Through the Looking Glass: The Cardiac Care Network of Ontario 10 Years Later

Abstract

This article was informed by input received from key stakeholders in January and February 2001 in preparation for a CCN strategic planning retreat. A total of 19 individuals were interviewed and 69 surveys were analyzed. Interviewees and survey respondents commented on CCN's strengths, weaknesses, its priorities and threats to meeting these priorities. Many of these observations are also included in CCN's 10-year case study, Cardiac Care Network of Ontario: Ten Years 1990-2000.

Association Between Hospital Cardiac Management and Outcomes for Acute Myocardial Infarction Patients

“…17 To improve access to invasive cardiac services, the Ontario Cardiac Care Network implemented a macro-level initiative to facilitate evidence-based, timely, equitable access for urgent patients using a regionalized system and explicit urgency ratings based on clinical criteria. 18,19 In spite of these quality improvements, rates of provision of interventional services remain low and variations in 30-day mortality rates across Ontario hospitals remain high. 20,21 Hospital quality improvement initiatives may not translate into improved outcomes because randomized clinical trials are conducted on ideal patients, not all ideal patients will benefit from improved evidence-based management because the number needed to treat may be large, and evidencebased therapies may not be targeted at patients most likely to benefit.…”

Association of Neighborhood-Level Marginalization With Health Care Use and Clinical Outcomes Following Hospital Discharge in Patients Who Underwent Coronary Catheterization for Acute Myocardial Infarction in a Single-Payer Health Care System

“…27 Invasive cardiac care is regionalized to improve patient access to essential services, with a network of 18 centers serving the province's population. 22…”

“…[13][14][15][16][17][18] However, the majority of Canadian data predate pervasive uptake of modern antiplatelet therapies and coordinated systems of care that improved access to coronary revascularization. [19][20][21][22] Further, much of the data consider only personal or household income, making it challenging to ascertain the long-term contributions of determinants of health beyond economic inequality. [1][2][3][4][5][6][7][8][9][10] Finally, much of the literature examined in-hospital care and outcomes, [1][2][3][4][5][6][7][8][9][10][11][12][23][24][25] which are largely driven by patients' preexisting risk factor burdens and disease severity on presentation.…”

Wait times in Canada

“…11 Provinces also changed the management of waiting lists; for example, the Ontario Cardiac Care Network created a centralized registry of patients on waiting lists and established a standardized urgency rating system that prioritized patients for treatment. 12 Both these ideas were incorporated into the 2004 Saskatchewan Surgical Care Network, which also created targeted times for treatment and the use of web sites to publicize wait times. 13 The Saskatchewan Surgical Initiative: An example of innovation in Canadian healthcare…”