title: Improving performance management for delivering appropriate care for patients no longer needing acute hospital care.
abstract: OBJECTIVE
  The public, providers and policy-makers are interested in a service continuum where care is provided in the appropriate place. Alternate level of care is used to define patients who no longer need acute care but remain in an acute care bed. Our aims were to determine how subacute care and convalescent care should be defined in British Columbia (BC); how these care levels should be aligned with existing legislation to provide more consistent service standards to patients and what reporting requirements were needed for system planning and performance management.
  
  
  METHODS
  A literature review was conducted to understand the international trends in performance management, care delivery models and change management. A Canada-wide survey was carried out to determine the directions of other provinces on the defined issues and a BC survey provided a current state analysis of programming within the five regional health authorities (HAs).
  
  
  RESULTS
  A provincial policy framework for subacute and convalescent care has been developed to begin to address the concerns raised and provide a base for performance measurement. The policy has been approved and disseminated to BC HAs for implementation. An implementation plan has been developed and implementation activities have been integrated into the work of existing provincial committees. Evaluation will occur through performance measurement. The benefits anticipated include: clear policy guidance for programme development; improved comparability of performance information for system monitoring, planning and integrity of the national acute care Discharge Abstracting Database; improved efficiency in acute care bed use; and improved equity of access, insurability and quality for patients requiring subacute and convalescent care. While a national reporting system exists for acute care in Canada, this project raises questions about the implications for this system, given the shifting definition of acute care as other care levels emerge. Questions are also raised by the finding in Australia that the current case-mix system is inadequate to describe these patients. Further, given the inadequacy of our understanding of health system capacity and output, consideration of a more comprehensive national reporting system along the care continuum may be warranted.
  
  
  CONCLUSIONS
  This project is an example of effective collaboration between the provincial government, a national organization and HAs, and suggests that provincial governments can participate in a meaningful way to accomplish research-informed health services policy.
authors.affiliation: Health Authority Division, Ministry of Health, Victoria, British Columbia, Canada. cpenney@telus.net
authors.forename: Christine
authors.initials: C
authors.lastname: Penney
authors.forename: Effie
authors.initials: E
authors.lastname: Henry
mesh_terms: D001955:British Columbia; D003266:Continuity of Patient Care / Q000592:standards*; D003289:Convalescence; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units; D011787:Quality of Health Care / Q000592:standards*