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Across time and space: variations in hospital use during Canadian health reform.

https://arctichealth.org/en/permalink/ahliterature198200
Source
Health Serv Res. 2000 Jun;35(2):467-87
Publication Type
Article
Date
Jun-2000
Author
K C Carriere
L L Roos
D C Dover
Author Affiliation
Dept. of Mathematical Sciences, University of Alberta, Edmonton, Canada.
Source
Health Serv Res. 2000 Jun;35(2):467-87
Date
Jun-2000
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Ambulatory Surgical Procedures - utilization
Child
Child, Preschool
Cluster analysis
Health Care Reform
Health Services Accessibility - economics
Hospitalization - statistics & numerical data
Hospitals - utilization
Humans
Income
Infant
Infant, Newborn
Length of Stay
Longitudinal Studies
Manitoba
Middle Aged
Surgical Procedures, Operative - utilization
Abstract
To investigate change in hospital utilization in a population and to discuss analytical strategies using large administrative databases, focusing on variations in rates of different types of hospital utilization by income quintile neighborhoods.
Hospital discharge abstracts from Manitoba Health, used to study the changes in utilization rates over eight fiscal years (1989-1996).
We test the hypotheses that health reform has changed utilization rates, that utilization rates differ significantly across income quintiles (defined by the relative affluence of neighborhood of residence), and that these variations have been maintained over time. Our approach uses generalized estimating equations to produce robust and consistent results for studying rates of recurrent and nonrecurrent events longitudinally.
Rates of individuals hospitalized, hospital discharges, days of hospitalization, and hospitalization for different types of medical conditions and surgical procedures are generated for the period April 1, 1989 through March 31, 1997 for residents of Winnipeg, Manitoba. Data are grouped according to the individual's age, gender, and neighborhood of residence on April 1 of each of the eight fiscal years for the rate calculations. Neighborhood of residence and the 1991 Canadian Census public use database are used to assign individuals to income quintiles.
The substitution of outpatient surgery for inhospital surgery accounted for much of the change in hospital utilization over the 1989-1996 period. Health care reform did not have a significant effect on the utilization gradient already observed across socioeconomic groups. Health reform markedly accelerated declines in in-hospital utilization.
Grouping the data with key characteristics intact facilitates the statistical analysis of utilization measures previously difficult to study. Such analyses of variations across time and space based on parametric models allows adjustment for continuous covariates and is more efficient than the traditional nonparametric approach using standardized rates.
Notes
Cites: JAMA. 1995 Jan 18;273(3):209-137807659
Cites: N Engl J Med. 1994 Oct 13;331(15):989-958084356
Cites: Health Aff (Millwood). 1993 Spring;12(1):162-738509018
Cites: JAMA. 1992 Nov 4;268(17):2388-941404795
Cites: Can J Public Health. 1991 May-Jun;82(3):209-111884318
Cites: Soc Sci Med. 1989;28(2):175-822928827
Cites: Lancet. 1986 Jan 25;1(8474):199-2022868216
Cites: Lancet. 1983 Mar 26;1(8326 Pt 1):691-66132049
Cites: Sci Am. 1982 Apr;246(4):120-347079718
Cites: Med Care. 1982 Mar;20(3):266-767078285
Cites: Milbank Q. 1996;74(1):3-318596520
Cites: Med Care. 1997 Jan;35(1):57-698998203
Cites: Milbank Q. 1997;75(1):89-1119063301
Cites: N Engl J Med. 1998 Apr 2;338(14):983-79521989
PubMed ID
10857472 View in PubMed
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Age-specific education and income gradients in morbidity and mortality in a Canadian province.

https://arctichealth.org/en/permalink/ahliterature207884
Source
Soc Sci Med. 1997 Aug;45(3):383-97
Publication Type
Article
Date
Aug-1997
Author
C A Mustard
S. Derksen
J M Berthelot
M. Wolfson
L L Roos
Author Affiliation
Manitoba Centre for Health Policy and Evaluation, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Canada.
Source
Soc Sci Med. 1997 Aug;45(3):383-97
Date
Aug-1997
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Cause of Death
Child
Child, Preschool
Feasibility Studies
Female
Health Surveys
Humans
Infant
Male
Manitoba - epidemiology
Medical Record Linkage
Middle Aged
Morbidity
Mortality
National Health Programs - utilization
Pilot Projects
Socioeconomic Factors
Abstract
While important age-related trends in the use of health care services over the past two decades in Canada have been well described, a comprehensive description of socioeconomic gradients in morbidity and mortality across age cohorts for a representative population has not been accomplished to date in Canada. The objective of this study was to describe age-specific socioeconomic differentials in mortality and morbidity for a representative sample of a single Canadian province. The study sample was formed from the linkage of individual respondent records in the 1986 census to vital statistics records and comprehensive records of health care utilization for a 5% sample of residents of the province of Manitoba. Using two measures of socioeconomic status derived from census responses, attained education and household income, individuals were stratified into age-specific quartile ranks. Based on diagnostic information contained on health care utilization records, the proportion of the sample in treatment during a 12-month observation period was calculated for 15 broadly defined categories of morbidity and tested for differences across socioeconomic quartiles. Mortality was inversely associated with both income and education quartile rank. In the analysis of morbidity, no association between socioeconomic status and treatment prevalence was observed in the majority, no association between socioeconomic status and treatment prevalence was observed in the majority of the 122 age- and disorder-specific strata tested. Of the observed associations, however, negative relationships were dominant, indicating a higher treatment prevalence among individuals of lower attained education or lower household income. Across the age course, negative relationships were most frequently present among young and middle aged adults, those aged 30-64, and were more consistently found for income than for education. The general findings of this study of a representative Canadian population support observations from other developed country settings that socioeconomic differences in relative rates of mortality and morbidity over the life course are greatest in the adult years.
PubMed ID
9232733 View in PubMed
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Aging and the demand for health services: which aged and whose demand?

https://arctichealth.org/en/permalink/ahliterature240867
Source
Gerontologist. 1984 Feb;24(1):31-6
Publication Type
Article
Date
Feb-1984

Alternative designs to study outcomes: the tonsillectomy case.

https://arctichealth.org/en/permalink/ahliterature246697
Source
Med Care. 1979 Nov;17(11):1069-87
Publication Type
Article
Date
Nov-1979
Author
L L Roos
Source
Med Care. 1979 Nov;17(11):1069-87
Date
Nov-1979
Language
English
Publication Type
Article
Keywords
Adenoidectomy - utilization
Attitude of Health Personnel
Computers
Data Collection
Humans
Manitoba
Outcome and Process Assessment (Health Care)
Patients
Research Design
Statistics as Topic
Tonsillectomy - utilization
Abstract
This article explores the impact of the tonsillectomy operation using a large data base and several different approaches. The likely range of effects of the surgery and various threats to validity are studied from a quasi-experimental perspective. Information on possible patient self-selection for tonsil surgery is provided. Selection is dealt with from another viewpoint by comparing the outcomes of patients under the care of physicians having a "high propensity to operate" with those going to physicians who tend to operate less. Finally, a computer simulation studies the extent to which the measured results of tonsil surgery might be explained by particular selection mechanisms working in conjunction with random processes of episode generation. The "savings" in respiratory episodes estimated by the various approaches ranges from 0.1 episodes to approximately 0.8 episode for the year following surgery.
PubMed ID
502614 View in PubMed
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Assessing data quality: a computerized approach.

https://arctichealth.org/en/permalink/ahliterature231412
Source
Soc Sci Med. 1989;28(2):175-82
Publication Type
Article
Date
1989
Author
L L Roos
S M Sharp
A. Wajda
Author Affiliation
Faculty of Management, University of Manitoba, Winnipeg, Canada.
Source
Soc Sci Med. 1989;28(2):175-82
Date
1989
Language
English
Publication Type
Article
Keywords
Data Collection - standards
Database Management Systems
Hospital records
Humans
Manitoba
Medical Records
Software
Abstract
With the growing reliance on large health care data bases, the need to verify data quality increases as well. Because of the considerable costs involved in checks using primary data collection, a computerized methodology for performing such checks is suggested. The technique seems appropriate for any situation where two data collection systems (i.e. hospital discharge abstracts and physician claims for payment) relate to the same event, such as a patient's hospitalization. After reviewing other approaches, this paper suggests linking physician claims for performing particular surgical procedures with hospital discharge abstracts for the stay in which the surgery took place. Physician and hospital data for adults age 25 and over in Manitoba from 1 April, 1979 to 31 March, 1984 were used to address the questions: 1. How well can the two data sets be linked? 2. Given linkage of the two data sets, how much agreement is there as to procedure and diagnosis? Linkage between hospital and physician data was excellent (over 95%) for 5 out of 11 surgical procedures (hysterectomy, prostatectomy, total hip replacement, coronary artery bypass surgery, and heart valve replacement); there was over 90% perfect agreement for three other procedures (cholecystectomy, cataract surgery and total knee replacement). Problems with matching the Manitoba Health Services Commission tariffs (on physician claims) with ICD-9-CM operation codes (on hospital data) led to only 77% perfect agreement for vascular surgery and 84% for gallbladder and biliary tract operations other than cholecystectomy; over 10% of the cases linked on surgeon and date but not on the designated procedures.(ABSTRACT TRUNCATED AT 250 WORDS)
PubMed ID
2928827 View in PubMed
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Assessing existing technologies: the Manitoba study of common surgical procedures.

https://arctichealth.org/en/permalink/ahliterature242047
Source
Med Care. 1983 Apr;21(4):454-62
Publication Type
Article
Date
Apr-1983
Author
L L Roos
N P Roos
Source
Med Care. 1983 Apr;21(4):454-62
Date
Apr-1983
Language
English
Publication Type
Article
Keywords
Epidemiologic Methods
Female
Humans
Longitudinal Studies
Male
Manitoba
Outcome and Process Assessment (Health Care)
Patient Readmission
Reoperation
Risk
Surgical Procedures, Operative - trends
Abstract
An overview of the Manitoba study of common surgical procedures is presented. The research is oriented toward describing and explaining the outcomes of nine relatively common procedures, using longitudinal data from the Manitoba Health Services Commission's population registry, medical claims, and physician claims. The research approach recognizes differences among surgical procedures, tailoring the analyses to specific characteristics of a given procedure. At the same time, this article describes the efforts made to achieve economies of scale in organizing the data base and writing the computer programs. The strategy used for assessing surgical risks and benefits is described at some length. Health services utilization before and after surgery is compared across small areas with widely differing surgical rates. Comparisons between surgical and other groups are suggested. The wealth of data permits a number of different types of studies. One study deals with patterns of surgical practice, types of operations performed, and risk characteristics of patients brought to surgery in areas with differing surgical rates. High-risk patients residing in high-rate areas are more likely to be operated upon than their counterparts in low-rate areas. A second study found that hysterectomy is apparently being used in situations where women have high rates of contact with the health care system before surgery; their rates of contact after surgery are almost as high. Ongoing activities in the research project are outlined.
PubMed ID
6843198 View in PubMed
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Assessing the impact of tonsillectomies.

https://arctichealth.org/en/permalink/ahliterature248554
Source
Med Care. 1978 Jun;16(6):502-18
Publication Type
Article
Date
Jun-1978
Author
L L Roos
N P Roos
P D Henteleff
Source
Med Care. 1978 Jun;16(6):502-18
Date
Jun-1978
Language
English
Publication Type
Article
Keywords
Adenoidectomy - economics - utilization
Adolescent
Child
Cost-Benefit Analysis
Humans
Manitoba
Quality of Health Care
Respiratory Tract Diseases - epidemiology
Tonsillectomy - economics - utilization
Abstract
This paper explores outcomes associated with the tonsillectomy operation using multiple control groups and a large claims-based data bank from the Canadian province of Manitoba. Given the difficulty of conducting large-scale clinical trials of common surgical procedures, the use of multiple methods for evaluating such interventions is both advocated and implemented in this study. When the data are restricted to respiratory diagnoses, the findings suggest that, on the average, tonsil surgery saves between one half and one and a half episodes of illness per patient over the two years after surgery. Such savings are much more pronounced among individuals having several tonsillitis episodes in the preoperative year. However, when all medical claims are considered, the estimated savings from the tonsillectomy operation are somewhat reduced. Individual variation in predisposition to "see the doctor" appears to account for such results; visits about conditions other than respiratory take up much of the "savings" produced by tonsil surgery. The findings are discussed in terms of the costs and benefits of the tonsillectomy operation, and future research needs are outlined.
PubMed ID
418278 View in PubMed
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Auditing the process of care in a new geriatric unit.

https://arctichealth.org/en/permalink/ahliterature247470
Source
J Am Geriatr Soc. 1979 Mar;27(3):107-11
Publication Type
Article
Date
Mar-1979
Author
J. Chekryn
L L Roos
Source
J Am Geriatr Soc. 1979 Mar;27(3):107-11
Date
Mar-1979
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Geriatrics
Hospital Units - standards
Humans
Long-Term Care - standards
Manitoba
Medical Records, Problem-Oriented
Outcome and Process Assessment (Health Care)
Patient care team
Patient Discharge
Rehabilitation
Abstract
To assess whether the objectives of a new Extended Care Unit were reflected in the care of the patients and in the outcome of that care, an audit of the patients' records was performed. The audit sample involved 101 geriatric patients who had been admitted to the Unit for rehabilitation therapy, and then discharged. The study included assessment of the records for compliance with individual audit criteria, examination of the records in terms of a composite audit score, and analysis of the relationship between these scores and three outcome indices. Although the audit did not show a significant correlation between recorded care processes and treatment outcomes, it did reveal the extent to which the Unit's goals were reflected in the care process.
PubMed ID
107211 View in PubMed
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Becoming more efficient at outcomes research.

https://arctichealth.org/en/permalink/ahliterature234342
Source
Int J Technol Assess Health Care. 1988;4(4):555-71
Publication Type
Article
Date
1988
Author
L L Roos
S M Sharp
Source
Int J Technol Assess Health Care. 1988;4(4):555-71
Date
1988
Language
English
Publication Type
Article
Keywords
Cholecystectomy - adverse effects - standards
Humans
Manitoba
Models, Theoretical
Outcome and Process Assessment (Health Care) - methods
Patient Readmission
Regression Analysis
Research Design
Technology Assessment, Biomedical - methods
Abstract
This paper discusses several practical problems in research design: Is it worth doing a relatively "quick and dirty" study or is a more thorough study using all available information necessary? All the desired information may either not be available or be time-consuming to collect. What are the likely biases in going ahead and doing the research with the data base "in hand"? Such issues are important because of the limited resources for technology assessment (in terms of money, number of researchers, and research interest) and the great number of unstudied technologies.
PubMed ID
10291099 View in PubMed
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Building individual histories with registries. A case study.

https://arctichealth.org/en/permalink/ahliterature241538
Source
Med Care. 1983 Oct;21(10):955-69
Publication Type
Article
Date
Oct-1983
Author
L L Roos
J P Nicol
Source
Med Care. 1983 Oct;21(10):955-69
Date
Oct-1983
Language
English
Publication Type
Article
Keywords
Data Collection
Death Certificates
Forms and Records Control - methods
Humans
Insurance Claim Reporting
Manitoba
Medical Record Linkage
Quality Control
Registries
Vital statistics
Abstract
This study concentrates on utilizing registries and assessing their quality for population-based research. A method of successive comparisons is used to develop and update a summary record of coverage (length of time on the registry) and mortality for each individual in the Manitoba Health Services Commission data base. Various ways to ascertain the accuracy of the summary records are discussed. These techniques are validated by efforts to follow over an 8-year period 4,794 individuals interviewed in 1971 as part of ongoing research on the Manitoba elderly. Ninety-seven percent of the total elderly sample (and 99% of those successfully matched with interviewees) were traced over 8 years. Deaths recorded on hospital claims but not on the master registry and possible unrecorded out-of-hospital deaths are outstanding problems with the Manitoba data base. Further checks against 1970-1977 vital statistics information in the Canadian Mortality Data Base will be made.
PubMed ID
6656326 View in PubMed
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