With the introduction of the LHS concept, the NAM has provided a compelling vision for the optimisation of health systems worldwide. In this article, we describe a conceptual framework that is guiding work by INESSS to foster greater learning and improvement in Canada. This framework comprises four main components, notably LHS core values, pillars and accelerators, processes, and outcomes. We argue that LHSs serve primarily to improve value in health systems, based on definitions of value that account for the diverse interests and objectives of actors within communities of interest.
In Canada, recent reports have drawn attention to the LHS as a foundation for a higher performing healthcare system [19,20,21]. Still, there are many challenges that must be overcome to achieve this vision, notably at the level of LHS pillars. For example, Canada has made massive investments in its data infrastructure over the past decade, including substantial efforts to support EHR system adoption in primary care, yet this infrastructure remains plagued by problems of interoperability and the inability to link and aggregate data [21, 110,111,112]. Efforts to build national clinical registries or EHR-based research networks have also been slowed due to the multitude of provincial laws governing personal health information and their interpretation by ethics review boards [113, 114]. National funding for health research is not yet adapted to support rapid innovation cycles and only scant funding has been directed to change management and the scale and spread of innovations [71, 115]. Few mechanisms have been introduced to ensure strong patient involvement in health system design and priority-setting and the routine collection of patient-reported outcome measures and patient-reported experience measures is far from a reality in most health jurisdictions [21, 116]. With an inadequate socio-technical architecture, provincial health systems have been largely unable to establish a culture of learning and improvement and make progress towards the objectives of the quadruple aim [19, 21, 117, 118].
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The current evidence based treatment for lymphedema of all sorts is the CDT, which is generally accepted as consensus treatment [41, 42]. However, some aspects of the CDT, namely the manual lymphatic drainage (MLD) are up for debate [43,44,45,46,47,48,49]. Although literature on the treatment of breast edema in specific is scarce, we recommend to extrapolate the CDT, which is thoroughly described for the extremities, for breast edema as well, to the utmost extent. CDT is currently the consensus treatment for lymphedema and consists of 4 main pillars: skin care, MLD, compression (bandaging and/or compressions garments) and exercise. The CDT is divided into 2 phases. The goal of phase 1, the intensive phase, is to reduce the swelling. The 4 components of phase 1 are skin care, MLD, compression using bandaging and exercise. Phase 2 aims at preserving the results of phase 1. It contains the same components as in phase 1, except for compression which is generally provided by compression garments instead of bandages. What follows is a synopsis of the 4 pillars of the CDT, and if applicable its evidence for breast edema. 2ff7e9595c
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