Rebuilding public health on more than thoughts and prayers.

Sweeping reviews will be conducted once the COVID-19 pandemic concludes to support public health system strengthening. Unfortunately, these reviews will find what past reviews on public health in Canada have found: limited evidence on the organization, financing, and delivery of public health services. This is due to inattention to the field of public health services and systems research (PHSSR) in Canada. To avoid this pandemic becoming "just another public health crisis," PHSSR must be prioritized by public health and health service research associations, funders, and scholars.

RéSUMé: Des révisions en profondeur seront menées à la conclusion de la COVID-19 pour appuyer le renforcement du système de santé publique. Malheureusement, ces révisions constateront les mêmes conclusions que les revues antérieures sur la santé publique au Canada : les preuves sur l'organisation, le financement et la prestation des services de santé publique sont limitées. Cela est dû au manque d'attention au domaine de la recherche sur les systèmes et les services de santé publique (RSSSP) au Canada. Afin d'éviter que cette pandémie ne devienne « rien qu'une autre crise de santé publique ¼, la RSSSP doit être une priorité pour les associations de recherche, les donateurs et les universitaires de la santé publique et des services de santé.

Sustainability drivers of Canada's most health-promoting hospital.

Sustaining large health promotion interventions in hospitals is notoriously difficult, and our understanding of sustainability enablers remains peripheral. This case study examined sustainability of Canada's largest hospital based health promotion facility: The Wellness Institute at Seven Oaks General Hospital in Winnipeg. Seven sustainability enablers were identified: (1) Community support and ownership; (2) Consistent, supportive, visionary leadership; (3) Well-managed operations; (4) Limited service overlap and duplication; (5) Alignment with the healthcare system; (6) Consistent, professional staffing; (7) Leading-edge facilities and services. Four sustainability barriers were identified: (1) Alignment with the healthcare system; (2) Limited funding; (3) Service duplication; (4) Sub-optimal location. Results can support leaders with future planning and implementation of health promotion programming.

Letter to the Editor - Eulogy for the Canadian health-promoting hospitals movement. / Lettre à la rédaction ­ Éloge funèbre du mouvement canadien des hôpitaux promoteurs de la santé.

This letter is in preparation for the death of the Canadian HPH movement.

RÉSUMÉ: Cette lettre est en prévision du décès du mouvement canadien des HPS.

Healthcare (Dis)connect - Letter to the Editor Re: Breton et al. (2018).

I applaud Breton et al. (2018) for their recent logic analysis on primary care centralized waiting lists (CWLs) in seven Canadian provinces, recently published in your journal. This is an important step towards better understanding the effectiveness of these approaches. Given the dire situation of primary care in many jurisdictions across Canada, CWLs deserve greater research attention. In particular, I agree with the authors' comments that future research should explore CWLs effectiveness from the patient perspective. I make these arguments as a researcher and a Canadian, who recently experienced the challenges with one of these systems first-hand.

Politics, health systems and population health: An interview with David Levine.

No abstract available.

Accountability for Community Benefit: A Reasonable Expectation for Canadian Hospitals.

North American hospitals have historically struggled to engage in prevention and health promotion activities because they have not been incentivized or held accountable for doing so. However, in order to be exempt from federal taxes, 3,000 non-profit hospitals in the US must now regularly assess the health status of the communities they serve, and take action to address identified health needs. This is called "accountability for community benefit," and it is required under the Patient Protection and Affordable Care Act (commonly known as Obamacare). A modified version of accountability for community benefit warrants exploration in the Canadian context, as it may support Canadian hospitals to direct resources towards prevention and health promotion activities - something many Canadian hospitals want to do, but struggle with in the current accountability environment. This is an important health policy topic because even a small shift in focus by hospitals towards prevention and health promotion has the potential to improve population health and reduce healthcare demand.

Criteria-Based Resource Allocation: A Tool to Improve Public Health Impact.

OBJECTIVE: Resource allocation in local public health (LPH) has been reported as a significant challenge for practitioners and a Public Health Services and Systems Research priority. Ensuring available resources have maximum impact on community health and maintaining public confidence in the resource allocation process are key challenges. A popular strategy in health care settings to address these challenges is Program Budgeting and Marginal Analysis (PBMA). This case study used PBMA in an LPH setting to examine its appropriateness and utility. DESIGN: The criteria-based resource allocation process PBMA was implemented to guide the development of annual organizational budget in an attempt to maximize the impact of agency resources. Senior leaders and managers were surveyed postimplementation regarding process facilitators, challenges, and successes. SETTING: Canada's largest autonomous LPH agency. RESULTS: PBMA was used to shift 3.4% of the agency budget from lower-impact areas (through 34 specific disinvestments) to higher-impact areas (26 specific reinvestments). Senior leaders and managers validated the process as a useful approach for improving the public health impact of agency resources. However, they also reported the process may have decreased frontline staff confidence in senior leadership. CONCLUSIONS: In this case study, PBMA was used successfully to reallocate a sizable portion of an LPH agency's budget toward higher-impact activities. PBMA warrants further study as a tool to support optimal resource allocation in LPH settings.

Rehabilitation of individuals with severe stroke: synthesis of best evidence and challenges in implementation.

PURPOSE: The rehabilitation of patients who are recovering from severe stroke is associated with a substantial use of resources but limited potential for functional improvement. As a result, these individuals are not perceived as being ideal candidates for inpatient stroke rehabilitation. The objective of this review was to describe the evidence for and discuss some of the challenges of providing inpatient rehabilitation services for individuals with severe stroke. METHODS: A literature search was conducted to identify relevant studies. Studies were included if (a) inpatient rehabilitation was compared to other rehabilitation settings and (b) the study population included individuals with severe stroke-related disability. Following data abstraction, the methodological quality of randomized controlled trials (RCTs) that met inclusion criteria was assessed using the PEDro scale. RESULTS: Fourteen studies (including 4 RCTs) met inclusion criteria. Despite making limited functional improvement, persons with severe strokes who received inpatient rehabilitation had reduced mortality, decreased lengths of hospital stay, and increased likelihood of discharge home when compared to those who received rehabilitation in other settings. Rehabilitation on specialized stroke units resulted in better outcomes than other forms of inpatient rehabilitation for this group. CONCLUSION: Inpatient rehabilitation is beneficial for individuals with severe stroke. However, for this group, it may be necessary to rethink the emphasis on functional improvement and focus more on discharge planning. These individuals may still have restricted access to rehabilitation as a result of limited resources, the perception that they have poor rehabilitation potential, limited understanding of the goals of rehabilitation for this population, and a lack of research.