Browsing by Author "Zhang, Lihui"

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Open Access
Assessing Value in Upstream Health Interventions: A Case Study of the Dr. Paul Schwann Centre Cardiac Rehabilitation Program
(Faculty of Graduate Studies and Research, University of Regina, 2015-07) Beck, Caroline Anna; Marchildon, Gregory; Zhang, Lihui; Zarzeczny, Amy; Mou, Haizhen; Daschuk, James
In the past several decades, a major ideological shift has occurred regarding the relative importance of broad socioeconomic factors as determinants of health over access to conventional health services. During this time, public health experts have continually re-emphasized the need to focus attention further “upstream” of disease, in order to prevent populations from developing poor health. While provincial health systems currently integrate some population and public health programming within the basket of services they offer, upstream health interventions represent only a very small proportion. While many factors can explain this pattern, one explanation is key; upstream health interventions must compete against conventional “downstream” services for a single funding pool, and in this evaluation process, three unique challenges arise. First, there must be a convincing argument that governments should intervene in these private markets to produce a socially optimal outcome. Second, there are unique challenges that arise in measuring the outcomes of upstream interventions, as upstream interventions tend to relate to broader social values that occur over the long-term rather than immediate, quantifiable improvements in health. Third, there have been structural challenges within the system of healthcare administration in Canada. As a result of these three challenges, upstream health interventions are often undervalued and can become subject to great financial instability. This is demonstrated by one upstream program in the Regina Qu’Appelle Health Region – the Dr. Paul Schwann Centre Cardiac Rehabilitation Program. This research investigates the policy problem of assessing value in upstream interventions through a case study of this upstream health intervention. Through a three-pronged analysis of program-level data, this thesis explores the question of how evidence in preventative health interventions can be synthesized with greater policy relevance to inform the reallocation of scarce healthcare dollars from downstream illness care interventions to the upstream. To explore these policy-relevant dimensions – effectiveness, client experience, and cost-effectiveness – three methodologies were used: (1) a quantitative analysis of available client health data to assess changes in health status throughout the program’s duration; (2) qualitative interviews with clients and staff to assess perceptions of experience, health impact, and overall value for money in the program; and (3) quantitative assessment of cost-effectiveness using economic evaluation techniques to allow for comparison to other health interventions. By comparing the results of these assessments to other studies from the literature, lessons were drawn regarding the potential health system value of such a program for the regional health system. While various methodological and data-related limitations must be recognized, this study demonstrates the ability to overcome some traditional challenges in the evaluation of upstream health interventions. As one example of this type of evaluation, this research acts as a guiding example for future studies examining health systems value of upstream interventions. By using multiple dimensions of relevance to policy and decision-making, findings of this research suggest that the use of mixed method research and evaluation methodologies may best illuminate the broader social and health-related outcomes of prevention-oriented programs in addition to their quantifiable outcomes.
Open Access
Determining the Impact of Telehealth on Rural and Remote Health Care Service Delivery in Canada
(Faculty of Graduate Studies and Research, University of Regina, 2014-03) Hill, Kimberly Anne; Marchildon, Gregory; Zhang, Lihui; Mou, Haizhen; Jeffery, Bonnie
There are disparities in health status and outcomes between rural and remote residents and their urban counterparts, and these disparities are caused in part by inequitable access to health services. For decades provincial and territorial decision makers have implemented numerous health human resource policies, most commonly financial incentives, to attract health providers to rural and remote areas to alleviate the inequity of access. The effect of these policies has been temporary in that health providers responding to these incentives rarely established permanent practices in rural and remote communities. In addition, these policies rarely address the fact that specialized health services and infrastructure are highly concentrated in urban centres. In recent decades, decision makers have explored the use of information and communication technology via provincial and regional telehealth programs to provide more specialized health services that were previously unavailable in underserviced communities. Using the widely adopted Triple Aim framework developed by the Institute for Healthcare Improvement, three modes of telehealth (telemedicine, health help lines, and online mental health therapy) are evaluated for their ability to simultaneously improve population health through improved access and improve the patient experience in rural and remote areas while maintaining or decreasing the per capita costs of health care. The analysis showed that telehelath does have the ability to improve access to health services, but low utilization, especially among provinces with high percent rurality, would indicate that its impact on access has been minimal. Additionally, there is evidence that health help lines may actually increase disparities by increasing the number of unnecessary visits to physicians and emergency departments. Data on changes in health status as a result of telehealth use is not available, and health outcomes have only been assessed as part of pilot projects and thus are not generalizable to telehealth as a whole. To date studies evaluating the cost savings of telehealth have been flawed and thus no determination could be made regarding telehealth’s ability to decrease the cost of care of rural and remote residents. Although telehealth has had minimal impact on improving access to care of rural and remote residence, research does demonstrate its promise in delivering care at a distance. Policies are in place to enable its use more broadly, but most jurisdictions lack implementation strategies that elicit the growth of telehealth. Jurisdictions must work together to collectively define telehealth, determine its goals and objectives, and then assign appropriate modes of telehealth to meet the needs of the population being served. Additionally, provincial and territorial telehealth programs would benefit from rigorous program evaluations and academic research to ensure effective service provision. Most importantly, provincial telehealth programing would benefit from the creation of a centralized governance structure whereby economies of scale can be leveraged in the procurement of technology, provision of consistent training and technical support, and coordination of care across the province or territory. Telehealth programing is a mechanism by which provincial and territorial health ministries can use to improve service provision in rural and remote areas, but more work is needed to translate telehealth’s potential benefits into realized gains for rural and remote residents.
Open Access
Is All Bullying the Same?
(Archives of Public Health, 2014) Zhang, Lihui; Osberg, Lars; Phipps, Shelley
We ask whether verbal abuse, threats of violence and physical assault among Canadian youth have the same determinants and whether these determinants are the same for boys and girls. If these are different, the catch-all term “bullying” may mis-specify analysis of what are really different types of behavior
Open Access
Western Policy Analyst Quarterly Volume 1 Issue 1
(2010-09) Elliott, Doug; Zhang, Lihui; Marshall, Jim
Population and Public Policy – 2; Crime Rates – 5; GDP by Industry – 10
Open Access
Western Policy Analyst Quarterly Volume 2 Issue 2
(2011-06) Zhang, Lihui; Fulton, Murray; Elliott, Doug
The Western Policy Analyst was a unique, online publication intended to provide policy makers and those interested in policy formation with useful, empirical analysis of western Canadian trends and issues. Provincial and federal government departments, business groups, academics, non-governmental organizations and municipalities were among the stakeholders who found the information beneficial in gaining a further understanding of public policy. The publication provided policy insights from a evidence-based point of view, based in part on information provided by Statistics Canada.
Open Access
Western Policy Analyst Quarterly Volume 2 Issue 3
(2011-09) Mou, Haizhen; Marshall, Jim; Zhang, Lihui; Olfert, Rose
The Public-Private Mix of Health Care Spending – 1; Pension Membership – 4; Internet Access – 6; Trends in the Western Labour Force – 8
Open Access
Western Policy Analyst Quarterly Volume 4 Issue 1
(2012-10) Zarzeczny, Amy; Zhang, Lihui; Judge, Rahatjan; Whyte, John D.; Elliott, Doug
The CCSVI Wave Sweeps Saskatchewan – 1; Youth Bullying Victimization – 5; First Nation Education: Policy and Political Legitmacy – 7; Households, Families, and Living Arrangements – 10
Open Access
Western Policy Analyst Quarterly Volume 4 Issue 2
(2012-12) Wilson, Stuart J.; Olfert, M. Rose; Marchildon, Gregory P.; Mou, Haizhen; Harris, Jonathan; Lockhart, Wallace; Zhang, Lihui
Resource Revenues and Heritage Funds – 1; Employment Options for On-Reserve Populations – 4; What does the New Canada Health Transfer Plan mean for Western Canada? – 7; Out-of-pocket Prescription Drug Cost – 10