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Hospital care for elderly patients with diseases of the circulatory system. A comparison of hospital use in the United States and Canada.

https://arctichealth.org/en/permalink/ahliterature229783
Source
N Engl J Med. 1989 Nov 23;321(21):1443-8
Publication Type
Article
Date
Nov-23-1989
Author
G M Anderson
J P Newhouse
L L Roos
Author Affiliation
Health Policy Research Unit, University of British Columbia, Vancouver, Canada.
Source
N Engl J Med. 1989 Nov 23;321(21):1443-8
Date
Nov-23-1989
Language
English
Publication Type
Article
Keywords
Aged
Cardiovascular Diseases - therapy
Coronary Artery Bypass - utilization
Coronary Disease - therapy
Diagnosis-Related Groups - statistics & numerical data
Health Services Accessibility
Hospitals - utilization
Humans
Length of Stay - statistics & numerical data
Manitoba
Medicare
Ontario
Patient Discharge - statistics & numerical data
Prospective Payment System
United States
Abstract
In an effort to determine how lower health care expenditures in Canada as compared with the United States translate into actual hospital services received, we examined discharge rates, lengths of stay, and the case-mix index (calculated from diagnosis-related group weights) for those 65 years of age and older hospitalized with cardiovascular disease in the United States and two Canadian provinces, Manitoba and Ontario, in 1981 and 1985. We expected that the effect of the prospective payment system might be reflected in changes between 1981 and 1985. Discharge rates for medical treatment of cardiovascular diseases were 2.9 percent higher in the United States than in Canada in 1981, but 1.8 percent lower in 1985; however, the case-mix index was 3.0 percent lower in 1981 and 4.8 percent higher in 1985. The case-mix index for combined medical and surgical discharges was 5.0 percent lower in the United States in 1981, but 10.7 percent higher in 1985. U.S. surgical discharge rates were 20 percent lower in 1981, but 20 percent higher in 1985. Rates of coronary bypass surgery were much higher in the United States in both years, but increased rapidly in both countries, particularly among those 75 and older. Elderly Canadians appeared to have access to cardiovascular surgery, with the exception of coronary bypass surgery, and to other hospital care for cardiovascular disease similar to that of elderly people in the United States.
PubMed ID
2509912 View in PubMed
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Postsurgical mortality in Manitoba and New England.

https://arctichealth.org/en/permalink/ahliterature229087
Source
JAMA. 1990 May 9;263(18):2453-8
Publication Type
Article
Date
May-9-1990
Author
L L Roos
E S Fisher
S M Sharp
J P Newhouse
G. Anderson
T A Bubolz
Author Affiliation
Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
Source
JAMA. 1990 May 9;263(18):2453-8
Date
May-9-1990
Language
English
Publication Type
Article
Keywords
Aged
Female
Hospital Departments - statistics & numerical data
Humans
Insurance, Health - statistics & numerical data
Logistic Models
Male
Manitoba - epidemiology
New England - epidemiology
Patient Discharge - statistics & numerical data
Surgical Procedures, Operative - mortality - statistics & numerical data
Survival Rate
Abstract
Per capita hospital expenditures in the United States exceed those in Canada, but little research has examined differences in outcomes. We used insurance databases to compare postsurgical mortality for 11 specific surgical procedures, both before and after adjustment for case mix, among residents of New England and Manitoba who were over 65 years of age. For low- and moderate-risk procedures, 30-day mortality rates were similar in both regions, but 6-month mortality rates were lower in Manitoba. For the two high-risk procedures, concurrent coronary bypass/valve replacement and hip fracture repair, both 30-day and 6-month mortality rates were lower in New England. Although no consistent pattern favoring New England for cardiovascular surgery was found, the increased mortality following hip fracture in Manitoba was found for all types of repair and all age groups. We conclude that for low- and moderate-risk procedures, the higher hospital expenditures in New England were not associated with lower perioperative mortality rates.
PubMed ID
2329632 View in PubMed
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Use of cardiac procedures and outcomes in elderly patients with myocardial infarction in the United States and Canada.

https://arctichealth.org/en/permalink/ahliterature208401
Source
N Engl J Med. 1997 May 22;336(21):1500-5
Publication Type
Article
Date
May-22-1997
Author
J V Tu
C L Pashos
C D Naylor
E. Chen
S L Normand
J P Newhouse
B J McNeil
Author Affiliation
Institute for Clinical Evaluative Sciences, North York, ON, Canada.
Source
N Engl J Med. 1997 May 22;336(21):1500-5
Date
May-22-1997
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty, Balloon, Coronary - statistics & numerical data - utilization
Cohort Studies
Coronary Angiography - statistics & numerical data - utilization
Coronary Artery Bypass - statistics & numerical data - utilization
Humans
Myocardial Infarction - mortality - radiography - therapy
Ontario - epidemiology
Physician's Practice Patterns - statistics & numerical data
Survival Rate
United States - epidemiology
Abstract
Acute myocardial infarction is a leading cause of morbidity and mortality in the United States and Canada. We performed a population-based study to compare the use of cardiac procedures and outcomes after acute myocardial infarction in elderly patients in the two countries.
We compared the use of invasive cardiac procedures and the mortality rates among 224,258 elderly Medicare beneficiaries in the United States and 9444 elderly patients in Ontario, Canada, each of whom had a new acute myocardial infarction in 1991.
The U.S. patients were significantly more likely than the Canadian patients to undergo coronary angiography (34.9 percent vs. 6.7 percent, P
Notes
Comment In: N Engl J Med. 1997 Oct 2;337(14):1008; author reply 1008-99312670
Comment In: N Engl J Med. 1997 Oct 2;337(14):1008; author reply 1008-99312671
Comment In: N Engl J Med. 1997 May 22;336(21):1522-39154775
Comment In: N Engl J Med. 2001 Mar 8;344(10):774-511236791
Erratum In: N Engl J Med 1997 Jul 10;337(2):139
PubMed ID
9154770 View in PubMed
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