Agnes Grudniewicz

University of Ottawa · Telfer School of Management

Introduction An increasing number of people are living longer with multiple health and social care needs, and may rely heavily on health system resources. When dealing with multiple conditions, patients, caregivers and healthcare providers (HCPs) often experience high treatment burden due to unclear care trajectories, a myriad of treatment decision...

Background: Interventions aimed at integrating care have become widespread in healthcare; however, there is significant variability in their success. Differences in organizational contexts and associated capabilities may be responsible for some of this variability. Purpose: This study develops and validates a conceptual framework of organizational...

Introduction Canadians report persistent problems accessing primary care despite an increasing per-capita supply of primary care physicians (PCPs). There is speculation that PCPs, especially those early in their careers, may now be working less and/or choosing to practice in focused clinical areas rather than comprehensive family medicine, but litt...

Objectives: To develop effective interventions to prevent publishing in presumed predatory journals (ie, journals that display deceptive characteristics, markers or data that cannot be verified), it is helpful to understand the motivations and experiences of those who have published in these journals. Design: An online survey delivered to two se...

In this paper, we discuss the processes of policy layering as they relate to health care reform. We focus on efforts to achieve systems of coordinated primary care, and demonstrate that material change can be achieved through processes of incremental policy layering. Such processes also have a high potential for unintended consequences. Thus, we pr...

Background Comprehensiveness of primary care has been declining, and much of the blame has been placed on early-career family physicians and their practice choices. To better understand early-career family physicians’ practice choices in Canada, we sought to identify the factors that most influence their decisions about how to practice. Methods We...

The Chronic Care Model has guided quality improvement in health care for almost 20 years, using a patient-centered, disease management approach to systems and care teams. To further advance efforts in person-centered care, we propose strengthening the Chronic Care Model with the goal-oriented care approach. Goal-oriented care is person-centered in...

Introduction Privatisation through the expansion of private payment and investor-owned corporate healthcare delivery in Canada raises potential conflicts with equity principles on which Medicare (Canadian public health insurance) is founded. Some cases of privatisation are widely recognised, while others are evolving and more hidden, and their exte...

Objective: To describe changes in the comprehensiveness of services delivered by family physicians across service settings and service areas in 4 Canadian provinces, to identify which settings and areas have changed the most, and to compare the magnitude of changes by physician characteristics. Design: Descriptive analysis of province-wide, popu...

Objective: The review aimed to identify which digital technologies are proposed or used within learning health systems (LHS) and to analyze the extent to which they support learning processes in LHS. Materials and methods: Multiple databases and grey literature were searched with terms related to LHS. Manual searches and backward searches of ref...

Introduction The Canadian population has poor and inequitable access to psychiatric care despite a steady per-capita supply of psychiatrists in most provinces. There is some quantitative evidence that practice style and characteristics vary substantially among psychiatrists. However, how this compares across jurisdictions and implications for workf...

Purpose: Comprehensiveness of primary care has been declining, and much of the blame has been placed on early-career family physicians and their practice choices. To better understand early-career family physicians' practice choices in Canada, we sought to identify the factors that most influence their decisions about how to practice. Methods: We c...

We describe changes in the comprehensiveness of services delivered by family physicians in 4 Canadian provinces (British Columbia, Manitoba, Ontario, Nova Scotia) during the periods 1999-2000 and 2017-2018 and explore if changes differ by years in practice. We measured comprehensiveness using province-wide billing data across 7 settings (home, long...

Background: Multicentric approaches are widely used in clinical trials to assess generalizability of findings, however they are novel in laboratory-based experimentation. It is unclear how multilaboratory studies may differ in conduct and results from single lab studies. Here we synthesized characteristics of these studies and quantitatively compar...

Aim: To use normalization process theory (NPT) to build a strategy for the implementation of goal-oriented care (GOC) in primary care in Flanders, Belgium. Background: GOC is a possible approach to more coordinated and integrated care and tailors care to patients' personal life goals. The concept has gained interest among policy makers and resea...

Background Team-based primary care reforms aim to improve care coordination by involving multiple interdisciplinary health professionals in patient care. Team-based primary care may support improved medication management for older adults with polypharmacy and multiple points of contact with the healthcare system. However, little is known about this...

Background: Lack of patient access to family physicians in Canada is a concern. The role of recent physician graduates in this problem of supply of primary care services has not been established. We sought to establish whether career stage or graduation cohort were related to family physician practice volume and continuity of care over time. Meth...

Background Many family medicine residency graduates indicate a desire to provide obstetric care, but a low proportion of family physicians (FPs) provide obstetric care within their practice. This suggests personal preference alone may not account for the low proportion of FPs who ultimately provide full obstetric care. If decisionmakers plan to aug...

Background Continuity of care has been shown to improve health outcomes and increase patient satisfaction. Goal-oriented care, a person-centered approach to care, has the potential to positively impact continuity of care. This study sought to examine how a goal-oriented approach impacts continuity of care in a long-term care setting. Methods Using...

Goal-oriented care is an approach to care delivery that uses patient-identified goals to drive care planning. Implementing goal-oriented care requires team members to cognitively shift the focus from “what is the matter” to “what matters to patients,” and align their mental models of what it means to care for patients. Yet, no empirical studies of...

Introduction: People with serious mental illness (SMI) have poor health outcomes, in part because of inequitable access to quality health services. Primary care is well suited to coordinate and manage care for this population; however, providers may feel ill-equipped to do so and patients may not have the support and resources required to coordinat...

Introduction Medical advancements are slow to reach the patient bedside due to issues with knowledge translation from preclinical studies. Multi-laboratory preclinical studies are a promising strategy for addressing the methodological deficiencies that weaken the translational impact of single laboratory findings. However, multi-laboratory preclini...

Over the last 15 years, there has been a trend in Canada to centralise the provision of health services that were previously administratively and fiscally decentralised. Canadian policy rhetoric on centralisation often identifies improved innovation as an anticipated outcome. This paper challenges the assumed relationship between centralisation and...

Introduction Many predatory journals fail to follow best publication practices. Studies assessing the impact of predatory journals have focused on how these articles are cited in reputable academic journals. However, it is possible that research from predatory journals is cited beyond the academic literature in policy documents and guidelines. Give...

Background Complaints about lack of access to family physicians (FPs) has led to concerns about the role recent physician graduates have had in changes in the supply of primary care services in Canada. This study investigates the impact of career stage, time period, and graduation cohort on family physician practice volume and continuity over two d...

Primary care is the foundation of health care systems around the world. Physician autonomy means that governments rely on a limited selection of levers to implement reforms in primary care delivery, and these policies may impact the practice choices, intentions, and patterns of primary care physicians. Using a systematic search strategy to capture...

Background Return-of-service (ROS) agreements require international medical graduates (IMGs) who accept medical residency positions in Canada to practice in specified geographic areas following completion of training. However, few studies have examined how ROS agreements influence career decisions. We examined IMG resident and early-career family p...

Background: Although focused practice within family medicine may be increasing globally, there is limited research on the factors contributing to decisions to focus practice. Aim: We aimed to examine the factors influencing resident and early-career family physician choices of focused practice across three Canadian provinces. Design and setting...

How does leadership emerge and function when multiple health care organizations come together to form a network? In this qualitative comparative case study, we draw on distributed leadership theory to examine the leadership practices that manifested during the implementation of three coordinated care networks. Thirty leaders and care providers part...

Multicentric approaches are widely used in clinical trials to assess generalizability of findings, however they are novel in preclinical experimentation. We synthesized characteristics of multilaboratory studies and quantitatively compared them to single laboratory studies. We systematically identified sixteen in vivo interventional multilaboratory...

Background Predatory journals are illegitimate journals that do not meet expected publication best practices. Many of these journals can be found using Google, making them readily available to patients searching online for health information. The goal of this study was to obtain information about how patients use the internet to get health informat...

Background: Although focused practice within family medicine may be increasing globally, there is limited research on the factors contributing to decisions to focus practice. We aimed to examine the factors influencing resident and early-career family physician choices of focused practice across three Canadian provinces. Methods: We analyzed a subs...

The challenges of polypharmacy and inappropriate prescribing are recognized internationally. This study synthesizes and compares the policies related to these issues introduced in Canada's two most populous provinces – Ontario and Quebec – over the first two decades of the 21st century. Drawing on policy documents and consultations with experts, we...

Introduction Canadians report persistent problems accessing primary care despite an increasing per-capita supply of primary care physicians (PCPs). There is speculation that PCPs, especially those early in their careers, may be working less and/or choosing to practice in focused clinical areas rather than comprehensive family medicine. Objectives...

Introduction: Person-centred integrated care is often at odds with how current health care systems are structured, resulting in slower than expected uptake of the model worldwide. Adopting goal-oriented care, an approach which uses patient priorities, or goals, to drive what kinds of care are appropriate and how care is delivered, may offer a way...

Objective To conduct a Delphi survey informing a consensus definition of predatory journals and publishers. Design This is a modified three-round Delphi survey delivered online for the first two rounds and in-person for the third round. Questions encompassed three themes: (1) predatory journal definition; (2) educational outreach and policy initia...

Background: Readiness is a critical precursor of successful change; it denotes whether those involved in the change are motivated and empowered to participate in the change. Research on readiness tends to focus on frontline providers or individuals in non-managerial positions and offers limited attention to individuals in middle management positio...

Background: Readiness is a critical precursor of successful change; it denotes whether those involved in the change are motivated and empowered to participate in the change. Research on readiness tends to focus on frontline providers or individuals in non-managerial positions and offers limited attention to individuals in middle management position...

Leading scholars and publishers from ten countries have agreed a definition of predatory publishing that can protect scholarship. It took 12 hours of discussion, 18 questions and 3 rounds to reach. Leading scholars and publishers from ten countries have agreed a definition of predatory publishing that can protect scholarship. It took 12 hours of di...

Context: Seniors are taking multiple medications and are at higher risk than the general population of inappropriate prescribing and potentially harmful medications. This may be linked to a lack of coordination in the delivery of care. Primary care reforms in Ontario and Quebec have sought to improve coordination, particularly through the implement...

Context: Comprehensiveness is a central element of primary care and family medicine but has not been clearly and consistently conceptualized in literature. The lack of an encompassing framework for comprehensiveness reduces our ability to measure and evaluate its presence and impact in primary care delivery. Objective: To examine the nature and ext...

Background: Posing as legitimate open access outlets, predatory journals and publishers threaten the integrity of academic publishing by not following publication best practices. Currently, there is no agreed upon definition of predatory journals, making it difficult for funders and academic institutions to generate practical guidance or policy to...

Introduction: Person-centered integrated care (PC-IC) is a concept combining person-centeredness and integrated care to better improve care for people with complex health and social needs. The World Health Organization describes PC-IC as “health services that are managed and delivered in a way so that patients receive both preventive and curative s...

Background: Care coordination is central in models of integrated care. Goal-oriented care is one approach that supports care coordination for multimorbid and complex patients by tailoring shared care plans to patient-identified goals rather than disease-specific targets. However, providers struggle with the adoption of goal-oriented care. Personal...

Introduction: Community based primary health care (CBPHC) organizations are critical providers of integrated care for complex patients. Exemplar cases exist, but efforts to scale up and spread successful models continue to face major challenges. While scale and spread has become a popular topic, there are still significant gaps in our understanding...

Introduction: Recently, there has been a paradigm shift in healthcare that calls for positioning patients as active partners in healthcare rather than passive recipients. This active partnership is even more evident with patients who live with multiple chronic diseases because with time, these patients become experts in their own bodies, symptoms a...

Providing care for increasingly medically and socially complex populations is a well-recognized challenge that necessitates coordinating services across multiple sectors and organizations. There is a need to re-organize how care is delivered to align with coordination efforts, in the form of inter-organizational networks. However, substantial gaps...

Background Readiness is a critical precursor of successful change; it denotes whether those involved in the change are motivated and empowered to participate in the change. Research on readiness tends to focus on frontline health care providers or individuals in non-managerial positions and offers limited attention to individuals in middle manageme...

Introduction Health systems in North America and Europe have been criticised for their lack of safety, efficiency and effectiveness despite rising healthcare costs. In response, healthcare leaders and researchers have articulated the need to transform current health systems into continuously and rapidly learning health systems (LHSs). While digital...

Multicenter preclinical studies have been suggested as a method to improve reproducibility, generalizability and potential clinical translation of preclinical work. In these studies, multiple independent laboratories collaboratively conduct a research experiment using a shared protocol. The use of a multicenter design in preclinical experimentation...

Open access article available from http://cmajopen.ca/content/7/1/E124.full Background: Family medicine residents choose among a range of practice options as they enter the physician workforce. We describe the demographic and personal characteristics of Canadian family medicine residents and examine differences in the intentions of residents from...

Trial and error, together: divergent thinking and collective learning in the implementation of integrated care networks Hybrid networks that link disparate professionals and organizations are a common approach to deliver integrated care to patients. Recent literature argues that successful implementation of these networks demands a socio-cognitive...

Background: There is no standardized definition of what a predatory journal is, nor have the characteristics of these journals been delineated or agreed upon. In order to study the phenomenon precisely a definition of predatory journals is needed. The objective of this scoping review is to summarize the literature on predatory journals, describe it...

Hybrid networks that link disparate professionals and organizations are a common approach to deliver integrated care to patients. Recent literature argues that successful implementation of these networks demands a socio-cognitive perspective in which stakeholder mental frames and thought processes are prioritized, investigated, and compared. The ai...

Background: There is no standardized definition of what a predatory journal is, nor have the characteristics of these journals been delineated or agreed upon. In order to study the phenomenon precisely a definition of predatory journals is needed. The objective of this scoping review is to summarize the literature on predatory journals, describe it...

Background: Postoperative delirium is a common preventable complication experienced by older adults undergoing elective surgery. In this systematic review and meta-analysis, we identified prognostic factors associated with the risk of postoperative delirium among older adults undergoing elective surgery. Methods: Medline, EMBASE, CINAHL, Cochran...

Background: Elective surgeries can be associated with significant harm to older adults. The present study aimed to identify the prognostic factors associated with the development of postoperative complications among older adults undergoing elective surgery. Methods: Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and Age...