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32 records – page 1 of 4.

An economic analysis of the Ottawa knee rule.

https://arctichealth.org/en/permalink/ahliterature200748
Source
Ann Emerg Med. 1999 Oct;34(4 Pt 1):438-47
Publication Type
Article
Date
Oct-1999
Author
G. Nichol
I G Stiell
G A Wells
L S Juergensen
A. Laupacis
Author Affiliation
Clinical Epidemiology Unit, Loeb Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada. grahamnichol@earthlink.net
Source
Ann Emerg Med. 1999 Oct;34(4 Pt 1):438-47
Date
Oct-1999
Language
English
Publication Type
Article
Keywords
Adult
Cost Savings
Decision Support Techniques
Fractures, Bone - radiography
Humans
Knee Injuries - economics - radiography
Medicare - economics
Ontario
Physician's Practice Patterns - economics
Referral and Consultation
United States
Abstract
To conduct an economic analysis of the implementation of the Ottawa Knee Rule.
The decision analysis compared usual practice based on physician judgment with practice based on a clinical decision rule, which allows more selective use of radiography. The study participants were all adults with blunt knee trauma. The likelihood and cost of radiography, missed fracture, lost productivity, and medicolegal actions were defined by published data and an expert panel. Separate analyses considered US Medicare and Canadian hospital costs. Sensitivity analyses considered a range of values for each variable in the model, including costs in a US fee-for-service setting. The study outcome was the mean cost per patient.
The mean cost savings associated with practice based on the Ottawa Knee Rule was $31 (95% confidence interval 22 to 44) to $34 (95% confidence interval 24 to 47) per patient. These results were robust to reasonable changes in the values of variables in the model.
Implementation of the Ottawa Knee Rule would be associated with meaningful reductions in societal health care costs both in the United States and Canada without a reduction in quality of care.
Notes
Comment In: Ann Emerg Med. 1999 Oct;34(4 Pt 1):535-710499954
PubMed ID
10499943 View in PubMed
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Aramark profile: Andreas Laupacis. Interview by Cynthia Martin.

https://arctichealth.org/en/permalink/ahliterature193409
Source
Hosp Q. 2000;3(4):56-8
Publication Type
Article
Date
2000
Author
A. Laupacis
Author Affiliation
Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario.
Source
Hosp Q. 2000;3(4):56-8
Date
2000
Language
English
Publication Type
Article
Keywords
Canada
Cost-Benefit Analysis
Evidence-Based Medicine
Health Services Research
Humans
Safety
Technology Assessment, Biomedical
PubMed ID
11530776 View in PubMed
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Awareness and use of the Ottawa ankle and knee rules in 5 countries: can publication alone be enough to change practice?

https://arctichealth.org/en/permalink/ahliterature195632
Source
Ann Emerg Med. 2001 Mar;37(3):259-66
Publication Type
Article
Date
Mar-2001
Author
I D Graham
I G Stiell
A. Laupacis
L. McAuley
M. Howell
M. Clancy
P. Durieux
N. Simon
J I Emparanza
J R Aginaga
A. O'connor
G. Wells
Author Affiliation
Department of Medicine, Faculty of Medicine, University of Ottawa, Canada. igraham@lri.ca
Source
Ann Emerg Med. 2001 Mar;37(3):259-66
Date
Mar-2001
Language
English
Publication Type
Article
Keywords
Adult
Ankle Injuries - radiography
Attitude of Health Personnel
Awareness
Canada
Critical Pathways
Cross-Cultural Comparison
Data Collection
Decision Support Systems, Clinical
Diffusion of Innovation
Europe
Female
Humans
Knee Injuries - radiography
Male
Middle Aged
Publishing
United States
Abstract
We evaluate the international diffusion of the Ottawa Ankle and Knee Rules and determine emergency physicians' attitudes toward clinical decision rules in general.
We conducted a cross-sectional, self-administered mail survey of random samples of 500 members each of the American College of Emergency Physicians, Canadian Association of Emergency Physicians, British Association for Accident and Emergency Medicine, Spanish Society for Emergency Medicine, and all members (n=1,350) of the French Speaking Society of Emergency Physicians, France. Main outcome measures were awareness of the Ottawa Ankle and Knee Rules, reported use of these rules, and attitudes toward clinical decision rules in general.
A total of 1,769 (57%) emergency physicians responded, with country-specific response rates between 49% (United States and France) and 79% (Canada). More than 69% of physicians in all countries, except Spain, were aware of the Ottawa Ankle Rules. Use of the Ottawa Ankle Rules differed by country with more than 70% of all responding Canadian and United Kingdom physicians reporting frequent use of the rules compared with fewer than one third of US, French, and Spanish physicians. The Ottawa Knee Rule was less well known and less used by physicians in all countries. Most physicians in all countries viewed decision rules as intended to improve the quality of health care (>78%), a convenient source of advice (>67%), and good educational tools (>61%). Of all physicians, those from the United States held the least positive attitudes toward decision rules.
This constitutes the largest international survey of emergency physicians' attitudes toward and use of clinical decision rules. Striking differences were apparent among countries with regard to knowledge and use of decision rules. Despite similar awareness in the United States, Canada, and the United Kingdom, US physicians appeared much less likely to use the Ottawa Ankle Rules. Future research should investigate factors leading to differences in rates of diffusion among countries and address strategies to enhance dissemination and implementation of such rules in the emergency department.
PubMed ID
11223761 View in PubMed
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Canadian Atrial Fibrillation Anticoagulation (CAFA) Study.

https://arctichealth.org/en/permalink/ahliterature225975
Source
J Am Coll Cardiol. 1991 Aug;18(2):349-55
Publication Type
Article
Date
Aug-1991
Author
S J Connolly
A. Laupacis
M. Gent
R S Roberts
J A Cairns
C. Joyner
Author Affiliation
Hamilton General Hospital, Ontario, Canada.
Source
J Am Coll Cardiol. 1991 Aug;18(2):349-55
Date
Aug-1991
Language
English
Publication Type
Article
Keywords
Aged
Atrial Fibrillation - complications
Canada
Cerebrovascular Disorders - epidemiology - prevention & control
Double-Blind Method
Female
Humans
Male
Risk factors
Statistics as Topic
Thromboembolism - epidemiology - prevention & control
Warfarin - therapeutic use
Abstract
The Canadian Atrial Fibrillation Anticoagulation Study was a randomized double-blind placebo-controlled trial to assess the potential of warfarin to reduce systemic thromboembolism and its inherent risk of hemorrhage. As a result of the publication of two other "positive" studies of similar design and objective, this study was stopped early before completion of its planned recruitment of 630 patients. There were 187 patients randomized to warfarin and 191 to placebo. Permanent discontinuation of study medication occurred in 26% of warfarin-treated and 23% of placebo-treated patients. The target range of the international normalized ratio was 2 to 3. For the warfarin-treated patients, the international normalized ratio was in the target range 43.7% of the study days, above it 16.6% of the study days and below it 39.6% of the study days. Fatal or major bleeding occurred at annual rates of 2.5% in warfarin-treated and 0.5% in placebo-treated patients. Minor bleeding occurred in 16% of patients receiving warfarin and 9% receiving placebo. The primary outcome event cluster was nonlacunar stroke, noncentral nervous systemic embolism and fatal or intracranial hemorrhage. Events were included in the primary analysis of efficacy if they occurred within 28 days of permanent discontinuation of the study medication. The annual rates of the primary outcome event cluster were 3.5% in warfarin-treated and 5.2% in placebo-treated patients, with a relative risk reduction of 37% (95% confidence limits, -63.5%, 75.5%, p = 0.17).(ABSTRACT TRUNCATED AT 250 WORDS)
PubMed ID
1856403 View in PubMed
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The Canadian C-spine rule for radiography in alert and stable trauma patients.

https://arctichealth.org/en/permalink/ahliterature192741
Source
JAMA. 2001 Oct 17;286(15):1841-8
Publication Type
Article
Date
Oct-17-2001
Author
I G Stiell
G A Wells
K L Vandemheen
C M Clement
H. Lesiuk
V J De Maio
A. Laupacis
M. Schull
R D McKnight
R. Verbeek
R. Brison
D. Cass
J. Dreyer
M A Eisenhauer
G H Greenberg
I. MacPhail
L. Morrison
M. Reardon
J. Worthington
Author Affiliation
Clinical Epidemiology Unit, F6, Ottawa Health Research Institute, 1053 Carling Ave, Ottawa, Ontario, Canada K1Y 4E9. istiell@ohri.ca
Source
JAMA. 2001 Oct 17;286(15):1841-8
Date
Oct-17-2001
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada
Cervical Vertebrae - radiography
Craniocerebral Trauma - radiography
Decision Support Techniques
Emergency Medical Services - standards
Female
Humans
Male
Middle Aged
Neck Injuries - radiography
Outcome and Process Assessment (Health Care)
Prospective Studies
Radiography - standards
Regression Analysis
Risk assessment
Sensitivity and specificity
Tomography, X-Ray Computed
Traumatology - standards
Wounds, Nonpenetrating - radiography
Abstract
High levels of variation and inefficiency exist in current clinical practice regarding use of cervical spine (C-spine) radiography in alert and stable trauma patients.
To derive a clinical decision rule that is highly sensitive for detecting acute C-spine injury and will allow emergency department (ED) physicians to be more selective in use of radiography in alert and stable trauma patients.
Prospective cohort study conducted from October 1996 to April 1999, in which physicians evaluated patients for 20 standardized clinical findings prior to radiography. In some cases, a second physician performed independent interobserver assessments.
Ten EDs in large Canadian community and university hospitals.
Convenience sample of 8924 adults (mean age, 37 years) who presented to the ED with blunt trauma to the head/neck, stable vital signs, and a Glasgow Coma Scale score of 15.
Clinically important C-spine injury, evaluated by plain radiography, computed tomography, and a structured follow-up telephone interview. The clinical decision rule was derived using the kappa coefficient, logistic regression analysis, and chi(2) recursive partitioning techniques.
Among the study sample, 151 (1.7%) had important C-spine injury. The resultant model and final Canadian C-Spine Rule comprises 3 main questions: (1) is there any high-risk factor present that mandates radiography (ie, age >/=65 years, dangerous mechanism, or paresthesias in extremities)? (2) is there any low-risk factor present that allows safe assessment of range of motion (ie, simple rear-end motor vehicle collision, sitting position in ED, ambulatory at any time since injury, delayed onset of neck pain, or absence of midline C-spine tenderness)? and (3) is the patient able to actively rotate neck 45 degrees to the left and right? By cross-validation, this rule had 100% sensitivity (95% confidence interval [CI], 98%-100%) and 42.5% specificity (95% CI, 40%-44%) for identifying 151 clinically important C-spine injuries. The potential radiography ordering rate would be 58.2%.
We have derived the Canadian C-Spine Rule, a highly sensitive decision rule for use of C-spine radiography in alert and stable trauma patients. If prospectively validated in other cohorts, this rule has the potential to significantly reduce practice variation and inefficiency in ED use of C-spine radiography.
Notes
Comment In: JAMA. 2002 Feb 6;287(5):583-411829682
Comment In: JAMA. 2001 Oct 17;286(15):1893-411597293
Comment In: JAMA. 2002 Feb 6;287(5):583; author reply 58411829681
PubMed ID
11597285 View in PubMed
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The Canadian CT Head Rule for patients with minor head injury.

https://arctichealth.org/en/permalink/ahliterature194656
Source
Lancet. 2001 May 5;357(9266):1391-6
Publication Type
Article
Date
May-5-2001
Author
I G Stiell
G A Wells
K. Vandemheen
C. Clement
H. Lesiuk
A. Laupacis
R D McKnight
R. Verbeek
R. Brison
D. Cass
M E Eisenhauer
G. Greenberg
J. Worthington
Author Affiliation
Divisions of Emergency Medicine, University of British Columbia, Vancouver, Canada. istiell@ohri.ca
Source
Lancet. 2001 May 5;357(9266):1391-6
Date
May-5-2001
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Brain Injuries - diagnosis - etiology
Canada
Craniocerebral Trauma - complications - diagnosis - etiology
Emergency Service, Hospital - statistics & numerical data
Female
Glasgow Coma Scale
Humans
Male
Middle Aged
Practice Guidelines as Topic
Prospective Studies
Sensitivity and specificity
Tomography, X-Ray Computed
Abstract
There is much controversy about the use of computed tomography (CT) for patients with minor head injury. We aimed to develop a highly sensitive clinical decision rule for use of CT in patients with minor head injuries.
We carried out this prospective cohort study in the emergency departments of ten large Canadian hospitals and included consecutive adults who presented with a Glasgow Coma Scale (GCS) score of 13-15 after head injury. We did standardised clinical assessments before the CT scan. The main outcome measures were need for neurological intervention and clinically important brain injury on CT.
The 3121 patients had the following characteristics: mean age 38.7 years); GCS scores of 13 (3.5%), 14 (16.7%), 15 (79.8%); 8% had clinically important brain injury; and 1% required neurological intervention. We derived a CT head rule which consists of five high-risk factors (failure to reach GCS of 15 within 2 h, suspected open skull fracture, any sign of basal skull fracture, vomiting >2 episodes, or age >65 years) and two additional medium-risk factors (amnesia before impact >30 min and dangerous mechanism of injury). The high-risk factors were 100% sensitive (95% CI 92-100%) for predicting need for neurological intervention, and would require only 32% of patients to undergo CT. The medium-risk factors were 98.4% sensitive (95% CI 96-99%) and 49.6% specific for predicting clinically important brain injury, and would require only 54% of patients to undergo CT.
We have developed the Canadian CT Head Rule, a highly sensitive decision rule for use of CT. This rule has the potential to significantly standardise and improve the emergency management of patients with minor head injury.
Notes
Comment In: Lancet. 2001 Sep 22;358(9286):1013-411586987
Comment In: Lancet. 2001 Sep 22;358(9286):1013; author reply 101411586988
PubMed ID
11356436 View in PubMed
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Canadian CT head rule study for patients with minor head injury: methodology for phase II (validation and economic analysis).

https://arctichealth.org/en/permalink/ahliterature193474
Source
Ann Emerg Med. 2001 Sep;38(3):317-22
Publication Type
Article
Date
Sep-2001
Author
I G Stiell
H. Lesiuk
G A Wells
D. Coyle
R D McKnight
R. Brison
C. Clement
M A Eisenhauer
G H Greenberg
I. Macphail
M. Reardon
J. Worthington
R. Verbeek
B. Rowe
D. Cass
J. Dreyer
B. Holroyd
L. Morrison
M. Schull
A. Laupacis
Author Affiliation
Ottawa Health Research Institute, Ottawa, Ontario, Canada.
Source
Ann Emerg Med. 2001 Sep;38(3):317-22
Date
Sep-2001
Language
English
Publication Type
Article
Keywords
Canada
Clinical Trials, Phase II as Topic
Cohort Studies
Cost Control
Craniocerebral Trauma - economics - radiography
Decision Support Techniques
Health Policy - economics
Health Services Research
Humans
National Health Programs - economics
Prospective Studies
Reproducibility of Results
Tomography, X-Ray Computed - economics
Abstract
Prospective validation on a new set of patients is an essential test of a new decision rule. However, many clinical decision rules are not prospectively assessed to determine their accuracy, reliability, clinical sensibility, or potential impact on practice. This validation process is important because many statistically derived rules or guidelines do not perform well when tested in a new population. The methodologic standards for a validation study are similar to those described in the article on phase I for derivation studies in the August 2001 issue of Annals of Emergency Medicine. The goal of phase II is to prospectively assess the accuracy, reliability, and acceptability of the decision rule in a new set of patients with minor head injury. This will determine the clinical utility of the rule and is essential if such a rule is to be widely adopted into clinical practice.
PubMed ID
11524653 View in PubMed
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The Canadian CT Head Rule Study for patients with minor head injury: rationale, objectives, and methodology for phase I (derivation).

https://arctichealth.org/en/permalink/ahliterature193952
Source
Ann Emerg Med. 2001 Aug;38(2):160-9
Publication Type
Article
Date
Aug-2001
Author
I G Stiell
H. Lesiuk
G A Wells
R D McKnight
R. Brison
C. Clement
M A Eisenhauer
G H Greenberg
I. MacPhail
M. Reardon
J. Worthington
R. Verbeek
B. Rowe
D. Cass
J. Dreyer
B. Holroyd
L. Morrison
M. Schull
A. Laupacis
Author Affiliation
Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Ontario, Canada K1Y 4E9.
Source
Ann Emerg Med. 2001 Aug;38(2):160-9
Date
Aug-2001
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Canada - epidemiology
Craniocerebral Trauma - epidemiology - radiography
Data Interpretation, Statistical
Decision Support Techniques
Emergency Service, Hospital - statistics & numerical data
Glasgow Coma Scale
Humans
Middle Aged
Practice Guidelines as Topic
Prospective Studies
Sensitivity and specificity
Tomography, X-Ray Computed
Abstract
Head injuries are among the most common types of trauma seen in North American emergency departments, with an estimated 1 million cases seen annually. "Minor" head injury (sometimes known as "mild") is defined by a history of loss of consciousness, amnesia, or disorientation in a patient who is conscious and talking, that is, with a Glasgow Coma Scale score of 13 to 15. Although most patients with minor head injury can be discharged without sequelae after a period of observation, in a small proportion, their neurologic condition deteriorates and requires neurosurgical intervention for intracranial hematoma. The objective of the Canadian CT Head Rule Study is to develop an accurate and reliable decision rule for the use of computed tomography (CT) in patients with minor head injury. Such a decision rule would allow physicians to be more selective in their use of CT without compromising care of patients with minor head injury. This paper describes in detail the rationale, objectives, and methodology for Phase I of the study in which the decision rule was derived. [Stiell IG, Lesiuk H, Wells GA, McKnight RD, Brison R, Clement C, Eisenhauer MA, Greenberg GH, MacPhail I, Reardon M, Worthington J, Verbeek R, Rowe B, Cass D, Dreyer J, Holroyd B, Morrison L, Schull M, Laupacis A, for the Canadian CT Head and C-Spine Study Group. The Canadian CT Head Rule Study for patients with minor head injury: rationale, objectives, and methodology for phase I (derivation). Ann Emerg Med. August 2001;38:160-169.]
Notes
Comment In: Ann Emerg Med. 2002 Mar;39(3):348-911867999
PubMed ID
11468612 View in PubMed
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Cost-effectiveness analysis of potential improvements to emergency medical services for victims of out-of-hospital cardiac arrest.

https://arctichealth.org/en/permalink/ahliterature211840
Source
Ann Emerg Med. 1996 Jun;27(6):711-20
Publication Type
Article
Date
Jun-1996
Author
G. Nichol
A. Laupacis
I G Stiell
K. O'Rourke
A. Anis
H. Bolley
A S Detsky
Author Affiliation
Clinical Epidemiology Unit, Loeb Medical Research Institute, Ottawa Civic Hospital, Ontario, Canada.
Source
Ann Emerg Med. 1996 Jun;27(6):711-20
Date
Jun-1996
Language
English
Publication Type
Article
Keywords
Cardiopulmonary Resuscitation - education
Cost-Benefit Analysis
Decision Trees
Electric Countershock - economics
Emergency Medical Services - economics
Heart Arrest - mortality - therapy
Humans
Life Support Care - economics
Ontario
Reaction Time
Abstract
To measure the incremental cost-effectiveness of various improvements to emergency medical services (EMS) systems aimed at increasing survival after out-of-hospital cardiac arrest.
We performed cost-effectiveness analysis based on (1) metaanalysis of effectiveness of the various EMS systems, (2) costing of each component of EMS systems, (3) modeling of the relationship between the proportion of cardiac arrest victims who receive CPR and the proportion of individuals trained, (4) modeling of the relationship between response time interval and the characteristics of the EMS system, (5) measurement of quality of life, and (6) decision analysis to combine the results of the first five components.
The incremental cost-effectiveness ratio for a 48-second improvement in mean response time in a one-tier EMS system yielded by the addition of more EMS providers was $368,000 per quality-adjusted life year (QALY). For improved response time in a two-tier EMS system by the addition of more basic life support (BLS)/BLS-defibrillator (BLS-D) providers to the first tier, the ratio was $53,000 per QALY with pump vehicles or $159,000 per QALY with ambulances. Change from a one-tier EMS to a two-tier EMS system by the addition of initial BLS/BLS-D providers in pump vehicles as the first tier was associated with a cost per QALY of $40,000. Change from one-tier EMS to two-tier EMS by the addition of initial BLS/BLS-D providers in ambulances as the first tier was associated with a cost per QALY of $94,000.
The most attractive options in terms of incremental cost-effectiveness were improved response time in a two-tier EMS system or change from a one-tier to a two-tier EMS system. Future research should be directed toward identification of the costs of instituting the first tier of a two-tier EMS system and identification of cost-effective methods of improving response time.
PubMed ID
8644957 View in PubMed
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Cost-effectiveness analysis of the Ottawa Ankle Rules.

https://arctichealth.org/en/permalink/ahliterature214242
Source
Ann Emerg Med. 1995 Oct;26(4):422-8
Publication Type
Article
Date
Oct-1995
Author
A H Anis
I G Stiell
D G Stewart
A. Laupacis
Author Affiliation
Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada.
Source
Ann Emerg Med. 1995 Oct;26(4):422-8
Date
Oct-1995
Language
English
Publication Type
Article
Keywords
Adult
Ankle Injuries - economics - radiography
Canada
Cost-Benefit Analysis
Decision Support Techniques
Decision Trees
Emergency Service, Hospital - economics - standards
Fractures, Bone - radiography
Humans
Probability
Sensitivity and specificity
United States
Abstract
To conduct an incremental cost-effectiveness analysis of implementation of the Ottawa Ankle Rules in emergency departments in the United States and Canada.
A decision analytic approach to technology assessment. Clinical decision rules that allow physicians to be more selective in their use of radiography were compared with current practice in a decision analytic model.
A university hospital adult ED.
ED physicians instructed in the use of the Ottawa Ankle Rules for adult patients with ankle injury.
Radiography, waiting time, lost productivity, and medicolegal costs were calculated. In the United States, the savings varied between US$614,226 and US$3,145,910 per 100,000 patients, depending on the charge rate for radiography. In Ontario, Canada, the total savings were CAN$730,145 per 100,000 patients. One- and two-way sensitivity analyses that varied the rate of missed fractures, cost of radiography, probability of lawsuits, and cost of lawsuits did not change the results substantially.
Implementation of the Ottawa Ankle Rules would result in significant savings of health care dollars despite the cost of missed fractures including litigation costs.
PubMed ID
7574122 View in PubMed
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32 records – page 1 of 4.