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Trends in 1-year survival of people admitted to hospital in Ontario, 1994-2009.

https://arctichealth.org/en/permalink/ahliterature106950
Source
CMAJ. 2013 Nov 5;185(16):E755-62
Publication Type
Article
Date
Nov-5-2013
Author
Carl van Walraven
Source
CMAJ. 2013 Nov 5;185(16):E755-62
Date
Nov-5-2013
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Aged, 80 and over
Cohort Studies
Comorbidity - trends
Disease-Free Survival
Female
Hospitalization - statistics & numerical data
Humans
Male
Middle Aged
Mortality - trends
Multivariate Analysis
Odds Ratio
Ontario - epidemiology
Retrospective Studies
Severity of Illness Index
Abstract
Changes in the long-term survival of people admitted to hospital is unknown. This study examined trends in 1-year survival of patients admitted to hospital adjusted for improved survival in the general population.
One-year survival after admission to hospital was determined for all adults admitted to hospital in Ontario in 1994, 1999, 2004, or 2009 by linking to vital statistics datasets. Annual survival in the general population was determined from life tables for Ontario.
Between 1994 and 2009, hospital use decreased (from 8.8% to 6.3% of the general adult population per year), whereas crude 1-year mortality among people with hospital admissions increased (from 9.2% to 11.6%). During this time, patients in hospital became significantly older (median age increased from 51 to 58 yr) and sicker (the proportion with a Charlson comorbidity index score of 0 decreased from 68.2% to 60.0%), and were more acutely ill on admission (elective admissions decreased from 47.4% to 42.0%; proportion brought to hospital by ambulance increased from 16.1% to 24.8%). Compared with 1994, the adjusted odds ratio (OR) for death at 1 year in 2009 was 0.78 (95% confidence interval [CI] 0.77-0.79). However, 1-year risk of death in the general population decreased by 24% during the same time. After adjusting for improved survival in the general population, risk of death at 1 year for people admitted to hospital remained significantly lower in 2009 than in 1994 (adjusted relative excess risk 0.81, 95% CI 0.80-0.82).
After accounting for both the increased burden of patient sickness and improved survival in the general population, 1-year survival for people admitted to hospital increased significantly from 1994 to 2009. The reasons for this improvement cannot be determined from these data.
Notes
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PubMed ID
24082022 View in PubMed
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The effect of participation in a weight loss programme on short-term health resource utilization.

https://arctichealth.org/en/permalink/ahliterature191136
Source
J Eval Clin Pract. 2002 Feb;8(1):37-44
Publication Type
Article
Date
Feb-2002
Author
Carl van Walraven
Robert Dent
Author Affiliation
Department of Medicine, Institute for Clinical Evaluative Sciences, University of Ottawa, Ottawa, Ontario, Canada. carlv@ohri.ca
Source
J Eval Clin Pract. 2002 Feb;8(1):37-44
Date
Feb-2002
Language
English
Publication Type
Article
Keywords
Adult
Female
Health Resources - utilization
Humans
Linear Models
Male
Middle Aged
Obesity - therapy
Ontario
Outcome Assessment (Health Care)
Weight Loss
Abstract
Obese people consume significantly greater amounts of health resources. This study set out to determine if health resource utilization by obese people decreases after losing weight in a comprehensive medically supervised weight management programme. Four hundred and fifty-six patients enrolled in a single-centred, multifaceted weight loss programme in a universal health care system were studied. Patient information was anonymously linked with administrative databases to measure health resource utilization for 1 year before and after the programme. Mean body mass index (BMI) decreased by more than 15%. The mean annual physician visits (pre = 9.6, post = 9.4) did not change significantly after the programme. However, patients saw a significantly fewer number of different physicians per year following the programme (pre = 4.5, post = 3.9; P
PubMed ID
11882100 View in PubMed
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Effect of follow-up physician visits on emergency readmissions.

https://arctichealth.org/en/permalink/ahliterature188304
Source
Am J Med. 2002 Sep;113(4):347; author reply 347
Publication Type
Article
Date
Sep-2002

The effect of a hepatitis serology testing algorithm on laboratory utilization.

https://arctichealth.org/en/permalink/ahliterature189105
Source
J Eval Clin Pract. 2002 Aug;8(3):327-32
Publication Type
Article
Date
Aug-2002
Author
Carl van Walraven
Vivek Goel
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Canada. carlv@ohri.ca
Source
J Eval Clin Pract. 2002 Aug;8(3):327-32
Date
Aug-2002
Language
English
Publication Type
Article
Keywords
Algorithms
Forms and Records Control
Hepatitis, Viral, Human - diagnosis
Humans
Laboratories - utilization
Ontario
Retrospective Studies
Serologic Tests - utilization
Abstract
Laboratory testing algorithms use patient and laboratory data to identify the optimal testing strategy for patients. Studies have shown that these algorithms can decrease test utilization. Since over-utilization of hepatitis serological tests was suspected, a hepatitis serology testing algorithm was initiated in Ontario, Canada. This study determined the effects of this algorithm on utilization.
Population-based retrospective observational study, involving all patients having viral hepatitis serological testing at private laboratories in Ontario, Canada, between July 1991 and December 1999. Prior to the testing algorithm, physicians listed the required specific antigens and antibodies on the test requisition form. In September 1996, the form was changed so that physicians identified the clinical indication--acute hepatitis, chronic hepatitis or immune status testing--for hepatitis serology testing. Therefore, the algorithm introduced a new 'tick-box' to the requisition form. Tests conducted by the laboratory depended upon which indication was chosen. Rates for hepatitis serological testing were calculated using population-based claims data.
Time-series modelling showed that the testing algorithm was associated with a slight but significant increase in the use of hepatitis serology (P
PubMed ID
12164979 View in PubMed
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Coding accuracy of abdominal aortic aneurysm repair procedures in administrative databases - a note of caution.

https://arctichealth.org/en/permalink/ahliterature140762
Source
J Eval Clin Pract. 2011 Feb;17(1):91-6
Publication Type
Article
Date
Feb-2011
Author
Prasad Jetty
Carl van Walraven
Author Affiliation
Division of Vascular Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada. pjetty@ottawahospital.on.ca
Source
J Eval Clin Pract. 2011 Feb;17(1):91-6
Date
Feb-2011
Language
English
Publication Type
Article
Keywords
Aortic Aneurysm, Abdominal - surgery
Clinical Coding - standards
Cohort Studies
Databases as Topic
Humans
Ontario
Surgical Procedures, Elective
Abstract
Administrative databases have been used to compare methods used for abdominal aortic aneurysm (AAA) repair. This requires the use of procedural codes whose accuracy has not been established. In this study we measured the accuracy of procedural codes for open AAA repair and endovascular aneurysm repair (EVAR) in administrative databases.
Between April 2000 and July 2005, we identified all surgeries of non-ruptured AAA using open or EVAR technique at a tertiary-care teaching hospital. During the same time period, we identified all patients who were coded with either an open AAA repair or EVAR.
During the study period, 514 people had an elective AAA repair or were coded with one. Coding quality of open AAA repair was poor (sensitivity 48.1%; specificity 77.4%; accuracy 52.9%) while that for EVAR was slightly better (sensitivity 58.2%; specificity 100%; accuracy 93.6%). We developed an algorithm that included similar procedures and considered anaesthetic type to improve the identification of both open repair (sensitivity 97.7%; specificity 86.9%; accuracy 95.9%) and EVAR (sensitivity 84.8%; specificity 99.5%; accuracy 97.3%).
Administrative database codes that are routinely used to identify open AAA repairs or EVARs are inaccurate. However, slight modifications to the coding algorithms permit the use of administrative databases to study AAA repair.
PubMed ID
20846277 View in PubMed
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The mortality risk score and the ADG score: two points-based scoring systems for the Johns Hopkins aggregated diagnosis groups to predict mortality in a general adult population cohort in Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature131239
Source
Med Care. 2011 Oct;49(10):940-7
Publication Type
Article
Date
Oct-2011
Author
Peter C Austin
Carl van Walraven
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. peter.austin@ices.on.ca
Source
Med Care. 2011 Oct;49(10):940-7
Date
Oct-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Comorbidity
Databases, Factual
Diagnosis-Related Groups
Female
Forecasting
Humans
Logistic Models
Male
Middle Aged
Mortality - trends
Ontario - epidemiology
Predictive value of tests
Retrospective Studies
Risk Assessment - methods
Abstract
Logistic regression models that incorporated age, sex, and indicator variables for the Johns Hopkins' Aggregated Diagnosis Groups (ADGs) categories have been shown to accurately predict all-cause mortality in adults.
To develop 2 different point-scoring systems using the ADGs. The Mortality Risk Score (MRS) collapses age, sex, and the ADGs to a single summary score that predicts the annual risk of all-cause death in adults. The ADG Score derives weights for the individual ADG diagnosis groups.
: Retrospective cohort constructed using population-based administrative data.
All 10,498,413 residents of Ontario, Canada, between the age of 20 and 100 years who were alive on their birthday in 2007, participated in this study. Participants were randomly divided into derivation and validation samples.
: Death within 1 year.
In the derivation cohort, the MRS ranged from -21 to 139 (median value 29, IQR 17 to 44). In the validation group, a logistic regression model with the MRS as the sole predictor significantly predicted the risk of 1-year mortality with a c-statistic of 0.917. A regression model with age, sex, and the ADG Score has similar performance. Both methods accurately predicted the risk of 1-year mortality across the 20 vigintiles of risk.
The MRS combined values for a person's age, sex, and the John Hopkins ADGs to accurately predict 1-year mortality in adults. The ADG Score is a weighted score representing the presence or absence of the 32 ADG diagnosis groups. These scores will facilitate health services researchers conducting risk adjustment using administrative health care databases.
PubMed ID
21921849 View in PubMed
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Risk of death or readmission among people discharged from hospital on Fridays.

https://arctichealth.org/en/permalink/ahliterature189329
Source
CMAJ. 2002 Jun 25;166(13):1672-3
Publication Type
Article
Date
Jun-25-2002
Author
Carl van Walraven
Chaim M Bell
Author Affiliation
Clinical and Epidemiology Unit, Ottawa Health Research Institute, Ottawa Hospital, ON. carlv@ohri.ca
Source
CMAJ. 2002 Jun 25;166(13):1672-3
Date
Jun-25-2002
Language
English
Publication Type
Article
Keywords
Comorbidity
Death
Female
Humans
Male
Middle Aged
Ontario
Patient Discharge - statistics & numerical data
Patient Readmission - statistics & numerical data
Proportional Hazards Models
Risk factors
Time Factors
Notes
Cites: J Gen Intern Med. 1999 Oct;14(10):610-610571706
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Cites: Mod Healthc. 1996 Nov 11;26(46):82, 84, 9910163080
Comment In: CMAJ. 2002 Sep 17;167(6):625-6; author reply 62612358185
PubMed ID
12126321 View in PubMed
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Using an interactive voice response system to improve patient safety following hospital discharge.

https://arctichealth.org/en/permalink/ahliterature163431
Source
J Eval Clin Pract. 2007 Jun;13(3):346-51
Publication Type
Article
Date
Jun-2007
Author
Alan J Forster
Carl van Walraven
Author Affiliation
Department of Medicine, University of Ottawa, Ottawa, ON, Canada. aforster@ohri.ca
Source
J Eval Clin Pract. 2007 Jun;13(3):346-51
Date
Jun-2007
Language
English
Publication Type
Article
Keywords
Aged
Cohort Studies
Female
Humans
Male
Middle Aged
Ontario
Patient Discharge
Prospective Studies
Safety Management
Speech Recognition Software
User-Computer Interface
Abstract
Patients often experience complications when transitioning from hospital to home. These complications are frequently related to poor monitoring. An interactive voice response system (IVRS) could improve post-discharge monitoring.
To determine the feasibility and utility of an IVRS to monitor patients following hospital discharge.
Prospective cohort study at an academic health sciences centre.
Consecutive internal medicine patients who had a touch-tone telephone, spoke English, had no cognitive impairments and were discharged home.
Feasibility was defined as the proportion of patients reached by the IVRS and the proportion completing an IVRS-based survey. Utility was defined as the percentage of patients whose outcomes could have been changed by the IVRS.
We programmed the IVRS to call patients and administer a simple survey 48 hours after discharge. The survey's objective was to identify all patients with new health problems. Such patients were telephoned by a nurse to clarify and address the problem.
We enrolled 77 patients who were predominantly male (68%), elderly (median age 65 years) and chronically ill (median number of co-morbidities = 3). The IVRS reached 45 of the 77 patients (58.4%). Forty patients (51.9%) answered all questions on the survey. Twenty patients (26%, 95% CI 17%-37%) indicated new or worsening symptoms, problems with their medications, or requested to talk to the clinic nurse. For 10 patients (13%, 95% CI 7%-22%), the IVRS could have made a difference in their outcome.
Using an IVRS, we were able to identify several important new health concerns arising following hospital discharge. Subtle changes could increase the feasibility and utility of IVRS technology in improving post-discharge outcomes.
PubMed ID
17518797 View in PubMed
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The use of quality indicators to promote accountability in health care: the good, the bad, and the ugly.

https://arctichealth.org/en/permalink/ahliterature128357
Source
Open Med. 2012;6(2):e75-9
Publication Type
Article
Date
2012
Author
Alan J Forster
Carl van Walraven
Author Affiliation
Performance Measurement, The Ottawa Hospital, Ottawa, Ontario, Canada. aforster@ohri.ca
Source
Open Med. 2012;6(2):e75-9
Date
2012
Language
English
Publication Type
Article
Keywords
Canada
Emergency Service, Hospital - standards
Hospital Mortality
Humans
Length of Stay
Patient Readmission
Quality Assurance, Health Care - methods - organization & administration
Quality Indicators, Health Care - organization & administration - standards
Social Responsibility
Abstract
In Canada, we place significant cultural and financial value on our healthcare system.  As such, it is imperative we measure its quality.  In this commentary, we highlight some of the potential benefits and harms associated with measuring quality using currently available indicators, such as hospital mortality rates, emergency department length of stays, and readmission rates.  These measures tend to focus on provider and process issues rather than patient outcomes and also reflect what we can measure rather than what we should measure.  We argue that the current approaches are inadequate and recommend a better understanding of the limitations of current indicators and more provider engagement.  To meet these recommendations the health system needs to increased investment in performance measurement systems.
Notes
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Cites: N Engl J Med. 2010 Dec 23;363(26):2477-8121142528
PubMed ID
23696772 View in PubMed
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Long-term outcomes and resource utilization of endovascular versus open repair of abdominal aortic aneurysms in Ontario.

https://arctichealth.org/en/permalink/ahliterature146326
Source
J Vasc Surg. 2010 Mar;51(3):577-83, 583.e1-3
Publication Type
Article
Date
Mar-2010
Author
Prasad Jetty
Paul Hebert
Carl van Walraven
Author Affiliation
Division of Vascular Surgery, The Ottawa Hospital, University of Ottawa, Ontario, Canada. pjetty@toh.on.ca
Source
J Vasc Surg. 2010 Mar;51(3):577-83, 583.e1-3
Date
Mar-2010
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - diagnosis - mortality - surgery
Aortography - utilization
Blood Vessel Prosthesis Implantation - adverse effects - mortality - utilization
Female
Health Resources - utilization
Hospital Mortality
Humans
Kaplan-Meier Estimate
Length of Stay
Long-Term Care - utilization
Male
Nursing Homes - utilization
Odds Ratio
Ontario
Patient Discharge
Patient Readmission
Propensity Score
Proportional Hazards Models
Reoperation
Retrospective Studies
Risk assessment
Surgical Procedures, Elective
Time Factors
Treatment Outcome
Abstract
Two large randomized trials showed that elective endovascular aneurysm repair (EVAR) had similar all-cause long-term mortality rates but increased costs compared with open repair for nonruptured abdominal aortic aneurysms (AAAs). Despite these data, the use of EVAR continues to increase in North America. Currently, there are very limited adjusted population-based data examining long-term outcomes and resource utilization.
All patients who underwent elective AAA repair between April 2002 and March 2007 in Ontario were identified using data from hospital discharge abstracts. Patients were identified with a validated algorithm. A propensity score analysis was used to adjust for treatment allocation. Clinical outcomes included time to all-cause death and discharge to a nursing home or long-term care facility. Resource utilization outcomes included imaging utilization, hospital utilization, and reintervention rates.
Overall, 6461 patients underwent treatment of nonruptured AAAs, comprising 888 EVARs and 5573 open repairs. EVAR patients were older and had more comorbidities. The adjusted mortality was significantly lower in the EVAR group at 30 days (adjusted odds ratio [adj-OR], 0.34; 95% confidence interval [95% CI], 0.20-0.59), but long-term mortality was similar (adj-OR, 0.95; 95% CI, 0.81-1.05). EVAR patients were significantly less likely to be discharged to a nursing home or other chronic care facility (adj-OR, 0.55; 95% CI, 0.41-0.74). Imaging utilization as well as urgent and vascular readmissions were significantly higher in the EVAR group. However, the EVAR group had a significantly shorter length of stay and less intensive care unit use for the index hospitalization and decreased hospital length of stay during follow-up. There was a trend toward a slightly increased risk of reintervention with EVAR (adj-OR, 1.3; 95% CI, 0.98-1.75).
Compared with open repair, EVAR significantly reduced short-term but not long-term mortality. The EVAR patients spent less time in health institutions, including long-term care facilities, but underwent more imaging studies. Future improvements in EVAR could result in further decreases in reinterventions and subsequent radiologic monitoring.
Notes
Comment In: J Vasc Surg. 2010 Sep;52(3):818-920816324
PubMed ID
20045624 View in PubMed
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59 records – page 1 of 6.