The objective of this study was to determine the cost and effectiveness of a transitional discharge model (TDM) of care with clients who have a chronic mental illness. The model was tested in a randomized clinical trial using a cluster design. This model consisted of: (1) Peer support for 1 year and (2) Ongoing support from hospital staff until a therapeutic relationship was established with the community care provider. Participants (n = 390) were interviewed at discharge, 1 month post-discharge, 6 months post-discharge and 1 year post-discharge. Data collected included demographics, quality of life, health care utilization, levels of functioning and the degree of intervention received. The intervention group post-discharge costs and quality of life were not significantly improved compared with the control group. Although not predicted a priori, intervention subjects were discharged an average of 116 days earlier per person. Based on the hospital per diem rate this would be equivalent to 12M dollars CDN hospital costs. Both under-implementation among implementation wards and contamination in control wards were found. This study demonstrates some of the multiple challenges in health system research.

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Healthcare organizations have been operating in a turbulent environment for years. Pressures from the government and competition U S well as escalating costs have driven administrators to search for effective management tools. Balanced scorecard (BSC), a strategic munagement system, has been implemented in business organizations with success and is gaining acceptance in the not-for-profit and healthcare sectors. Despite potential benefits, there are challenges for implementers of BSC such as judgment biases, information overload, and the synthesis of information. This paper proposes to apply the analytic hierarchy process (AHP) to hospital scorecards in performance ussessment. Although AHP could be a time-consuming exercise, it allows participative input in determining a comprehensive measure for comparing performance of healthcare organizations.JEL classifications: M41, M49

The subset of 33 QIs developed on the basis of a systematic literature review and consensus provides the basis for the selection of a set of QIs for ongoing, standardized monitoring of various dimensions of quality in a childhood cancer system.