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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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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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Factors that influence length of stay for in-patient gynaecology surgery: is the Case Mix Group (CMG) or type of procedure more important?

https://arctichealth.org/en/permalink/ahliterature169549
Source
J Obstet Gynaecol Can. 2006 Feb;28(2):149-55
Publication Type
Article
Date
Feb-2006
Author
Mark S Carey
Rahi Victory
Larry Stitt
Nicole Tsang
Author Affiliation
Department of Obstetrics and Gynecology, University of Western Ontario, London ON; London Health Sciences Centre, London ON.
Source
J Obstet Gynaecol Can. 2006 Feb;28(2):149-55
Date
Feb-2006
Language
English
Publication Type
Article
Keywords
Age Factors
Anesthesia Recovery Period
Body Weight - physiology
Canada
Current Procedural Terminology
Diagnosis-Related Groups
Female
Genital Diseases, Female - classification - surgery
Gynecologic Surgical Procedures - adverse effects - classification - utilization
Humans
Length of Stay - statistics & numerical data
Linear Models
Medical Audit
Middle Aged
Multivariate Analysis
Obstetrics and Gynecology Department, Hospital - standards - utilization
Postoperative Complications
Time Factors
Abstract
To compare the association between the Case Mix Group (CMG) code and length of stay (LOS) with the association between the type of procedure and LOS in patients admitted for gynaecology surgery.
We examined the records of women admitted for surgery in CMG 579 (major uterine/adnexal procedure, no malignancy) or 577 (major surgery ovary/adnexa with malignancy) between April 1997 and March 1999. Factors thought to influence LOS included age, weight, American Society of Anesthesiologists (ASA) score, physician, day of the week on which surgery was performed, and procedure type. Procedures were divided into six categories, four for CMG 579 and two for CMG 577. Data were abstracted from the hospital information costing system (T2 system) and by retrospective chart review. Multivariable analysis was performed using linear regression with backwards elimination.
There were 606 patients in CMG 579 and 101 patients in CMG 577, and the corresponding median LOS was four days (range 1-19) for CMG 579 and nine days (range 3-30) for CMG 577. Combined analysis of both CMGs 577 and 579 revealed the following factors as highly significant determinants of LOS: procedure, age, physician, and ASA score. Although confounded by procedure type, the CMG did not significantly account for differences in LOS in the model if procedure was considered. Pairwise comparisons of procedure categories were all found to be statistically significant, even when controlled for other important variables.
The type of procedure better accounts for differences in LOS by describing six statistically distinct procedure groups rather than the traditional two CMGs. It is reasonable therefore to consider changing the current CMG codes for gynaecology to a classification based on the type of procedure.
PubMed ID
16643718 View in PubMed
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The impact of geographic variations in treatment on outcomes in ovarian cancer.

https://arctichealth.org/en/permalink/ahliterature117455
Source
Int J Gynecol Cancer. 2013 Feb;23(2):282-7
Publication Type
Article
Date
Feb-2013
Author
Ulrike Dehaeck
Colleen E McGahan
Jennifer L Santos
Mark S Carey
Kenneth D Swenerton
Janice S Kwon
Author Affiliation
University of British Columbia and BC Cancer Agency, Vancouver, British Columbia, Canada.
Source
Int J Gynecol Cancer. 2013 Feb;23(2):282-7
Date
Feb-2013
Language
English
Publication Type
Article
Keywords
Aged
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
British Columbia - epidemiology
Cohort Studies
Female
Geography
Gynecologic Surgical Procedures - statistics & numerical data
Health Services Accessibility - statistics & numerical data
Healthcare Disparities - statistics & numerical data
Humans
Middle Aged
Neoplasms, Glandular and Epithelial - diagnosis - epidemiology - mortality - therapy
Ovarian Neoplasms - diagnosis - epidemiology - mortality - therapy
Prognosis
Retrospective Studies
Survival Rate
Treatment Outcome
Abstract
There are significant regional differences in survival outcomes across British Columbia among women with ovarian cancer. The age-adjusted hazard ratio for mortality is 1.27 (95% confidence interval, 1.08-1.49) in 1 health authority region compared to the provincial mean. The objective of this study was to look at variations in the treatment of epithelial ovarian cancer among the 5 health authority regions in the province of British Columbia and determine their effect on survival.
This was a population-based retrospective cohort study of all incident cases of epithelial ovarian cancer diagnosed in British Columbia from 2005 to 2008. Health authority regions were compared with the ?(2) test for demographic and disease characteristics, as well as treatment practices including assessment by a gynecologic oncologist, rate of optimal debulking, and proportion receiving platinum-based combination chemotherapy. Multivariable Cox regression analysis evaluated the effect of covariates on survival.
There were 854 evaluable patients. Across health authority regions, there were significant differences in disease characteristics, including the proportion with serous histotype (44.0%-60.7%, P = 0.043) and stage IIIC/IV disease (50.3%-69.4%, P = 0.0048). There were also significant differences in treatment, including the proportion of patients assessed by a gynecologic oncologist (56.8%-79.4%, P = 0.0003), rate of suboptimal debulking, (21.4%-60.2%, P = 0.0036), and the proportion receiving combination chemotherapy, (61.5%-81.9%, P
PubMed ID
23295939 View in PubMed
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