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Improving access to healthcare has been a consistent priority for Canadians. In particular, reducing patient waiting times for health services has been a prominent policy issue. Across the country, governments are using a range of strategies to reduce patient waiting times for care, with a particular focus on reducing waits for specialized services. Although information is emerging on waits for selected procedures, there is limited information on whether the utilization of services or waiting experiences of Canadians with health problems are different from those of the general population. Data from the Health Services Access Survey (2001–2005) were used to compare waiting experiences for specialized services between adults with health problems and healthier adults. The specialized services included specialist visits for a new illness or condition, non-emergency surgery and diagnostic tests. National-level estimates revealed that adults with health problems were more likely to self-report that they required specialized services. However, the median waiting times for these services were comparable to those of healthier adults.

IntroductionAround the world, the need for mental health, addictions and home care services is growing. Government commitment and collective efforts to bridge data gaps, develop indicators and publicly report results are key elements in Canada's efforts to improve access.
Objectives and ApproachThis symposium will demonstrate how a coalition of stakeholders united to use real-world data to measure progress and drive change. Each presentation highlights a different aspect of the project with participant interaction, aiming for the Canadian context to spark knowledge exchange across sectors and countries:

Presentation 1 - Coalitions and consensus (10 min.): processes and engagement for successful collaboration between governments, providers, measurement experts and people with lived experiences to select and develop indicators

Facilitated Q&A (5 min.)


Presentation 2 - Standards and data infrastructure (10 min.): new standards to enhance data comparability and strengthened data infrastructure to support measurement and reporting

Facilitated Q&A (5 min.)


Presentation 3 - Indicator development (10 min.): the indicator development cycle, methodological approaches using linked and partial data, and development strategies for new concepts

Facilitated Q&A (5 min.)


Presentation 4 - Public reporting and policy impact (10 min.): describes how public reporting supports sustained commitments and energizes change using targeted tools and messages

Facilitated Q&A (15 min.)



ResultsPublic reporting began in 2019, with 3 new indicators released annually over 4 years. Initial reporting provides a baseline to track improvements, and a starting point for health system planners to learn from peers across Canada. The indicators have been a catalyst to fill important data gaps in emergency and home care services.
Conclusion / ImplicationsThrough shared priorities, coalitions and linked data, information gaps are being filled to drive advancements in access to mental health and addictions services, and home care. Lessons learned in Canada can be adapted internationally to galvanize needed improvements in these sectors.

Abstract
In-depth analysis of the content of broadcast tornado warning coverage is limited. Such analysis is important due to local television's role as a key source for tornado warning information. This study attempts to fill gaps in our knowledge regarding broadcast coverage of tornado warnings by demonstrating how local television news stations' coverage of tornadic events can be systematically analyzed to better understand this element of warning communication. We reviewed both visual and verbal content for information such as the prominence of specific radar products, the geographic scale of warning communication, and common themes in verbal communication. A combination of deductive and inductive coding approaches was used to summarize the verbal content of the broadcasts. We found that the stations heavily used radar products with reflectivity and velocity surpassing correlation coefficient. The geographic scale of mapped products (street, city/county, and state level) appeared to be related to the rural or urban nature of the area warned, which may have implications for how readily rural residents would be able to personalize tornado threats. Verbal content was very similar between the two stations. The theme of monitoring and updating conditions, which included processes such as zooming in and out, making adjustments, reinforcing conditions, and providing damage reports was the most frequent communication type, likely because weathercasters use these processes to both communicate the warning and also to help themselves understand the situation. The results can inform future studies examining the influence of specific elements of broadcast warning coverage on risk perception and protective actions.

Significance Statement
Television is a key source for receiving or confirming tornado warnings, but few studies have examined the content of broadcast warnings in depth. This study examined the visual and verbal content of broadcast tornado warnings on two local television stations. Radar products were used heavily, and street-level coverage was more common when a tornado affected a metropolitan area. Coverage was most common at the city/county level. Verbal content included many elements of effective warning communication but at times included jargon that may not be understood by viewers. The results can serve as a springboard for future research on the impacts of these elements on risk perception and response. It can also serve future research by distinguishing what viewers of severe weather broadcasts are exposed to that nonviewers are not.

AbstractDisasters occur at the intersections of social, natural, and built environments, and robust understanding of these interactions can only occur through insight generated from different disciplines. Yet, there are cultural, epistemological, and methodological differences across the many disciplines concerned with hazards and disasters that can make conducting interdisciplinary research difficult. Approaches are needed to overcome these challenges. This article argues that interdisciplinary disaster research can be successful when it entails an iterative process in which researchers from different disciplines work collaboratively and exert reciprocal influence to generate disaster systems knowledge. Disaster systems knowledge is interdisciplinary and is defined as a comprehensive understanding of the intersections of built, natural, and human environmental factors and their interplay in hazards and disasters. The iterative process can reduce disciplinary biases and privileges by encouraging collaboration among researchers to help ensure disciplinary knowledge complements other disciplinary knowledge, to ultimately generate interdisciplinary disaster systems knowledge. The article concludes by illustrating the process by analyzing a research case study of an interdisciplinary approach to volcanic risk reduction.

AbstractHazard and disaster research requires a willingness to step outside of traditional disciplinary ontological and epistemological assumptions to both accommodate and integrate different perspectives. Moreover, the complex qualities of hazards and disasters necessitate interdisciplinary approaches to inform theory development that encompasses environmental, human, and infrastructure systems at multiple scales and units of analysis. Unfortunately, truly integrative hazard and disaster theory at a scale broad enough to account for the many systems and processes involved is currently limited. In this article, we argue that robust hazard and disaster theory can only arise from interdisciplinary research and collaboration. We examine challenges to the development of interdisciplinary hazard and disaster theory, and discuss the characteristics of theory necessary for the goal‐oriented nature of research aimed at reducing disaster impact.

AbstractThe coronavirus disease 2019 (COVID-19) pandemic resulted in unprecedented challenges that dramatically affected the way of life in the United States and globally in 2020. The pandemic also made the process of protecting individuals from tornadoes more challenging, especially when their personal residence lacks suitable shelter, particularly for residents of mobile homes. The necessity of having to shelter with other families – either in a public shelter or at another residence – in order to protect themselves from a tornado threat conflicted with the advice of public health officials who recommended avoiding public places and limiting contact with the public to minimize the spread of COVID-19. There was also a perception that protecting against one threat could amplify the other threat. A survey was undertaken with the public to determine the general viewpoint to see if that was indeed the case.The results found that it was possible to attenuate both threats provided that careful planning and actions were undertaken. Understanding how emergency managers should react and plan for such dual threats is important to minimize the spread of COVID-19 while also maintaining the safety of the public. As there was no precedence for tornado protection scenarios amidst a pandemic, both short-term and long-term recommendations were suggested which may also be useful in future pandemic situations.

AbstractA great deal of research has been conducted regarding tornado warnings and protective actions taken, including some studies in which respondents were presented with hypothetical tornado warning scenarios. Much less research has been conducted in which respondents were presented with tornado watch scenarios, even though they cover a larger area and longer time period, thus potentially disrupting a far greater number of people. To address this lack of research, surveys were used to determine the influence of severe weather watches on planned Saturday afternoon and evening activities away from the immediate vicinity of the respondent's home. Respondents were presented a hypothetical watch scenario, in which they had some activity planned for later that afternoon or evening. Each respondent rated his or her likelihood to continue an activity depending on the severity of the watch and the length of the activity. Respondents were provided information about each hypothetical watch including duration and primary threats. Responses from the survey indicated that as the severity of the watch or the length of the activity increased, the likelihood of the respondent continuing the activity decreased. For a severe thunderstorm watch, a tornado watch, and a particularly dangerous situation (PDS) tornado watch, 36.1%, 51.2%, and 80.2% of the respondents, respectively, would not continue an activity lasting 30 min or longer.

Abstract
Color is an important variable in the graphical communication of weather information. The effect of different colors on understanding and perception is not always considered prior to releasing an image to the public. This study tests the influence of color as well as legend values on the effectiveness of communicating storm surge potential. In this study, 40 individuals participated in an eye-tracking experiment in which they responded to eight questions about five different storm scenarios. Color was varied among three palettes (shades of blue, green to red, and yellow to purple), and legends were varied to display categorical values in feet (<3, 3–6, etc.) or text descriptions (low, medium, etc.). Questions measured accuracy, perceived risk, and perceived helpfulness. Overall, accuracy was high and few statistically significant differences were observed across color/legend combinations. Evidence did suggest that the blue values condition may have been the most difficult to interpret. Statistical support for this claim includes longer response times and a greater number of eye fixations on the legend. The feet values condition also led to a greater number of eye fixations on the legend and letter markers than the category text condition. The green–red condition was the strong preference among all groups as the color condition that best informs the public about storm surge risk. This color palette led to slightly higher levels of accuracy and perceived helpfulness, but the differences were not significant.

Abstract
Although there is clear evidence that proximity to a tornado or forecast tornado increases an individual's risk perception, the specific relationships between risk personalization and spatial variables are unclear. It has also been established that one's own evaluation of distance does not always match objective measurement. This study sought to explain the differences in the distance at which an individual would personalize the risk from a tornado across personally relevant geospatial factors such as the distance between places frequented (e.g., home and work), urban/rural classification of the area, and the length of residence in the county. A survey of 1023 respondents across eight states (Alabama, Arkansas, Georgia, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee) was used to obtain risk personalization distances, which were distinguished as "worry distances" (the distances at which one would worry about their house or loved ones, or take protective action) and "confirmation distances" (the distances at which one would expect to see, hear, or feel the effects of a tornado). We found that individuals who traveled greater distances and traveled more frequently to the grocery store and another location, those who self-defined their area as urban, and those with advanced degrees had increased risk personalization distances. Lengthier residency in the county influenced these distances as well. Future research is required to better comprehend the relationship of place, risk perception, and geographic mobility on protective action when a tornado occurs.

Significance Statement
Greater tornado risk personalization distances were associated with self-defining as urban, having an advanced degree, and driving farther and more frequently to the grocery store and to another location. Longer length of residence was associated with shorter risk personalization distances. With rural participants expressing shorter tornado risk personalization distances, warning communicators with the ability to tailor messages to multiple communities may wish to adjust messages no the basis of whether they are targeted to rural communities or to urban communities.

One hundred-fifteen pet care professionals (veterinarians, boarding kennels, groomers, etc.) from Louisiana, Mississippi, and Texas were surveyed following Hurricanes Gustav and Ike regarding their preparedness for and response to these hurricanes. Results indicate this group is similar to the public in some respects including reliance on television for weather information, and evacuation being related to 1) having a plan for evacuation, 2) being in an area ordered to evacuate, and 3) not requiring outside resources to accomplish the evacuation. Respondents' decisions were uniquely complicated by their role as both residents and also caregivers of animals owned by other residents who also may need to evacuate. Finally, a large percentage of this group had emergency plans, which may have been influenced by state laws or their experiences with Hurricanes Katrina or Rita. Back-up plans are recommended when emergency plans rely on owners claiming animals prior to an evacuation.

Background: In Canada, 30%-60% of patients presenting to emergency departments are ambulatory. This category has been labeled as a source of emergency department overuse. Acting on the presumption that primary care practices and walk-in clinics offer equivalent care at a lower cost, governments have invested massively in improving access to these alternative settings in the hope that patients would present there instead when possible, thereby reducing the load on emergency departments. Data in support of this approach remain scarce and equivocal. Objective: The aim of this study is to compare the value of care received in emergency departments, walk-in clinics, and primary care practices by ambulatory patients with upper respiratory tract infection, sinusitis, otitis media, tonsillitis, pharyngitis, bronchitis, influenza-like illness, pneumonia, acute asthma, or acute exacerbation of chronic obstructive pulmonary disease. Methods: A multicenter prospective cohort study will be performed in Ontario and Québec. In phase 1, a time-driven activity-based costing method will be applied at each of the 15 study sites. This method uses time as a cost driver to allocate direct costs (eg, medication), consumable expenditures (eg, needles), overhead costs (eg, building maintenance), and physician charges to patient care. Thus, the cost of a care episode will be proportional to the time spent receiving the care. At the end of this phase, a list of care process costs will be generated and used to calculate the cost of each consultation during phase 2, in which a prospective cohort of patients will be monitored to compare the care received in each setting. Patients aged 18 years and older, ambulatory throughout the care episode, and discharged to home with one of the aforementioned targeted diagnoses will be considered. The estimated sample size is 1485 patients. The 3 types of care settings will be compared on the basis of primary outcomes in terms of the proportion of return visits to any site 3 and 7 days after the initial visit and the mean cost of care. The secondary outcomes measured will include scores on patient-reported outcome and experience measures and mean costs borne wholly by patients. We will use multilevel generalized linear models to compare the care settings and an overlap weights approach to adjust for confounding factors related to age, sex, gender, ethnicity, comorbidities, registration with a family physician, socioeconomic status, and severity of illness. Results: Phase 1 will begin in 2021 and phase 2, in 2023. The results will be available in 2025. Conclusions: The end point of our program will be for deciders, patients, and care providers to be able to determine the most appropriate care setting for the management of ambulatory emergency respiratory conditions, based on the quality and cost of care associated with each alternative.