Digital Commons Network^™

Exploring The Quality Performance Of Ethno-Specific And Mainstream Not-For-Profit Long-Term Care Homes In Ontario, Lanei Amein

Electronic Thesis and Dissertation Repository

The purpose of this retrospective study was to determine how ethno-specific not-for-profit long-term care (LTC) homes in Ontario perform in comparison to mainstream not-for-profit LTC homes using nine RAI-MDS 2.0 quality indicators. Publicly available data from three sources: the Canadian Institute for Health Information "Your Health System: In Depth" database from the Continuing Care Reporting System, data on Ontario ethno-specific not-for-profit LTC homes from the Home and Community Care Support Services, and data on home and ownership records from the Ministry of Long-Term Care “Public Reporting” website, between 2017-2022, were retrieved and analyzed. Descriptive analysis suggests that for all quality …

Models Of Shared Care For The Management Of Psychotic Disorder After First Diagnosis In Ontario., Joshua C. Wiener, Rebecca Rodrigues, Jennifer N S Reid, Kelly K. Anderson

Epidemiology and Biostatistics Publications

OBJECTIVE: To describe the provision of care for young people following first diagnosis of psychotic disorder.

DESIGN: Retrospective cohort study using health administrative data.

SETTING: Ontario.

PARTICIPANTS: People aged 14 to 35 years with a first diagnosis of nonaffective psychotic disorder in Ontario between 2005 and 2015 (N=39,449).

MAIN OUTCOME MEASURES: Models of care, defined by psychosis-related service contacts with primary care physicians and psychiatrists during the 2 years after first diagnosis of psychotic disorder.

RESULTS: During the 2-year follow-up period, 29% of the cohort received only primary care, 30% received only psychiatric care, and 32% received both primary and …

Teachers’ Work: Communicating On Difficult Knowledge In Ontario Schools, Zsofia Agoston Villalba

Electronic Thesis and Dissertation Repository

This thesis examines how K-12 teachers in Ontario navigate the complexities of teaching "difficult knowledge"—topics such as racial and ethnic injustices, Indigenous perspectives, immigration experiences, and gender issues—within the parameters of the school and the curriculum. Utilizing an institutional ethnography approach, the study examines the curriculum as an institutional text that coordinates and shapes teachers’ practices. Working with and against the curriculum, teachers find innovative ways to engage their students on difficult knowledge topics. Based on interviews with 12 K-12 teachers, this research explores teachers’ work and pedagogical approaches. They employ diverse teaching methods like storytelling, open dialogues, and collaborative …

Designing Systems For The Care We Need: A Transformation Journey In Southwestern Ontario., Shannon L. Sibbald, Jacobi Elliott, Alexander Smith, Mulugeta B. Chala, Nancy Dool Kontio, Amber Alpaugh-Bishop, Sarah Jarmain, Atharv Joshi, Mike Mcmahon, Matthew Meyer

Health Studies Publications

Primary care is considered the foundation of any health system. In Ontario, Canada Bills 41 and 74 introduced in 2016 and 2019, respectively, aimed to move towards a primary care-focused and sustainable integrated care approach designed around the needs of local populations. These bills collectively set the stage for integrated care and population health management in Ontario, with Ontario Health Teams (OHTs) introduced as a model of integrated care delivery systems. OHTs aim to streamline patient connectivity through the healthcare system and improve outcomes aligned with the Quadruple Aim. When Ontario released a call for health system partners to apply …

Young Arabs In Canada: Ethnic Identity And Intersectionality, Rama Eloulabi

Electronic Thesis and Dissertation Repository

Arabs make up almost 2% of the population in Canada, and their numbers are growing rapidly. Yet, literature on Arabs in Canada is sparse, both from academic and governmental sources. Using ethnic identity and intersectionality frameworks, this study explores the meanings of Arab identity for youth in Ontario, Canada, and the interactions between their Arab identity and their other identities. Semi-structured in-depth interviews were conducted in Arabic and English with 30 participants (ages 18-30) who are from, or whose background is from, the Arab world. Findings highlighted the diversity of the population, and the themes that emerged regarding self-identification with …

Exposing Neoliberalism's Erosion Of Special Education In Ontario Schools, Emily Ellwood

The Dissertation in Practice at Western University

My positionality as a critical scholar frames the problem of practice. The POP discusses a lack of transparency stemming from a longstanding hierarchy of influence from the ministry of education to local school boards and then to individual schools. A political, economic and social analysis frames the organizational context which impacts my role and agency within the organization. The organization’s worldview, tied to the ministry’s worldview, undermines student experience, as does both organization’s leadership approach. Using a critical bureaucracy and anti-oppressive theory, this organizational improvement plan investigates the physical and bureaucratic barriers that undermine special education student experience. Critical theory …

“Return To Play”: The Impact Of, And Changes To, Ontario Children’S Physical Activity During Covid-19, Monika B. Szpunar Ms.

Electronic Thesis and Dissertation Repository

This dissertation explored parents’ and their children’s perspectives of returning to play/sport during the COVID-19 pandemic in Ontario, Canada, and assessed how children’s physical activity levels changed during COVID-19. To understand the initial impact of the pandemic, Study 1 (August 2020) explored the influence of family sociodemographic factors (e.g., housing type) and risk tolerance (using the validated Tolerance of Risk in Play Scale) on parents’ return to play/sport attitudes. Via interviews with parents (n = 9) and children (n = 12), Study 2 (December 2020 – January 2021) gathered participants’ experiences of getting active …

Patient And Physician Factors Associated With First Diagnosis Of Non-Affective Psychotic Disorder In Primary Care, Joshua C. Wiener, Rebecca Rodrigues, Jennifer N S Reid, Suzanne Archie, Richard G Booth, Chiachen Cheng, Saadia Hameed Jan, Paul Kurdyak, Arlene G Macdougall, Lena Palaniyappan, Bridget L Ryan, Kelly K. Anderson

Epidemiology and Biostatistics Publications

Primary care physicians play a central role in pathways to care for first-episode psychosis, and their increased involvement in early detection could improve service-related outcomes. The aim of this study was to estimate the proportion of psychosis first diagnosed in primary care, and identify associated patient and physician factors. We used linked health administrative data to construct a retrospective cohort of people aged 14-35 years with a first diagnosis of non-affective psychosis in Ontario, Canada between 2005-2015. We restricted the sample to patients with help-seeking contacts for mental health reasons in primary care in the six months prior to first …

Rapid Rhino Vs. Merocel: A Retrospective Analysis Of Patients With Anterior Epistaxis Visiting Emergency Rooms In London, Ontario, Dhatri Shukla

Electronic Thesis and Dissertation Repository

When patients present to an emergency room (ER) with a nosebleed, one technique that physicians employ is the application of nasal packing. Merocel is a common nasal pack utilized in ER because of their low cost. Rapid Rhino is a nasal packing that is more comfortable for patients but is more costly than Merocel. Costing for epistaxis treatment is more than initial treatment costs and needs to consider rebleed rates. Using a retrospective cohort study design with covariates adjusted by propensity scores, we compared the costs associated with Merocel, and Rapid Rhino from the hospital and provincial healthcare perspectives. Merocel …

Association Of Pediatric Buccal Epigenetic Age Acceleration With Adverse Neonatal Brain Growth And Neurodevelopmental Outcomes Among Children Born Very Preterm With A Neonatal Infection., Noha Gomaa, Chaini Konwar, Nicole Gladish, Stephanie H Au-Young, Ting Guo, Min Sheng, Sarah M Merrill, Edmond Kelly, Vann Chau, Helen M Branson, Linh G Ly, Emma G Duerden, Ruth E Grunau, Michael S Kobor, Steven P Miller

Department of Medicine Publications

IMPORTANCE: Very preterm neonates (24-32 weeks' gestation) remain at a higher risk of morbidity and neurodevelopmental adversity throughout their lifespan. Because the extent of prematurity alone does not fully explain the risk of adverse neonatal brain growth or neurodevelopmental outcomes, there is a need for neonatal biomarkers to help estimate these risks in this population.

OBJECTIVES: To characterize the pediatric buccal epigenetic (PedBE) clock-a recently developed tool to measure biological aging-among very preterm neonates and to assess its association with the extent of prematurity, neonatal comorbidities, neonatal brain growth, and neurodevelopmental outcomes at 18 months of age.

DESIGN, SETTING, AND …

Guidance Counselors' Enactment Of Educational Equity Policies: A Cross-Case Analysis Of Ontario And Trinidad And Tobago, Kathleen Sandy-Thompson

Electronic Thesis and Dissertation Repository

This dissertation examined the experiences of guidance counselors in enacting educational equity policies in one district school board and eight secondary schools in Ontario; and three school districts and eight secondary schools in Trinidad and Tobago (T&T). In Ontario, the enactment of educational equity policy in local district school boards is influenced by broader issues of neoliberal globalization and their impact on education equity, causing a shift in focus on reducing student gaps and increasing student achievement towards the marketization and commodification of education. Likewise in T&T, the issues in education and policy enactment are centred around the lingering effects …

Cancer Incidence And Stage At Diagnosis Among People With Recent-Onset Psychotic Disorders: A Retrospective Cohort Study Using Health Administrative Data From Ontario, Canada., Jared C Wootten, Lucie Richard, Phillip S Blanchette, Joshua C. Wiener, Kelly K. Anderson

Epidemiology and Biostatistics Publications

OBJECTIVE: Prior evidence on the relative risk of cancer among people with psychotic disorders is equivocal. The objective of this study was to compare incidence and stage at diagnosis of cancer for people with psychotic disorders relative to the general population.

METHOD: We constructed a retrospective cohort of people with a first diagnosis of non-affective psychotic disorder and a comparison group from the general population using linked health administrative databases in Ontario, Canada. The cohort was followed for incident diagnoses of cancer over a 25-year period. We used Poisson and logistic regression models to compare cancer incidence and stage at …

Teacher Education In The Arts Before, During, And After The Covid-19 Pandemic, Jake E. Knight

Undergraduate Student Research Internships Conference

The purpose of this research is to construct a detailed picture of teacher education in the arts within Ontario, with a specific focus on the Primary-Junior arts discipline. This project will survey publicly-funded educational institutions in order to create a baseline of information on arts teacher education. This foundational information will allow for differences to be identified between pre-service teacher arts programs, and will also initiate a dialogue as to whether or not arts programs are equitably administered throughout the province. Moreover, this project will examine the professional practices of teacher educators in the arts before, during, and after the …

Partners In Education: Leveraging School Social Workers To Support Transformative Equity And Well-Being Work In An Ontario K-12 Public School Board, Stefani F. Burosch

The Dissertation in Practice at Western University

School social workers (SSWs) have been an integral part of Ontario’s K-12 public education system for over one hundred years. Their unique training, skill set, and practice perspectives enables provision of comprehensive services benefitting the whole school community. The social work profession is grounded in a code of ethics committed to the advancement of social justice for all and draws from a rich history of critical theorizing and evidence-based practice to further this goal. These features of the profession ideally position SSWs to serve as leaders and partners in the school mission, particularly at a time when the need for …

A Framework To Support The Progressive Implementation Of Integrated Team-Based Care For The Management Of Copd: A Collective Case Study., Shannon L. Sibbald, Vaidehi Misra, Madelyn Dasilva, Christopher Licskai

Health Studies Publications

BACKGROUND: In Canada, there is widespread agreement about the need for integrated models of team-based care. However, there is less agreement on how to support the scale-up and spread of successful models, and there is limited empirical evidence to support this process in chronic disease management. We studied the supporting and mitigating factors required to successfully implement and scale-up an integrated model of team-based care in primary care.

METHODS: We conducted a collective case study using multiple methods of data collection including interviews, document analysis, living documents, and a focus group. Our study explored a team-based model of care for …

Not So Sweet Dreams: Adults' Quantity, Quality, And Disruptions Of Sleep During The Initial Stages Of The Covid-19 Pandemic, Katie J. Shillington, Leigh M. Vanderloo, Shauna M. Burke, Victor Ng, Patricia Tucker, Jennifer D. Irwin

Paediatrics Publications

Objectives: The purpose of this study was to investigate Ontario adults' reported sleep quantity, quality, and disturbances during the early months of the COVID-19 pandemic (April–July 2020). Methods: As part of a larger, chronic disease-focused, and ongoing longitudinal study designed to explore Ontario adults' health and wellness-related behaviors during the pandemic, participants completed an online survey that included demographic information and the Pittsburgh Sleep Quality Index (PSQI). The PSQI consists of 19 items, one of which is open-ended, designed to assess an individual's quantity, quality, and patterns of sleep on seven domains (ie, subjective sleep quality, sleep latency, sleep duration, …

Better Solutions: A Comparative Analysis Of Long-Term Care Home Policies In Canada, China And Japan, Chaoran Wu

Electronic Thesis and Dissertation Repository

Failures of long-term care (LTC) policies caused undesirable negative outcomes for Canadian long term care residents during the COVID-19 pandemic. The purpose of this study was to explore similarities and differences in LTC policies between Ontario (Canada, Ontario), China, and Japan and identify potentially beneficial ideas for policy improvement in all countries. An adapted framework for comparing health care systems guided data collection. Information about four major policy areas: regulation, service provision, PSW workforce, and financial policies was extracted from LTC policy documents, government reports, and research articles. Data was described and compared for similarities and differences. Findings show that …

Cross-Sectional Study Of Factors Associated With Suicide Ideation In Ontario Adolescents, Jonah Rakoff, Jesus Chavarria, Hayley A. Hamilton, Tara Elton-Marshall

Neuroscience Institute Publications

Objective: Suicide is the second leading cause of death in Canadian adolescents. The Interpersonal Theory of Suicide attempts to explain suicide etiology and proposes that feelings of perceived burdensomeness or thwarted belongingness lead to suicide ideation, but this has not been extensively studied in adolescents. This study aimed to use the Interpersonal Theory of Suicide to examine factors that may be associated with suicide ideation in adolescents. The factors of interest were school connectedness, perceived availability of support, self-esteem, feelings of worthlessness, feelings of hopelessness, bullying and cyberbullying victimization, substance use, and social media use. Methods: Data were from the …

Parents’ Attitudes Regarding Their Children’S Play And Sport During Covid-19, Monika B. Szpunar, Leigh M. Vanderloo, Brianne A. Bruijns, Stephanie Truelove, Shauna M. Burke, Jason Gilliland, Jennifer D. Irwin, Patricia Tucker

Geography & Environment Publications

The COVID-19 pandemic and associated public health measures have interrupted the daily routines of parents and children. The purpose of this study was to explore parents’ attitudes regarding their children’s play/sport during COVID-19. A secondary objective was to explore the influence of parent demographics and parent-reported physical activity levels and risk tolerance on these attitudes. Ontario parents of children aged 12 and younger completed an online survey (August—December 2020) that assessed their attitudes (grouped by support, safety and socialization-related attitudes; n = 14 items) regarding their child(ren)’s play/sport, their physical activity levels (n = 2 items), and demographic details …

Supporting The Integration Of Internationally Educated Teachers To Foster Equitable Schools, Nadine Trépanier-Bisson

The Dissertation in Practice at Western University

Within a change process grounded in constructivist and transformative worldviews, internationally educated teachers (IETs), an underemployed group in the education sector, can support equity efforts in Ontario schools. The Organizational Improvement Plan (OIP) presents an overview of the organizational and environmental factors that contribute to the necessity for change and which influence the change process. A new way of supporting equity work in schools is proposed through a dual change process intended to bring change at the principal organization (meso) and in schools (micro). Kotter’s (2012) eight-stage process is embedded within Cawsey et al.’s (2016) change path model to support …

Confronting Complexity And Supporting Transformation Through Health Systems Mapping: A Case Study., Anna J Hussey, Shannon L Sibbald, Madonna Ferrone, Alyson Hergott, Robert Mckelvie, Cathy Faulds, Zofe Roberts, Andrew D Scarffe, Matthew J Meyer, Susan Vollbrecht, Christopher Licskai

Health Studies Publications

INTRODUCTION: Health systems are a complex web of interacting and interconnected parts; introducing an intervention, or the allocation of resources, in one sector can have effects across other sectors and impact the entire system. A prerequisite for effective health system reorganisation or transformation is a broad and common understanding of the current system amongst stakeholders and innovators. Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are common chronic diseases with high health care costs that require an integrated health system to effectively treat.

STUDY DESCRIPTION: This case study documents the first phase of system transformation at a regional level …

Community Attitudes And Wind Energy Development Types: A Comparative Study In Ontario And Nova Scotia, Sara M. Wilson

Electronic Thesis and Dissertation Repository

Wind turbines will continue to be an important part of the green energy transition in Canada. However, opposition to onshore wind projects from potential host communities has increased over time, and install rates are flattening. Dimensions such as NIMBYism, place, distance from turbines and connections to landscapes have proved relatively inadequate for explaining community attitudes. The value of community-based development models over developer-led models has had recent traction, however limited empirical investigation has been done. I used a mail-out mail-back survey in Ontario (n=192) and Nova Scotia (n=170), to communities with (n=172) and without (n=190) a community-based development model. Using …

Enhancing Experiential Learning Opportunities Through The Integration Of Continuous Improvement Practices, Alena Shah Ms.

The Dissertation in Practice at Western University

Experiential learning (EL) in higher education has become a prominent academic curriculum component. Recent provincial guidelines emphasize that post-secondary institutions provide students EL opportunities, outlining criteria as to what counts as an EL activity. While these guidelines provide instruction on what an EL opportunity should contain, it does not detail how post-secondary institutions should develop and implement these activities responsive to their unique student population needs. This Organizational Improvement Plan (OIP) aims to determine how an Ontario university can provide meaningful, student-focused EL opportunities through a centralized, theoretically-informed EL implementation framework. It centers around a Problem of Practice (PoP) at …

Mental Health Services Provision In Primary Care And Emergency Department Settings: Analysis Of Blended Fee-For-Service And Blended Capitation Models In Ontario, Canada., Thyna Vu, Kelly K Anderson, Nibene H Somé, Amardeep Thind, Sisira Sarma

Epidemiology and Biostatistics Publications

Treating mental illnesses in primary care is increasingly emphasized to improve access to mental health services. Although family physicians (FPs) or general practitioners are in an ideal position to provide the bulk of mental health care, it is unclear how best to remunerate FPs for the adequate provision of mental health services. We examined the quantity of mental health services provided in Ontario's blended fee-for-service and blended capitation models. We evaluated the impact of FPs switching from blended fee-for-service to blended capitation on the provision of mental health services in primary care and emergency department using longitudinal health administrative data …

Changes In Income-Related Inequalities In Oral Health Status In Ontario, Canada, Cheng Fang, Musfer Aldossri, Julie Farmer, Noha Gomaa, Carlos Quiñonez, Vahid Ravaghi

Paediatrics Publications

Objectives: Oral health inequalities impose a substantial burden on society and the healthcare system across Canadian provinces. Monitoring these inequalities is crucial for informing public health policy and action towards reducing inequalities; however, trends within Canada have not been explored. The objectives of this study are as follows: (a) to assess trends in income-related inequalities in oral health in Ontario, Canada's most populous province, from 2003 to 2014, and (b) to determine whether the magnitude of such inequalities differ by age and sex. Methods: Data representative of the Ontario population aged 12 years and older were sourced from the Canadian …

Quality Of Diabetes Care In Blended Fee-For-Service And Blended Capitation Payment Systems., Mary Aderayo Bamimore, Rose Anne Devlin, Gregory S Zaric, Amit X Garg, Sisira Sarma

Epidemiology and Biostatistics Publications

OBJECTIVES: In the middle to late 2000s, many family physicians switched from a Family Health Group (FHG; a blended fee-for-service model) to a Family Health Organization (FHO; a blended capitation model) in Ontario, Canada. The evidence on the link between physician remuneration schemes and quality of diabetes care is mixed in the literature. We examined whether physicians who switched from the FHG to FHO model provided better care for individuals living with diabetes relative to those who remained in the FHG model.

METHODS: Using longitudinal health administrative data from 2006 to 2016, we investigated the impact of physicians switching from …

Emergency Department Use Following Incentives To Provide After-Hours Primary Care: A Retrospective Cohort Study., Michael Hong, Amardeep Thind, Gregory S Zaric, Sisira Sarma

Epidemiology and Biostatistics Publications

BACKGROUND: Access to primary care outside of regular working hours is limited in many countries. This study investigates the relation between the after-hours premium, an incentive for primary care physicians to provide services after hours, and less-urgent visits to the emergency department in Ontario, Canada.

METHODS: We analyzed a retrospective cohort of a random sample of Ontario residents from April 2002 to March 2006, and a subcohort of patients followed from April 2005 to March 2016. We linked patient and primary care physician data with emergency department visit data. We used fixed-effects regression models to analyze the association between the …

Physician Remuneration Schemes, Psychiatric Hospitalizations And Follow-Up Care: Evidence From Blended Fee-For-Service And Capitation Models., Thyna Vu, Kelly K Anderson, Rose Anne Devlin, Nibene H Somé, Sisira Sarma

Epidemiology and Biostatistics Publications

Psychiatric hospitalizations could be reduced if mental illnesses were detected and treated earlier in the primary care setting, leading to the World Health Organization recommendation that mental health services be integrated into primary care. The mental health services provided in primary care settings may vary based on how physicians are incentivized. Little is known about the link between physician remuneration and psychiatric hospitalizations. We contribute to this literature by studying the relationship between physician remuneration and psychiatric hospitalizations in Canada's most populous province, Ontario. Specifically, we study family physicians (FPs) who switched from blended fee-for-service (FFS) to blended capitation remuneration …

Population-Based Studies On Medications And Fall-Related Injury In Older Adults, Yu Ming

Electronic Thesis and Dissertation Repository

Background: Fall-related injuries in older adults result in serious consequences to individuals and health care system, especially with the increasing aging population. The purpose of this study was to (1) describe medication prescription patterns within one year prior to fall-related injuries; (2) identify medication classes prescribed within 30 days prior to the injury that were associated to fall-related injury; and (3) examine the association between fall-related injuries and continuous use or new initiation of most commonly prescribed medications.

Methods: Studies used administrative health care data in Ontario. Study 1 described the frequency of medications prescribed to older adults within one …

The Impact Of The Diabetes Management Incentive On Diabetes-Related Services: Evidence From Ontario, Canada., Thaksha Thavam, Rose Anne Devlin, Amardeep Thind, Gregory S Zaric, Sisira Sarma

Epidemiology and Biostatistics Publications

Financial incentives have been introduced in several countries to improve diabetes management. In Ontario, the most populous province in Canada, a Diabetes Management Incentive (DMI) was introduced to family physicians practicing in patient enrollment models in 2006. This paper examines the impact of the DMI on diabetes-related services provided to individuals with diabetes in Ontario. Longitudinal health administrative data were obtained for adults diagnosed with diabetes and their family physicians. The study population consisted of two groups: DMI group (patients enrolled with a family physician exposed to DMI for 3 years), and comparison group (patients affiliated with a family physician …