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Rethinking Evidence – the Global Evidence Commission on Evidence to Address Societal Challenges

By: Tushar Sood, Vikita Mehta 

Edited by: Dr. Michael Wilson

Among many transformations, the COVID-19 pandemic has revealed deep societal inequities and prompted us to rethink how we approach policies to address societal challenges. This has created a “once-in-a-generation focus on evidence among governments, businesses and non-governmental organizations, many types of professionals, and citizens” (mcmasterhealthforum, 2022). Given this emphasis, it is time to formally systematize what is going well when using evidence and addressing any shortfalls. This includes “creating the capacities, opportunities and motivation to use evidence to address societal challenges, and putting in place the structures and processes to sustain them” (Global Commission on Evidence to Address Societal Challenges, 2022). This approach can be expanded to many societal challenges, from educational achievement to climate change to health-system performance. The Global Commission on Evidence to Address Societal Challenges, hereafter referred to as the Evidence Commission, was formed to address this challenge.

The Evidence Commission 

On 27 January 2022, the Evidence Commission was launched through a webinar hosted by the Secretariat Co-Leads John Lavis and Jeremy Grimshaw and Executive Lead Jenn Thornhill Verma and Secretariat. It featured a brief overview of the report by John Lavis by commissioners David Halpern (Chief Executive of the Behavioural Insights Team), Kerry Albright (Deputy Director ad interim and Chief, Research Facilitation and Knowledge Management, UNICEF Office of Research – Innocenti), and Modupe Adefeso-Olateju (Managing Director of The Education Partnership Centre). The report has two main goals: 1) provide the context, concepts or vocabulary that underpin work in this area; and 2) provide recommendations about how we can and must improve the use of evidence, both in routine times and during future global crises. 

In this report, which considers equity throughout its text, evidence refers to research evidence which is collected by researchers and may be used by decision-makers (Global Commission on Evidence to Address Societal Challenges, 2022). Specifically, the Evidence Commission outlines eight types of evidence. These include data analytics, modelling, evaluation, behavioural/implementation research, qualitative insights, evidence synthesis, technology assessment/cost-effectiveness analysis and guidelines (Global Commission on Evidence to Address Societal Challenges, 2022). In addition, the Evidence Commission focuses on four types of decision-makers, which include government policymakers, professionals, organizational leaders, and citizens, aiming to help them prepare for challenges, prepare for decision-making, and to consider evidence (Global Commission on Evidence to Address Societal Challenges, 2022). 

The Evidence Commission’s report includes the following chapters, further divided into 52 sections available for download on the website: https://www.mcmasterforum.org/networks/evidence-commission.  

  1. Introduction 
  2. Nature of societal challenges 
  3. Decision and decision-makers: Demand for evidence 
  4. Studies, syntheses and guidelines: Supply of evidence 
  5. Role of evidence intermediaries 
  6. Need for global public goods and equitably distributed capacities 
  7. Recommendations 
  8. Appendices 

The eight most important recommendations of the report are highlighted in Figure 1.

Figure 1: Main recommendations of the Evidence Commission report (Global Commission on Evidence to Address Societal Challenges, 2022).

Further, the report contains 52 sections that are available for download on the website.  

The Evidence Commission has garnered international attention. For example, an editorial in Nature discusses a priority recommendation from the Commission for multilateral organizations to provide greater support for the use of research evidence in making decisions, such as the way the Intergovernmental Panel on Climate Change evaluates climate science to inform policy related to the climate (Nature Editors, 2022). It also calls to attention the need for a central agency to coordinate the independent efforts by each nation, to ultimately “get the right evidence to those who need it at the right time” (Nature Editors, 2022). 

Next Steps 

Next steps for the Commission include systematizing what went well and address what didn’t during and before the pandemic. At the country-level, the report highlights the need for countries to conduct rapid jurisdictional assessments and contribute to a cross-jurisdictional network of government entities engaged in similar systematizing work. Other potential next steps for evidence producers include starting conversations about issues such as duplication and ensuring quality evidence, as well as exposing them to new approaches to gathering evidence including living syntheses and guidelines. Experimenting with new evidence products such as infographics that collect many forms of evidence and engage citizens and stakeholders was also proposed. One example that has been highlighted for consideration locally is adapting the UK cabinet office approach where political leaders can bring unanswered policy-related questions to the cabinet, and the evidence funding can subsequently be given to these priority areas. At the global level, one way forward could be efforts to spearhead a G20 brief and advocacy effort focused on securing a soft commitment by all members and hard commitment by select members on important evidence-building priorities.  

On an individual level, we can all contribute to this global effort for evidence-informed policymaking by learning more about the Global Commission on Evidence through social media (@evidencecomm on Twitter and LinkedIn) and sharing posts with our networks. To share the Commission’s work more broadly, you can also write a story or op-ed about the Global Commission on Evidence for your national news media or publish a commentary in an academic journal.  

We have all learned a great deal from the COVID-19 pandemic. For us to never again reach a level of global crisis that was the pandemic, it is integral that more robust and interlinked evidence systems be built and used by all nations. The Global Evidence Commission’s recommendations are the first step in achieving this goal.  

References 

Global Commission on Evidence to Address Societal Challenges. (2022, January 27). The Evidence Commission report: A wake-up call and path forward for decisionmakers, evidence intermediaries, and impact-oriented evidence producers—Executive Summary. https://www.mcmasterforum.org/docs/default-source/evidence-commission/executive-summary—evidence-commission-report.pdf?Status=Master&sfvrsn=d5f745e8_5/Executive-summary—Evidence-Commission-report 

mcmasterhealthforum. (2022, January 27). Evidence Commission report launch. https://www.youtube.com/watch?v=fiZRoU5L4uY 

Nature Editors. (2022). Wanted: Better systems for turning evidence into action. Nature, 603(7899), 7–8. https://doi.org/10.1038/d41586-022-00559-9 

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Long-Term Care in Ontario – COVID-19 Crisis and Renewal

By: Tushar Sood, Vikita Mehta

Edited by: Dr. Michael Wilson

In Canada, long-term care (LTC) homes offer adults who can no longer live independently a place to live, which is equipped with accessible supports (Liu et al., 2020). While the Canada Health Act mandates that each province and territory provide first-dollar coverage for “medically necessary” physician and hospital services, the costs for LTC homes are typically not fully covered. Consequently, LTC policies, funding, and standards vary across provinces. In Ontario, LTC is governed under the Long-Term Care Homes Act and residents typically provide a co-payment to live there (Liu et al., 2020).

Understanding the State of LTC in Ontario

To better understand the state of LTC in Ontario, it is helpful to compare it to another Canadian province. For example, a recent paper which compared the LTC sector in Ontario with that of British Columbia (BC) found the following (Liu et al., 2020):

  • In 2018-19, the average funding per diem per Ontarian resident was $203, about 8.6% lower than that of BC ($222)
  • Before the COVID-19 pandemic, BC residents received more hours of direct care per day than Ontarian residents (3.25 vs. 2.71 hours) and were less likely to live in shared rooms than in Ontario (24% vs. 63%)
  • LTC in either province is subject to regular inspection, but after 2018, fewer homes in Ontario received comprehensive inspections
  • In recent years, the connections between hospitals, LTC, and public health have been stronger in BC than in Ontario
  • Similarly, BC’s health system organizational structure has recently been more stable than that of Ontario, which is transitioning from Local Health Integration Networks (LHINs) to a centralized organization, Ontario Health
  • While LTC homes in both provinces are managed on either a non-profit or for-profit basis, more LTC homes in Ontario are managed for-profit than in BC (58% vs. 34%)

This last statistic is critical as existing evidence suggests that for-profit homes generally deliver inferior care across several process and outcome measures (Liu et al., 2020). Notably, the vast majority of Canadian provinces and territories have higher proportions of publicly owned LTC homes than Ontario (Waddell et al., 2021).

LTC Crisis in Ontario

LTC in Ontario has long been at crisis levels. In 2019-20, patients waited a median of 145 days to get placed in a LTC home (90 days if their previous location was a hospital and up to 159 days if it was the community) (Health Quality Ontario (HQO), n.d.). The lack of available LTC beds can result in hospital bed-blocking, a situation where hospital patients who are ready to be discharged to a nursing home must delay their discharge as they are unable to find a spot. Ultimately, patients end up staying in a more costly substitute – the hospital (Gaughan et al., 2015). While a modest effect, an increase in LTC homes by 10% would reduce social care delayed discharges by up to 9% (Gaughan et al., 2015). Moreover, there are numerous impacts to consider at the personal level. What does bed-blocking mean for patients? Do they have to stay at the hospital or at home? Does this change their level of support? If staying at home with minimal support, what are the negative impacts on caregivers? These are just some of the many questions we can ask regarding the trickle-down effects of a “universal” LTC system which is not truly accessible to all.

Perhaps this would be less of an issue if there were comparable alternatives, such as home care. Home care is an integral part of the Canadian health care system, allowing individuals to live with comfort, independence, and dignity at their own residences (Yakerson, 2019). However, as Yakerson (2019) reports, the current home care system in Ontario is “underfunded, understaffed, and inequitable in access to care”. Unfortunately, policies continue to be strategically blinded to the harsh realities of this sector, which often involves cost cutting, deregulation, and service privatization (Yakerson, 2019).

LTC and the COVID-19 Pandemic

The COVID-19 pandemic has highlighted the long-standing issues in Ontario’s inadequately funded LTC system. As of December 29, 2021, there have been 23,351 cases of COVID-19 in Ontario LTC homes, with 15,849 of them in residents and 7,502 in staff. There has also been a total of 3,846 deaths in LTC, with all but 13 of them being residents (Government of Ontario, 2021c). Compared to BC, rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Ontario LTC homes have been several times higher, at 7.6% compared to 1.7%. COVID-19 mortality among residents followed a similar trend, with Ontario and British Columbia at 2.3% vs. 0.6%, respectively. Case fatality rates remained similar across jurisdictions, suggesting that similar proportions of residents would die upon contracting the virus (Liu et al., 2020).

During the pandemic, numerous reports were released documenting the rampant physical and emotional abuse in LTC. For example, approximately 85% of Ontario’s LTC homes having repeatedly broke the law with little to no consequences. Common offences included those involving skin and wound care, medication errors, abuse, neglect, and hydration (Pedersen et al., 2020).

Priorities and Options for LTC Renewal

The current Progressive Conservative government in Ontario has made the creation of 30,000 net new LTC beds over ten years a priority, while also pledging to upgrade many more (Government of Ontario, 2021b). In March 2021, Ontario also began accepting applications for 6,000 tuition-free accelerated Personal Support Worker education spots to address staffing shortages (Government of Ontario, 2021a). The current federal Liberal government has committed to funding provinces and territories through its Safe Long-term Care Fund which, in addition to billions of dollars in previous commitments, will support long-term care facilities (Waddell et al., 2021).

Considering the pandemic’s severe impacts on the LTC sector, major parties in the recent 2021 Canadian General Election also made many promises, despite LTC being under provincial jurisdiction. For example, the governing Liberals supported increasing the wages of personal support workers in the LTC sector as well as hiring 50,000 more workers, providing $3 billion to improve LTC homes, and allocating $3 billion to ensure provinces and territories provide a certain standard of care in their LTC homes. The Conservatives promised $3 billion over three years to renovate LTC homes. Some of the NDP’s promises included ending private for-profit homes, setting national standards for LTC and home care and regulating them under the Canada Health Act (funding tied to meeting standards), spending $5 billion of LTC systems, and committing to increasing the Canada Health Transfer. The Greens also pitched placing the LTC system under the Canada Health Act, ending for-profit LTC business, creating a dedicated Seniors’ Care Transfer, and boosting wages and training of LTC workers (Maclean’s, 2021). There is clear consensus that more needs to be done, but there remains debate as to how things should change moving forward.

Given this, what should governments do next? This is not a simple problem – it is complex, multi-faceted, and requires collaboration across jurisdictions to draft and implement effective evidence-informed policy. At the McMaster Health Forum, we have conducted a series of LTC Crisis and Renewal COVID-19 Living Evidence Profiles (LEPs). These documents collect and synthesize information regarding supporting LTC renewal during and after the COVID-19 pandemic. They are intended to inform policymakers’ decisions regarding this sector. To access these documents, visit https://www.mcmasterforum.org/find-evidence/products/project/covid-19-living-evidence-profile-2-what-is-known-about-preventing-and-managing-covid-19-outbreaks-and-about-supporting-renewal-in-long-term-care-homes.

References

Gaughan, J., Gravelle, H., & Siciliani, L. (2015). Testing the Bed-Blocking Hypothesis: Does Nursing and Care Home Supply Reduce Delayed Hospital Discharges? Health Economics, 24(S1), 32–44. https://doi.org/10.1002/hec.3150

Government of Ontario. (2021a, March 8). Ontario Colleges Now Accepting Applications for Accelerated Personal Support Workers Program. Ontario Newsroom. https://news.ontario.ca/en/release/60593/ontario-colleges-now-accepting-applications-for-accelerated-personal-support-workers-program

Government of Ontario. (2021b, March 18). Ontario Making Historic Investment to Modernize Long-Term Care. Ontario Newsroom. https://news.ontario.ca/en/release/60796/ontario-making-historic-investment-to-modernize-long-term-care

Government of Ontario. (2021c, December 29). Long-term care homes. COVID-19 (Coronavirus) in Ontario. https://covid-19.ontario.ca/data/long-term-care-homes

Health Quality Ontario (HQO). (n.d.). Long-Term Care Home Wait Times in Ontario. Health Quality Ontario (HQO). Retrieved December 29, 2021, from https://www.hqontario.ca/System-Performance/Long-Term-Care-Home-Performance/Wait-Times

Liu, M., Maxwell, C. J., Armstrong, P., Schwandt, M., Moser, A., McGregor, M. J., Bronskill, S. E., & Dhalla, I. A. (2020). COVID-19 in long-term care homes in Ontario and British Columbia. CMAJ, 192(47), E1540–E1546. https://doi.org/10.1503/cmaj.201860

Maclean’s. (2021, July 23). 2021 federal election platform guide: Where the parties stand on everything. Maclean’s. https://www.macleans.ca/rankings/2021-federal-election-platform-guide/

Pedersen, K., Mancini, M., Common, D., & Wolfe-Wylie, W. (2020, October 23). 85% of Ont. Nursing homes break the law repeatedly with almost no consequences, data analysis shows | CBC News. CBC News. https://www.cbc.ca/news/marketplace/nursing-homes-abuse-ontario-seniors-laws-1.5770889

Waddell, K. A., Wilson, M. G., Bain, T., Al-Khateeb, S., Bhuiya, A., & Lavis, J. N. (2021). Appendices for COVID-19 living evidence profile #2 (version 2.5): What is known about supporting renewal in long-term care homes? McMaster Health Forum. https://www.mcmasterforum.org/docs/default-source/product-documents/living-evidence-profiles/covid-19-living-evidence-profile-2.5-appendix_what-is-known-about-preventing-and-managing-covid-19-outbreaks-and-about-supporting-renewal-in-long-term-care-homes.pdf?sfvrsn=be026212_7

Yakerson, A. (2019). Home Care in Ontario: Perspectives on Equity. International Journal of Health Services, 49(2), 260–272. https://doi.org/10.1177/0020731418804403

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Social Systems Evidence provides policymakers and stakeholders with better access to research evidence

SSE

With a growing international focus on evidence-informed policymaking across government and on achieving the UN’s Sustainable Development Goals, Forum+ has launched the beta version of Social Systems Evidence to better support policymakers, stakeholders and researchers who want to access the best available research evidence in a timely manner.

“For all those looking for evidence to support policy decisions, we’re trying to help you do this better or more efficiently,” said John N. Lavis, Director of Forum+.

The addition to the McMaster Optimal Aging Portal of Social Systems Evidence content about the social aspects of aging (such as civic engagement, consumer protection, and transportation), will complement the high-quality information already provided about the health aspects of aging. The broader range of content will better support citizens in making informed decisions as they age.

Social Systems Evidence will soon be the world’s most comprehensive, continuously updated repository of research evidence about the programs, services and products available in 16 government sectors and program areas (i.e., community and social services, culture and gender, economic development and growth, education, transportation), as well as the governance, financial and delivery arrangements within which these programs and services are provided, and the implementation strategies that can help to ensure that these programs and services get to those who need them.

>> Visit https://www.socialsystemsevidence.org