Re-imagining Healthcare: The Northwest Territories Transitions to an Integrated Chronic Disease Management Strategy
Bibliographic record
Abstract
With the goal to improve healthcare services and delivery, Stanton Territorial Hospital in the Northwest Territories (NWT) invited the Canadian Health Services Research Foundation (CHSRF) to explore opportunities to collaborate in the redesign and improvement of the health system. This article describes the NWT’s efforts to transform its healthcare delivery to more appropriately care for people living with chronic diseases. It also sets the context for the initial meeting between the NWT and CHSRF and the collaborative journey that continues, with the bringing together of 40 health system managers, policy makers and clinicians, along with CHSRF staff and guest faculty, with a shared vision to redesign care to better meet the needs of people living with chronic diseases in the territory. In the NWT, chronic diseases account for approximately 70% of all deaths and half of all hospital admission days (Northwest Territories Department of Health and Social Services [DHSS] 2011b). As elsewhere, it is understood that healthcare services are not currently meeting population needs. Canadian health systems rank poorly in international comparisons that focus on the delivery of primary care, especially to those with multiple chronic conditions (Schoen et al. 2009). It is also well recognized in Canada that few healthcare systems are patient centred. In a recently commissioned CHSRF synthesis on transformation, professors Ross Baker and Jean-Louis Denis (2011) remarked, “Healthcare systems tend to reproduce their dominant logic and consequently neglect other areas where major care deficits persist.” In another CHSRF-commissioned synthesis on transformation, Professor Denis and colleagues (2011) noted that “a clear vision and a coherent set of strategies are required to transform the system and achieve better alignment between the care offered and the care the population needs today.” Such is the challenge for the NWT. In its recently released 2011–2016 strategic plan, DHSS (2011a) set a priority to “improve the health status of the population” through the development of a culturally appropriate chronic disease management model that tracks system quality outcome measures. With a senior leadership dedicated to improving the health status of its population as a key strategic priority and highly engaged throughout the change management process, the NWT is well positioned to improve healthcare services and delivery through transformation. CHSRF, in partnership with NWT leadership, intends to support the territory through its longer-term vision, to strategically reorient the health system for the benefit of all those living in the territory. We also hope that the lessons we learn here hold value for learning elsewhere.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.022 | 0.012 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.017 | 0.013 |
| Scholarly communication | 0.022 | 0.013 |
| Open science | 0.004 | 0.021 |
| Research integrity | 0.009 | 0.015 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".