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Addressing wait times for endometrial cancer surgery in Ontario.

https://arctichealth.org/en/permalink/ahliterature159994
Source
J Obstet Gynaecol Can. 2007 Dec;29(12):982-7
Publication Type
Article
Date
Dec-2007
Author
Janice S Kwon
Mark S Carey
E Francis Cook
Feng Qiu
Lawrence F Paszat
Author Affiliation
Department of Gynecologic Oncology, MD Anderson Cancer Center, Houston TX, USA.
Source
J Obstet Gynaecol Can. 2007 Dec;29(12):982-7
Date
Dec-2007
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Catchment Area (Health)
Comorbidity
Delivery of Health Care, Integrated
Endometrial Neoplasms - surgery
Female
Health Services Accessibility - statistics & numerical data
Hospitals, Teaching - utilization
Humans
Middle Aged
Ontario
Retrospective Studies
Time Factors
Waiting Lists
Abstract
Wait times for cancer surgery in Ontario have increased over the last decade. We reviewed trends in wait times for endometrial cancer surgery from 1996 to 2000 and identified determinants that may need to be addressed in order to reduce these wait times.
The study population included women diagnosed with endometrial cancer (ICD-9 codes 179 or 182) prior to surgery. Surgical wait time was defined as the interval between date of diagnosis and hospital admission for surgery. Univariate analyses assessed demographic, treatment, and hospital factors associated with wait times. A multilevel linear regression model was created to account for clustering of patients at the hospital level and regional level defined by local health integration networks (LHINs). Effects of covariates were expressed as estimates of the median proportional change in wait time.
There were 2042 cases in this analysis. Mean wait time increased from 32 to 40 days (P = 0.0012). Prolonged wait times were associated with age > 70 years, presence of comorbidities, and surgery performed at a teaching hospital and by a gynaecologic oncologist. Wait times were not associated with income level or region of residence defined by LHIN.
Wait times for endometrial cancer surgery have increased significantly in Ontario. Determinants of these prolonged wait times need to be addressed, and criteria for referral to a teaching hospital and gynaecologic oncologist should be developed to ensure that local health integration networks provide equal and timely access to care.
PubMed ID
18053383 View in PubMed
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Analysis of administrative data finds endoscopist quality measures associated with postcolonoscopy colorectal cancer.

https://arctichealth.org/en/permalink/ahliterature140652
Source
Gastroenterology. 2011 Jan;140(1):65-72
Publication Type
Article
Date
Jan-2011
Author
Nancy N Baxter
Rinku Sutradhar
Shawn S Forbes
Lawrence F Paszat
Refik Saskin
Linda Rabeneck
Author Affiliation
Department of Surgery and Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. baxtern@smh.toronto.on.ca
Source
Gastroenterology. 2011 Jan;140(1):65-72
Date
Jan-2011
Language
English
Publication Type
Article
Keywords
Adenoma - diagnosis
Adult
Aged
Aged, 80 and over
Clinical Competence
Colonoscopy - education
Colorectal Neoplasms - diagnosis
Early Detection of Cancer - standards
Female
Humans
Male
Middle Aged
Ontario
Quality Control
Young Adult
Abstract
Most quality indicators for colonoscopy measure processes; little is known about their relationship to patient outcomes. We investigated whether characteristics of endoscopists, determined from administrative data, are associated with development of postcolonoscopy colorectal cancer (PCCRC).
We identified individuals diagnosed with colorectal cancer in Ontario from 2000 to 2005 using the Ontario Cancer Registry. We determined performance of colonoscopy using Ontario Health Insurance Plan data. Patients who had complete colonoscopies 7 to 36 months before diagnosis were defined as having a PCCRC. Patients who had complete colonoscopies within 6 months of diagnosis had detected cancers. We determined if endoscopist factors (volume, polypectomy and completion rate, specialization, and setting) were associated with PCCRC using logistic regression, controlling for potential covariates.
In the study, 14,064 patients had a colonoscopy examination within 36 months of diagnosis; 584 (6.8%) with distal and 676 (12.4%) with proximal tumors had PCCRC. The endoscopist's specialty (nongastroenterologist/nongeneral surgeon) and setting (non-hospital-based colonoscopy) were associated with PCCRC. Those who underwent colonoscopy by an endoscopist with a high completion rate were less likely to have a PCCRC (distal: odds ratio [OR], 0.73; 95% confidence interval [CI], 0.54-0.97; P = .03; proximal: OR, 0.72; 95% CI, 0.53-0.97; P = .002). Patients with proximal cancers undergoing colonoscopy by endoscopists who performed polypectomies at high rates had a lower risk of PCCRC (OR, 0.61; 95% CI, 0.42-0.89; P
Notes
Comment In: Gastroenterology. 2011 Jan;140(1):19-2121110966
PubMed ID
20854818 View in PubMed
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Are there regional differences in gynecologic cancer outcomes in the context of a single-payer, publicly-funded health care system? A population-based study.

https://arctichealth.org/en/permalink/ahliterature156237
Source
Can J Public Health. 2008 May-Jun;99(3):221-6
Publication Type
Article
Author
Janice S Kwon
Mark S Carey
E Francis Cook
Feng Qiu
Lawrence F Paszat
Author Affiliation
Division of Gynecologic Oncology, University of British Columbia and BC Cancer Agency, Vancouver, BC. janice.kwon@vch.ca
Source
Can J Public Health. 2008 May-Jun;99(3):221-6
Language
English
Publication Type
Article
Keywords
Delivery of Health Care
Female
Humans
Ontario
Outcome Assessment (Health Care)
Public Health
Reimbursement Mechanisms
Uterine Neoplasms - classification - radiotherapy - surgery
Abstract
Canada has a single-payer, publicly-funded health care system that provides comprehensive health care, and therefore significant disparities in health outcomes are not expected in our population. The objective of this study was to determine if differences exist in endometrial cancer outcomes across regions in Ontario.
This was a population-based study of all endometrial (uterine) cancer cases diagnosed from 1996 to 2000 in Ontario and linked to various administrative databases. Univariate analyses examined trends in demographics (age, income, co-morbidities), treatment (surgical staging and adjuvant pelvic radiotherapy), and pathology (grade, histology, stage) across 14 geographic regions defined by local health integration networks (LHINs) in Ontario. Primary outcome was 5-year overall survival among LHINs, which were compared in a multilevel Cox regression model to account for clustering of patient data at the hospital level.
There were 3,875 evaluable cases with complete information on demographics, treatment, pathology, and outcomes. There was significant variation in patient demographics, treatment, and pathology across the 14 LHINs. Low income level and surgery at a low-volume, community hospital without gynecologic oncologists were not associated with a higher risk of death. There was a trend towards clustering of patients within hospitals. After adjustment for covariates, there was no significant difference in survival across LHINs.
In the context of a single-payer, publicly-funded health care system, we did not find significant regional differences in endometrial cancer outcomes.
PubMed ID
18615946 View in PubMed
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Association between colonoscopy rates and colorectal cancer mortality.

https://arctichealth.org/en/permalink/ahliterature145114
Source
Am J Gastroenterol. 2010 Jul;105(7):1627-32
Publication Type
Article
Date
Jul-2010
Author
Linda Rabeneck
Lawrence F Paszat
Refik Saskin
Therese A Stukel
Author Affiliation
Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Linda.Rabeneck@sunnybrook.ca
Source
Am J Gastroenterol. 2010 Jul;105(7):1627-32
Date
Jul-2010
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cohort Studies
Colonoscopy - statistics & numerical data
Colorectal Neoplasms - mortality
Female
Humans
Incidence
Male
Middle Aged
Ontario - epidemiology
Proportional Hazards Models
Risk factors
Abstract
Although colonoscopy use has increased in the United States and Canada since the early 1990s, it is unclear whether this has been associated with benefit at the population level. Our objective was to evaluate the association between regional colonoscopy rates and death from colorectal cancer (CRC).
We conducted a natural experiment involving a 14-year follow-up of a cohort of all men and women 50-90 years of age living in Ontario on 1 January 1993 exposed to different intensities of colonoscopy use. Each member of the study cohort was assigned to a region each year, on the basis of his/her residence. Each individual was followed up through 31 December 2006; age- and sex-standardized CRC incidence rates were calculated and all CRC deaths were identified. Each year, for each region, the rate of colonoscopies performed on persons 50-90 years of age, per 1,000 population 50-90 years of age, living in the region, was calculated. Multivariable cox proportional hazards models were used to evaluate the association between colonoscopy rate and death from CRC, adjusting for age, sex, comorbidity, income, and location of residence (urban/rural).
The study cohort comprised 2,412,077 persons 50-90 years of age. The mean age was 64 years, and 53.7% were women. Colonoscopy rates increased in all regions during 1993-2006. The increased rate of complete colonoscopy was inversely associated with death from CRC. For every 1% increase in complete colonoscopy rate, the hazard of death decreased by 3%.
Increased colonoscopy use was associated with mortality reduction from CRC at the population level.
Notes
Comment In: Am J Gastroenterol. 2010 Jul;105(7):1633-520606662
PubMed ID
20197758 View in PubMed
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Association of colonoscopy and death from colorectal cancer.

https://arctichealth.org/en/permalink/ahliterature153711
Source
Ann Intern Med. 2009 Jan 6;150(1):1-8
Publication Type
Article
Date
Jan-6-2009
Author
Nancy N Baxter
Meredith A Goldwasser
Lawrence F Paszat
Refik Saskin
David R Urbach
Linda Rabeneck
Author Affiliation
Li Ka Shing Knowledge Institute, St Michael's Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. baxtern@smh.toronto.on.ca
Source
Ann Intern Med. 2009 Jan 6;150(1):1-8
Date
Jan-6-2009
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Case-Control Studies
Colon - pathology
Colonoscopy
Colorectal Neoplasms - diagnosis - mortality - prevention & control
Comorbidity
Early Detection of Cancer
Female
Humans
Male
Middle Aged
Odds Ratio
Ontario - epidemiology
Regression Analysis
Abstract
Colonoscopy is advocated for screening and prevention of colorectal cancer (CRC), but randomized trials supporting the benefit of this practice are not available.
To evaluate the association between colonoscopy and CRC deaths.
Population-based, case-control study.
Ontario, Canada.
Persons age 52 to 90 years who received a CRC diagnosis from January 1996 to December 2001 and died of CRC by December 2003. Five controls matched by age, sex, geographic location, and socioeconomic status were randomly selected for each case patient.
Administrative claims data were used to detect exposure to any colonoscopy and complete colonoscopy (to the cecum) from January 1992 to an index date 6 months before diagnosis in each case patient and the same assigned date in matched controls. Exposures in case patients and controls were compared by using conditional logistic regression to control for comorbid conditions. Secondary analyses were done to see whether associations differed by site of primary CRC, age, or sex.
10 292 case patients and 51 460 controls were identified; 719 case patients (7.0%) and 5031 controls (9.8%) had undergone colonoscopy. Compared with controls, case patients were less likely to have undergone any attempted colonoscopy (adjusted conditional odds ratio [OR], 0.69 [95% CI, 0.63 to 0.74; P
Notes
Comment In: Endoscopy. 2010 Jan;42(1):49-5219856248
Comment In: Can J Surg. 2010 Jun;53(3):202-420507794
Comment In: Gastroenterology. 2009 May;136(5):1827-819318100
Comment In: Ann Intern Med. 2009 Jun 2;150(11):816; author reply 819-2019487719
Comment In: Ann Intern Med. 2009 Jun 2;150(11):817-8; author reply 819-2019487720
Comment In: Ann Intern Med. 2009 Jun 2;150(11):817; author reply 819-2019487721
Comment In: Ann Intern Med. 2009 Jun 2;150(11):818; author reply 819-2019487723
Comment In: Ann Intern Med. 2009 Jun 2;150(11):816-7; author reply 819-2019487718
Comment In: Ann Intern Med. 2009 Jun 2;150(11):818-9; author reply 819-2019487722
Comment In: Ann Intern Med. 2009 Jun 2;150(11):819; author reply 819-2019487724
Comment In: Ann Intern Med. 2009 Jan 6;150(1):50-219075200
SummaryForPatientsIn: Ann Intern Med. 2009 Jan 6;150(1):I2819075199
PubMed ID
19075198 View in PubMed
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Association of socioeconomic status and receipt of colorectal cancer investigations: a population-based retrospective cohort study.

https://arctichealth.org/en/permalink/ahliterature178605
Source
CMAJ. 2004 Aug 31;171(5):461-5
Publication Type
Article
Date
Aug-31-2004
Author
Sheldon M Singh
Lawrence F Paszat
Cindy Li
Jingsong He
Chris Vinden
Linda Rabeneck
Author Affiliation
Department of Medicine, University of Toronto, Toronto, Ont.
Source
CMAJ. 2004 Aug 31;171(5):461-5
Date
Aug-31-2004
Language
English
Publication Type
Article
Keywords
Aged
Analysis of Variance
Chi-Square Distribution
Colonoscopy - utilization
Colorectal Neoplasms - diagnosis - epidemiology
Female
Health Services Accessibility - economics
Humans
Logistic Models
Male
Middle Aged
Ontario - epidemiology
Population Surveillance
Registries
Retrospective Studies
Social Class
Abstract
Although the Canadian health care system was designed to ensure equal access, inequities persist. It is not known if inequities exist for receipt of investigations used to screen for colorectal cancer (CRC). We examined the association between socioeconomic status and receipt of colorectal investigation in Ontario.
People aged 50 to 70 years living in Ontario on Jan. 1, 1997, who did not have a history of CRC, inflammatory bowel disease or colorectal investigation within the previous 5 years were followed until death or Dec. 31, 2001. Receipt of any colorectal investigation between 1997 and 2001 inclusive was determined by means of linked administrative databases. Income was imputed as the mean household income of the person's census enumeration area. Multivariate analysis was performed to evaluate the relationship between the receipt of any colorectal investigation and income.
Of the study cohort of 1,664,188 people, 21.2% received a colorectal investigation in 1997-2001. Multivariate analysis demonstrated a significant association between receipt of any colorectal investigation and income (p
Notes
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PubMed ID
15337726 View in PubMed
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Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice.

https://arctichealth.org/en/permalink/ahliterature154626
Source
Gastroenterology. 2008 Dec;135(6):1899-1906, 1906.e1
Publication Type
Article
Date
Dec-2008
Author
Linda Rabeneck
Lawrence F Paszat
Robert J Hilsden
Refik Saskin
Des Leddin
Eva Grunfeld
Elaine Wai
Meredith Goldwasser
Rinku Sutradhar
Therese A Stukel
Author Affiliation
Department of Medicine, University of Toronto, Toronto, Ontario, Canada. linda.rabeneck@sunnybrook.ca
Source
Gastroenterology. 2008 Dec;135(6):1899-1906, 1906.e1
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Aged
Alberta - epidemiology
British Columbia - epidemiology
Colonic Diseases - diagnosis - surgery
Colonoscopy - adverse effects
Female
Follow-Up Studies
Gastrointestinal Hemorrhage - epidemiology - etiology
Humans
Incidence
Intestinal Perforation - epidemiology - etiology
Male
Middle Aged
Nova Scotia - epidemiology
Ontario - epidemiology
Outpatients - statistics & numerical data
Population Surveillance
Prognosis
Retrospective Studies
Risk factors
Survival Rate - trends
Abstract
The most widely quoted complication rates for colonoscopy are from case series performed by expert endoscopists. Our objectives were to evaluate the rates of bleeding, perforation, and death associated with outpatient colonoscopy and their risk factors in a population-based study.
We identified all individuals 50 to 75 years old who underwent an outpatient colonoscopy during April 1, 2002, to March 31, 2003, in British Columbia, Alberta, Ontario, and Nova Scotia, Canada. Using administrative data, we identified all individuals who were admitted to hospital with bleeding or perforation within 30 days following the colonoscopy in each province. We calculated the pooled rates of bleeding and perforation from the 4 provinces. In Ontario, we abstracted the hospital charts of all deaths that occurred within 30 days following the procedure. We used generalized estimating equations models to evaluate factors associated with bleeding and perforation.
We identified 97,091 persons who had an outpatient colonoscopy. The pooled rates of colonoscopy-related bleeding and perforation were 1.64/1000 and 0.85/1000, respectively. The death rate was 0.074/1000 or approximately 1/14,000. Older age, male sex, having a polypectomy, and having the colonoscopy performed by a low-volume endoscopist were associated with increased odds of bleeding or perforation.
Although colonoscopy has established benefits for the detection of colorectal cancer and adenomatous polyps, the procedure is associated with risks of serious complications, including death. Older age, male sex, having a polypectomy, and having the procedure done by a low-volume endoscopist were independently associated with colonoscopy-related bleeding and perforation.
Notes
Comment In: Gastroenterology. 2008 Dec;135(6):1845-719000685
PubMed ID
18938166 View in PubMed
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ColonCancerCheck Primary Care Invitation Pilot project: family physician perceptions.

https://arctichealth.org/en/permalink/ahliterature119869
Source
Can Fam Physician. 2012 Oct;58(10):e570-7
Publication Type
Article
Date
Oct-2012
Author
Jill Tinmouth
Paul Ritvo
S Elizabeth McGregor
Criss Guglietti
Josh Green
Danielle Claus
Cheryl Levitt
Lawrence F Paszat
Linda Rabeneck
Author Affiliation
Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Room HG40, Toronto, ON M4N 3M5. jill.tinmouth@sunnybrook.ca
Source
Can Fam Physician. 2012 Oct;58(10):e570-7
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Colonoscopy - utilization
Colorectal Neoplasms - diagnosis - prevention & control
Early Detection of Cancer
Female
Focus Groups
Humans
Male
Occult Blood
Ontario
Physicians, Family
Pilot Projects
Primary Health Care - methods
Questionnaires
Abstract
To determine family physician perspectives regarding the acceptability and effectiveness of 2 interventions-a targeted, mailed invitation for screening to patients, and family physician audit-feedback reports-and on the colorectal cancer (CRC) screening program generally. This information will be used to guide program strategies for increasing screening uptake.
Qualitative study.
Ontario.
Family physicians (n = 65).
Seven 1-hour focus groups were conducted with family physicians using teleconferencing and Web-based technologies. Responses were elicited regarding family physicians' perspectives on the mailing of invitations to patients, the content and design of the audit-feedback reports, the effect of participation in the pilot project on daily practice, and overall CRC screening program function.
Key themes included strong support for both interventions and for the CRC screening program generally. Moderate support was found for direct mailing of fecal occult blood testing (FOBT) kits. Participants identified potential pitfalls if interventions were implemented outside of patient enrolment model practices. Participants expressed relatively strong support for colonoscopy as a CRC screening test but relatively weak support for FOBT.
Although the proposed interventions to increase the uptake of CRC screening were highly endorsed, concerns about their applicability to non-patient enrolment model practices and the current lack of physician support for FOBT will need to be addressed to optimize intervention and program effectiveness. Our study is highly relevant to other public health programs planning organized CRC screening programs.
Notes
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PubMed ID
23064936 View in PubMed
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ColonCancerCheck primary care invitation pilot project: patient perceptions.

https://arctichealth.org/en/permalink/ahliterature256909
Source
Can Fam Physician. 2013 Dec;59(12):e541-9
Publication Type
Article
Date
Dec-2013
Author
Jill Tinmouth
Paul Ritvo
S Elizabeth McGregor
Jigisha Patel
Crissa Guglietti
Cheryl A Levitt
Lawrence F Paszat
Linda Rabeneck
Author Affiliation
Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Room HG40, Toronto, ON M4N 3M5. jill.tinmouth@sunnybrook.ca.
Source
Can Fam Physician. 2013 Dec;59(12):e541-9
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Aged
Colonic Neoplasms - diagnosis
Correspondence as Topic
Early Detection of Cancer
Family Practice
Female
Focus Groups
Health Knowledge, Attitudes, Practice
Humans
Male
Middle Aged
Occult Blood
Ontario
Patient Acceptance of Health Care
Perception
Physician's Role
Pilot Projects
Primary Health Care
Qualitative Research
Abstract
To describe the perceptions of those who received invitations to the ColonCancerCheck Primary Care Invitation Pilot (the Pilot) about the mailed invitation, colorectal cancer (CRC) screening in general, and their specific screening experiences.
Qualitative study with 6 focus group sessions, each 1.5 hours in length.
Hamilton, Ont; Ottawa, Ont; and Thunder Bay, Ont.
Screening-eligible adults, aged 50 years and older, who received a Pilot invitation for CRC screening.
The focus groups were conducted by a trained moderator and were audiorecorded and transcribed verbatim. The transcripts were analyzed using grounded-theory techniques facilitated by the use of electronic software.
Key themes related to the invitation letter, the role of the family physician, direct mailing of the fecal occult blood testing (FOBT) kit, and alternate CRC screening promotion strategies were identified. Specifically, participants suggested the letter content should use stronger, more powerful language to capture the reader's attention. The importance of the family physician was endorsed, although participants favoured clarification of the physician and program roles in the actual mailed invitation. Participants expressed support for directly mailing FOBT kits to individuals, particularly those with successful previous test completion, and for communication of both negative and positive screening results.
This study yielded a number of important findings including strategies to optimize letter content, support for directly mailed FOBT kits, and strategies to report results that might be highly relevant to other health programs where population-based CRC screening is being considered.
Notes
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PubMed ID
24336559 View in PubMed
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Colorectal cancer screening in Canada: why not consider nurse endoscopists?

https://arctichealth.org/en/permalink/ahliterature184183
Source
CMAJ. 2003 Aug 5;169(3):206-7
Publication Type
Article
Date
Aug-5-2003
Author
Linda Rabeneck
Lawrence F Paszat
Author Affiliation
Institute for Clinical Evaluative Sciences, and the Department of Medicine, University of Toronto, Toronto, Ont.
Source
CMAJ. 2003 Aug 5;169(3):206-7
Date
Aug-5-2003
Language
English
Publication Type
Article
Keywords
Canada
Colorectal Neoplasms - prevention & control
Humans
Mass Screening - nursing
Nurses
Occult Blood
Sigmoidoscopy - nursing
Notes
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PubMed ID
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