title: Health system capacity and infrastructure for adopting innovations to care for patients with venous thromboembolic disease.
abstract: BACKGROUND
  Diagnosis and treatment for venous thromboembolic disease (VTE) have evolved considerably through diagnostic and therapeutic innovations. Despite their considerable potential for enhancing care, however, the extent to which these innovations are being adopted in usual practice is unknown. We documented the infrastructure available in hospitals and health regions across Canada for provision of optimal diagnosis and therapy for VTE disease.
  
  
  METHODS
  Over the period January 2008 through October 2009, we studied health system infrastructure for care of VTE disease in Canada's 10 provinces and 3 territories and all 94 health regions therein. We interviewed health system managers and/or clinical leaders from all 658 acute care hospitals in Canada and documented key elements of health system infrastructure at the hospital level for these institutions.
  
  
  RESULTS
  There was considerable variation across Canada in the availability of key infrastructure for the diagnosis and management of VTE disease. Provinces with higher populations tended to have a large proportion of hospitals with capability to measure d-dimer levels, whereas less populated provinces were more likely to send samples to centralized analysis facilities for d-dimer testing. All provinces and territories had some facilities offering advanced diagnostic imaging, but the number of institutions and the availability of imaging were highly variable (with the proportion offering at least limited availability ranging from 0% to 90%). Only 6 provinces had regions with availability of dedicated early and/or long-term outpatient clinics for VTE disease.
  
  
  CONCLUSIONS
  Infrastructure in Canada for optimal care of patients with VTE disease was suboptimal during the study period and was not entirely in step with the evidence. Such shortfalls in health system infrastructure limit the extent to which health care providers can deliver optimal, evidence-based care to their patients. Nationwide evaluations of health system infrastructure such as this one should be undertaken internationally to better characterize quality of care and potential for improvement.
authors.affiliation: Danielle A. Southern, MSc, is a Programmer/Analyst in the Department of Community Health Sciences and a member of the Institute for Public Health, University of Calgary, Calgary, Alberta.
authors.forename: Danielle A
authors.initials: DA
authors.lastname: Southern
authors.affiliation: Jasmine Poole is a Research Assistant in the Department of Medicine, McGill University Health Centre, Montreal, Quebec.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Poole
authors.affiliation: Alka Patel, PhD, is an Adjunct Assistant Professor in the Department of Community Health Sciences and a member of the Institute for Public Health, University of Calgary, Calgary, Alberta.
authors.forename: Alka
authors.initials: A
authors.lastname: Patel
authors.affiliation: Nigel Waters, PhD, is a Professor in the Department of Geography and GeoInformation Science, George Mason University, Fairfax, Virginia.
authors.forename: Nigel
authors.initials: N
authors.lastname: Waters
authors.affiliation: Louise Pilote, MD, MPH, PhD, is a Professor in the Department of Medicine, McGill University Health Centre, Montreal, Quebec.
authors.forename: Louise
authors.initials: L
authors.lastname: Pilote
authors.affiliation: Russell D. Hull, MBBS, MSc, is a Professor in the Faculty of Medicine, University of Calgary, Calgary, Alberta.
authors.forename: Russell D
authors.initials: RD
authors.lastname: Hull
authors.affiliation: William A. Ghali, MD, MPH, FRCPC, is a Professor in the Departments of Community Health Sciences and of Medicine and is Director of the Institute for Public Health, University of Calgary, Calgary, Alberta.
authors.forename: William A
authors.initials: WA
authors.lastname: Ghali
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D019538:Health Care Surveys; D006295:Health Resources / Q000706:statistics & numerical data / Q000600:supply & distribution*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006739:Hospital Administration / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D020380:Needs Assessment; D009936:Organizational Innovation; D011156:Population Density; D054556:Venous Thromboembolism / Q000175:diagnosis* / Q000628:therapy*; D055815:Young Adult