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Purpose: The purpose of this study was to describe factors contributing to the decision-making processes of elderly persons as they formulate advance directives in long-term care. Design and Methods: This study was qualitative, based on grounded theory. Recruitment was purposive and continued until saturation was reached. Nine residents of a long-term-care facility were interviewed by use of a semistructured format. Open and axial coding of interview transcripts were carried out and the factors contributing to the decision process were defined. Results: Elders based their decisions primarily on information gathered from personal experiences with death and illness. They obtained very little information from professionals or the media. Major factors considered by elders as they weighed information included spiritual, emotional, and social considerations. Implications: The factors considered during the decision-making process were oriented more toward the individual's experiences and less on contributions from objective sources than anticipated. Decision making for advance directives is a highly personalized process. The approach of health professionals when assisting with end-of-life decision making should be planned with these contributing factors in mind, so that the services offered to the individuals in this population best meet their needs. Key Words: End of life, Advance care planning, Theoretical model, Grounded theory

ABSTRACT This study was designed to determine whether shifting specialists from fee-for-service practice to annual block funding at an academic health center in Ontario, Canada, would be accompanied by shifts [...]

This study takes advantage of a natural experimental setting to examine the impact that a change from fee-for-service payment to annual block funding had on surgical specialty practice at a Canadian academic health center in comparison to four other fee-for-service s. Five years of administrative data for the five Ontario academic health centers were analyzed in this retrospective pre-post study. Four sentinel procedures, known to have a large discretionary component, were chosen for study. Clinicians were surveyed to identify potential confounders. Changes found in the center after the implementation of an alternative funding plan were similar to those found in the other four academic health centers in the province. Survey results indicated no experiential differences between centers. The authors concluded that changing the physician payment mechanism did not alter surgical practice patterns. These findings and this conclusion have important implications for health system design., In Canada, as in most developed nations, the last decade has witnessed strenuous efforts to curtail rising health care costs. One approach to cost containment focuses on changing the way [...]

Examines the attempt by the Ontario Workers' Compensation Board to delineate a policy for the compensation of chronic stress. Policy process within the context of workers' compensation legislation; Arguments for compensating stress rest; Decision 918 issued by the Ontario Workers' Compensation Appeals Tribunal; Policy options; Employment-related stress.

Abstract: Purpose:: The purpose of this project was to demonstrate the development and use of a decision support tool based on simulation modeling of breast cancer screening to evaluate the implications for the provision of health services and the economic impact of extending routine radiographic screening for breast cancer to women in the 40–49 age group between 2002 and 2021. Methods:: The main method was computer simulation with a Markov model that used published estimates of population size by age group, breast cancer prevalence and incidence, screening program participation rate, sensitivity and specificity of the screening test and diagnostic test, stage transition probabilities, directed diagnosis rates and costs. Findings:: The model predicted that changes to age eligibility requirements would result in the detection of an additional 6610 women with breast cancer in Ontario requiring treatment, at an additional cost of CAN$ 795 per case. These costs include those related to screening, diagnosis and initial treatment and apply to the 20-year period. Conclusions:: The model provided a useful decision support tool for those planning and implementing breast cancer screening programs. [Copyright &y& Elsevier]