and Community Care in Northeastern Ontario
Investigators: W. Warry, E. Neufeld, P. Timony, M. Blind, K. Jacklin, and A. Gauthier
The North East Community Care Access Centre (NE CCAC) is the gateway for home and community care provision in the North East serving approximately 15,000 people every day over 415,000 km2. There is currently under-representation of patient engagement in northern, rural and remote home and community care planning. This project is a means to engage citizens from northern, rural and remote communities on the future of home and community care needs of older adults in the North East. By collaborating with the McMaster Health Forum in Hamilton Ontario and building on the success of their home and community care citizen panel, we aim to establish three representative patient panels that include Aboriginal, Francophone, and Mainstream rural and urban populations in North East Ontario. (funded by the Government of Ontario Ministry of Health and Long-Term Care Health System Research Fund; the North East Community Care Access Centre; and McMaster University's Labarge Optimal Aging Initiative).
Case Studies of Mental Health Services in Smaller Communities in Northern Ontario
Investigators: J.R. Swenson, R.W. Pong, R. Cooke, A. Rudnick, F. Grondin, P. Montgomery, J.E. Sherman, M.G. French, and P.E. Timony
CRaNHR collaborated with the Ontario Psychiatric Outreach Programs (OPOP) to examine the delivery of psychiatric outreach and mental health services in smaller Northern Ontario communities. The case study approach examined services at the community level (rather than at the individual provider level), with a particular focus on access to care, service integration and the development of shared care models. Building on three earlier phases, the study used rapid community assessment methods to develop community case studies. Researchers compared communities currently receiving outreach services from OPOP to those without OPOP services. (commissioned by the Ontario Psychiatric Outreach Program).
Development of an Evaluation Framework for the Local Education Groups (LEGs) Initiative
Investigators: W. Warry, J.E. Sherman, and J.J. Bickford*
Alternative Funding Plans (AFPs) in Ontario support physicians who provide clinical teaching to medical students and residents. Although AFPs exist at other Ontario medical schools, the Northern Ontario School of Medicine's (NOSM's) distributed medical education (DME) model requires a different approach to supporting clinical faculty. Local Education Groups (LEGs) are self-organized groups of NOSM clinical faculty who are responsible for providing selected medical education services at the undergraduate and/or postgraduate level. The goal of this research project is to develop an evaluation framework for the LEGs Initiative. The project will also document the LEGs Initiative's accomplishments to date. (funded by the Northern Ontario Academic Medical Association).
Do Monash Rural Background Students Become Rural Doctors?
Investigators: R.P. Strasser, M. McGrail, J.C. Hogenbirk, S. Lacarte, M. Lewenberg, and A. Kevat
This international collaborative study is being conducted by researchers at the Centre for Rural and Northern Health Research (CRaNHR), Northern Ontario School of Medicine (NOSM) and Monash University in Australia. The study tracks medical students who graduated in 1998-2005 from Monash University's Rural Medical School (the MBBS program) as they move through Australia's postgraduate medical education programs (vocational training) and into independent practice after becoming fully vocationally qualified. This on-going research programme compliments tracking studies conducted on NOSM students and residents. Similarities and differences in the socio-political context, education programming and study findings are expected to continue to help inform policy and decision-making on medical education and medical human resources planning in Australia and Canada. (funded by the Northern Ontario School of Medicine).
Evaluation of Community Paramedicine Programs in Northern Ontario
Investigators: S. Ritchie, J.E. Sherman, C. Prevost, J. Nixon, D. Wolff, D. Cremin, J. Greenaway, D. Black, and K. Gallo
The Ontario Ministry of Health and Long-term Care has identified community paramedicine (CP) as an important new healthcare delivery model, designed to fill gaps in community-based health services, reduce avoidable use of emergency services, and promote health, particularly among seniors and those living with chronic conditions. In 2014, several CP pilot programs were funded, including a partnership between Manitoulin-Sudbury District EMS and Cochrane District EMS in the northeast, and programs developed by Rainy River District EMS and Superior North EMS in the northwest. The model is being developed and tested in rural and northern Ontario is distinct from southern and urban-based models which usually operate community paramedicine as an ancillary service, with staff time dedicated to CP activities. However, in northern rural districts, paramedics must be available despite relatively lower call volumes and can experience significant "downtime" between emergency calls. Because of this, as well as concerns about the sustainability of community paramedicine, these four northern EMS providers have developed an innovative model where community paramedicine is integrated within the regular duties of paramedics. Specific components of the CP programs are home visits (including follow-up after hospital discharge), wellness clinics, and referrals to and from other healthcare providers.
The research and evaluation project is focused on assisting the EMS services with the process and impact evaluation activities, including a survey of patients/clients and caregivers, a survey of paramedics and other health professionals, and a quantitative analysis of health outcomes. Lessons learned from the pilot programs will be documented and shared through KTE activities.
Exploring Administrative Health Data to Inform the Development of a Seniors' Wellness Strategy for the City of Greater Sudbury
Investigator: E. Neufeld
The City of Greater Sudbury (CGS) is proposing to develop a Seniors Wellness Strategy. The main goal of the Seniors Wellness Strategy is to create a senior-friendly community and transform the CGS into an age-friendly city. This research study will inform recommendations for a broader Well-Being Master Plan being developed by the CGS using a robust examination of retrospective data to operationalize health and wellbeing, and examine associated factors that enhance or hinder seniors' opportunities for a healthy lifestyle, access to health care, civic engagement and social capital.
The research design is a cross-sectional examination of administrative health data, between 2011 and 2013, across four sectors of the health care system: home care, continuing care, community support services, and inpatient psychiatry. Data requests to the Canadian Institute for Health Information (CIHI) and the MOHLTC's Community Care Information Management (CCIM) - Integrated Assessment Record (IAR) project will provide access to the administrative health data. All data were collected as part of standardized practice in the province of Ontario.
Through the examination of administrative health data for Greater Sudbury, a comprehensive understanding of the health and wellness needs of older adults across the care continuum can be achieved. By mapping aggregated health and wellness trends, the findings can visually inform where services and resources would be most beneficial based on the needs of the CGS population. The findings from this research will be used by municipal community planners to develop recommendations for the Seniors' Wellness Strategy that are evidence-based and generalizable to the CGS. (funding from the City of Greater Sudbury, North East Centre of Excellence in Seniors Health).
How Well Does Ontario's Primary Health Care Nurse Practitioner Education Prepare Nurses for Advanced Professional Practice Roles and Responsibilities?
Investigators: I. Koren, O. Mian, E. Rukholm, S. Lacarte, R. Heale, and J.-L. Fournier
This project examined perceived preparedness of the Ontario's PHC NP graduates for advanced professional practice in a variety of roles, practice models and settings in the province. The study was built on the more than decade-long studies of NP education and practice conducted by CRaNHR (Caty, Michel, Pong, and Stewart, 1997,1998, 2000, 2001, 2002; Koren, Mian, and Rukholm, 2010; and Mian, Koren, and Rukholm, 2012). The findings of the study informed PHC NP education decision makers with graduates’ assessment of their competence and capability at the practice level, perceptions of strengths and gaps in their educational preparation and factors influencing these perceptions. (funded by the Consortium of Ontario University Programs in Nursing, Primary Health Care Nurse Practitioner Evaluation Fund).
Inclusion of Mental Health and Addictions Services in Interprofessional Primary Health Care Delivery in Northern, Rural or Remote Settings
Investigators: E. Neufeld, J. Bickford, S. Lacarte, and K. Viau
This project assessed and summarized Canadian and international literature examining the integration of mental health and addictions services in interprofessional primary healthcare delivery models. Four primary healthcare models were identified that addressed the access-related challenges to healthcare delivery experienced by northern, rural or remote communities in Canada. These challenges cover health human resource shortages, a lack of coordination across sectors and jurisdictions, and geographic barriers. This synthesis utilized evidence from over ninety peer-reviewed papers and grey literature to develop recommendations for communities moving to integrate mental health and addictions services in primary healthcare services. (funded by the Canadian Foundation for Healthcare Improvement).
Socio-Economic Contribution of Health Sciences North/Horizon Santé-Nord
Investigators: J.C. Hogenbirk, D. Zitikyte, D. Kaymak, M. Lasota, M. McCracken, S.E. Barnett*, O.M. Mian, and M.G. Delmege
Health Sciences North/Horizon Santé-Nord (HSN) is a regional resource and referral centre for more than half a million residents of northeastern Ontario. The hospital is developing into an academic health sciences centre complete with teaching and research facilities and resources, including faculty who are cross-appointed to the Northern Ontario School of Medicine (NOSM). This study assessed the socio-economic impact on the City of Greater Sudbury and nearby communities. An economic model (developed by Informetrica Ltd - a partner in this study) was used to determine the direct, indirect and induced economic contribution to the City of Greater Sudbury. The model was also used to explore the economic contribution of hospital outreach programs on nearby communities as well as the impact of new or expanded research, teaching or clinical initiatives. Finally, a number of interviews were conducted with key informants from several communities so as to assess the impact of HSN on social and professional networking opportunities, as well as on business and educational opportunities. Model results and interview findings were used to assess the impact of hospital activities and inform recommendations for the strategic development and support of teaching, research, clinical services as well as outreach and satellite clinical programs. (funded by Health Sciences North/Horizon Santé-Nord).
Trauma System Development in Canada: Overcoming the Challenges of Geography through an Evaluation of Structure and Process
Investigators: A.B. Nathens, A.R. Gagliardi, R.W. Pong, G. Rubenfeld, N.C. Schuurman, J.E. Sherman, O. Mian, J.C. Hogenbirk, M.B. Gibbon, M.G. Delmege, et al.
Severely injured patients have a lower mortality risk if cared for in trauma centres. Thus, survival is dependent on an integrated regional system of care so that these patients are identified, supported and rapidly transported to a trauma centre. But trauma centres are mostly located in urban regions, limiting prompt access to 20% of Canadians living in rural areas. Owing to the distribution of trauma patients and centres, 50% of trauma patients receive preliminary care at non-designated centres before transfer to a trauma centre. As trauma system configuration and preliminary care might have a significant impact on ensuring the "right patient gets to the right place at the right time," the project proposed the following overarching objectives: (1) to assess the relationship between trauma system structure and process; (2) to optimize the preliminary care of the patient with major injury. (funded by the Canadian Institutes of Health Research).
Social Inclusion of Informal Caregivers in Elliot Lake
Investigators: J.E. Sherman, S.A. Lacarte, and P.E. Timony
Informal caregivers may have lower levels of access to and participation in economic, recreational, volunteer, civic or other social activities that contribute to their own wellbeing. Providers of informal care may be seniors and/or recipients of care themselves, multiplying the challenges that they face toward full and active participation. The City of Elliot Lake in northeastern Ontario is well-known for its successful transformation from a former mining community into a thriving retirement community and provides for an excellent case study of informal caregiving. In the first phase of this project, a scoping study was conducted to review available information on social inclusion of seniors and caregivers in Elliot Lake. The second phase focused on informal caregivers, and described their experience of social inclusion or exclusion, perceptions of supports and barriers to social participation, and perceived unmet needs. The project identified effective practices for the social inclusion of informal caregivers and identified issues for public policy and program consideration. (funded by Human Resources and Skills Development Canada).
Sustaining the Nursing Workforce in Northeastern Ontario
Investigators: E.E. Rukholm, I.E. Koren, B. Nowrouzi, and O.M. Mian
There is an immediate urgency to build experienced RN and RPN replacement and sustainability capacity to address the increasingly complex health care demands in NE Ontario. The purpose of the project was to examine barriers and facilitators to sustaining the nursing workforce in Northeastern Ontario. Data collection included a mail survey of the nursing workforce and key informant interviews of employers. Deliverables included directory and profile of nurses and their workplaces in Northeastern Ontario across multiple sectors including public health, acute care, and long-term care; profile of organizational recruitment and retention practices and policies in the above healthcare sectors; report detailing the recruitment and retention barriers/facilitators, strategies/ideas identified by practicing nurses, employers, and senior nursing students; knowledge translation activities such as presentations to key stakeholders; online toolkit of key sustainability strategies on the CRaNHR website; information in formats accessible to the public; and academic publications. (funded by the Ontario Ministry of Health and Long-Term Care / Nursing Health Services Research Unit).
The Nurse Practitioner Tracking Study
Investigators: I.E. Koren, E.E. Rukholm, O.M. Mian, R.W. Pong, S.A. Lacarte, and C.W. Sloan
Nurse practitioners (NPs) are registered nurses who have acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice. A graduate degree in nursing is considered essential for this advanced practice role. In Ontario, amendments to legislation regulating NP practice in 2007 resulted in protection of the "Nurse Practitioner" title and three areas of specialization were designated: Adult, Pediatric and Primary Health Care. In 2006, the Nursing Secretariat of the Ontario Ministry of Health and Long-Term Care has commissioned CRaNHR to conduct annual tracking surveys of NPs in the province in order to document the integration of NPs into the health care system. In addition to core questions on demographics, education, practice and client characteristics, a set of questions on topics of interest is added to the survey from year to year. The 2009 survey included questions about nursing leadership, collaboration with other healthcare providers and barriers to practice. The previous year surveys asked NPs about preferences for continuing education; retirement plans; incentives to work with underserved populations in inner-city, rural and remote areas; and, the use of medical directives. (funded by the Ministry of Health and Long-Term Care)
Critical Appraisal of Health Human Resources Forecasting Tools Suitable for the Northeast Local Health Integration Network
Investigators: J.C. Hogenbirk, P.E. Timony, and R.W. Pong
Health human resource (HHR) planning requires dependable and meaningful data on existing health service personnel and reliable estimates of future surplus or deficits for key personnel. This is particularly challenging for Local Health Integration Networks (LHINs) that have to work with a wide array of agencies and locations. The purpose of this project was to critically appraise available HHR forecasting models in regard to their suitability for use in the NE LHIN. Nine models were identified through a search of the literature and after consultation with experts. These models vary based on data needs, theoretical underpinnings as well as the spatial and temporal scales of the forecast.
Results of this study were used by the NE LHIN's Health Human Resources Plan Steering Committee to identify and pilot test one model to address human resources needs for a 3-12 month time span among 5 health care organizations (hospital, long-term care facility, etc.). The NE LHIN plans to pilot-test a second model. CRaNHR's research study emerged in response to practical research need to address HHR planning across the NE LHIN so as to consolidate recruitment strategies, facilitate inter-agency cooperation and eventually permit cross-appointment of personnel. All of this research underwrites an effort to improve service delivery by ensuring that the right people are in the right place at the right time to provide health and social care. In addition, successful HHR planning should help to realize system efficiencies in combining recruitment efforts and facilitating retention of qualified health and social care providers across the NE LHIN. (funded by the Northeast Local Health Integration Network)
Developing Metrics to Evaluate the Performance of the Revised Underserviced Area Program
Investigators: E.F. Wenghofer, J.C. Hogenbirk, R.W. Pong, and I.L. Bourgeault
The Centre for Rural and Northern Health Research at Laurentian University and the Ontario Health Human Resources Research Network jointly conducted a research study to provide the Ontario Ministry of Health and Long-Term Care with a list of baseline metrics and preliminary performance measures suitable for the evaluation of the revised Underserviced Area Program. These metrics and measures were developed so that future evaluations could address the following questions:
1. Have the new programs changed (a) the number of physicians providing services in eligible communities and (b) the nature of physician services in eligible communities?
2. Has the new program encouraged participating physicians to stay in these communities? (funded by Ontario Health Human Resources Research Network)
Psychiatric Outreach Service Models in Smaller Communities in Northern Ontario
Investigators: J.R. Swenson, R.W. Pong, P. Ravitz, R. Cooke, A. Rudnick, P. Montgomery, J.E. Sherman, M.G. Delmege, and P.E. Timony
In this project, CRaNHR researchers collaborated with the Ontario Psychiatric Outreach Program (OPOP) to examine models of psychiatric outreach in smaller Northern Ontario communities. Using a mixed method approach that included a systematic review of the literature, a survey of OPOP consultants and local mental health and primary care providers, key informant interviews, and focus groups, the project described and compared models of psychiatric outreach in mental health service delivery, and the factors contributing to the selection of models, in communities both served and not served by OPOP.The project objectives were to document and explain alternative approaches to increasing access to psychiatric care, particularly outside of large urban settings, as well as the perceived impacts of these approaches on the organization and delivery of local mental health services. The study was the first step towards the development of an evidence-based approach for planning and assessing services provided by OPOP. (commissioned by the Ontario Psychiatric Outreach Program)
Inventory and Documentation of Outcomes of the 2004 Rural and Northern Networks Funding Initiative
Investigators: E.F. Wenghofer, J.E. Sherman, R.W. Pong, and M.G. Delmege
The Rural and Northern Health Care Framework Funding Initiative was a one-time, $10M incentive program in 2003/2004 designed to facilitate the implementation of hospital networks in support of the 1997 Rural and Northern Health Framework. The Framework was developed to guide the MOHLTC and partners in restructuring health care services so as to improve access to and quality of health care in rural and northern Ontario. Projects funded under this initiative were to have been completed by early 2005. This study investigated what has been achieved through the 2004 Rural and Northern Network Funding Initiative. By reviewing relevant documents and interviewing stakeholders, the project explored whether and how the funding initiative has advanced the objectives of the 1997 Rural and Northern Health Care Framework and the extent to which rural hospitals work collaboratively. (commissioned by the Ministry of Health and Long-Term Care)
Nursing in Ontario, 2007: A Geographical Analysis
Investigators: R.W. Pong and J.R. Pitblado
This project provided baseline (2007) information to assist the Ontario Nursing Secretariat in nursing workforce planning. The study provided descriptive and statistical summaries (based on demographic, educational, employment and mobility characteristics) of the Ontario nursing workforce of registered nurses, nurse practitioners and registered practical nurses based on College of Nurses of Ontario 2007 registrations. The geographical units of analysis and results included: provincial overviews; rural-urban overviews; individual local health integration network (LHIN) characteristics and LHIN comparisons; and rural-urban analyses within each LHIN. It is well known that healthcare personnel is not always well distributed relative to the geographic distribution of the general population. This is particularly the case when examining sub-provincial distributions (e.g., by LHIN) or when comparing rural and urban areas. This project identified where and if these so-called maldistributions of nurses occurred in Ontario in 2007. This study enabled the Nursing Secretariat to identify locations that need the most attention to overcome imbalances, where they exist. It is also recognized that health human resources planning is a complex enterprise that requires multiple inputs or modeling considerations. The project dealt only with what would be considered one component of that enterprise - the "supply side". (commissioned by the Nursing Secretariat, Ministry of Health and Long-Term Care)
Development of a Methodology to Allocate Resources to Help Overcome Physician Shortages in Underserviced Communities
Investigators: R.W. Pong, J.R. Pitblado, K.V. Nagarajan*, R. Strasser, J.C. Hogenbirk, D. Heng, M.G. Delmege, and S.M. MacPherson
Geographic maldistribution of health care practitioners is an enduring and almost universal phenomenon. Physicians, in particular, tend to concentrate in large urban centers, such that many smaller or more remote communities do not have an adequate supply of physicians to meet their medical care needs. Over the years, the Ontario Ministry of Health and Long-Term Care has introduced a broad array of programs to deal with this problem, including the Underserviced Areas Program. This research project focused on developing a new approach with a view to identifying communities or regions that may need assistance to overcome physician shortages and determining the relative levels of assistance that may be required. The research combined an examination of existing resource allocation methodologies, literature reviews, interviews, and focus groups to help identify issues, creating indices of medical care needs and physician requirements, and testing the "goodness of fit" of such indices against current situations. (commissioned by the Ministry of Health and Long-Term Care)
Secondary Analysis of CGS Physician Retention Survey
Investigators: J.C. Hogenbirk and S.M. MacPherson
CRaNHR was asked to conduct additional statistical analyses on survey data. The survey was conducted in spring of 2006 by Oraclepoll Research Ltd and was endorsed by the Sudbury and District Medical Society, the Sudbury Regional Hospital and the Mayor and Council's Roundtable on Physician Recruitment and Retention in the City of Greater Sudbury. CRaNHR's approach was to compare groups of physicians to see if there were major differences in their responses to selected questions. In total, 9 groupings and 20 questions were analyzed in a series of cross-tabulations that were used to explore differences and identify factors that can be influenced by stakeholders to improve recruitment and retention in the city. (commissioned by Mayor and Council's Roundtable on Physician Recruitment and Retention in the City of Greater Sudbury)
A Profile of the North Simcoe Muskoka Region and Implications for Health Services Planning
Investigators: R.W. Pong, J.C. Hogenbirk, S.M. MacPherson, and D. Heng
CRaNHR researchers developed a population health profile of the North Simcoe Muskoka Local Health Integration Network region and discussed what the health profile meant from the perspective of health services planning. This profile described the health status of the region's residents and provided baseline data with which future changes can be compared. The health status and health service utilization indicators used in this report were based on secondary data from a variety of sources. The indicators were categorized as sociodemographic characteristics, self-reported health status, morbidity and mortality, prevalence of selected chronic health conditions, health behaviors and practices, and health services utilization (including preventive care). In addition, the report discussed several special issues such as the health care implications of population aging and health services utilization by seasonal or tourist populations. The research was intended to support regional health services planning. (commissioned by North Simcoe Muskoka Local Health Integration Network)
Full-Time/Part-time Employment of Nurses in Small Hospitals in Rural and Northern Ontario: Current Status, Issues, and Options
Investigators: R.W. Pong, E. Rukholm, J.R. Pitblado, S. Larocque, and C.W. Sloan
The Ministry of Health and Long-Term Care has indicated that it "will continue to work with employers to increase the percentage of nurses employed full time, with a goal of 70 percent of nurses working full time in Ontario." Some administrators of small hospitals believe that they may experience problems meeting the 70 percent full-time employment target because of the small size of their programs and the small numbers of nurses employed. Using several methodological approaches and data from a variety of sources, this study examined the impact of this policy on small hospitals in rural and northern Ontario and identified implementation options. It interviewed senior hospital administrators and surveyed a sample of nurses living in smaller rural and northern communities. The information, along with other data, was used to describe the current full time, part time and casual employment status of registered nurses and registered practical nurses in rural and northern Ontario, and to examine the problems these hospitals face in implementing the 70 percent full-time policy. Focus groups were drawn on the information to develop alternative strategies and approaches to facilitate optimal employment status of nurses in small hospitals. (funded by the Ministry of Health and Long-Term Care)
Using Performance Indicators and Benchmarks in Primary Health Care
Investigators: J. Barnsley, W. Berta, J. Bloom, R. Cockerill, L. Jaakkimainen, R.W. Pong, and Y. Talbot
The main objective of this research project was to design and validate a set of performance indicators and benchmarks that can be used to assess primary care practices in different settings (e.g., those in rural areas vs. those in urban areas; those in fee-for-service reimbursement arrangements vs. those in alternative payment plans). Performance data were collected from about 50 primary care practices in Ontario by means of chart abstraction, key informant interviews, and direct observation. Data from other sources such as OHIP were used to validate the performance indicators and benchmarks. CRaNHR was a collaborator in this project that is led by researchers at the University of Toronto. One of CRaNHR's roles was to develop primary care practice profiles from secondary data sources, against which the performance data were compared and interpreted. (funded by the Primary Health Care Transition Fund)
Canada's Rural Communities: Understanding Rural Health and Its Determinants
Investigators: M. Desmeules, R.W. Pong, J.R. Pitblado, I. Koren, C. Lagacé, R. Bollman, J. Guernsey, A. Kazanjian, D. Manuel, and D. Heng
This research program was a collaborative endeavor involving CRaNHR, Public Health Agency of Canada, Institute for Clinical Evaluative Sciences, Dalhousie University and the University of British Columbia.
2005 Ontario Training Centre Summer Institute
Investigators: R.W. Pong, D.M. Cudney, V.G. Guérin, N. Booth, L. Kay, Summer Institute Planning Committee, and OTC Principals
The Ontario Training Centre in Health Services and Policy Research (OTC) had its second Summer Institute at Laurentian University and the theme was "Health Human Resources Research and Policy: A Focus on Rural and Northern Issues." It focused on research and policy issues in relation to the health workforce, with an emphasis on health workforce challenges in rural or northern settings. The OTC Summer Institutes provide opportunities for students to learn from experts, to share knowledge, and to exchange ideas. The OTC Summer Institutes are designed to expose students to important health services and policy issues and challenge them to a) develop program-specific monitoring and evaluation strategies that are scientifically rigorous; and b) design dissemination approaches that would facilitate the uptake of research results by decision- or policy-makers. (funded by the Canadian Health Services Research Foundation, the Ministry of Health and Long-Term Care, the Canadian Institutes of Health Research, Health Canada, the Canadian Institute for Health Information, and the Ontario Training Centre in Health Services and Policy Research)
The Nurse Practitioner Workforce Survey
Investigators: R.W. Pong, C.W. Sloan*, S. Caty*, and E. Rukholm
Nurse Practitioners are registered nurses with additional education that allows them to provide a broader scope of health care. From 1998 through 2002, about 400 new NP positions have been created with funding from the provincial government. Since 2003, the new government has made a further commitment to adding 252 NP positions by 2005. The objective of this study was twofold. First, CRaNHR conducted a survey of all Primary Health Care Nurse Practitioners and Acute Care/Specialty Nurse Practitioners in order to obtain employment and practice information about NPs in Ontario. Second, this information was used by CRaNHR and/or Nurse Practitioners Association of Ontario (NPAO) researchers to examine the demographic characteristics, geographic distribution, employment trends and practice profiles of NPs. As well, NPAO used selected information items to develop a publicly accessible website in order to provide information on the availability of NPs. (funded by the Nurse Practitioner Association of Ontario)
Triage Activities in Hospital Emergency Departments in Ontario
Investigators: R.W. Pong, V. Sahai, and C.W. Sloan
This study was part of a large project designed to improve the use of the Canadian Emergency Department Triage and Acuity Scale (CTAS) in Ontario hospitals. A survey of hospital emergency departments was conducted by CRaNHR to find out how CTAS is used and how triage is affected by various factors such as community characteristics, staff qualification and emergency department layout. Secondary data from the National Ambulatory Care Reporting System (NACRS) was also used to supplement the survey data. Information collected from the survey and NACRS was analyzed with a view to informing the development of triage training programs and quality assurance guidelines. This study was a collaborative effort between CRaNHR and the Northern Health Information Partnership. (funded by the Ontario Hospital Association)
Knowledge Translation and Exchange in Children's Mental Health in Rural Communities
Investigators: K.M. Boydell, E. Stasiulis, M. Barwick, R.W. Pong, and N. Greenberg
This study examined the uptake and utilization of research findings and information on children's mental health by health care practitioners, decision-makers and consumers in rural Ontario. To this end, the study sought to identify research utilization practices of key stakeholders in children's mental health in several rural communities in northern and southern Ontario and to assess community readiness for adopting various knowledge translation strategies. This study was a collaborative effort involving researchers at the Hospital for Sick Children and CRaNHR. (funded by the Canadian Institutes of Health Research)
An Evaluation of the Nurse Practitioner Continuing Education Implementation Project:
Final Report to the Council of Ontario University Programs in Nursing (COUPN)
Investigators: K.C. Tilleczek, S. Caty, N. Russell, R.W. Pong, and E. Rukholm
In 1995, the Council of Ontario University Programs in Nursing (COUPN) began offering the Primary Health Care Nurse Practitioner Education Program via distance education. The program is offered in English at ten university schools of nursing and in French at two university schools of nursing. Health Canada has announced that COUPN will administer a $1.5 million fund to support continuing education programs for NPs who work in rural, northern, and remote areas in Ontario. Prior to designing and piloting continuing education programs for nurse practitioners (NPs), COUPN commissioned CRaNHR to conduct a continuing education needs assessment study, with a focus on the NPs in rural, northern, and remote communities in Ontario. A multiple method approach was used to answer the following three general questions: 1. Did participants learning what they want and need? 2. Did the method of delivery helping or hindering? 3. What other continuing education activities could be developed? (funded by the Council of Ontario University Programs in Nursing (COUPN))
Nature of Nursing Practice in Rural and Remote Canada
Investigators: J. Kulig, M. MacLeod, J.R. Pitblado, N. Stewart, and J. Medves
The aim of this project was to examine the nature of registered nurses' practice in primary care, acute care, community health, continuing care (home care), and long-term care settings in rural and remote Canada. The study provided detailed information that can be employed in policy-making and program planning on the practice, recruitment, retention, and education of nurses in rural and remote Canada. This was a multi-center, multi-disciplinary study, involving researchers from across the country, including those at CRaNHR. (funded by the Canadian Health Service Research Foundation and other organizations)
Rural Perspective on Continuity of Care: Pathways and Barriers to Care for Children with Emotional and Behavioural Disorders
Investigators: K. Boydell, R.W. Pong, K.C. Tilleczek*, A. Salmoni*, S. Milne, R. Landry, J. Iserman, B. Everett, and D. Cote
Utilizing a qualitative approach, this research addressed the issue of access to care by children and youth with emotional and behavioral disorders in rural areas from the perspectives of both service providers and families. In-depth interviews were conducted with health care practitioners, informal caregivers, and other individuals who work with children with emotional and behavioral problems. Facilitators of and barriers to care were identified and discussed. The study was conducted in the Sudbury and Owen Sound areas. The research project was based on an approach designed to have decision-makers participate in all aspects of the study from implementation to dissemination.(funded by the Canadian Health Services Research Foundation and the Ministry of Health and Long-Term Care)
The Northern Ontario Child and Youth Health Report
Steering Committee Members
The Northern Ontario Child and Youth Health Report presented the most current regional information on the health status and determinants of health for children and youth residing in Northern Ontario, Canada in June of 2003. This project has been a collaborative effort headed by The Northern Health Information Partnership (NHIP). The advisory committee is co-chaired by Vic Sahai of NHIP, and Kate Tilleczek of the Centre for Rural and Northern Health Research (CRaNHR). Members of the advisory group include representatives from Laurentian University, Nipissing University, Lakehead University, three Northern Ontario District Health Councils, District Health Units, and the Ministry of Health and Long-Term Care. Many other community members have provided valuable research direction and input into the use of the report. The project has attempted to provide a baseline description of the health of children and youth from ages 7 to 19 years in Northern Ontario, Canada. Children and youth live in families, families live in communities and communities are embedded in regions. Regional information on children and youth is, therefore, important in providing contextual information about the lives of children and youth. (funded by the Northern Health Information Partnership)
Assessing Continuing Education Needs of Nurse Practitioners in Northern and Rural Southern Ontario
Investigators: S. Caty, K.C. Tilleczek, R.W. Pong, I. Michel*, and S. Lemieux
Health Canada has provided funding for the development and delivery of continuing education programs to support the learning needs of nurse practitioners in rural and northern Ontario. This initiative is administered by the Council of Ontario University Programs in Nursing (COUPN). In preparation for the development of continuing education strategies and programs, CRaNHR has been commissioned by COUPN to conduct an assessment of the learning needs of the nurse practitioners working in rural and northern communities of the province. The needs assessment will also examine how these continuing education programs should be delivered and the approaches to be used in maintaining and enhancing the competency and knowledge of nurse practitioners. (funded by the Rural and Remote Health Innovations Initiative, Health Canada)
A Review and Synthesis of Policy and Strategy Documents on the Rural Health Workforce
Investigators: R.W. Pong and N. Russell
Shortages of health care providers are a reality in many parts of rural Canada. Many attempts have been made by federal and provincial governments, as well as by various health-care agencies and professional organizations. Many commission reports, task force studies, policy papers, and strategic planning documents have been issued on this persistent and vexing problem. The purpose of this study is to review these policy and strategy documents and to synthesize their findings and recommendations with a view to informing future policy development and health service planning exercises. This study is an integral component of a rural health human resources development project spearheaded by The Ontario Rural Council. (funded by Human Resources Development Canada)
Continuity of Care for Community-dwelling Seniors
Investigators: A. Salmoni, R.W. Pong, E. Rukholm, M. Lemonde, J. Horne, R. Knight, R. Joly, B. MacLellan, D. McMillan, L. Andrighetti, L. Martin, and K. Byrne
This study seeks to identify the important elements of continuity of care as they pertain to seniors being discharged from hospital to community-based care. While there is agreement that continuity is an important dimension of quality of care, there is no consensus on what constitutes continuity of care. In addition, current definitions of continuity of care have been derived without inputs from different stakeholders. The primary objective of this study is to survey a sample of stakeholders to identify the critical elements for continuity of care. The stakeholders include seniors (in- and out-patients discharged from hospital), hospital and community-care administrators, physicians, nurses, case managers, and informal caregivers. A valid operational definition of continuity, as well as a set of potential performance indicators, will help set guidelines for case, and promote the effective and efficient use of scarce resources. (funded by the Canadian Health Services Research Foundation)
Health and the National Atlas of Canada
Investigator: J.R. Pitblado
Since 1906, the National Atlas of Canada has played a major role in interpreting Canada cartographically. However, from the first to the fifth edition of the Atlas there has been relatively little included about the health of Canadians. This project is meant to remedy that by expanding the content of the sixth edition now delivered entirely via the Internet. Components of health are not uniformly distributed in space and regional variations are often best portrayed and analyzed cartographically in, for example, atlas form. Through a series of maps (in digital form), explanatory text, a glossary, and the provision of links to related websites, a number of key health indicators are presented and explained. The health of Canadians in general is the focus of the initial work. The health of Canadians in general is the focus of this work, though there is a section on the health of rural Canadians. (commissioned by the National Atlas of Canada, Natural Resources Canada)
Tracking Changes in Informal Care: A Feasibility Study
Investigators: A. Salmoni, R.W. Pong, R. Mannell, E. Rukholm, and L. Martin
The health care system in Ontario is transforming from a predominantly institutional to a community-based focus. Increasingly, informal care is becoming an extension of formal care. This study is the first in a series of studies that will examine changes in informal care, how informal care is affected by changes in the health care system, and how the growing demand for care is affecting the caregivers. As a feasibility study, it seeks to develop an overall research strategy for tracking changes in informal caregiving and clarify conceptual and methodological issues. Data collection took place in Sudbury, Waterloo, and Toronto. (funded by the Change Foundation)
Situational Analysis of Physician Recruitment and Retention in Rural and Northern Canada: Models, Programs and Evaluations
Investigators: B. Minore, R.W. Pong, and R. Ariss
At the request of the Ministry of Health and Long-Term Care (MOHLTC), CRaNHR conducted a situational analysis of information on the recruitment and retention of rural physicians in Canada. This involved an extensive review of the literature (both academic and the so-called grey literature such as government reports) and telephone interviews with key individuals responsible for managing rural physician recruitment and retention programs in various provinces and territories. The resulting report highlighted the various ways that underserviced areas are defined, the recruitment and retention approaches used and evaluations of program effectiveness. (funded by the Ontario Ministry of Health and Long-Term Care)
The 2001 National Family Physician Survey
Investigators: R.W. Pong, M. Lefebvre, A. Irvine*, and L.J. Liboiron, in collaboration with the College of Family Physicians of Canada
The College of Family Physicians of Canada decided in 1997 to survey a sample of family physicians across the country and to establish a family physician workforce database. CRaNHR was commissioned to conduct the 1997 survey. In order to measure changes in practice pattern over time, the College of Family Physicians of Canada also decided to conduct the survey on a periodic basis. Unlike the 1997 survey, the 2001 survey attempted to contact all family physicians and general practitioners across Canada (over 28,000 family doctors). The 2001 survey sought to obtain information on various aspects of the work of family physicians: practice setting, clinical practice profile, on-call, access to care, changes in practice, personal/family life, education/training, etc. The advisory committee of the 2001 National Family Physician Survey included representatives of the Canadian Medical Association, the Royal College of Physicians and Surgeons of Canada, La fédération des médecins omnipracticiens du Québec, the Canadian Institute of Health Information, etc. (commissioned by the College of Family Physicians of Canada)
The 1997 National Family Physician Survey
Investigators: R.W. Pong, C. Gutkin (CFPC), N. Busing (CFPC), A. Irvine, and D.A. Pearson
The 1997 National Family Physician Survey, the first of its kind, was conducted by CRaNHR, in collaboration with the College of Family Physicians of Canada (CFPC). One of the main objectives of this survey was to improve the understanding of the present and future roles of family physicians in providing medical care to Canadians. This survey, which was part of the CFPC Janus Project, surveyed over 5,000 family physicians and general practitioners in order to develop a national family physician workforce database. For a summary of the survey findings, please visit the CFPC website at: http://www.cfpc.ca/janus/ (commissioned by the College of Family Physicians of Canada)
Development of Performance Indicators for Mental Health Services
Investigators: K.T. Chan*, A. Irvine*, and R.W. Pong
In an attempt to improve the quality and delivery of mental health services in northern and rural communities, the Northeast Mental Health Centre (formerly Network North) commissioned CRaNHR to develop a continuous quality improvement system. As part of the process, CRaNHR researchers worked with the management and staff of the Northeast Mental Health Centre to develop a set of performance indicators for institutional services, community-based services, and corporate services in order to assess performance and to monitor changes in service quality over time. (commissioned by Northeast Mental Health Centre)
Local Economic Impact of Health Care Institutions in the Sudbury Region
Investigators: M.C. McCracken, R.W. Pong, J.C. Hogenbirk, and M. Lasota
This study was jointly conducted by CRaNHR and Informetrica Limited, an Ottawa-based economic consulting firm, with the participation of several health-care institutions and the physician community in Sudbury. A health care institution like a hospital or a nursing home provides a service to a community and thereby contributes to the health and well-being of the residents. But does it do more than that? From an economic perspective, a health care institution is no different from any other business or organization in a community: it hires people and pays them wages, its buys goods and services, it pays local taxes and receives income from its "customers." In other words, besides making health services available, a health care institution has an economic impact on the community in which it is located. This study was conducted with a view to examining the economic impact on the Sudbury region of seven health care institutions (Sudbury Regional Hospital, Northeastern Ontario Regional Cancer Centre, Northeast Mental Health Centre, and four long-term care facilities) and physicians practicing in Sudbury. The results of the study show that the seven health care institutions and the physicians had a major impact on the local economy of the Sudbury region. (funded by FedNor and Sudbury Regional Hospital)
Impact Assessment of an Outreach Chemotherapy Program in Northern Ontario
Investigators: R.W. Pong, A. Irvine*, C. McChesney, H. Blanco, C. DesRochers, and A. Valiquette
In order to enhance access to cancer care by rural residents, the Northeastern Ontario Regional Cancer Centre (NEORCC) has introduced a Chemotherapy Outreach Program. Because little is known about the impact the program had on the patients, providers, and agencies involved, NEORCC and CRaNHR jointly conducted an impact assessment of the program. The impact assessment focused on several aspects: (1) the impact of the program on cancer patients, particularly in terms of quality of life, patient satisfaction, and costs incurred; (2) the impact on providers (physicians, nurses, pharmacists, etc.) in terms of changes in roles and activities, training needs, etc.; and (3) the impact on NEORCC, especially in terms of organizational structure, costs, and operational processes. (commissioned by the Northeastern Ontario Regional Cancer Centre)
Assessment of the Northern Health Travel Grant Program
Investigators: R.W. Pong, A. Irvine, and D.A. Pearson
The main purpose of this study is to examine the utilization trends of the Northern Health Travel Grant Program and to see if the program is consistent with the policy objectives laid down by the 1990 and 1993 program reviews. Selected administrative data from the program, as well as data from related programs, were used to conduct the review. (commissioned by the Ontario Ministry of Health and Long-Term Care)
Rural Health Research in the Canadian Institutes of Health Research
Investigators: R.W. Pong, A.M. Atkinson (Atlantic Health Science Centre), A. Irvine*, M. MacLeod (UNBC), B. Minore, A. Pegoraro, J.R. Pitblado, M. Stones, and G. Tesson
The establishment of the Canadian Institutes of Health Research (CIHR) ushers in a new era in health research in Canada. Not only will there be more money to support health research, but it will also be done in a more integrative manner. A position paper was developed by CRaNHR, in collaboration with the University of Northern British Columbia (UNBC), to argue for the creation of an Institute for Rural Health Research in the CIHR. It examined the status of rural health research in Canada, made a case for greater support for rural health research, and presented a blueprint for further developing rural health research in Canada. (commissioned by the Canadian Health Services Research Foundation and the Social Sciences and Humanities Research Council)
Assessing Rural Health: Toward Developing Health Indicators for Rural Canada
Investigators: J.R. Pitblado, R.W. Pong, A. Irvine*, K.V. Nagarajan*, V. Sahai*, J. Zelmer, and L. Dunikowski
The objective of this study is to examine the conceptual basis and feasibility of developing rural health indicators that could be used to achieve a better understanding of rural health. One of the major tasks was to come up with some operational definitions of "rural". In order to examine whether existing data series could be used to develop rural health indicators, a database of existing health indicators was developed. The extent to which these health indicators could be converted to rural health indicators, using one or more operational definitions of "rural", was examined. Some rural health indicators were developed for illustrative purposes. The final report contains recommendations on health data collection and future development of rural health indicators. (funded by the National Health Research and Development Program, Health Canada)
Geographic Distribution of Physicians in Canada
Investigators: J.R. Pitblado and R.W. Pong
The maldistribution of physicians in Canada is a major concern to rural residents and policy-makers. This study comprised two parts. The first was an extensive review of the literature with a view to understanding what "rural" means and exploring some of the conceptual and methodological complexities in examining the geographic distribution of physicians. The second was an empirical analysis of the distribution of physicians in Canada. Geographic information systems technique was used extensively to show where physicians are located. (funded by Knowledge Development and Analysis Unit, Health Promotion and Programs Branch, Health Canada)
Resource Mapping of Rural Health Information in Canada
Investigators: A. Irvine, A. Bromley, R.W. Pong, and D. Matheson
The Canadian Health Network (CHN), in an effort to improve access to health information by Canadians, has developed a website which integrates providers of health information from across the country. CRaNHR was commissioned to develop the "rural health" component of this health information website. With the help of a panel of experts and data from a survey, CRaNHR identified more than 50 organizations that were important sources of rural health information for health consumers and health care providers. (commissioned by the Canadian Health Network)
Developing a Framework for Planning and Evaluating Community-based Health Services in Canada
Investigators: D. Saunders, R.W. Pong, J. Church, M. Wanke, and P. Cappon
This study was conducted in collaboration with researchers at the University of Alberta. With advances in medical technology and changes in health care policies, the provision of health services is gradually shifting from institutions to the community. Increasingly, there is a less reliance on hospitals, nursing homes and psychiatric institutions. Instead, community-based health services are playing an increasingly important role. Thus, there is a need to examine community-based health services more closely. The purpose of this study was to design a framework for planning and evaluating community-based health services in Canada. To facilitate the development of such a framework, two literature reviews and syntheses were conducted, one on health human resources issues and the other on organizational models in relation to community-based health services. The third component was the development of a planning and evaluation framework. Four reports were produced and Health Canada, which commissioned the study, has made them available on-line. (commissioned by Health Canada)
Elliot Lake Seniors' Needs Assessment Study
Investigators: A. Salmoni, R.W. Pong, and J. Lewko
Elliot Lake, a former uranium mining community in northern Ontario, experienced a rapid increase in the number of older persons as a result of the transformation of its economic base (collapse of mining) and its Retirement Living Program. This study examined the characteristics of the older population and assessed the future health care and human services needs in this emerging retirement community. Many papers and presentations based on this study have been published or presented at conferences. (commissioned by the City of Elliot Lake)
Evaluation of Palliative Care Education Programs in Northern Ontario
Investigators: S. Caty*, M.E. Hill, J.B. Minore, and R.W. Pong
The Ministry of Health commissioned the Northern Health Human Resources Research Unit (NHHRRU) to conduct an in-depth evaluation of palliative care education programs that were to be delivered in Northern Ontario during 1994-95. The evaluation focussed on the "Train the Trainer" educational model employed in the initiatives, by profiling the educational programs, documenting the educational experience of the participants, and examining the effects of the programs on the participants' knowledge and attitudes toward palliative care. Six of the thirteen palliative care education programs, including physician-specific and interdisciplinary programs, were evaluated. (commissioned by the Ministry of Health and Long-Term Care)