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81 records – page 1 of 9.

Acute myocardial infarction: survey of urban and rural hospital mortality.

https://arctichealth.org/en/permalink/ahliterature242342
Source
Am Heart J. 1983 Jan;105(1):44-53
Publication Type
Article
Date
Jan-1983
Author
A L Morris
V. Nernberg
N P Roos
P. Henteleff
L. Roos
Source
Am Heart J. 1983 Jan;105(1):44-53
Date
Jan-1983
Language
English
Publication Type
Article
Keywords
Aged
Coronary Care Units
Female
Hospitals
Hospitals, Municipal
Humans
Male
Manitoba
Middle Aged
Myocardial Infarction - mortality
Random Allocation
Resuscitation
Retrospective Studies
Rural Population
Urban Population
Ventricular Fibrillation - mortality
Abstract
Mortality rates for acute myocardial infarction (AMI) in the province of Manitoba were studied by a retrospective, randomized survey of urban and rural hospital records. Urban hospitals had formal coronary care unit (CCU). Selected rural hospitals lacked CCUs but usually possessed portable monitoring and defibrillation equipment. Twenty-seven percent of 852 cases in the study population died. The mortality rate for unequivocal AMI was 14% to 15% to both urban and rural hospitals. Patients with possible AMI had high mortality rates in both facilities (41% to 45%). Subgroup analysis of the definite AMI population failed to reveal statistically significant differences in urban vs rural mortality, although a consistent trend toward superior performance in urban centers was found. The magnitude of the potential of a rural hospital intervention program to reduce the AMI mortality nevertheless appeared to be small.
PubMed ID
6849240 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

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 physicians' compliance with guidelines for Papanicolaou testing.

https://arctichealth.org/en/permalink/ahliterature223703
Source
Med Care. 1992 Jun;30(6):514-28
Publication Type
Article
Date
Jun-1992
Author
M M Cohen
N P Roos
L. MacWilliam
A. Wajda
Author Affiliation
Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Canada.
Source
Med Care. 1992 Jun;30(6):514-28
Date
Jun-1992
Language
English
Publication Type
Article
Keywords
Adult
Cooperative Behavior
Fees, Medical
Female
Health Services Research
Humans
Manitoba
Middle Aged
Papanicolaou test
Patient Acceptance of Health Care - statistics & numerical data
Physician's Practice Patterns - statistics & numerical data
Physicians - psychology
Primary Health Care - standards
Research Design
Uterine Cervical Neoplasms - prevention & control
Vaginal Smears - economics
Abstract
In this study, population-based data were used to examine the appropriateness of Papanicolaou (Pap) testing from the perspective of the women being tested and their physicians. The approach used is unique in its assessment of overtesting and undertesting in the primary care setting. From the data base of the province of Manitoba's universal health insurance plan, 4-year health histories (1981 to 1984) were constructed for each woman from a random sample of the population of women who, in 1982, were between the ages of 25 to 64 years (n = 22,287). At the last visit to a general practitioner, gynecologist, or general surgeon in 1984 (termed the current visit), the authors determined whether a Pap test was given for each woman. Using decision rules from a Canadian task force report on cervical screening and previous health history, the authors evaluated the appropriateness of screening by determining whether a Pap test was given and was needed, or whether a women who had not received a Pap test required one. Overall, 55.7% of women were tested appropriately. Of the 5352 women who received a Pap test at the current visit, 62.8% were overtested. Of the 16,935 women not tested at the current visit, 38.5% required screening (i.e. were undertested). Characteristics of a physician's practice that were significantly related to compliance with the guidelines included having a high proportion of patients visiting for obstetric or gynecologic reasons. Variables that were associated with negative compliance were 1) being a gynecologist; and 2) having a high proportion of patients who lived in inner city or rural areas. Because physicians are paid a fee for every Pap smear taken and the guidelines were well disseminated, these results should be reasonably representative of fee-for-service practice in North America, where preventive care is not subject to user charges. This study supports previous findings that a passive approach to dissemination of guidelines is insufficient to effect practice.
PubMed ID
1593917 View in PubMed
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Assessing surgical risks in a population: patient histories before and after cholecystectomy.

https://arctichealth.org/en/permalink/ahliterature237825
Source
Soc Sci Med. 1986;22(5):571-8
Publication Type
Article
Date
1986
Author
N P Roos
R. Danzinger
Source
Soc Sci Med. 1986;22(5):571-8
Date
1986
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Adult
Aged
Cholecystectomy
Emergencies
Female
Gallstones - surgery
Humans
Male
Manitoba
Medical Records
Medical Records, Problem-Oriented
Middle Aged
Postoperative Complications - mortality
Reoperation
Risk
Abstract
Claims data from the Manitoba Health Services Commission on all health care contacts during the 2 years preceding and the 2 years following gallbladder surgery were used to describe the histories of patients prior to cholecystectomy, and to assess surgical outcomes. The study is unique in focusing on essentially all patients in the population undergoing surgery (whether at large academic centres or small rural hospitals) and in tracking post discharge events (deaths and complications). Many patients presenting for surgery with acute/urgent conditions were previously asymptomatic or at least their gallbladder disease was undiagnosed (27%). Although overall mortality rates were low (0.7%), 26% of the deaths occurred following discharge from the hospital where surgery was performed. In addition, 3.4% of the patients were readmitted to hospital with complications of the gallbladder surgery, 13.5% continued to visit the physician with abdominal symptoms after surgery and 17% presented with psychological problems. Multiple logistic regression is used to estimate the risk of poor surgical outcomes according to a patient's presurgical characteristics. The analysis suggests that most published data are biased towards underestimating the risks associated with cholecystectomy (as well as the risks associated with other common surgical procedures).
PubMed ID
3486478 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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Centralization, certification, and monitoring. Readmissions and complications after surgery.

https://arctichealth.org/en/permalink/ahliterature236350
Source
Med Care. 1986 Nov;24(11):1044-66
Publication Type
Article
Date
Nov-1986
Author
L L Roos
S M Cageorge
N P Roos
R. Danzinger
Source
Med Care. 1986 Nov;24(11):1044-66
Date
Nov-1986
Language
English
Publication Type
Article
Keywords
Cholecystectomy
Female
Follow-Up Studies
Hospital Departments - standards
Humans
Hysterectomy
Male
Manitoba
Medical Staff Privileges
Outcome and Process Assessment (Health Care) - methods
Patient Readmission
Postoperative Complications
Prostatectomy
Quality of Health Care
Registries
Statistics as Topic
Surgery Department, Hospital - standards
Surgical Procedures, Operative - standards
Abstract
Research on adverse outcomes following common surgical procedures has suggested the importance of hospital and surgeon variables. Policy directions depend on which factors are important in influencing patient outcomes and what sorts of policies are feasible. Focusing on where a given procedure is performed highlights a concern for centralization; emphasizing who should perform a particular operation implies physician certification. Finally, monitoring involves identifying particular hospitals that appear to have relatively poor (or relatively good) results. This paper analyzes patient, surgeon, and hospital characteristics associated with serious postdischarge complications of hysterectomy, cholecystectomy, and prostatectomy in patients age 25 and over in Manitoba, Canada, following surgery during 1974 through 1976. The three procedures differ markedly in the ease of prediction of the probability of complications and in the predictive importance of patient, hospital, and physician variables. The predictors worked fairly well for cholecystectomy, somewhat less well for hysterectomy, and not well at all for prostatectomy. Hospital variables were not generally important in the multiple logistic regressions. After controlling for case mix and type of surgery, physician surgical experience was found to account for relatively large differences (almost two to one) in the probability of patient complications following cholecystectomy. Cholecystectomy might be a candidate for certification because of the epidemiology of the operation. As of the mid-1970s, a substantial proportion of the cholecystectomies were being performed by physicians with comparatively little ongoing experience with this type of procedure. Moreover, a monitoring perspective identified one hospital with a significantly higher postcholecystectomy complication rate, even after physician experience was taken into account. Both identifying which procedures should be attended to and focusing on problems following surgery are important beyond Manitoba and highly relevant to such American requirements as Peer Review Organizations. Methods of increasing the efficiency of using claims data for quality assurance studies are outlined.
PubMed ID
3773578 View in PubMed
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The centralization of operations and access to treatment: total hip replacement in Manitoba.

https://arctichealth.org/en/permalink/ahliterature239219
Source
Am J Public Health. 1985 Feb;75(2):130-3
Publication Type
Article
Date
Feb-1985
Author
N P Roos
D. Lyttle
Source
Am J Public Health. 1985 Feb;75(2):130-3
Date
Feb-1985
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Female
Health Services Accessibility
Hip Prosthesis - trends
Humans
Male
Manitoba
Middle Aged
Regional Health Planning
Rural Population
Abstract
The impact of centralized facilities on access to care was tested by studying total hip arthroplasty in the Province of Manitoba, Canada. Data from the Manitoba Health Services Commission, which insures costs of all medical services in the Province, show that the availability of this surgical procedure has increased steadily over the 1973-78 period at a rate similar to that elsewhere in North America. Although Manitoba's population is geographically dispersed, specialized orthopedic services are concentrated in two urban centers. No important difference in access to care for this condition was found between urban center residents and residents distant from the surgical facilities.
Notes
Cites: Med Care. 1982 Mar;20(3):266-767078285
Cites: N Engl J Med. 1982 Nov 11;307(20):1242-57133055
Cites: Med Care. 1984 Feb;22(2):95-76700279
Cites: J Bone Joint Surg Br. 1972 Feb;54(1):61-765011747
Cites: Med Care. 1984 Feb;22(2):98-1146700280
Cites: N Engl J Med. 1979 Dec 20;301(25):1364-9503167
Cites: Surgery. 1981 Feb;89(2):151-627455900
Cites: N Engl J Med. 1981 Jul 23;305(4):200-47242599
Cites: N Engl J Med. 1981 Nov 26;305(22):1319-237290154
Cites: Med Care. 1977 JAN;15(1):1-18834081
PubMed ID
3966616 View in PubMed
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Characteristics of patients with a regular source of care.

https://arctichealth.org/en/permalink/ahliterature190533
Source
Can J Public Health. 2001 Jul-Aug;92(4):299-303
Publication Type
Article
Author
V H Menec
N P Roos
C. Black
B. Bogdanovic
Author Affiliation
Department of Community Health Sciences, Manitoba Centre for Health Policy and Evaluation, University of Manitoba, Winnipeg, MB R3E 0W3. vmenec@cpe.umanitoba.ca
Source
Can J Public Health. 2001 Jul-Aug;92(4):299-303
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Continuity of Patient Care
Demography
Female
Health Services Accessibility
Health Status Indicators
Humans
Logistic Models
Male
Manitoba - epidemiology
Middle Aged
National Health Programs
Outpatients - classification
Socioeconomic Factors
Urban Health Services - utilization
Abstract
This study was designed to describe patient characteristics associated with having a regular source of care among all patients who received care from large urban clinics in Manitoba over a three-year period (N = 298,222). Using administrative data, patients were classified as having a regular source of care if they made 75% or more of their total ambulatory visits to the same clinic. Overall, 44.2% of patients had a regular source of care. A logistic regression showed that children and adults aged 45 and older were more likely to have a regular source of care than patients aged 18-44. Moreover, patients with a regular source of care tended to live in more affluent neighbourhoods and were healthier than individuals with no regular source of care. Systemic changes might be needed to enhance continuity of care (e.g., mechanisms to enhance access) among vulnerable segments of the population like the poor.
PubMed ID
11962117 View in PubMed
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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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81 records – page 1 of 9.