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A comparative study of the costliness of Manitoba hospitals.

https://arctichealth.org/en/permalink/ahliterature201463
Source
Med Care. 1999 Jun;37(6 Suppl):JS101-22
Publication Type
Article
Date
Jun-1999
Author
M. Shanahan
M. Loyd
N P Roos
M. Brownell
Author Affiliation
Centre for Health Economics and Evaluation, University of Sydney, Camperdown, NSW, Australia.
Source
Med Care. 1999 Jun;37(6 Suppl):JS101-22
Date
Jun-1999
Language
English
Publication Type
Article
Keywords
Bed Occupancy - economics - statistics & numerical data
Cost Savings
Data Collection
Data Interpretation, Statistical
Diagnosis-Related Groups - economics
Economics, Hospital - statistics & numerical data
Health Expenditures - statistics & numerical data
Health Services Research
Hospital Bed Capacity - economics - statistics & numerical data
Hospital Charges - statistics & numerical data
Hospital Costs - statistics & numerical data
Hospitals, Community - economics
Hospitals, Rural - economics
Hospitals, Teaching - economics
Hospitals, Urban - economics
Humans
Length of Stay - economics
Manitoba
Maryland
Severity of Illness Index
Abstract
In light of ongoing discussions about health care policy, this study offered a method of calculating costs at Manitoba hospitals that compared relative costliness of inpatient care provided in each hospital.
This methodology also allowed comparisons across types of hospitals-teaching, community, major rural, intermediate and small rural, as well as northern isolated facilities.
Data used in this project include basic hospital information, both financial and statistical, for each of the Manitoba hospitals, hospital charge information by case from the State of Maryland, and hospital discharge abstract information for Manitoba. The data from Maryland were used to create relative cost weights (RCWs) for refined diagnostic related groups (RDRGs) and were subsequently adjusted for Manitoba length of stay. These case weights were then applied to cases in Manitoba hospitals, and several other adjustments were made for nontypical cases. This case mix system allows cost comparisons across hospitals.
In general, hospital case mix costing demonstrated variability in hospital costliness, not only across types of hospitals but also within hospitals of the same type and size.
Costs at the teaching hospitals were found to be considerably higher than the average, even after accounting for acuity and case mix.
PubMed ID
10409003 View in PubMed
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Epidemiology of varicella zoster virus infection in Canada and the United Kingdom.

https://arctichealth.org/en/permalink/ahliterature192644
Source
Epidemiol Infect. 2001 Oct;127(2):305-14
Publication Type
Article
Date
Oct-2001
Author
M. Brisson
W J Edmunds
B. Law
N J Gay
R. Walld
M. Brownell
L. Roos
G. De Serres
Author Affiliation
PHLS CDSC, and City University, London.
Source
Epidemiol Infect. 2001 Oct;127(2):305-14
Date
Oct-2001
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Canada - epidemiology
Chickenpox - epidemiology - prevention & control
Chickenpox Vaccine - economics
Child
Child, Preschool
Cost-Benefit Analysis
Great Britain - epidemiology
Herpes Zoster - epidemiology - prevention & control
Hospitalization - statistics & numerical data
Humans
Incidence
Infant
Middle Aged
Risk factors
Seasons
Sentinel Surveillance
Abstract
Many countries are currently studying the possibility of mass vaccination against varicella. The objective of this study was to provide a comprehensive picture of the pre-vaccine epidemiology of the varicella zoster virus (VZV) to aid in the design of immunization programs and to adequately measure the impact of vaccination. Population-based data including physician visit claims, sentinel surveillance and hospitalization data from Canada and the United Kingdom were analysed. The key epidemiological characteristics of varicella and zoster (age specific consultation rates, seasonality, force of infection, hospitalization rates and inpatient days) were compared. Results show that the overall epidemiology of varicella and zoster is remarkably similar between the two countries. The major difference being that, contrary to Canada, the epidemiology of varicella seems to be changing in the United Kingdom with an important decrease in the average age at infection that coincides with a significant increase in children attending preschool. Furthermore, differences exist in the seasonality between the United Kingdom and Canada, which seem to be primarily due to the school calendar. These results illustrate that school and preschool contact patterns play an important role in the dynamics of varicella. Finally, our results provide baseline estimates of varicella and zoster incidence and morbidity for VZV vaccine effectiveness and cost-effectiveness studies.
PubMed ID
11693508 View in PubMed
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Factors associated with hospitalisations for ambulatory care-sensitive conditions among persons with an intellectual disability: a publicly insured population perspective.

https://arctichealth.org/en/permalink/ahliterature126664
Source
J Intellect Disabil Res. 2013 Mar;57(3):226-39
Publication Type
Article
Date
Mar-2013
Author
R S Balogh
H. Ouellette-Kuntz
M. Brownell
A. Colantonio
Author Affiliation
Dual Diagnosis Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. robert.balogh@utoronto.ca
Source
J Intellect Disabil Res. 2013 Mar;57(3):226-39
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Adult
Ambulatory Care - statistics & numerical data
Comorbidity
Female
Hospitalization - statistics & numerical data
Humans
Income - statistics & numerical data
Indians, North American - statistics & numerical data
Intellectual Disability - epidemiology - therapy
Male
Manitoba - epidemiology
Middle Aged
Multivariate Analysis
National Health Programs - statistics & numerical data
Primary Health Care - statistics & numerical data
Regression Analysis
Retrospective Studies
Risk factors
Rural Population - statistics & numerical data
Urban Population - statistics & numerical data
Young Adult
Abstract
Hospitalisations for ambulatory care-sensitive (ACS) conditions are used as an indicator of access to, and the quality of, primary care. The objective was to identify factors associated with hospitalisations for ACS conditions among adults with an intellectual disability (ID) in the context of a publicly insured healthcare system.
This study examined adults with an ID living in a Canadian province between 1999 and 2003 identified from administrative databases. Using 5 years of data for the study population, characteristics of persons hospitalised or not hospitalised for ACS conditions were compared. Using a conceptual model, independent variables were selected and an analysis performed to identify which were associated with hospitalisations for ACS conditions. The correlated nature of the observations was accounted for statistically.
Living in a rural area [odds ratio (OR) 1.3; 95% confidence intervals (CI) = 1.0, 1.8], living in an area with a high proportion of First Nations people (OR 2.3; 95% CI = 1.3, 4.1), and experiencing higher levels of comorbidity (OR 25.2; 95% CI = 11.9, 53.0) were all associated with a higher likelihood of being hospitalised for an ACS condition. Residing in higher income areas had a protective effect (OR 0.56; 95% CI = 0.37, 0.85). None of the health service resource variables showed statistically significant associations.
Persons with an ID experience inequity in hospitalisations for ACS conditions according to rurality, income and proportion who are First Nations in a geographic area. This suggests that addressing the socio-economic problems of poorer areas and specifically areas densely populated by First Nations people may have an impact on the number of hospitalisations for ACS conditions. Study strengths and limitations and areas for potential future research are discussed.
PubMed ID
22369576 View in PubMed
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A framework for modelling differences in regional mortality over time.

https://arctichealth.org/en/permalink/ahliterature180582
Source
J Epidemiol Community Health. 2004 May;58(5):420-5
Publication Type
Article
Date
May-2004
Author
L M Lix
O. Ekuma
M. Brownell
L L Roos
Author Affiliation
Manitoba Centre for Health Policy, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg, Manitoba, Canada R3C 3P5. Lisa_Lix@cpe.umanitoba.ca
Source
J Epidemiol Community Health. 2004 May;58(5):420-5
Date
May-2004
Language
English
Publication Type
Article
Keywords
Health status
Heart Diseases - mortality
Humans
Manitoba - epidemiology
Models, Statistical
Mortality - trends
Population Surveillance - methods
Risk factors
Rural Population
Abstract
To present a conceptual framework for testing differences in mortality for small geographical areas over time using the generalised linear model with generalised estimating equations. This framework can be used to test whether the magnitude of regional inequalities in health status has changed over time.
A Poisson regression model for correlated data is used to investigate the relation of population health status to demographic, geographical, and temporal explanatory variables. Differences between regions at one or more points in time are tested with linear contrasts.
A case example shows the application of the framework. All cause mortality and cause specific mortality were compared for three rural regions of Manitoba, Canada between 1985 and 1999. The data were obtained from Vital Statistics records and the provincial health registry.
Tests of linear contrasts on the regression coefficients for time and region show an increase in the magnitude of the difference in the risk of all cause mortality and heart disease mortality between northern and southern regions of the province for the 1985-1989 and 1995-1999 time periods. No significant differences are identified for cancer, injury, or respiratory disease mortality.
The proposed framework enables testing of a variety of hypotheses about differences between regions and time periods and can be applied to other measures of population health status.
Notes
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Cites: Can J Public Health. 1993 Mar-Apr;84(2):112-78334602
Cites: Am J Epidemiol. 1994 Nov 15;140(10):943-557977282
Cites: Biometrics. 1983 Sep;39(3):665-746652201
PubMed ID
15082744 View in PubMed
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Good news about difficult decisions: the Canadian approach to hospital cost control.

https://arctichealth.org/en/permalink/ahliterature204346
Source
Health Aff (Millwood). 1998 Sep-Oct;17(5):239-46
Publication Type
Article

Hospitalisation rates for ambulatory care sensitive conditions for persons with and without an intellectual disability--a population perspective.

https://arctichealth.org/en/permalink/ahliterature141598
Source
J Intellect Disabil Res. 2010 Sep;54(9):820-32
Publication Type
Article
Date
Sep-2010
Author
R. Balogh
M. Brownell
H. Ouellette-Kuntz
A. Colantonio
Author Affiliation
Centre for Addiction and Mental Health, Dual Diagnosis Program, Toronto, Ontario, Canada. robert.balogh@utoronto.ca
Source
J Intellect Disabil Res. 2010 Sep;54(9):820-32
Date
Sep-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Ambulatory Care - statistics & numerical data
Child
Child, Preschool
Epilepsy - epidemiology
Female
Health Services Accessibility - statistics & numerical data
Hospitalization - statistics & numerical data
Humans
Infant
Infant, Newborn
Intellectual Disability - epidemiology
Male
Manitoba - epidemiology
Middle Aged
National Health Programs - statistics & numerical data
Prevalence
Primary Health Care - statistics & numerical data
Rural Population - statistics & numerical data
Schizophrenia - epidemiology
Urban Population - statistics & numerical data
Young Adult
Abstract
There is evidence that persons with an intellectual disability (ID) face barriers to primary care; however, this has not been extensively studied at the population level. Rates of hospitalisation for ambulatory care sensitive conditions are used as an indicator of access to, and quality of, primary care. The objective of the study was to compare hospitalisation rates for ambulatory care sensitive conditions between persons with and without an ID in a publicly insured population.
Persons with an ID were identified among the general population of a Canadian province between 1999 and 2003. Using a list of conditions applicable to persons with an ID, rates of hospitalisations for ambulatory care sensitive conditions for persons with and without an ID were calculated and compared. Regression models were used to adjust for age, sex and place of residence. Hospitalisation rates for specific conditions were also compared, controlling for differences in disease prevalence where possible.
Persons with an ID were consistently hospitalised for ambulatory care sensitive conditions at a higher rate than persons without an ID. Between 1999 and 2003 the adjusted rate ratio (RR) was 6.1 [95% confidence interval (CI) = 5.6, 6.7]. Rate ratios were highest when comparing persons with, to persons without, an ID between the ages of 30-39 (RR = 13.1; 95% CI = 10.6, 16.2) and among urban area dwellers (RR = 7.0; 95% CI = 6.2, 7.9). Hospitalisation rates for epilepsy and schizophrenic disorders were, respectively, 54 and 15 times higher for persons with compared with persons without an ID. Rate ratios for diabetes and asthma remained significant after controlling for the population prevalence of these diseases.
The large discrepancy in rates of hospitalisation between persons with and without an ID is an indicator of inadequate primary care for this vulnerable population. Decreasing the number of ambulatory care sensitive condition hospitalisations through specialised outpatient programmes for persons with an ID would potentially lead to better health, improved quality of life and cost savings. Future research should include potentially important factors such as disease severity, socio-economic variables and measures of health service organisation in the analysis. International comparisons of ambulatory care sensitive condition hospitalisation rates could point to the benefits and limitations of the health service policy directions adopted by different countries.
PubMed ID
20704636 View in PubMed
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Introducing data into the health policy process: developing a report on the efficiency of bed use in Manitoba.

https://arctichealth.org/en/permalink/ahliterature215829
Source
Healthc Manage Forum. 1994;7(2):46-50
Publication Type
Article
Date
1994
Author
N P Roos
M. Brownell
Author Affiliation
Department of Community Health Sciences, University of Manitoba.
Source
Healthc Manage Forum. 1994;7(2):46-50
Date
1994
Language
English
Publication Type
Article
Keywords
Bed Occupancy - statistics & numerical data
Data Collection
Digestive System Diseases
Efficiency, Organizational
Evaluation Studies as Topic
Health Policy
Health Services Research - methods
Hospitals - statistics & numerical data - utilization
Humans
Length of Stay - statistics & numerical data
Manitoba
Policy Making
Abstract
The Manitoba Centre for Health Policy and Evaluation (MCHPE) is a university-based centre funded by the provincial government to provide analyses for use in policy development and management of the health care system. At the government's request, the MCHPE undertook an analysis of bed use in the major hospitals in the province. This article reviews the formulation, execution and delivery of the project to illustrate how health services researchers, administrative data and key actors in the health care system can interact in the policy process.
PubMed ID
10134902 View in PubMed
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7 records – page 1 of 1.