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Admission waiting times: a national survey.

https://arctichealth.org/en/permalink/ahliterature103208
Source
Dimens Health Serv. 1990 Feb;67(1):32-4
Publication Type
Article
Date
Feb-1990

Ambulatory case mix funding systems in Canada.

https://arctichealth.org/en/permalink/ahliterature215824
Source
Healthc Manage Forum. 1994;7(2):21-8
Publication Type
Article
Date
1994
Author
P. Jacobs
J R Lave
E. Hall
C. Botz
Author Affiliation
Department of Health Services Adminisration, University of Alberta, Edmonton.
Source
Healthc Manage Forum. 1994;7(2):21-8
Date
1994
Language
English
Publication Type
Article
Keywords
Alberta
Ambulatory Care - classification - economics
Ambulatory Surgical Procedures - classification - economics
Canada
Day Care - classification - economics
Diagnosis-Related Groups - economics
Emergency Medical Services - economics - utilization
Humans
Insurance, Hospitalization - statistics & numerical data
National Health Programs - economics
Ontario
Outpatient Clinics, Hospital - economics - utilization
Outpatients - classification
Rate Setting and Review - methods
United States
Abstract
The implementation of inpatient case mix funding in Alberta and Ontario does not allow for adequate incentives to shift resources to an outpatient basis, where appropriate, or to provide outpatient care efficiently. This paper explores the prospects and problems of further extending case mix tools into this area. The availability of tools to characterize output for day surgery, special clinics and emergency care is surveyed. We conclude that case mix funding is desirable and feasible for ambulatory surgery; however, it is questionable for emergency care and special clinics. However, developments in this area in the United States will continue, and this will likely maintain an interest in Canada.
PubMed ID
10171879 View in PubMed
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Challenges and successes of recruitment in the "angiotensin-converting enzyme inhibition in infants with single ventricle trial" of the Pediatric Heart Network.

https://arctichealth.org/en/permalink/ahliterature121164
Source
Cardiol Young. 2013 Apr;23(2):248-57
Publication Type
Article
Date
Apr-2013
Author
Nancy A Pike
Victoria Pemberton
Kerstin Allen
Jeffrey P Jacobs
Daphne T Hsu
Alan B Lewis
Nancy Ghanayem
Linda Lambert
Kari Crawford
Teresa Atz
Rosalind Korsin
Mingfen Xu
Chitra Ravishankar
James Cnota
Gail D Pearson
Author Affiliation
School of Nursing, University of California Los Angeles, CA 90095, USA. npike@sonnet.ucla.edu
Source
Cardiol Young. 2013 Apr;23(2):248-57
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Canada
Heart Defects, Congenital - drug therapy
Humans
Infant
Infant, Newborn
Multicenter Studies as Topic - methods
Patient Selection
Randomized Controlled Trials as Topic - methods
United States
Abstract
Identify trends of enrolment and key challenges when recruiting infants with complex cardiac diseases into a multi-centre, randomised, placebo-controlled drug trial and assess the impact of efforts to share successful strategies on enrolment of subjects.
Rates of screening, eligibility, consent, and randomisation were determined for three consecutive periods of time. Sites collectively addressed barriers to recruitment and shared successful strategies resulting in the Inventory of Best Recruiting Practices. Study teams detailed institutional practices of recruitment in post-trial surveys that were compared with strategies of enrolment initially proposed in the Inventory.
The number of screened patients increased by 30% between the Initial Period and the Intermediate Period (p = 0.007), whereas eligibility decreased slightly by 7%. Of those eligible for entry into the study, the rate of consent increased by 42% (p = 0.025) and randomisation increased by 71% (p = 0.10). During the Final Period, after launch of a competing trial, fewer patients were screened (-14%, p = 0.06), consented (-19%, p = 0.12), and randomised (-34%, p = 0.012). Practices of recruitment in the post-trial survey closely mirrored those in the Inventory.
Early identification and sharing of best strategies of recruitment among all recruiting sites can be effective in increasing recruitment of critically ill infants with congenital cardiac disease and possibly other populations. Strategies of recruitment should focus on those that build relationships with families and create partnerships with the medical providers who care for them. Competing studies pose challenges for enrolment in trials, but fostering trusting relationships with families can result in successful enrolment into multiple studies.
Notes
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Erratum In: Cardiol Young. 2013 Apr;23(2):314
PubMed ID
22931751 View in PubMed
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A comparison of intensive care unit utilization in Alberta and western Massachusetts.

https://arctichealth.org/en/permalink/ahliterature214625
Source
Crit Care Med. 1995 Aug;23(8):1336-46
Publication Type
Article
Date
Aug-1995
Author
J. Rapoport
D. Teres
R. Barnett
P. Jacobs
A. Shustack
S. Lemeshow
C. Norris
S. Hamilton
Author Affiliation
Department of Economics, Mount Holyoke College, South Hadley, MA 01075, USA.
Source
Crit Care Med. 1995 Aug;23(8):1336-46
Date
Aug-1995
Language
English
Publication Type
Article
Keywords
Aged
Alberta - epidemiology
Diagnosis-Related Groups
Health Services Research
Hospital Mortality
Humans
Intensive Care Units - utilization
Length of Stay - statistics & numerical data
Massachusetts
Middle Aged
Patient Admission - statistics & numerical data
Patient Discharge - statistics & numerical data
Population Density
Retrospective Studies
Severity of Illness Index
Utilization Review - statistics & numerical data
Abstract
To analyze differences in intensive care unit (ICU) utilization between a Canadian province and a U.S. area.
Retrospective data analysis of hospital discharge data and existing data from an international study of severity of illness in ICU patients.
Administrative data for the province of Alberta and the four counties of western Massachusetts for the years 1990 to 1991 were used. Detailed data on consecutive ICU admissions from two Alberta hospitals, one western Massachusetts hospital, and 24 other U.S. hospitals for 3 months in 1991 were used.
ICU use and hospital mortality rates were compared for 50,030 hospital admissions divided into 11 patient groups. ICU days per million population were two to three times as great in western Massachusetts as in Alberta. The primary reason was higher ICU incidence (percent of hospitalized patients treated in the ICU) rather than a difference in hospital admission rate or length of ICU stay. ICU incidence in western Massachusetts was significantly higher in ten of 11 patient groups--for the coronary bypass surgery group, there was no difference. The hospital mortality rate in western Massachusetts was similar to, or higher than, the mortality rate in Alberta. In Alberta, a much higher proportion of ICU patients received mechanical ventilation. For elective surgery patients, the ICU severity of illness was lower in western Massachusetts and in other U.S. hospitals than in Alberta.
Western Massachusetts hospitalized patients are more likely to be treated in an ICU than are similar patients in Alberta. There is no evidence that the greater ICU utilization in western Massachusetts led to a lower hospital mortality rate.
PubMed ID
7634803 View in PubMed
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[Cost control for intensive care units].

https://arctichealth.org/en/permalink/ahliterature226383
Source
Dimens Health Serv. 1991 May;68(4):13-5
Publication Type
Article
Date
May-1991
Author
P. Jacobs
T. Noseworthy
Author Affiliation
Services de santé et en médecine communautaire à l'université de l'Alberta.
Source
Dimens Health Serv. 1991 May;68(4):13-5
Date
May-1991
Language
French
Publication Type
Article
Keywords
Canada
Cost Control
Health Care Rationing - economics
Health Facility Administrators - methods
Health services needs and demand
Humans
Intensive Care Units - economics - trends
PubMed ID
2060730 View in PubMed
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A cost-effectiveness analysis of the application of nitric oxide versus oxygen gas for near-term newborns with respiratory failure: results from a Canadian randomized clinical trial.

https://arctichealth.org/en/permalink/ahliterature196085
Source
Crit Care Med. 2000 Mar;28(3):872-8
Publication Type
Article
Date
Mar-2000
Author
P. Jacobs
N N Finer
C M Robertson
P. Etches
E M Hall
L D Saunders
Author Affiliation
Department of Public Health Sciences, University of Alberta, Edmonton, Canada. philip.jacobs@ualberta.ca
Source
Crit Care Med. 2000 Mar;28(3):872-8
Date
Mar-2000
Language
English
Publication Type
Article
Keywords
Administration, Inhalation
Bronchodilator Agents - economics - therapeutic use
Canada - epidemiology
Cost-Benefit Analysis
Extracorporeal Membrane Oxygenation - economics
Female
Health Care Costs
Hernia, Diaphragmatic - complications - congenital - economics
Humans
Infant, Newborn
Intensive Care, Neonatal - economics
Male
Nitric Oxide - economics - therapeutic use
Oxygen Inhalation Therapy - economics
Respiratory Distress Syndrome, Newborn - economics - etiology - mortality - therapy
Statistics, nonparametric
Survival Rate
Treatment Outcome
Abstract
To conduct a cost-effectiveness analysis of the use of inhaled nitric oxide (NO) vs. oxygen administered to near-term (gestational age > or =34 wks) newborns with severe respiratory illness that were referred for consideration of extracorporeal membrane oxygenation (ECMO).
The cost-effectiveness analysis is based on outcome and utilization data from two multicentered randomized clinical trials conducted by the Canadian Inhaled Nitric Oxide Study group, one for patients with congenital diaphragmatic hernia (CDH) and one for patients without CDH. Data from the western Canadian ECMO center were used to establish costs.
Patients were cared for in Canadian regional neonatal intensive care units, including two ECMO centers. Air transport was used for transporting patients between centers.
Term and near-term newborns with severe respiratory illness who were receiving maximum conventional therapy and whose oxygenation index was >40.
Patients randomly received NO or oxygen. If their conditions deteriorated, they qualified for ECMO. Not all that qualified for ECMO received it because of individual parent/ physician preferences.
The cost-effectiveness ratio was the ratio of net cost (including neonatal intensive care, ECMO, and transport) to net outcome (survival) for the two interventions. For non-CDH cases, the cost-effectiveness ratio was $36,613 (Canadian) per life saved; the confidence intervals were wide and the results were not statistically significant. For CDH patients, the death rate was lower for oxygen and the oxygen patients cost less; the results were not statistically significant.
The small numbers of patients in the trials precluded significant results. Further, our results have a short-term time horizon (discharge to home or death). Thus, for non-CDH patients, the favorable ratio provides very qualified evidence in favor of NO.
Notes
Comment In: Crit Care Med. 2000 Mar;28(3):902-310752860
PubMed ID
10752844 View in PubMed
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Cost effectiveness of Streetworks' needle exchange program of Edmonton.

https://arctichealth.org/en/permalink/ahliterature201563
Source
Can J Public Health. 1999 May-Jun;90(3):168-71
Publication Type
Article
Author
P. Jacobs
P. Calder
M. Taylor
S. Houston
L D Saunders
T. Albert
Author Affiliation
Department of Public Health Sciences, University of Alberta, Edmonton. Philip.Jacobs@ualberta.ca
Source
Can J Public Health. 1999 May-Jun;90(3):168-71
Language
English
Publication Type
Article
Keywords
Adult
Alberta - epidemiology
Cost-Benefit Analysis
Female
HIV Infections - economics - epidemiology - etiology - prevention & control
HIV Seroprevalence
Health Knowledge, Attitudes, Practice
Humans
Male
Middle Aged
Needle-Exchange Programs - economics - utilization
Program Evaluation
Questionnaires
Substance Abuse, Intravenous - complications - psychology
Urban Health Services - economics
Abstract
To conduct a cost-effectiveness analysis of the Edmonton Streetworks needle exchange program, in terms of the additional cost per HIV infection averted. The main outcome measures were needle use with and without Streetworks, HIV cases averted, and program costs.
We conducted interviews and HIV saliva tests on a sample of street-involved intravenous drug users (IDU) who are regular Streetworks' clients. Outcomes were used in a cost-effectiveness model.
It is projected that the program has a cost-effectiveness of $9,500 (Canadian) per HIV infection delayed for one year.
The discounted cost per case averted is less than the cost of a case of AIDS. Continuing the program is a dominant strategy.
PubMed ID
10401166 View in PubMed
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Costing methods in the Canadian literature on the economic evaluation of health care. A survey and assessment.

https://arctichealth.org/en/permalink/ahliterature210877
Source
Int J Technol Assess Health Care. 1996;12(4):721-34
Publication Type
Article
Date
1996
Author
P. Jacobs
J. Bachynsky
Author Affiliation
University of Alberta.
Source
Int J Technol Assess Health Care. 1996;12(4):721-34
Date
1996
Language
English
Publication Type
Article
Keywords
Bias (epidemiology)
Canada
Cost-Benefit Analysis - methods
Health Care Costs
Health Services Research - methods
Humans
Reproducibility of Results
Research Design
Abstract
We reviewed the Canadian literature on cost-effectiveness from 1980-95 with regard to costing methodologies. We abstracted each study using a list of data elements that describe costing methodology, and evaluated costing methodologies in the light of biases in costing methods, site, and case-mix selection.
PubMed ID
9136479 View in PubMed
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Economic and ethical consideration in the intensive care unit.

https://arctichealth.org/en/permalink/ahliterature226851
Source
Healthc Manage Forum. 1990;3(2):3-18
Publication Type
Article
Date
1990
Author
T W Noseworthy
P. Jacobs
Author Affiliation
University of Alberta, Edmonton.
Source
Healthc Manage Forum. 1990;3(2):3-18
Date
1990
Language
English
French
Publication Type
Article
Keywords
Adult
Aged
Canada
Decision Making
Ethics
Ethics, Institutional
Euthanasia, Passive
Female
Humans
Intensive Care Units - economics - standards
Male
Patient Advocacy
Resuscitation - standards
Abstract
Intensive care units (ICUs) sustain life but, in certain cases, this resource becomes a means to prolong dying, with great physical, emotional and financial impact. The cost to care for patients in the ICU is at least three times more than general ward care; thus, ICUs have become one of the largest cost centres in the hospital. Economic pressures require us to be mindful of whom the ICU treats and for how long. Health professionals working in the ICU must critically appraise the ethical basis for their behaviour and actions. In so doing, many are likely to appeal to the patient's right to self-determination and the physician's reliance on the principles of beneficence and non-maleficence as the underpinnings of morality in medicine. One approach is to examine the issues and rights pertinent to an individual case using a circular model. Decisions are based on medical facts and prognosis, a patient's right to self-determination, a patient's best interests and external factors. Health personnel would be compelled to consider all of these issues. Within this framework, prevention or resolution of moral dilemma can take place within the clinical rather than the legal forum.
PubMed ID
10105181 View in PubMed
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Episodic acute care costs: linking inpatient and home care.

https://arctichealth.org/en/permalink/ahliterature215226
Source
Can J Public Health. 1995 May-Jun;86(3):200-5
Publication Type
Article
Author
P. Jacobs
E. Hall
I. Henderson
D. Nichols
Author Affiliation
Department of Public Health Sciences, University of Alberta, Edmonton.
Source
Can J Public Health. 1995 May-Jun;86(3):200-5
Language
English
Publication Type
Article
Keywords
Acute Disease - economics
Alberta
Computer Communication Networks
Episode of Care
Health Care Costs
Home Care Services - economics
Hospital Costs
Humans
Abstract
To develop a measure of an acute care "episode of care" that incorporates hospital and home care portions of care, and to measure the costs of such episodes.
Patient level data from a home care program and an acute care hospital were linked using patient health insurance identification numbers. The linked database contained information on inpatient case mix, home care patient classification (i.e., type of care) and cost data for both settings. Data by patient classification were analyzed.
Patterns of resource use were very different for medical and surgical cases, home care costs being 25% of a medical episode and only 5% of a surgical episode. For surgical cases, the marginal cost of an extra surgical day is about equal to the marginal cost of an extra short-term home care case (i.e., a one-day reduction in a surgical inpatient length of stay would cover the cost of a home care stay). Medical cases would require a three-day reduction in inpatient cost.
PubMed ID
7671208 View in PubMed
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27 records – page 1 of 3.