Life-expectancy and Life-years lost are frequently used and analyzed indices of survival. Life tables and Markov models are two exact approaches to calculate these indices; however cumbersome calculation limits their usage in real situations. Some simple approximation approaches have therefore been developed since a convenient and accurate approximation is critical both to develop a treatment plan of a patient by physicians and to assess health policies by health policy makers. These approximation approaches include the DEALE (Declining Exponential Approximation of Life Expectancy), new DEALEs, the IPH method (A method developed at Institute of Population Health, University of Ottawa) and the Keyfitz approach. A new approach has been developed to achieve better accuracy and maintain ease of application by extending the Keyfitz approach. To make the new approach less dependent on age-stratified tabulations, a convenient formula for the EME (Established market economics) region is developed. Its accuracy, robustness, and ease of application are demonstrated.

Clinical Decision Support Systems (CDSS), for providing patient specific advice, can only be accepted in clinical practice if they can fit in a clinician workflow. This would require such a CDSS to have diversified support capabilities, to be mobile, and to have flexible functionality. Such a system can be designed and developed only in a modular fashion where the high level abstractions describe the logic among different system components. Ontology, which is a formal specification of shared conceptualization, can be used to create a high level abstraction. Such decoupling of abstract CDSS logic from low level implementation facilitates developing and adding new applications and increases the reusability of different system components. In this research it is argued that a developed CDSS, according to ontology driven design with the ontological model of a problem domain expanded by a clinical decision support requirements, allows the creation of a system that is aligned with clinical workflow. In this research the proposed approach is illustrated with the CDSS for triaging pediatric hip pain (HP) in the Emergency Department. This application (called MET-HP) is created within the MET (Mobile Emergency Triage) environment that implements the ontology driven design principles. MET-HP is a mobile CDSS that includes a decision model derived from the analysis of retrospective chart data and it facilitates early triage of a child using incomplete data. Keywords. Ontology; ontological model; ontology driven design; ontological engineering; clinical decision support system; data mining; knowledge model; knowledge based system.

Surgical site infection surveillance (enumeration, and reporting of cases) reduces infection incidence. Data-driven "trigger" mechanisms focus surveillance on high-probability cases, yet often lack specificity. We aimed to develop trigger mechanisms with greater specificity for surveillance of cardiac surgical site infection. We developed these mechanisms in a two part study: systematic review to identify potential trigger factors; and nested case-control study to derive trigger mechanisms from a novel information structure called a data warehouse. Among 158 studies, we identified 570 trigger factors, which we grouped into themes, using the top 33 in the case-control study Using 203 cases and 516 controls, we derived two models for surveillance trigger mechanisms. These models provided true positive rates of 0.941 and 0.931 respectively (non-inferior to the current trigger mechanism), with false positive rates of 0.1085 each (superior to the current trigger mechanism). These trigger mechanisms may standardize and automate surgical site infection surveillance triggering.

The Ottawa Influenza Decision Aid (OIDA) is a newly developed tool to assist healthcare personnel (HCP) make an informed decision regarding the seasonal influenza vaccine. The primary objective of this thesis is to determine approaches to implementing the OIDA into healthcare organizations by 1) conducting a systematic review of influenza immunization campaigns for HCP; 2) facilitating consultation meetings with healthcare organizers to collect their ideas on using the OIDA within their workplace; and 3) develop an OIDA implementation questionnaire based on the findings from the systematic review and consultation meetings. The systematic review results suggest that education-only campaigns only have a minimal impact on immunization rates. Future studies require improved reporting on the follow-up of HCP and calculation of HCP immunization rates. The consultation meetings identified ten approaches to implementing the OIDA within a healthcare setting. The OIDA Implementation Questionnaire was designed and a survey implementation approach recommended.

Research Question: This research will assess whether the Roma population are able to effectively access primary care services, and if not, what barriers prevent them from doing so. Background: The Canadian International Development Agency (CIDA), in partnership with the Serbian government and the Canadian Society for international Health, has prioritized equitable access to healthcare services for vulnerable populations in Serbia. As part of this larger initiative, the factors that affect access to primary care services for the Roma population will be analyzed in an attempt to determine if and how services can be improved. Methodology: Disaggregated data was collected from three population groups in Serbia; the general population, the poorest quintile (not including the Roma), and the Roma population. The effective coverage framework, which incorporates availability, affordability, accessibility, acceptability, and effectiveness, was used to structure the analysis. Results: This research found that the Roma are disadvantaged across a range of equity dimensions. The Roma are less likely to be able to afford health services, or physically access primary care centers, and are more likely to be discriminated against by health workers.

The recognition of the need to improve communication has led healthcare organizations to integrating health informatics technologies. This study investigated the extent to which mHealth applications influenced communication and information sharing patterns between interdisciplinary healthcare providers in the delivery of healthcare services. The study was conducted at a multi-campus health organization in Ontario. Sociotechnology theory examines the influence of sociological factors in the introduction and use of information and communication technologies. Through a sociotechnical approach, this research study focused on how the communicative and social aspects of an organization influence health informatics integration, as well as the extent to which information sharing and communication patterns were influenced. This study found that several factors contributed to the integration of mHealth technologies, including: significant end user contribution to system design, an organizational culture open to technological change, the use of creative internal communication practices, training, and evaluation procedures. Findings indicated that the limited use of mHealth technologies were a result of poor ergonomical design and a lack of employee consultation prior to integration. That being said, participants indicated that the accessibility of information and convenience of mHealth technologies ameliorated their work routines. Research shows that health informatics has the potential to improve healthcare service delivery, and consequently, future studies must look at the affect of these technologies on the fundamental elements of healthcare, including communication and information sharing patterns among healthcare providers.

In the immediate aftermath of Chaoulli vs. Quebec (Attorney General), it seemed that this decision would constitute a turning point in the way public health care is delivered in Canada. However, the lack of change in the following years has left this theory largely suspect. This thesis sets out to establish how two separate, yet equally powerful reactions to this case, proliferated in the wake of this decision. It aims to validate an original hypothesis that suggests that the treatment of the case from academia and from the print media (Canadian daily newspapers) constituted the most dominant discourses in the wake of the Chaoulli case. Furthermore it examines whether these two sectors were predominantly homogenous in their views of the case. However, this thesis concludes that, while these were two of the most dominant reactions to the Chaoulli case, the boundaries of these discourses and their respective supporters were not relegated exclusively to any given sector.

Background: It is important to understand Canadians' expectations of health care services and the costs of delivering care in the Emergency Department (ED) in order to continue to provide health care in a sustainable manner. Objectives: To examine the reasons patients present to the ED, and to conduct a cost analysis to compare the costs of seeking care in the ED versus a primary care setting. Methodology: We surveyed patients (n=606) triaged to the cubicles of the ED of The Ottawa Hospital, Civic Campus. The survey asked about their perceived urgency level and their patterns of health service use. Patient surveys were accompanied by physician surveys to assess each patient's level of urgency from a medical perspective. We performed bivariate analysis and logistic regression on survey variables of interest. We also conducted a cost analysis to determine the costs of providing non-urgent care in the ED. Results: Both a presenting symptom of a musculoskeletal injury (OR=2.93, CI 1.42-6.04) and having heard of TeleHealth Ontario (OR=2.08, CI1.08-4.03) were significantly associated with non-urgent ED use from the patient perspective. We also found that non-urgent ED visits cost an average of $248.75, which is significantly more costly than a primary care visit. Implications: Our results provide insights regarding patient factors influencing ED use and relative costs of non-urgent ED visits versus outpatient family doctor visits. However, additional work may be required to identify non-medical factors influencing patient motivations for seeking care in the ED.

Integrative healthcare (IHC), the combination of biomedical disciplines and expertise in various forms of complementary and alternative medicine (CAM), is an example of interdisciplinary collaboration that has emerged over the last two decades. Little has been written so far to gain an understanding of how the healthcare practitioners in such setting collaborate. The main goal of this doctoral dissertation was to better understand what is inside the "black box" of interdisciplinary collaboration within IHC clinics so that appropriate links related to clinic effectiveness and cost-effectiveness as well as patient outcomes could be tested in future research. This thesis explored the concept of interprofessional collaboration in IHC using three theoretical and conceptual models: Input Process Output, Relationship-Centered Care, and Models of Team Healthcare Practice. Inductive and deductive inquiries were conducted through sequential mixed methods and methodological triangulation techniques. Four objectives were proposed to better understand how collaboration was experienced and conceptualized within these clinics and how the related factors interacted with each others. Finally, assumptions of a conceptual model of classification of IHC clinics were tested. Constructs contributing to collaboration included practitioners' attitudes and educational background, as well as external factors such as the healthcare system and financial pressures. Major processes affecting collaboration consisted in communication, patient referral and power relationships. These determinants of collaboration resulted in learning opportunities for practitioners, modified burden of work and ultimately, higher affective commitment toward the clinic. The quantitative inquiry revealed that interpersonal relationships were shown to be central to the collaborative practice of IHC delivery. Additionally, beliefs in the benefits of collaboration were found to play an important role in an IHC collaborative enterprise. Finally, clinic model comparisons confirmed that interprofessional collaboration is modulated by the practice model. Suggestions to improve the conceptual model of classification were made. This multi-method study was the first to summarize systematically the factors that impact and ensue from interprofessional collaboration in the context of Canadian IHC. The framework lay down by this dissertation represents an important step to investigate further the impact of IHC on patients and the Canadian healthcare system and to guide the development of more effective IHC clinics.

Introduction: Enhancing health equity remains of international political importance with endorsement from the World Health Assembly in 2009. The failure of systematic reviews to consider effects on health equity is described by decision-makers as a limitation to using systematic reviews as a basis for evidence-informed decisions. Hence, there is a need for guidance on the role of systematic reviews in assessing effects on health equity. Methods: Four studies were conducted to assess the role of systematic reviews in assessing effects on health equity. A Cochrane Collaboration methodology review and a methodology study assessed methods used in published systematic reviews to assess effects of interventions on health equity across ten categories defined by the acronym PROGRESS-Plus: Place of residence, Race/ethnicity, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital. Plus considers other factors associated with unequal opportunities for good health such as age, disability and developing country settings. A qualitative study assessed implementation factors that are associated with success of interventions in vulnerable populations and mapped these factors to the equity-effectiveness loop framework. An equity plausibility algorithm was developed and tested to predict the likelihood of effects of interventions on health equity. Results: Only 13% of published systematic reviews assess effects on health equity. Four methods were used to assess effects of interventions on health equity: 1) description of people in studies; 2) description of subgroup analyses; 3) analysis of differences; and 4) applicability assessment. Only lout of 20 methodological studies used an analytic method. Implementation factors that predict success of interventions on improving health of homeless people in Ottawa mapped well onto the equity effectiveness loop framework, suggesting this framework can be used to appraise and improve interventions to promote health equity. Testing of the equity plausibility algorithm developed based on these studies showed that 67% of respondents thought that differences in relative effects of interventions were likely across sex and socioeconomic status, but there was little to no inter-rater agreement for these judgments. Discussion: These studies show that systematic reviews lack consideration of effects of interventions on health equity. This dissertation makes recommendations to improve reporting and conduct of systematic reviews to improve the contribution of systematic reviews to the evidence-base on promoting health equity. Methodological research is needed to improve methods for assessing applicability of systematic reviews for populations across PROGRESS-Plus characteristics, by both those who conduct systematic reviews and those who use them as a basis for decision-making.