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Avoidable admissions and repeat admissions: what do they tell us?

https://arctichealth.org/en/permalink/ahliterature164938
Source
Healthc Q. 2007;10(1):26-8
Publication Type
Article
Date
2007

Developing an efficient model to select emergency department patient satisfaction improvement strategies.

https://arctichealth.org/en/permalink/ahliterature174095
Source
Ann Emerg Med. 2005 Jul;46(1):3-10
Publication Type
Article
Date
Jul-2005
Author
Adalsteinn D Brown
Guillermo A Sandoval
Carey Levinton
Paula Blackstien-Hirsch
Author Affiliation
Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada. adalsteinn.brown@utoronto.ca
Source
Ann Emerg Med. 2005 Jul;46(1):3-10
Date
Jul-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Emergency Service, Hospital - organization & administration - statistics & numerical data
Female
Health Care Surveys
Humans
Infant
Male
Middle Aged
Models, Theoretical
Ontario
Patient Satisfaction - statistics & numerical data
Professional-Patient Relations
Quality Assurance, Health Care - methods
Regression Analysis
Abstract
Patient satisfaction is an important performance measure for emergency departments (EDs), but the most efficient ways of improving satisfaction are unclear. This study uses optimization techniques to identify the best possible combination of predictors of overall patient satisfaction to help guide improvement efforts.
The results of a satisfaction survey from 20,500 patients who visited 123 EDs were used to develop ordinal logistic regression models for overall quality of care, overall medical treatment, willingness to recommend the ED to others, and willingness to return to the same ED. Originally, 68,981 surveys were mailed, and 20,916 were returned, representing an overall response rate of 30.3%. We then incorporated these regressions into an optimization model to select the most efficient combination of predictors necessary to increase the 4 overall satisfaction measures by 5%. A sensitivity analysis was also conducted to explore differences across hospital peer groups and regions.
Results differ slightly for each of the 4 overall satisfaction measures. However, 4 predictors were common to all of these measures: "perceived waiting time to receive treatment," "courtesy of the nursing staff," "courtesy of the physicians," and "thoroughness of the physicians." The selected predictors were not necessarily the strongest predictors identified through regression models. The optimization model suggests that most of these predictors must be improved by 15% to increase the overall satisfaction measures by 5%.
This study introduces the use of optimization techniques to study ED patient satisfaction and highlights an opportunity to apply this technique to widely collected data to help inform hospitals' improvement strategies. The results suggest that hospitals should focus most of their improvement efforts on the 4 predictors mentioned above.
Notes
Comment In: Ann Emerg Med. 2005 Jul;46(1):11-215988418
PubMed ID
15988417 View in PubMed
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The importance of place of residence in patient satisfaction.

https://arctichealth.org/en/permalink/ahliterature132466
Source
Int J Qual Health Care. 2011 Oct;23(5):495-502
Publication Type
Article
Date
Oct-2011
Author
Carey Levinton
Jeremy Veillard
Arthur Slutsky
Adalsteinn Brown
Author Affiliation
Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Source
Int J Qual Health Care. 2011 Oct;23(5):495-502
Date
Oct-2011
Language
English
Publication Type
Article
Keywords
Female
Health Care Surveys
Humans
Inpatients - psychology
Length of Stay - statistics & numerical data
Male
Middle Aged
Ontario
Patient satisfaction
Quality Indicators, Health Care
Regression Analysis
Reimbursement, Incentive - standards
Residence Characteristics
Rural Population
Urban Population
Abstract
To determine the effect of patients' place of residence on their evaluations of care, and to explore related policy implications.
We used a conditional regression analysis of stratum matched case controls to examine whether place of residence of patients living in the Greater Toronto Area (GTA) or in Ontario outside of the GTA affects patient satisfaction with their experiences during hospitalization.
One hundred and six acute care hospitals located in the province of Ontario, Canada.
A total of 101 683 Ontario residents hospitalized as inpatients between 1 October 2002 and 30 June 2004.
Patient satisfaction indicators publicly reported in Ontario comprising patient perceptions of consideration, responsiveness, communication, and overall impressions, scored on a continuous scale from 1 to 100.
Patients who lived outside Toronto were consistently more satisfied than patients who lived inside Toronto when both types of patients were hospitalized in Toronto (P
PubMed ID
21813507 View in PubMed
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A one-year economic evaluation of six alternative strategies in the management of uninvestigated upper gastrointestinal symptoms in Canadian primary care.

https://arctichealth.org/en/permalink/ahliterature141534
Source
Can J Gastroenterol. 2010 Aug;24(8):489-98
Publication Type
Article
Date
Aug-2010
Author
Alan N Barkun
Ralph Crott
Carlo A Fallone
Wendy A Kennedy
Jean Lachaine
Carey Levinton
David Armstrong
Naoki Chiba
Alan Thomson
Sander Veldhuyzen van Zanten
Paul Sinclair
Sergio Escobedo
Bijan Chakraborty
Sandra Smyth
Robert White
Helen Kalra
Krista Nevin
Author Affiliation
McGill University, Montréal, Quebec. alan.barkun@muhc.mcgill.ca
Source
Can J Gastroenterol. 2010 Aug;24(8):489-98
Date
Aug-2010
Language
English
Publication Type
Article
Keywords
Anti-Ulcer Agents - economics - therapeutic use
Canada
Cost of Illness
Cost-Benefit Analysis
Disease Management
Dyspepsia - economics - therapy
Endoscopy, Gastrointestinal - economics
Humans
Markov Chains
Monte Carlo Method
Omeprazole - economics - therapeutic use
Primary Health Care
Quality-Adjusted Life Years
Randomized Controlled Trials as Topic
Upper Gastrointestinal Tract
Abstract
The cost-effectiveness of initial strategies in managing Canadian patients with uninvestigated upper gastrointestinalsymptoms remains controversial.
To assess the cost-effectiveness of six management approaches to uninvestigated upper gastrointestinal symptoms in the Canadian setting.
The present study analyzed data from four randomized trials assessing homogeneous and complementary populations of Canadian patients with uninvestigated upper gastrointestinal symptoms with comparable outcomes. Symptom-free months, qualityadjusted life-years (QALYs) and direct costs in Canadian dollars of two management approaches based on the Canadian Dyspepsia Working Group (CanDys) Clinical Management Tool, and four additional strategies (two empirical antisecretory agents, and two prompt endoscopy) were examined and compared. Prevalence data, probabilities, utilities and costs were included in a Markov model, while sensitivity analysis used Monte Carlo simulations. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves were determined.
Empirical omeprazole cost $226 per QALY ($49 per symptom-free month) per patient. CanDys omeprazole and endoscopy approaches were more effective than empirical omeprazole, but more costly. Alternatives using H2-receptor antagonists were less effective than those using a proton pump inhibitor. No significant differences were found for most incremental cost-effectiveness ratios. As willingness to pay (WTP) thresholds rose from $226 to $24,000 per QALY, empirical antisecretory approaches were less likely to be the most costeffective choice, with CanDys omeprazole progressively becoming a more likely option. For WTP values ranging from $24,000 to $70,000 per QALY, the most clinically relevant range, CanDys omeprazole was the most cost-effective strategy (32% to 46% of the time), with prompt endoscopy-proton pump inhibitor favoured at higher WTP values.
Although no strategy was the indisputable cost effective option, CanDys omeprazole may be the strategy of choiceover a clinically relevant range of WTP assumptions in the initial management of Canadian patients with uninvestigated dyspepsia.
Notes
Cites: Aliment Pharmacol Ther. 2008 Sep 1;28(5):534-4418616641
Cites: Gut. 2008 Sep;57(9):1214-2018441005
Cites: Lancet. 2009 Jan 17;373(9659):215-2519150702
Cites: Scand J Gastroenterol Suppl. 1999;231:38-4710565622
Cites: Pharmacoeconomics. 1999 Dec;16(6):679-9710724795
Cites: BMJ. 2000 Sep 16;321(7262):659-6410987767
Cites: Gut. 1999 Sep;45 Suppl 2:II37-4210457043
Cites: Aliment Pharmacol Ther. 2005 May 15;21(10):1189-20215882239
Cites: Can J Gastroenterol. 2005 May;19(5):285-30315915244
Cites: Gastroenterology. 2005 Jun;128(7):1838-4415940619
Cites: Am J Gastroenterol. 2005 Jul;100(7):1477-8815984968
Cites: Cochrane Database Syst Rev. 2005;(4):CD00196116235292
Cites: Aliment Pharmacol Ther. 2006 Feb 15;23(4):521-916441473
Cites: Rheumatology (Oxford). 2006 May;45(5):606-1316368733
Cites: Am J Gastroenterol. 2006 Jun;101(6):1200-816771937
Cites: World J Gastroenterol. 2006 Aug 21;12(31):5010-616937497
Cites: Pharmacoeconomics. 2007;25(1):3-617192114
Cites: Aliment Pharmacol Ther. 2007 Nov 1;26(9):1267-7517944741
Cites: Can J Gastroenterol. 2008 Feb;22(2):155-6018299734
Cites: BMJ. 2008 Mar 22;336(7645):651-418310262
Cites: Lancet. 2000 Dec 9;356(9246):1965-911130524
Cites: Am J Gastroenterol. 2001 Feb;96(2):338-4711232673
Cites: J Clin Gastroenterol. 2001 Apr;32(4):307-911276272
Cites: Int J Technol Assess Health Care. 2001 Fall;17(4):517-2711758296
Cites: Health Econ. 2002 Apr;11(3):249-6411921321
Cites: Gut. 2002 May;50 Suppl 4:iv10-211953338
Cites: BMJ. 2002 Apr 27;324(7344):1012-611976244
Cites: Gastroenterology. 2002 May;122(5):1270-8511984514
Cites: Arch Intern Med. 2002 Jun 24;162(12):1361-612076234
Cites: Med Decis Making. 2002 Jul-Aug;22(4):290-30812150595
Cites: Postgrad Med J. 2002 Dec;78(926):707-1612509687
Cites: Aliment Pharmacol Ther. 2003 Jun 15;17(12):1481-9112823150
Cites: Int J Technol Assess Health Care. 2003 Summer;19(3):446-6412962332
Cites: Am J Gastroenterol. 2004 Jun;99(6):1059-6215180725
Cites: Health Econ. 1994 Sep-Oct;3(5):309-197827647
Cites: Ann Intern Med. 1995 Aug 15;123(4):260-87611591
Cites: Gastroenterology. 1996 Jan;110(1):72-838536890
Cites: Am J Gastroenterol. 1996 Sep;91(9):1773-78792696
Cites: Aliment Pharmacol Ther. 1996 Feb;10(1):83-98871447
Cites: Ann Intern Med. 1997 Feb 15;126(4):280-919036800
Cites: J Fam Pract. 1997 Jun;44(6):545-559191627
Cites: Qual Life Res. 1998 Jan;7(1):75-839481153
Cites: Can J Gastroenterol. 1998 Jan-Feb;12(1):83-909544418
PubMed ID
20711528 View in PubMed
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Validation of a decision model for preventive pharmacological strategies in postmenopausal women.

https://arctichealth.org/en/permalink/ahliterature175818
Source
Eur J Epidemiol. 2005;20(1):89-101
Publication Type
Article
Date
2005
Author
Sylvie Perreault
Carey Levinton
Claudine Laurier
Yola Moride
Louis-Georges Ste-Marie
Ralph Crott
Author Affiliation
Faculty of Pharmacy, University of Montreal, Quebec, Canada. sylvie.perreault@umontreal.ca
Source
Eur J Epidemiol. 2005;20(1):89-101
Date
2005
Language
English
Publication Type
Article
Keywords
Aged
Decision Support Techniques
Estrogen Replacement Therapy - adverse effects
Female
Humans
Markov Chains
Middle Aged
Postmenopause
Quebec
Risk factors
Abstract
Benefits and risks of a combined hormone replacement therapy (HRT) based on randomized clinical trial emerged on various disease endpoints in 2002. The Women's Health Initiative (WHI) provides an important health answer for healthy postmenopausal women, such as do not use combined HRT to prevent chronic disease, because of the elevated risk of coronary artery disease (CHD), stroke and venous thromboembolism. In March 2004, the NIH stopped the drugs in the estrogen-alone trial after finding an increase risk of stroke and no effect, neither an increase or a decrease, on risk of CHD after an average of 7 years in the trial. On the other hand, raloxifene, which does not seem to significantly increase the risk of cardiovascular events and could retain skeletal benefits without stimulating endometrial and breast tissue, requires decision-makers since no current data on these disease clinical endpoints have been published.
To construct a multi-disease model based on patient-specific risk factor profiles, and to validate the multi-disease model with several tools of internal and external validities.
A Markov state model was developed. The risks of these various diseases (including coronary artery disease, stroke, hip fracture and breast cancer) are derived from published hazards proportional models which take into account significant risk factors. Canadian-specific rates and data sources for these transition probabilities are derived from published studies and Canadian Health Statistics. The validation of our model were based on several tools of internal and external validities, such as Canadian life expectancy, population-based incidence rate of diseases, clinical trials and other published life expectancy models.
First, presumably, small changes in the lifetime probability of dying support the hypothesis that the disease states operate in a largely independent fashion. For instance, the difference in the probability of dying from a particular disease by the complete elimination of a selected disease, such as CHD, stroke or breast cancer, ranged from 0.2 to 2.2% of difference in the lifetime probability of dying of these diseases. Second, we demonstrated that the model adequately predicted the Canadian population lifetable and disease-incidence rates from population-based data among women from 45 to 75 years old. The predictions of the model were cross-checked from non-source data, such as predicted outcomes versus observed outcomes from results of clinical trials. Predicted relative risks of CHD event, breast cancer and hip fracture fell in the reported 95% confidence interval of clinical trials. Finally, predicted treatment benefits are comparable with those of published life expectancy models.
The results of the study demonstrated that this multi-disease model, including coronary artery disease, stroke, hip fracture and breast cancer, is a valid model to predict the impact on life expectancy or number of events prevented for preventive pharmacological interventions.
PubMed ID
15756909 View in PubMed
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