Skip header and navigation

Refine By

8 records – page 1 of 1.

Family practice residents' awareness of medical care costs in British Columbia.

https://arctichealth.org/en/permalink/ahliterature191217
Source
Fam Med. 2002 Feb;34(2):104-9
Publication Type
Article
Date
Feb-2002
Author
G Michael Allan
Grant Innes
Author Affiliation
Base Hospital, CFB Esquimalt, Victoria, British Columbia, Canada. M&B_Allan@telus.net
Source
Fam Med. 2002 Feb;34(2):104-9
Date
Feb-2002
Language
English
Publication Type
Article
Keywords
Awareness
British Columbia
Cost Control
Cross-Sectional Studies
Data Collection
Diagnostic Techniques and Procedures - economics
Drug Costs
Family Practice - economics - education
Female
Health Care Costs - classification
Humans
Internship and Residency - economics - standards
Knowledge
Male
Therapeutics - economics
Abstract
Health economics continues to be an important issue, and past studies in the United States and Europe have found that physicians and physicians in training have a limited understanding of medical care costs. No medical care cost-awareness studies have been done in Canada. In this study, the costs of 46 commonly used diagnostic tests and therapeutics were determined, and family practice residents' awareness of these costs was assessed.
Ninety-seven first- and second-year residents of the University of British Columbia Family Practice Program were surveyed using the modified Dillman Total Design Method. Resident cost estimations were considered correct if within 25% or 50% of actual costs, and awareness was correlated with training location, gender, residency year, and importance ratings for ordering behavior. Degree of error was assessed by calculating median percent errors and confidence intervals for each therapeutic and diagnostic test.
Costs were determined from the British Columbia Medical Association Guide to Fees, British Columbia Centre for Disease Control, hospital finance departments, and pharmaceutical wholesalers. A total of 82 (85%) residents completed the survey, but 11 were only partially completed. Few residents could estimate the cost of diagnostic tests or therapeutics to within 25% of the true cost, and the estimations were highly variable. Residents underestimated the cost of expensive drugs and overestimated the cost of inexpensive drugs. There was no relationship between cost awareness and training location, gender, residency year, or residents rating cost as important in ordering behaviour.
Resident physicians in British Columbia, Canada have limited awareness of medical care costs.
PubMed ID
11874018 View in PubMed
Less detail

Frequency, determinants and impact of overcrowding in emergency departments in Canada: a national survey.

https://arctichealth.org/en/permalink/ahliterature160289
Source
Healthc Q. 2007;10(4):32-40
Publication Type
Article
Date
2007
Author
Kenneth Bond
Maria B Ospina
Sandra Blitz
Marc Afilalo
Sam G Campbell
Michael Bullard
Grant Innes
Brian Holroyd
Gil Curry
Michael Schull
Brian H Rowe
Author Affiliation
Capital Health/University of Alberta Evidence-Based Practice Center, Edmonton.
Source
Healthc Q. 2007;10(4):32-40
Date
2007
Language
English
Publication Type
Article
Keywords
Canada
Crowding
Emergency Service, Hospital - organization & administration
Health Care Surveys
Humans
National Health Programs
Abstract
Several reports have documented the prevalence and severity of emergency department (ED) overcrowding at specific hospitals or cities in Canada; however, no study has examined the issue at a national level. A 54-item, self-administered, postal and web-based questionnaire was distributed to 243 ED directors in Canada to collect data on the frequency, impact and factors associated with ED overcrowding. The survey was completed by 158 (65% response rate) ED directors, 62% of whom reported overcrowding as a major or severe problem during the past year. Directors attributed overcrowding to a variety of issues including a lack of admitting beds (85%), lack of acute care beds (74%) and the increased length of stay of admitted patients in the ED (63%). They perceived ED overcrowding to have a major impact on increasing stress among nurses (82%), ED wait times (79%) and the boarding of admitted patients in the ED while waiting for beds (67%). Overcrowding is not limited to large urban centres; nor is it limited to academic and teaching hospitals. The perspective of ED directors reinforces the need for further examination of effective policies and interventions to reduce ED overcrowding.
PubMed ID
18019897 View in PubMed
Less detail

Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus skin and soft tissue infection in a Canadian emergency department.

https://arctichealth.org/en/permalink/ahliterature148302
Source
CJEM. 2009 Sep;11(5):430-8
Publication Type
Article
Date
Sep-2009
Author
Robert Stenstrom
Eric Grafstein
Marc Romney
Jahan Fahimi
Devin Harris
Garth Hunte
Grant Innes
Jim Christenson
Author Affiliation
Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada. robstenstrom@shaw.ca
Source
CJEM. 2009 Sep;11(5):430-8
Date
Sep-2009
Language
English
Publication Type
Article
Keywords
British Columbia - epidemiology
Case-Control Studies
Chi-Square Distribution
Emergency Service, Hospital
Female
Hospitals, Urban
Humans
Logistic Models
Male
Methicillin-Resistant Staphylococcus aureus
Middle Aged
Prevalence
Risk factors
Soft Tissue Infections - drug therapy - epidemiology - microbiology
Staphylococcal Infections - drug therapy - epidemiology - microbiology
Staphylococcal Skin Infections - drug therapy - epidemiology - microbiology
Abstract
We sought to estimate the period prevalence of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infection (SSTI) and evaluate risk factors for MRSA SSTI in an emergency department (ED) population.
We carried out a cohort study with a nested case-control design. Patients presenting to our ED with a wound culture and a discharge diagnosis of SSTI between January 2003 and September 2004 were dichotomized as MRSA positive or negative. Fifty patients with MRSA SSTI matched by calendar time to 100 controls with MRSA-negative SSTI had risk factors assessed using multivariate conditional logistic regression.
Period prevalence of MRSA SSTI was 54.8% (95% confidence interval [CI] 50.2%-59.4%). The monthly period prevalence increased from 21% in January 2003 to 68% in September 2004 (p
Notes
Comment In: CJEM. 2009 Sep;11(5):417-2219788783
Erratum In: CJEM. 2009 Nov;11(6):570
PubMed ID
19788787 View in PubMed
Less detail

The role of full capacity protocols on mitigating overcrowding in EDs.

https://arctichealth.org/en/permalink/ahliterature136575
Source
Am J Emerg Med. 2012 Mar;30(3):412-20
Publication Type
Article
Date
Mar-2012
Author
Cristina Villa-Roel
Xiaoyan Guo
Brian R Holroyd
Grant Innes
Lyndsey Wong
Maria Ospina
Michael Schull
Benjamin Vandermeer
Michael J Bullard
Brian H Rowe
Author Affiliation
Department of Emergency Medicine, School of Public Health, University of Alberta, Edmonton, Alberta, Canada T6G 2T4.
Source
Am J Emerg Med. 2012 Mar;30(3):412-20
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Canada
Crowding
Emergency Service, Hospital - organization & administration - standards
Great Britain
Hospital Bed Capacity
Humans
Length of Stay
Outcome and Process Assessment (Health Care)
Patient Admission
Patient Transfer - organization & administration - standards
Quality Improvement
United States
Abstract
Overcrowding is an important issue facing many emergency departments (EDs). Access block (admitted patients occupying ED stretchers) is a leading contributor, and expeditious placement of admitted patients is an area of research interest. This review examined the effectiveness of full capacity protocols (FCPs) on mitigating ED overcrowding.
A comprehensive literature search was undertaken to identify potentially relevant studies between 1966 and 2009. Intervention studies in which an FCP was used to influence ED/hospital length of stay and ED/hospital access block were included as a single program or part of a systemwide intervention. Two reviewers independently assessed citation relevance, inclusion, study quality, and extracted data; because of limited data, pooling was not undertaken.
From 14 446 potentially relevant studies, 2 abstracts from the same comparative study were included. From 29 studies on systemwide intervention, 4 contained an FCP component. The included study was a single-center ED study using a before-after design; its methodological quality was rated as weak. One of the abstracts reported that an FCP was associated with less ED length of stay (5-hour reduction) when compared with the comparison period; the other reported that an FCP decreased ED and hospital access block (28% and 37% reduction, respectively). The ED triggers, format, and implementation of FCP protocols varied widely.
Although FCPs may be a promising alternative for overcrowded EDs, the available evidence upon which to support implementation of an FCP is limited. Additional efforts are required to improve the outcome reporting of FCP research using high-quality research methods.
PubMed ID
21367554 View in PubMed
Less detail

Safety and efficiency of calcium channel blockers versus beta-blockers for rate control in patients with atrial fibrillation and no acute underlying medical illness.

https://arctichealth.org/en/permalink/ahliterature115353
Source
Acad Emerg Med. 2013 Mar;20(3):222-30
Publication Type
Article
Date
Mar-2013
Author
Frank Xavier Scheuermeyer
Eric Grafstein
Rob Stenstrom
Jim Christenson
Claire Heslop
Brett Heilbron
Lorraine McGrath
Grant Innes
Author Affiliation
Department of Emergency Medicine, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada. frank.scheuermeyer@gmail.com
Source
Acad Emerg Med. 2013 Mar;20(3):222-30
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - adverse effects - therapeutic use
Aged
Aged, 80 and over
Atrial Fibrillation - drug therapy - epidemiology
Calcium Channel Blockers - adverse effects - therapeutic use
Canada - epidemiology
Cohort Studies
Comorbidity
Female
Heart Rate - drug effects
Humans
Male
Middle Aged
Patient Admission - statistics & numerical data
Retrospective Studies
Stroke - epidemiology
Abstract
Many patients with atrial fibrillation (AF) are not candidates for rhythm control and may require rate control, typically with beta-blocking (BB) or calcium channel blocking (CCB) agents. Although these patients appear to have a low 30-day rate of stroke or death, it is unclear if one class of agent is safer or more effective. The objective was to determine whether BBs or CCBs would have a lower hospital admission rate and to measure 30-day safety outcomes including stroke, death, and emergency department (ED) revisits.
This retrospective cohort study used a database from two urban EDs to identify consecutive patients with ED discharge diagnoses of AF from April 1, 2006, to March 31, 2010. Comorbidities, rhythms, management, and immediate outcomes were obtained by manual chart review, and patients with acute underlying medical conditions were excluded by predefined criteria. Patients managed only with rate control agents were eligible for review, and patients receiving BB agents were compared to those receiving CCB agents. The primary outcome was the proportion of patients requiring hospital admission; secondary outcomes included the ED length of stay (LOS), the proportion of patients having adverse events, the proportion of patients returning within 7 or 30 days, and the number of patients having a stroke or dying within 30 days.
A total of 259 consecutive patients were enrolled, with 100 receiving CCBs and 159 receiving BBs. Baseline demographics and comorbidities were similar. Twenty-seven percent of BB patients were admitted, and 31.0% of CCB patients were admitted (difference = 4.0%, 95% confidence interval [CI] = -7.7% to 16.1%), and there were no significant differences in ED LOS, adverse events, or 7- or 30-day ED revisits. One patient who received metoprolol had a stroke, and one patient who received diltiazem died within 30 days.
In this cohort of ED patients with AF and no acute underlying medical illness who underwent rate control only, patients receiving CCBs had similar hospital admission rates to those receiving BBs, while both classes of medications appeared equally safe at 30 days. Both CCBs and BBs are acceptable options for rate control.
PubMed ID
23517253 View in PubMed
Less detail

Safety and efficiency of emergency department assessment of chest discomfort.

https://arctichealth.org/en/permalink/ahliterature179804
Source
CMAJ. 2004 Jun 8;170(12):1803-7
Publication Type
Article
Date
Jun-8-2004
Author
Jim Christenson
Grant Innes
Douglas McKnight
Barb Boychuk
Eric Grafstein
Christopher R Thompson
Frances Rosenberg
Aslam H Anis
Ken Gin
Jessica Tilley
Hubert Wong
Joel Singer
Author Affiliation
Department of Surgery, University of British Columbia, and Department of Emergency Medicine, Providence Health Care, St. Paul's Hospital, Vancouver, BC. jimchris@interchange.ubc.ca
Source
CMAJ. 2004 Jun 8;170(12):1803-7
Date
Jun-8-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada
Chest Pain - etiology
Diagnostic Errors
Emergency Service, Hospital - standards
Female
Humans
Length of Stay
Male
Middle Aged
Myocardial Infarction - diagnosis
Observation
Outcome and Process Assessment (Health Care)
Patient Discharge
Prospective Studies
Abstract
Most Canadian emergency departments use an unstructured, individualized approach to patients with chest pain, without data to support the safety and efficiency of this practice. We sought to determine the proportions of patients with chest discomfort in emergency departments who either had acute coronary syndrome (ACS) and were inappropriately discharged from the emergency department or did not have ACS and were held for investigation.
Consecutive consenting patients aged 25 years or older presenting with chest discomfort to 2 urban tertiary care emergency departments between June 2000 and April 2001 were prospectively enrolled unless they had a terminal illness, an obvious traumatic cause, a radiographically identifiable cause, severe communication problems or no fixed address in British Columbia or they would not be available for follow-up by telephone. At 30 days we assigned predefined explicit outcome diagnoses: definite ACS (acute myocardial infarction [AMI] or definite unstable angina) or no ACS.
Of 1819 patients, 241 (13.2%) were assigned a 30-day diagnosis of AMI and 157 (8.6%), definite unstable angina. Of these 398 patients, 21 (5.3%) were discharged from the emergency department without a diagnosis of ACS and without plans for further investigation. The clinical sensitivity for detecting ACS was 94.7% (95% confidence interval [CI] 92.5%- 96.9%) and the specificity 73.8% (95% CI 71.5%- 76.0%). Of the patients without ACS or an adverse event, 71.1% were admitted to hospital or held in the emergency department for more than 3 hours.
The current individualized approach to evaluation and disposition of patients with chest discomfort in 2 Canadian tertiary care emergency departments misses 5.3% of cases of ACS while consuming considerable health care resources for patients without coronary disease. Opportunities exist to improve both safety and efficiency.
Notes
Cites: Med Decis Making. 1986 Jan-Mar;6(1):12-73945181
Cites: Ann Intern Med. 1987 Feb;106(2):181-63800180
Cites: Am J Cardiol. 1987 Aug 1;60(4):219-243618483
Cites: N Engl J Med. 1988 Mar 31;318(13):797-8033280998
Cites: J Electrocardiol. 1988;21 Suppl:S11-73063767
Cites: Am Heart J. 2002 Oct;144(4):630-512360158
Cites: J Am Coll Cardiol. 2002 Oct 2;40(7):1366-7412383588
Cites: Eur Heart J. 2002 Dec;23(23):1809-4012503543
Cites: N Engl J Med. 1982 Sep 2;307(10):588-967110205
Cites: JAMA. 1983 Sep 2;250(9):1177-816876356
Cites: South Med J. 1989 Sep;82(9):1083-92505390
Cites: Ann Emerg Med. 1989 Oct;18(10):1029-342802275
Cites: Am J Cardiol. 1991 Jul 15;68(2):145-92063775
Cites: Ann Emerg Med. 1993 Mar;22(3):579-828442548
Cites: J Am Coll Cardiol. 1994 Nov 1;24(5):1249-597930247
Cites: Ann Emerg Med. 1995 Jan;25(1):1-87802357
Cites: Ann Intern Med. 1995 Mar 15;122(6):434-77856992
Cites: Circulation. 1996 Jul 15;94(2):143-508674172
Cites: J Am Coll Cardiol. 1996 Jul;28(1):25-338752791
Cites: Ann Emerg Med. 1997 Jan;29(1):88-988998087
Cites: Ann Emerg Med. 1997 Jan;29(1):116-258998090
Cites: Acad Emerg Med. 1997 Jul;4(7):693-89223693
Cites: Ann Intern Med. 1997 Dec 1;127(11):996-10059412306
Cites: N Engl J Med. 1997 Dec 4;337(23):1648-539385123
Cites: Clin Cardiol. 1998 Jan;21(1):22-69474462
Cites: Ann Intern Med. 1998 Dec 1;129(11):845-559867725
Cites: Am J Cardiol. 1999 Apr 1;83(7):1033-710190515
Cites: N Engl J Med. 1998 Dec 24;339(26):1882-89862943
Cites: Int J Cardiol. 2000 Jan 15;72(2):101-1010646950
Cites: N Engl J Med. 2000 Apr 20;342(16):1163-7010770981
Cites: JAMA. 2000 Aug 16;284(7):835-4210938172
Cites: J Am Coll Cardiol. 2000 Nov 1;36(5):1500-611079649
Cites: CMAJ. 2001 May 1;164(9):1309-1611341143
Cites: Acad Emerg Med. 2001 Jul;8(7):696-70211435183
Cites: Circulation. 2002 Oct 1;106(14):1893-90012356647
Comment In: CMAJ. 2004 Nov 23;171(11):1322; author reply 1322-315557568
Comment In: CMAJ. 2004 Nov 23;171(11):1322; author reply 1322-315557567
PubMed ID
15184334 View in PubMed
Less detail

Value of information of a clinical prediction rule: informing the efficient use of healthcare and health research resources.

https://arctichealth.org/en/permalink/ahliterature159163
Source
Int J Technol Assess Health Care. 2008;24(1):112-9
Publication Type
Article
Date
2008
Author
Sonia Singh
Bohdan Nosyk
Huiying Sun
James Malcolm Christenson
Grant Innes
Aslam Hayat Anis
Author Affiliation
Clinical Assistant Professor, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada. sonia.singh@fraserhealth.ca
Source
Int J Technol Assess Health Care. 2008;24(1):112-9
Date
2008
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - diagnosis
Aged
British Columbia
Chest Pain - diagnosis
Cost-Benefit Analysis
Decision Support Systems, Clinical - economics
Decision Support Techniques
Efficiency, Organizational
Emergency Service, Hospital
Female
Hospitals, Teaching
Humans
Male
Middle Aged
Abstract
The aim of this study was to estimate the potential cost-effectiveness and expected value of perfect information of a recently derived clinical prediction rule for patients presenting to emergency departments with chest discomfort.
A decision analytic model was constructed to compare the Early Disposition Prediction Rule (EDPR) with the current standard of care. Results were used to calculate the potential cost-effectiveness of the EDPR, as well as the Value of Information in conducting further research. Study subjects were adults presenting with chest discomfort to two urban emergency departments in Vancouver, British Columbia, Canada. The clinical prediction rule identifies patients who are eligible for early discharge within 3 hours of presentation to the emergency department. The outcome measure used was inappropriate emergency department discharge of patients with acute coronary syndrome (ACS).
The incremental cost-effectiveness ratio of the EDPR in comparison to usual care was (negative) $2,999 per inappropriate ACS discharge prevented, indicating a potential cost-savings in introducing the intervention. The expected value of perfect information was $16.3 million in the first year of implementation, suggesting a high benefit from conducting further research to validate the decision rule.
The EDPR is likely to be cost-effective; however, given the high degree of uncertainty in the estimates of costs and patient outcomes, further research is required to inform the decision to implement the intervention. The potential health and monetary benefits of this clinical prediction rule outweigh the costs of doing further research.
PubMed ID
18218176 View in PubMed
Less detail

8 records – page 1 of 1.