Patients First
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by Mark Poznansky, Ph.D., President, Robarts Research Institute xi
by Ross Tsuyuki, MD, BSc (Pharm), MSc, Pharm D, Director, The Epidemiology Coordinating and Research Centre (EPICORE) xv
Acknowledgements xix
Introduction 1
Part 1: The Theory
Chapter 1: How We Got to Where We Are 11
Chapter 2: Defining Quality of Care 25
Chapter 3: The Care Gap and Its Causes 35
Chapter 4: The Prescribing Gap 43
Chapter 5: The Compliance, Concordance and Adherence Gaps: Challenges and Opportunities 51
Chapter 6: Access, Health and the Economy: Can We Afford Access Gaps? 67
Chapter 7: The Care Gap Gorilla: Bigger Gaps for Older Patients 81
Part 2: The Practice—Patient Health Management (PHM)
Chapter 8: Background and Rationale of Patient Health Management 97
Chapter 9: Learning Experiences: The Epidemiology Coordinating and Research Centre (EPICORE), the Heart Function Clinic and the Clinical Quality Improvement Network (CQIN) 111
Chapter 10: A Pivotal Experience: Improving Cardiovascular Outcomes in Nova Scotia 143
Chapter 11: Other Experiences in Patient Health Management 165
Part 3: What Have We Learned So Far?
Chapter 12: What Works: The Action Plan 189
Chapter 13: What Doesn't Work 197
Part 4: Vision for the Future
Chapter 14: The Strategic Alternatives 203
Chapter 15: Skate to Where the Puck Will Be: Wayne Gretzky's Strategic Plan 213
Appendix A: Statement of Institutional Ethics 221
Appendix B: Management Guideline Template, Heart Function Clinic, circa 1994 224
Appendix C: CQIN Mission, Goals and Objectives 224
Appendix D: Representative CQIN Partnership/Governance Structure 225
Appendix E: Physician Order Sheet for Management of Patients with Heart Attack from a Representative CQIN Hospital, circa 1992–1996 227
Appendix F: ICONS Members and Affiliations 228
Appendix G: ICONS Care Map: Management of Anticoagulation in Atrial Fibrillation 230
Appendix H: ICONS Care Map: Management of Heart Failure 231
Appendix I: ICONS Standardized Discharge Order Sheet 234
Appendix J: ICONS Provider Newsletter 235
Appendix K: ROCQ Project Outline 236
Appendix L: CURATA Treatment Algorithm for Osteoarthritis Patients 237
Appendix M: Examples of Diabetes Hamilton Newsletters 238
Bibliography 239
Index 247