Case study on priority setting in rural Southern Alberta: keeping the house from blowing in.
OBJECTIVE
This case study describes the priority-setting process undertaken by health care providers in the Municipal District of Taber, Alta., to improve and integrate chronic disease services within a fixed budget.


METHODS
Providers first reviewed the current chronic disease management system, then considered alternatives based on program priorities and costs and benefits of potential changes.


RESULTS
Despite reaching consensus that a chronic disease clinic was the top priority for funding, providers were unable to redesign services accordingly. Redesign efforts were hampered by the groups' difficulty in identifying services that should receive fewer resources in order to fund priority areas, inexperience with priority-setting frameworks, group composition, the belief that many programs were already at "bare bone" funding levels, and perceptions of limited budget control. In the end, recommendations were made to use attrition to release resources, establish multi-disciplinary teams and group visits, where appropriate, and relocate providers to a centralized location. Upon review of study outcomes, Taber providers were granted more decision-making authority.


CONCLUSIONS
Overall, the use of a systematic priority-setting process, culminating in recommendations for action, has moved Taber providers closer to an integrated model of service delivery. It is recommended that formal priority-setting frameworks continue to be used in Taber for primary care renewal or at any level where consideration of existing evidence and projected costs is required.
Halma
Lisa
L
Lethbridge Regional Hospital, 960 19th St. S, Lethbridge AB T1J 1W5.
Mitton
Craig
C
Donaldson
Cam
C
West
Bruce
B
D000416:Alberta; D002908:Chronic Disease / Q000628:therapy*; D019468:Disease Management; D015276:Health Care Rationing / Q000458:organization & administration*; D006292:Health Priorities / Q000458:organization & administration*; D006801:Humans; D012040:Regional Health Planning / Q000458:organization & administration*; D012424:Rural Population