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The 2003 Canadian recommendations for dyslipidemia management: revisions are needed.

https://arctichealth.org/en/permalink/ahliterature175311
Source
CMAJ. 2005 Apr 12;172(8):1027-31
Publication Type
Article
Date
Apr-12-2005
Author
Douglas G Manuel
Peter Tanuseputro
Cameron A Mustard
Susan E Schultz
Geoffrey M Anderson
Sten Ardal
David A Alter
Andreas Laupacis
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Ont. doug.manuel@ices.on.ca
Source
CMAJ. 2005 Apr 12;172(8):1027-31
Date
Apr-12-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Canada
Cholesterol, LDL - blood
Coronary Disease - mortality - prevention & control
Cost-Benefit Analysis
Health Expenditures
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Hyperlipidemias - drug therapy
Hypolipidemic Agents - therapeutic use
Middle Aged
Practice Guidelines as Topic
Risk factors
Notes
Cites: Eur Heart J. 2003 Sep;24(17):1601-1012964575
Cites: CMAJ. 2003 Jun 24;168(13):1644-5; author reply 1645-612821610
Cites: Can J Cardiol. 2003 Nov;19(12):1359-6614631469
Cites: Can J Cardiol. 2003 Dec;19(13):1499-50214760440
Cites: Am J Med. 2004 Apr 15;116(8):540-515063816
Cites: JAMA. 2004 Apr 21;291(15):1864-7015100205
Cites: Am Heart J. 1991 Jan;121(1 Pt 2):293-81985385
Cites: N Engl J Med. 1998 Nov 5;339(19):1349-579841303
Cites: Can J Cardiol. 1999 Apr;15(4):445-5110322254
Cites: CMAJ. 2003 Oct 28;169(9):921-414581310
Cites: Fam Pract. 2003 Feb;20(1):16-2112509365
Cites: JAMA. 2002 Jul 24-31;288(4):462-712132976
Cites: JAMA. 2002 Jul 24-31;288(4):455-6112132975
Cites: JAMA. 1999 Dec 22-29;282(24):2340-610612322
Cites: CMAJ. 2000 May 16;162(10):1441-710834048
Cites: CMAJ. 2000 Aug 22;163(4):403-810976255
Cites: Lancet. 2002 Jul 6;360(9326):7-2212114036
Comment In: CMAJ. 2005 Nov 8;173(10):1210; author reply 121016275979
Comment In: CMAJ. 2005 Nov 8;173(10):1207; author reply 121016275976
Comment In: CMAJ. 2005 Apr 12;172(8):1033-4; discussion 103715824410
Erratum In: CMAJ. 2005 Jul 19;173(2):133
PubMed ID
15824409 View in PubMed
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Defining needs-based urban health planning areas is feasible and desirable: a population-based approach in Toronto, Ontario.

https://arctichealth.org/en/permalink/ahliterature172343
Source
Can J Public Health. 2005 Sep-Oct;96(5):380-4
Publication Type
Article
Author
Richard H Glazier
Mandana Vahabi
Cynthia Damba
Dianne Patychuk
Sten Ardal
Ian Johnson
Graham Woodward
Donald P DeBoer
Adalsteinn Brown
Harvey Low
Claire McConnell
Lynne Lawrie
Scott Dudgeon
Author Affiliation
Inner City Health Research Unit, St. Michael's Hospital, Toronto, ON. richard.glazier@utoronto.ca
Source
Can J Public Health. 2005 Sep-Oct;96(5):380-4
Language
English
Publication Type
Article
Keywords
Catchment Area (Health)
Censuses
Community Health Planning - methods
Demography
Feasibility Studies
Female
Health promotion
Humans
Male
Needs Assessment
Ontario
Residence Characteristics - classification - statistics & numerical data
Small-Area Analysis
Socioeconomic Factors
Urban Health - statistics & numerical data
Abstract
Reporting health data for large urban areas presents numerous challenges. In the case of Toronto, Ontario, amalgamation in 1998 merged six census subdivisions into one mega-city, resulting in the disappearance of standard reporting units. A population-based approach was used to define new health planning areas. Census tracts were used as building blocks and combined according to residential income homogeneity, respecting natural and man-made boundaries, forward sortation areas and the City of Toronto's community neighbourhoods whenever possible. Correlations and maps were used to establish area boundaries. The city was divided into 5 major planning areas which were further subdivided creating 15 minor areas. Both major and minor areas showed significant differences in population characteristics, health status and health service utilization. This commentary demonstrates the feasibility and describes the outcomes of one method for establishing planning and reporting areas in large urban centres. Next steps include the further generation of health data for these areas, comparisons with other Canadian urban areas, and application of these methods to recently announced Ontario Local Health Integration Networks. These areas can be used for planning and evaluating health service delivery, comparison with other Canadian urban areas and ongoing monitoring of and advocacy for equity in health.
PubMed ID
16238159 View in PubMed
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Effectiveness and efficiency of different guidelines on statin treatment for preventing deaths from coronary heart disease: modelling study.

https://arctichealth.org/en/permalink/ahliterature169059
Source
BMJ. 2006 Jun 17;332(7555):1419
Publication Type
Article
Date
Jun-17-2006
Author
Douglas G Manuel
Kelvin Kwong
Peter Tanuseputro
Jenny Lim
Cameron A Mustard
Geoffrey M Anderson
Sten Ardal
David A Alter
Andreas Laupacis
Author Affiliation
Institute for Clinical Evaluative Sciences G106-2075 Bayview Avenue, Toronto, Ontario M4N 3M5. doug.manuel@ices.on.ca
Source
BMJ. 2006 Jun 17;332(7555):1419
Date
Jun-17-2006
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada - epidemiology
Coronary Disease - blood - mortality - prevention & control
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Lipids - blood
Male
Middle Aged
Practice Guidelines as Topic - standards
Treatment Outcome
Abstract
To examine the potential effectiveness and efficiency of different guidelines for statin treatment to reduce deaths from coronary heart disease in the Canadian population.
Modelled outcomes of screening and treatment recommendations of six national or international guidelines--from Canada, Australia, New Zealand, the United States, joint British societies, and European societies.
Canada.
Details for 6760 men and women aged 20-74 years from the Canadian Heart Health Survey (weighted sample of 12,300,000 people) that included physical measurements including a lipid profile.
The number of people recommended for treatment with statins, the potential number of deaths from coronary heart disease avoided, and the number needed to treat to avoid one coronary heart disease death with five years of statin treatment if the recommendations from each guideline were fully implemented.
When applied to the Canadian population, the Australian and British guidelines were the most effective, potentially avoiding the most deaths over five years (> 15,000 deaths). The New Zealand guideline was the most efficient, potentially avoiding almost as many deaths (14,700) while recommending treatment to the fewest number of people (12.9% of people v 17.3% with the Australian and British guidelines). If their "optional" recommendations are included, the US guidelines recommended treating about twice as many people as the New Zealand guidelines (24.5% of the population, an additional 1.4 million people) with almost no increase in the number of deaths avoided.
By focusing recommendations on people with the highest risk of coronary heart disease, the Canadian, US, and European societies guidelines could improve either their effectiveness (in terms of hundreds of avoided deaths) or efficiency (in terms of thousands of fewer people recommended treatment) in the Canadian population.
Notes
Cites: Int J Epidemiol. 2004 Apr;33(2):235-915082618
Cites: J Chronic Dis. 1985;38(4):339-513923014
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Cites: JAMA. 1999 Dec 22-29;282(24):2340-610612322
Cites: S Afr Med J. 2000 Feb;90(2 Pt 2):164-74, 176-810745972
Cites: JAMA. 2000 Jun 14;283(22):2935; author reply 293610865266
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Cites: JAMA. 2001 Jul 11;286(2):180-711448281
Cites: Med J Aust. 2001 Nov 5;175 Suppl:S57-8511758552
Cites: Lancet. 2002 Jul 6;360(9326):7-2212114036
Cites: CMAJ. 1992 Jun 1;146(11):1969-741596846
Cites: Circulation. 1998 May 12;97(18):1837-479603539
Cites: J Clin Epidemiol. 1999 Jan;52(1):49-559973073
Cites: Can J Cardiol. 1999 Apr;15(4):445-5110322254
Cites: JAMA. 2002 Jul 24-31;288(4):462-712132976
Cites: J Atheroscler Thromb. 2002;9(1):1-2712238634
Cites: Eur Heart J. 2003 Jun;24(11):987-100312788299
Cites: Eur Heart J. 2003 Sep;24(17):1601-1012964575
Cites: Can J Cardiol. 2003 Oct;19(11):1249-5914571310
Cites: CMAJ. 2003 Oct 28;169(9):921-414581310
Cites: JAMA. 2003 Nov 5;290(17):2243-514600168
Cites: Can J Cardiol. 2003 Nov;19(12):1359-6614631469
Cites: Am J Med. 2004 Apr 15;116(8):540-515063816
Comment In: BMJ. 2006 Jun 17;332(7555):142216737981
Comment In: BMJ. 2006 Jul 1;333(7557):4616809724
PubMed ID
16737980 View in PubMed
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High-cost users of Ontario's healthcare services.

https://arctichealth.org/en/permalink/ahliterature107860
Source
Healthc Policy. 2013 Aug;9(1):44-51
Publication Type
Article
Date
Aug-2013
Author
Saad Rais
Amir Nazerian
Sten Ardal
Yuriy Chechulin
Namrata Bains
Kamil Malikov
Author Affiliation
Methodologist, Health Analytics Branch, Ontario Ministry of Health and Long-Term Care, Toronto, ON.
Source
Healthc Policy. 2013 Aug;9(1):44-51
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Child
Child, Preschool
Emergency Service, Hospital - economics - utilization
Female
Health Care Costs - statistics & numerical data
Health Services - economics - utilization
Hospitalization - economics - statistics & numerical data
Humans
Infant
Infant, Newborn
Male
Middle Aged
Ontario - epidemiology
Sex Factors
Young Adult
Abstract
Approximately 1.5% of ontario's population, represented by the top 5% highest cost-incurring users of ontario's hospital and home care services, account for 61% of hospital and home care costs. Similar studies from other jurisdictions also show that a relatively small number of people use a high proportion of health system resources. Understanding these high-cost users (hcus) can inform local healthcare planners in their efforts to improve the quality of care and reduce burden on patients and the healthcare system. To facilitate this understanding, we created a profile of hcus using demographic and clinical characteristics. The profile provides detailed information on hcus by care type, geography, age, sex and top clinical conditions.
Notes
Cites: J Health Serv Res Policy. 2003 Oct;8(4):215-2414596756
Cites: JAMA. 2012 Mar 14;307(10):1037-4522416099
PubMed ID
23968673 View in PubMed
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Hospital standardized mortality ratio: the way forward in Ontario.

https://arctichealth.org/en/permalink/ahliterature155912
Source
Healthc Pap. 2008;8(4):43-9; discussion 69-75
Publication Type
Article
Date
2008
Author
John McKinley
Debbie Gibson
Sten Ardal
Author Affiliation
Ministry of Health and Long-Term Care, Health System Information Management and Investment.
Source
Healthc Pap. 2008;8(4):43-9; discussion 69-75
Date
2008
Language
English
Publication Type
Article
Keywords
Hospital Administration - standards
Hospital Mortality
Humans
Ontario
Palliative Care - statistics & numerical data
Patient Discharge - statistics & numerical data
Quality Assurance, Health Care - organization & administration
Quality Indicators, Health Care - standards
Reproducibility of Results
Safety Management - standards
Abstract
Variations in quality of care persist despite an increased understanding of optimal practice and an improved ability to monitor outcomes. The reporting of hospital standardized mortality ratios (HSMRs) is an important step in highlighting the need to improve quality; but, as with most measures, the HSMR is not without flaws. Intense debate in the United Kingdom and the United States, and now here in Canada, has focused too much on the shortcomings of this measure and not enough on the issue at hand. The Ontario Ministry of Health and Long-Term Care--assuming our commitment to steward the healthcare system--embraces the themes of transparency and accountability as key tools in focusing attention on system performance and quality. The analysis of HSMRs in Ontario has indicated limitations to its interpretation, similar to those observed in the Winnipeg Regional Health Authority. The HSMR may not be a specific measure of adverse events, but this does not negate its usefulness in tracking the impact of quality improvement initiatives over time; it may be considered a valuable tool among a suite of indicators. In light of this, there is an opportunity to develop better statistics, including better data and measurement frameworks, and to educate the public to facilitate accurate interpretation, which will drive improvements in practice, quality and patients' experiences.
Notes
Comment On: Healthc Pap. 2008;8(4):4-518667875
PubMed ID
18667870 View in PubMed
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Regionalization reigns--but is care being delivered accordingly? An evaluation of perinatal care delivery in a regionalized child health network.

https://arctichealth.org/en/permalink/ahliterature167211
Source
Healthc Manage Forum. 2006;19(2):22-6
Publication Type
Article
Date
2006
Author
Shehnaz Alidina
Sten Ardal
Paul Lee
Lynn Raskin
Andrew Shennan
Linda Marie Young
Author Affiliation
Health System Intelligence Project.
Source
Healthc Manage Forum. 2006;19(2):22-6
Date
2006
Language
English
Publication Type
Article
Keywords
Cooperative Behavior
Humans
Infant
Infant Welfare
Medical Audit
Multi-Institutional Systems
Ontario
Perinatal Care - standards
Abstract
The Child Health Network for the Greater Toronto Area (CHN), a network of 20 hospitals and 9 community care access centres, assessed one component of its early progress in building a regionalized system of perinatal care. Focusing on the relationship between hospital level of care and gestational age, the study showed that most births occurred at appropriately designated facilities. However, a quarter of newborns of gestational age
PubMed ID
17017761 View in PubMed
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Under-reporting of live births in Ontario: 1991-1997.

https://arctichealth.org/en/permalink/ahliterature182201
Source
Can J Public Health. 2003 Nov-Dec;94(6):463-7
Publication Type
Article
Author
Graham L Woodward
Monica K Bienefeld
Sten Ardal
Author Affiliation
Central East Health Information Partnership, Toronto, ON.
Source
Can J Public Health. 2003 Nov-Dec;94(6):463-7
Language
English
Publication Type
Article
Keywords
Adult
Birth rate
Documentation - economics
Female
Humans
Infant, Newborn
Maternal Age
Ontario
Registries
Rural Population
Urban Population
Abstract
To examine unregistered births in Ontario and consider related factors, including adoption of administrative fees for birth registration.
Documents from both the parents and the attending physician are required for births to be entered into Ontario's live birth database. Our study used data from the Ontario Registrar General to look at the prevalence and characteristics of unregistered births, and a survey of municipal clerks to identify municipalities charging fees for parental documentation.
The percentage of births going unrecorded increased threefold from 1991 to 1997. The odds of an unregistered birth were higher for teenage mothers, low birthweight babies, and mothers residing in a municipality that charged birth registration fees.
The introduction of registration fees by some municipalities appears to account for an increase in unregistered births. It is recommended that the Ontario Registrar General work to remove financial and administrative barriers that compromise birth statistics.
PubMed ID
14700248 View in PubMed
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7 records – page 1 of 1.