Sholom Glouberman's blog

January 16, 2012 - I met with Katherine Smith last week to discuss her research into the dearth of policy effects of the British research into inequalities in health. The last fifteen years have been an exceptionally fertile time for inequalities in health research, but not for the policies that would reduce such inequalities. Katherine explored the issue and argued convincingly against the orthodox Canadian view that there are distinct policy and research communities that must be brought together through knowledge brokerage. She believes instead that it is necessary to engage the public in the issues and create broad public acceptance of policies that might help. John Wilkinson, one of the foremost British researchers, now appears to be following this kind of advice by travelling everywhere to present his views to a wider community.

January 4, 2012 - An article in today’s edition of the Journal of the American Medical Association (JAMA) compares readmission rates of 5745 heart attack patients in the U.S., Canada, Australia, New Zealand and 13 European countries. It concludes that patients in the U.S. are more likely to be readmitted to the hospital within 30 days of discharge than any of the others, specifically 14% of American patients versus 9% of all other patients were readmitted. The second strongest predictor of readmission after an acute heart episode was that the patient was in the United States.

January 2, 2012 - Today we received Health Care in Canada, 2011: A Focus on Seniors and Aging from the Canadian Institute for Health Information (CIHI). The report considers the health status of Canadians and recognizes the growing need to provide more ongoing support for people with chronic conditions. It declares that 48% of people aged 45-64 and 76% of people over 65 reported at least one chronic condition. “With increasing age the likelihood of having at least one chronic condition also increased” (19).

Access to health care was more closely correlated to the number of chronic conditions that people have than to age. And self-reported poor health status was similarly correlated with the number of chronic conditions. In 2009, 74% of seniors with only one chronic condition reported good self-perceived health, compared with only 27% of those with four or more” (19).

(As published in the Journal of Evaluation in Clinical Practice January 2011)

Abstract: "How can we deal with the increase in ‘grey zones’ that arise from our deepening scientific understanding? Science will not solve the puzzles associated with such grey zones, nor will it reduce their scope. Increased scientific research will increasingly extend the area of uncertainty associated with birth and death. As more infants survive earlier and earlier births and as more aspects of brain death are reversed, the grey zone will increase."

Read this article to understand why "An Effective Patient Voice Needs Organizational Support" and "The Deeper Historical Reason for a Patients’ Association."

Here Sholom Glouberman expands on why the 1900s modern acute care hospital was so successful but why it now needs modernization.

Parts of this talk have been delivered to more than 3000 people at more than 20 venues during 2011.

This is the newest presentation offered from PAC. It distinguishes the type of care needed for acute diseases versus chronic conditions, why this matters, and why the patient perspective needs to be taken into account.

This presentation was delivered for the Advances in Health Informatics Conference in 2010 as part of the Think Tank on Revisiting eHealth Strategies at the University of Waterloo. The presentation is based on the place of patient information in complex systems.

The story of scurvy is an object lesson in adaptive policy development. The Royal Navy has traditionally been accused of delaying the application of research results for about 50 years before it introduced the use of fresh lemons and limes to eliminate scurvy among its sailors. In fact, the complex history of this policy shows just the opposite. It demonstrates the navy introduced citrus fruits well in advance of accepted scientific research, and that this introduction was a significant factor in the Napoleonic Wars. The story of the fight against scurvy in the UK can help us understand that adaptive policy development is not a new phenomenon. This presentation can also serve as a demonstration of how policy is actually developed in complex environments.