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Cardiologists' charting varied by risk factor, and was often discordant with patient report.

https://arctichealth.org/en/permalink/ahliterature157753
Source
J Clin Epidemiol. 2008 Oct;61(10):1073-9
Publication Type
Article
Date
Oct-2008
Author
Shannon Gravely-Witte
Donna E Stewart
Neville Suskin
Lyall Higginson
David A Alter
Sherry L Grace
Author Affiliation
University Health Network Women's Health Program, 200 Elizabeth St., Toronto, Ontario, Canada. sgravely@yorku.ca
Source
J Clin Epidemiol. 2008 Oct;61(10):1073-9
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Aged
Cardiovascular Diseases - epidemiology - etiology
Clinical Competence
Diabetes Mellitus - epidemiology
Dyslipidemias - complications - epidemiology
Epidemiologic Methods
Female
Humans
Hypertension - complications - epidemiology
Male
Medical Records - standards
Middle Aged
Ontario - epidemiology
Outpatient Clinics, Hospital
Self Disclosure
Smoking - adverse effects - epidemiology
Socioeconomic Factors
Abstract
To assess the completeness of cardiac risk factor documentation by cardiologists, and agreement with patient report.
A total of 68 Ontario cardiologists and 789 of their ambulatory cardiology patients were randomly selected. Cardiac risk factor data were systematically extracted from medical charts, and a survey was mailed to participants to assess risk factor concordance.
With regard to completeness of risk factor documentation, 90.4% of charts contained a report of hypertension, 87.2% of diabetes, 80.5% of dyslipidemia, 78.6% of smoking behavior, 73.0% of other comorbidities, 48.7% of family history of heart disease, and 45.9% of body mass index or obesity. Using Cohen's k, there was a concordance of 87.7% between physician charts and patient self-report of diabetes, 69.5% for obesity, 56.8% for smoking status, 49% for hypertension, and 48.4% for family history.
Two of four major cardiac risk factors (hypertension and diabetes) were recorded in 90% of patient records; however, arguably the most important reversible risk factors for cardiac disease (dyslipidemia and smoking) were only reported 80% of the time. The results suggest that physician chart report may not be the criterion standard for quality assessment in cardiac risk factor reporting.
Notes
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PubMed ID
18411042 View in PubMed
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CCORT/CCS quality indicators for acute myocardial infarction care.

https://arctichealth.org/en/permalink/ahliterature186778
Source
Can J Cardiol. 2003 Jan;19(1):38-45
Publication Type
Article
Date
Jan-2003
Author
Chau T T Tran
Douglas S Lee
Virginia F Flintoft
Lyall Higginson
F Curry Grant
Jack V Tu
Jafna Cox
Doug Holder
Cynthia Jackevicius
Louise Pilote
Paul Tanser
Christopher Thompson
Edward Tsoi
Wayne Warnica
Andreas Wielgosz
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Ontario.
Source
Can J Cardiol. 2003 Jan;19(1):38-45
Date
Jan-2003
Language
English
Publication Type
Article
Keywords
Ambulatory Care
Benchmarking
Canada
Cardiovascular Agents - standards - therapeutic use
Guideline Adherence
Humans
International Classification of Diseases
Length of Stay
Myocardial Infarction - diagnosis - therapy
Outcome and Process Assessment (Health Care)
Quality Indicators, Health Care - standards
Abstract
Although quality indicators for the care of acute myocardial infarction (AMI) patients have been described for other countries, there are none specifically designed for the Canadian health care system. The authors' goal was to develop a set of Canadian quality indicators for AMI care.
A literature review identified existing quality indicators for AMI care. A list of potential indicators was assessed by a nine-member panel of clinicians from a variety of disciplines using a modified-Delphi panel process. After an initial round of rating the potential indicators, a series of indicators was identified for a second round of discussion at a national meeting. Further refinement of indicators occurred following a teleconference and review by external reviewers.
To identify an AMI cohort, case definition criteria were developed, using a hospital discharge diagnosis for AMI of International Classification of Diseases-Ninth revision (ICD-9) code 410.x. Thirty-seven indicators for AMI care were established. Pharmacological process of care indicators included administration of acetylsalicylic acid, beta-blockers, angiotensin-converting enzyme inhibitors, thrombolytics and statins. Mortality and readmissions for AMI, unstable angina and congestive heart failure were recommended as outcome indicators. Nonpharmacological indicators included median length of stay in the emergency department, and median waiting times for cardiac catheterization, percutaneous coronary intervention and/or coronary artery bypass graft surgery.
A set of Canadian quality indicators for the care of AMI patients has been established. It is anticipated that these indicators will be useful to clinicians and researchers who want to measure and improve the quality of AMI patient care in Canada.
PubMed ID
12571693 View in PubMed
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Contribution of patient and physician factors to cardiac rehabilitation enrollment: a prospective multilevel study.

https://arctichealth.org/en/permalink/ahliterature154911
Source
Eur J Cardiovasc Prev Rehabil. 2008 Oct;15(5):548-56
Publication Type
Article
Date
Oct-2008
Author
Sherry L Grace
Shannon Gravely-Witte
Janette Brual
George Monette
Neville Suskin
Lyall Higginson
David A Alter
Donna E Stewart
Author Affiliation
York University, 4700 Keele St, Toronto, Ontario M3J 1P3, Canada. sgrace@yorku.ca
Source
Eur J Cardiovasc Prev Rehabil. 2008 Oct;15(5):548-56
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Adult
Aged
Attitude of Health Personnel
Coronary Artery Disease - rehabilitation
Female
Health Knowledge, Attitudes, Practice
Health Services Accessibility
Humans
Male
Marital status
Middle Aged
Ontario
Outpatients - psychology
Patient Education as Topic
Patient Participation
Patient Selection
Perception
Physician's Role
Physician-Patient Relations
Prospective Studies
Questionnaires
Referral and Consultation
Abstract
Cardiac rehabilitation (CR) is an established means of reducing mortality, yet is grossly underutilized. This is due to both health system and patient-level factors; issues that have yet to be investigated concurrently. This study utilized a hierarchical design to examine physician and patient-level factors affecting verified CR enrollment.
A prospective multisite study, using a multilevel design of 1490 coronary artery disease outpatients nested within 97 Ontario cardiology practices (mean 15 per cardiologist).
Cardiologists completed a survey regarding CR attitudes. Outpatients were surveyed prospectively to assess factors affecting CR enrollment. Patients were mailed a follow-up survey 9 months later to self-report CR enrollment. This was verified with 40 CR sites.
Five hundred and fifty (43.4%) outpatients were referred, and 469 (37.0%) enrolled in CR. In mixed logistic regression analyses, factors affecting verified CR enrollment were greater strength of physician endorsement (P=0.005), shorter distance to CR (P=0.001), being married (P=0.01), and fewer perceived CR barriers (P=0.03).
Both physician and patient factors play a part in CR enrollment. Patient CR barriers should be addressed during referral discussions, and reasons why physicians fail to uniformly endorse CR exploration. Although distance to CR was related to patient enrollment patterns, greater access to home-based CR services should be provided.
Notes
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Cites: Cochrane Database Syst Rev. 2001;(1):CD00180011279730
PubMed ID
18830085 View in PubMed
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Contribution of patient and physician factors to cardiac rehabilitation referral: a prospective multilevel study.

https://arctichealth.org/en/permalink/ahliterature156787
Source
Nat Clin Pract Cardiovasc Med. 2008 Oct;5(10):653-62
Publication Type
Article
Date
Oct-2008
Author
Sherry L Grace
Shannon Gravely-Witte
Janette Brual
Neville Suskin
Lyall Higginson
David Alter
Donna E Stewart
Author Affiliation
York University, Toronto, ON, Canada. sgrace@yorku.ca
Source
Nat Clin Pract Cardiovasc Med. 2008 Oct;5(10):653-62
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Aged
Ambulatory Care - statistics & numerical data
Attitude of Health Personnel
Comprehension
Coronary Artery Disease - rehabilitation
Female
Health Knowledge, Attitudes, Practice
Health Services Accessibility
Health Services Research
Humans
Male
Middle Aged
Ontario
Outpatients - psychology - statistics & numerical data
Patient Education as Topic
Perception
Physician-Patient Relations
Physicians - psychology - statistics & numerical data
Prospective Studies
Quality of Health Care
Questionnaires
Referral and Consultation - statistics & numerical data
Abstract
Cardiac rehabilitation (CR), in most developed countries, is a proven means of reducing mortality but it is grossly underutilized owing to factors involving both the health system and patients. These issues have not been investigated concurrently. To this end, we employed a hierarchical design to investigate physician and patient factors that affect verified CR referral.
This study was prospective with a multilevel design. We assessed 1,490 outpatients with coronary artery disease attending 97 cardiology practices. Cardiologists completed a survey about attitudes to CR referral. Outpatients were surveyed prospectively to assess sociodemographic, clinical, behavioral, psychosocial and health system factors that affected CR referral. Responses were analyzed by mixed logistic regression analyses. After 9 months, CR referral was verified at 40 centers.
Health-care providers referred 550 (43.4%) outpatients to CR. Factors affecting verified referral included positive physician perceptions of CR (P = 0.03), short distance to the closest CR site (P = 0.003), the perception of fewer barriers to CR (P
Notes
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Cites: Prog Cardiovasc Nurs. 2002 Winter;17(1):8-1711872976
Cites: Gen Hosp Psychiatry. 2002 May-Jun;24(3):127-3412062136
Cites: Clin Rehabil. 2002 Aug;16(5):541-5212194625
Cites: J Womens Health (Larchmt). 2002 Nov;11(9):773-9112632591
Cites: Med J Aust. 2003 Oct 6;179(7):332-314503890
Cites: J Cardiopulm Rehabil. 2003 Nov-Dec;23(6):398-40314646785
Cites: Rehabil Nurs. 2004 Jan-Feb;29(1):18-2314727472
Cites: Arch Intern Med. 2004 Jan 26;164(2):203-914744845
Cites: Am J Med. 2004 May 15;116(10):682-9215121495
Cites: Med Care. 2004 Jul;42(7):661-915213491
Cites: Can J Cardiol. 2004 Sep;20(11):1101-715457306
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Cites: Am J Cardiol. 1989 Sep 15;64(10):651-42782256
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Comment On: Nat Clin Pract Cardiovasc Med. 2008 Oct;5(10):671-218695694
PubMed ID
18542104 View in PubMed
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Degree and correlates of patient trust in their cardiologist.

https://arctichealth.org/en/permalink/ahliterature150338
Source
J Eval Clin Pract. 2009 Aug;15(4):634-40
Publication Type
Article
Date
Aug-2009
Author
Sheena Kayaniyil
Shannon Gravely-Witte
Donna E Stewart
Lyall Higginson
Neville Suskin
David Alter
Sherry L Grace
Author Affiliation
Department of Kinesiology and Health Science, York University, Toronto, Canada.
Source
J Eval Clin Pract. 2009 Aug;15(4):634-40
Date
Aug-2009
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cardiology
Coronary Artery Disease
Female
Health Care Surveys
Humans
Male
Middle Aged
Ontario
Physician-Patient Relations
Trust
Abstract
Trust in one's doctor has been associated with increased treatment adherence, patient satisfaction and improved health status. This study investigated the level and correlates of patient trust in their cardiac specialist.
All 386 urban cardiologists in Southern Ontario (95 participating, response rate = 30%) were approached to recruit a sample of their coronary artery disease outpatients. A total of 1111 recent and consecutive patients consented to participate (approximately 13 patients per cardiologist, 317 female (26.7%); response rate = 60%), and clinical data were extracted from their medical charts. Participants completed a mailed survey including the Trust in Physicians scale, in addition to an assessment of socio-demographic, clinical and psychosocial correlates.
The mean trust score was equivalent to that reported in studies of primary care patients. Results of the significant multivariate model (F = 7.631, P
Notes
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PubMed ID
19522723 View in PubMed
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Development of the Champlain primary care cardiovascular disease prevention and management guideline: tailoring evidence to community practice.

https://arctichealth.org/en/permalink/ahliterature133736
Source
Can Fam Physician. 2011 Jun;57(6):e202-7
Publication Type
Article
Date
Jun-2011
Author
Lorraine Montoya
Clare Liddy
William Hogg
Sophia Papadakis
Laurie Dojeiji
Grant Russell
Ayub Akbari
Andrew Pipe
Lyall Higginson
Author Affiliation
Heart Health Education Centre, University of Ottawa Heart Institute, Ontario.
Source
Can Fam Physician. 2011 Jun;57(6):e202-7
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Algorithms
Cardiovascular Diseases - prevention & control - therapy
Community Health Services
Evidence-Based Medicine
Humans
Information Dissemination
Ontario
Practice Guidelines as Topic
Primary Health Care
Program Development
Abstract
A well documented gap remains between evidence and practice for clinical practice guidelines in cardiovascular disease (CVD) care.
As part of the Champlain CVD Prevention Strategy, practitioners in the Champlain District of Ontario launched a large quality-improvement initiative that focused on increasing the uptake in primary care practice settings of clinical guidelines for heart disease, stroke, diabetes, and CVD risk factors.
The Champlain Primary Care CVD Prevention and Management Guideline is a desktop resource for primary care clinicians working in the Champlain District. The guideline was developed by more than 45 local experts to summarize the latest evidence-based strategies for CVD prevention and management, as well as to increase awareness of local community-based programs and services.
Evidence suggests that tailored strategies are important when implementing specific practice guidelines. This article describes the process of creating an integrated clinical guideline for improvement in the delivery of cardiovascular care.
Notes
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Cites: Can J Cardiol. 2006 Jan;22(1):23-4516450016
PubMed ID
21673196 View in PubMed
Less detail
Source
CMAJ. 2008 Apr 22;178(9):1187
Publication Type
Article
Date
Apr-22-2008
Author
Lyall Higginson
Source
CMAJ. 2008 Apr 22;178(9):1187
Date
Apr-22-2008
Language
English
Publication Type
Article
Keywords
Canada
Consumer Product Safety
Diet
Food Labeling
Health Knowledge, Attitudes, Practice
Heart Diseases - prevention & control
Humans
Nutritive Value
Notes
Cites: CMAJ. 2008 Feb 12;178(4):386-718202143
Comment On: CMAJ. 2008 Feb 12;178(4):386-718202143
PubMed ID
18427103 View in PubMed
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Women's angiographic vitamin and estrogen trial: design and methods.

https://arctichealth.org/en/permalink/ahliterature187213
Source
Control Clin Trials. 2002 Dec;23(6):708-27
Publication Type
Article
Date
Dec-2002
Author
Judith Hsia
Edwin L Alderman
Joel I Verter
William J Rogers
Paul Thompson
Barbara V Howard
Frederick R Cobb
Pamela Ouyang
Jean Claude Tardif
Lyall Higginson
Vera Bittner
Ivan Barofsky
Michael Steffes
David J Gordon
Michael Proschan
Naji Younes
David Waters
Author Affiliation
Department of Medicine, George Washington University, Washington, DC, USA. jhsia@mfa.gwu.edu
Source
Control Clin Trials. 2002 Dec;23(6):708-27
Date
Dec-2002
Language
English
Publication Type
Article
Keywords
Antioxidants - therapeutic use
Canada
Coronary Angiography
Coronary Disease - prevention & control
Endpoint Determination
Estrogen Replacement Therapy
Female
Humans
Multicenter Studies as Topic
Randomized Controlled Trials as Topic - methods - statistics & numerical data
Research Design
United States
Abstract
The Women's Angiographic Vitamin and Estrogen trial was a randomized, double-blind, placebo-controlled study designed to test the efficacy of estrogen replacement and antioxidant vitamins for preventing angiographic progression of coronary artery disease. Postmenopausal women with one or more angiographically documented coronary stenoses of 15-75% at baseline were assigned in a 2 x 2 factorial randomization to active hormone replacement therapy (conjugated estrogens for women who had had a hysterectomy or conjugated estrogens with medroxyprogesterone for women with intact uteri) or placebo and to active vitamins E and C or their placebos. Seven clinical centers, five in the United States and two in Canada, randomized 423 women between July 1997 and July 1999. Quantitative coronary angiography was performed at baseline and repeated after projected mean follow-up of 3 years.
PubMed ID
12505248 View in PubMed
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8 records – page 1 of 1.