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Algorithms can be used to identify fragility fracture cases in physician-claims databases.

https://arctichealth.org/en/permalink/ahliterature136865
Source
Osteoporos Int. 2012 Feb;23(2):483-501
Publication Type
Article
Date
Feb-2012
Author
S. Jean
B. Candas
É. Belzile
S. Morin
L. Bessette
S. Dodin
J P Brown
Author Affiliation
National Institute of Public Health of Québec, 945, Wolfe Avenue, Quebec, QC G1V 5B3, Canada. sonia.jean@inspq.qc.ca
Source
Osteoporos Int. 2012 Feb;23(2):483-501
Date
Feb-2012
Language
English
Publication Type
Article
Keywords
Aged
Algorithms
Clinical Coding
Databases, Factual
Fees, Medical - statistics & numerical data
Female
Humans
Incidence
Middle Aged
Osteoporosis, Postmenopausal - complications - epidemiology
Osteoporotic Fractures - epidemiology - etiology
Quebec - epidemiology
Sensitivity and specificity
Abstract
Physician-billing claims databases can be used to determine the incidence of fractures in the community. This study tested three algorithms designed to accurately and reliably identify fractures from a physician-billing claims database and concluded that they were useful for identifying all types of fractures, except vertebral, sacral, and coccyx fractures.
To develop and validate algorithms that identify fracture events from a physician-billing claims database (PCDs).
Three algorithms were developed using physician's specialty, diagnostic, and medical service codes used in a PCD from the province of Quebec. Algorithm validity was assessed via calculation of positive predictive values (PPV; via verification of a sample of algorithm-identified cases with hospitalization files) and sensitivities (via cross-referencing respective algorithm-identified fracture cases with a well-characterized fracture cohort).
PPV and sensitivity varied across fracture sites. For most fracture sites, the PPV with algorithm 3 was higher than with algorithms 1 or 2. Except for knee fracture, the PPVs ranged from 0.81 to 0.96. Sensitivities were low at the vertebral, sacral, and coccyx sites (0.40-0.50), but high at all other fracture sites. For 95% of fractures, the fracture site identified by algorithm agreed with the fracture site from patients' medical records. Fracture dates identified by algorithm were within 2 days of the actual fracture date in 88% of fracture cases. Among cases identified by algorithm 3 to have had an open reduction (N?=?461), 95% underwent surgery according to their respective medical charts.
Algorithms using PCDs are accurate and reliable for identifying incident fractures associated with osteoporosis-related fracture sites. The identification of these fractures in the community is important for helping to estimate the burden associated with osteoporosis and the utility of programs designed to reduce the rates of fragility fracture.
PubMed ID
21336492 View in PubMed
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Childhood asthma surveillance using administrative data: consistency between medical billing and hospital discharge diagnoses.

https://arctichealth.org/en/permalink/ahliterature156742
Source
Can Respir J. 2008 May-Jun;15(4):188-92
Publication Type
Article
Author
France Labrèche
Tom Kosatsky
Raymond Przybysz
Author Affiliation
Montreal Department of Public Health, Montreal, Quebec. france.labreche@inspq.qc.ca
Source
Can Respir J. 2008 May-Jun;15(4):188-92
Language
English
Publication Type
Article
Keywords
Asthma - diagnosis - epidemiology - therapy
Child
Child, Preschool
Cohort Studies
Feasibility Studies
Fees, Medical - statistics & numerical data
Female
Hospitalization - statistics & numerical data
Humans
Infant
Male
Patient Credit and Collection - statistics & numerical data
Population Surveillance - methods
Quebec - epidemiology
Reproducibility of Results
Retrospective Studies
Abstract
The absence of ongoing surveillance for childhood asthma in Montreal, Quebec, prompted the present investigation to assess the validity and practicality of administrative databases as a foundation for surveillance.
To explore the consistency between cases of asthma identified through physician billings compared with hospital discharge summaries.
Rates of service use for asthma in 1998 among Montreal children aged one, four and eight years were estimated. Correspondence between the two databases (physician billing claims versus medical billing claims) were explored during three different time periods: the first day of hospitalization, during the entire hospital stay, and during the hospital stay plus a one-day margin before admission and after discharge ('hospital stay +/- 1 day').
During 1998, 7.6% of Montreal children consulted a physician for asthma at least once and 0.6% were hospitalized with a principal diagnosis of asthma. There were no contemporaneous physician billings for asthma 'in hospital' during hospital stay +/- 1 day for 22% of hospitalizations in which asthma was the primary diagnosis recorded at discharge. Conversely, among children with a physician billing for asthma 'in hospital', 66% were found to have a contemporaneous in-hospital record of a stay for 'asthma'.
Both databases of hospital and medical billing claims are useful for estimating rates of hospitalization for asthma in children. The potential for diagnostic imprecision is of concern, especially if capturing the exact number of uses is more important than establishing patterns of use.
Notes
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PubMed ID
18551199 View in PubMed
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Clinical response of salaried consultants to economic incentives.

https://arctichealth.org/en/permalink/ahliterature199604
Source
Dev Health Econ Public Policy. 1998;6:137-58
Publication Type
Article
Date
1998
Author
T. Iversen
Author Affiliation
University of Oslo, Norway.
Source
Dev Health Econ Public Policy. 1998;6:137-58
Date
1998
Language
English
Publication Type
Article
Keywords
Ambulatory Surgical Procedures - economics - utilization
Decision Making
Fees, Medical - statistics & numerical data
Health Care Costs - statistics & numerical data
Health Priorities - economics
Health Services Research
Hospital Charges - statistics & numerical data
Hospitals, Public - economics - manpower
Humans
Medical Staff, Hospital - economics - statistics & numerical data
Models, Econometric
Motivation
Norway
Operating Rooms - economics - utilization
Patient Selection
Physician's Practice Patterns - economics - statistics & numerical data
Referral and Consultation - economics
Salaries and Fringe Benefits
Sampling Studies
Social Justice
Surgical Procedures, Operative - economics - utilization
Abstract
Several studies have found a relation between economic incentives and physicians' clinical decisions. The bulk of these studies deals with data from private organisations providing medical care. The purpose of the present study is to explore whether a similar relationship is valid in a system where hospital care is provided by salaried physicians in the public sector. A distinction is made between medical and economic prioritysetting. If the relative fees influence the proportion of outpatient surgery or the compositions of treatments, economic prioritysetting is said to take place. Data were collected from a sample of Norwegian hospitals. The main findings of the empirical section can be summarised in two points: (i) Economic prioritysetting seems to be applied in the choice between inpatient and outpatient surgical treatment for patients with an identical diagnosis. (ii) Medical priority setting seems to be applied in the priority among patients with different diagnoses.
PubMed ID
10662401 View in PubMed
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Equity in the delivery of health care in Sweden.

https://arctichealth.org/en/permalink/ahliterature72446
Source
Scand J Soc Med. 1998 Dec;26(4):259-64
Publication Type
Article
Date
Dec-1998
Author
U G Gerdtham
G. Sundberg
Author Affiliation
Centre for Health Economics, Stockholm School of Economics, Uppsala, Sweden. heug@hhs.se
Source
Scand J Soc Med. 1998 Dec;26(4):259-64
Date
Dec-1998
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Delivery of Health Care - standards - utilization
Fees, Medical - statistics & numerical data
Female
Health Care Surveys
Health Policy
Health Services Accessibility - standards
Health Services Needs and Demand - statistics & numerical data
Humans
Income - statistics & numerical data
Male
Middle Aged
Patient Acceptance of Health Care - psychology - statistics & numerical data
Questionnaires
Sweden
Abstract
There is mutual agreement that health care should be delivered according to need. In this article, although we employ different specifications for need, we conclude that there is inequity in the delivery of health care in Sweden. Higher income groups visit doctors more often than lower income groups in relation to need, but lower income groups remain in hospital longer once they have been admitted. These findings may be interpreted to mean that lower income groups, for various reasons, wait too long before visiting a doctor for a specific disease, the consequence being that the disease is so serious by the time the doctor is contacted that inpatient care and a longer time in hospital are necessary. The policy implication of this situation is that lower patient fees and/or higher incomes may help to reduce the inequities in health care.
PubMed ID
9868749 View in PubMed
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Expenditure on health care in obese women with and without sleep apnea.

https://arctichealth.org/en/permalink/ahliterature152448
Source
Sleep. 2009 Feb;32(2):247-52
Publication Type
Article
Date
Feb-2009
Author
Katsuhisa Banno
Clare Ramsey
Randy Walld
Meir H Kryger
Author Affiliation
Sleep Disorders Centre, Kitatsushima Hospital, Inazawa-city, Aichi, Japan.
Source
Sleep. 2009 Feb;32(2):247-52
Date
Feb-2009
Language
English
Publication Type
Article
Keywords
Body mass index
Fees, Medical - statistics & numerical data
Female
Health Care Costs - statistics & numerical data
Health Expenditures - statistics & numerical data
Health Services - economics - utilization
Humans
Manitoba
Middle Aged
Obesity - complications - economics
Obesity Hypoventilation Syndrome - economics - therapy
Referral and Consultation - economics - utilization
Sleep Apnea, Obstructive - economics - therapy
Utilization Review - statistics & numerical data
Abstract
To determine the effect of obesity and sleep apnea on health care expenditure in women over 10 years.
Retrospective observational study
Tertiary university-based medical center
Three groups of age-matched women: 223 obese women with OSAS (body mass index: 39.3 +/- 0.6 kg/m2), and from the general population, 223 obese controls (BMI 36.3 +/- 0.4) and 223 normal weight controls (BMI 23.9 +/- 0.4).
None.
We examined health care utilization in the 3 matched groups for the 10 years leading up to the documentation of OSAS. The mean physician fees and the number of physician visits were significantly higher in obese controls than in normal weight controls during the observed period. Physician fees and physician visits progressively increased in the 10 years before diagnosis in the OSAS cases and were significantly higher than in the matched obese controls. Physician fees, in Canadian dollars, one year before diagnosis in the OSAS cases were higher than in obese controls: $547.49 +/- 34.79 vs $246.85 +/- 20.88 (P
Notes
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Comment In: Sleep. 2009 Feb;32(2):135-619238798
PubMed ID
19238812 View in PubMed
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Factors explaining the increase in cost for physician care in Quebec's elderly population.

https://arctichealth.org/en/permalink/ahliterature210516
Source
CMAJ. 1996 Dec 1;155(11):1555-60
Publication Type
Article
Date
Dec-1-1996
Author
M. Demers
Author Affiliation
Direction des affaires médicales et de l'évaluation des programmes, Régie de l'assurance-maladie du Québec, Sillery.
Source
CMAJ. 1996 Dec 1;155(11):1555-60
Date
Dec-1-1996
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Aged, 80 and over
Fees, Medical - statistics & numerical data - trends
Health Services for the Aged - economics - trends - utilization
Hospitalization - trends
Humans
Quebec
Abstract
To examine what role demographic factors and increases in physician fees and utilization played in the rise in costs of physician services provided for elderly people in Quebec between 1982 and 1992, and to investigate changes in patterns of care (type and amount of services) related to utilization.
Retrospective study of population-based data.
Province of Quebec.
Elderly people (65 years of age and over) in Quebec in 1982 (n = 589,800) and in 1992 (n = 803,600).
Proportion of the increase in physician care costs attributable to (a) aging (defined as a shift in the age distribution) of the elderly population, (b) the increase in the size of the elderly population, (c) the increase in physician fees and (d) the increase in utilization of physician services; proportion of care provided by general practitioners (GPs) and by specialists; proportion of minor and complete examinations provided by GPs; and rates of hospital admissions and surgery.
Aging was responsible for 0.5% of the increase in physician care costs between 1982 and 1992, population growth for 27.0% and the increase in physician fees for 25.5%. The increased utilization accounted for 47.0% of the total cost increase. Analyses of the utilization data revealed a shift toward more costly services, more visits to specialists and higher rates of hospital admissions and surgery in 1992 than in 1982.
Aging and population growth had minor effects on the increase in physician care costs between 1982 and 1992. Increased utilization was the most important factor. The appropriateness of this trend needs to be verified.
Notes
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Comment In: CMAJ. 1996 Dec 1;155(11):1584-68956836
PubMed ID
8956832 View in PubMed
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Fee increases and target income hypothesis: data from Quebec on physicians' compensation and service volumes.

https://arctichealth.org/en/permalink/ahliterature256896
Source
Healthc Policy. 2013 Nov;9(2):30-5
Publication Type
Article
Date
Nov-2013
Author
Damien Contandriopoulos
Mélanie Perroux
Author Affiliation
Associate Professor, Faculté des sciences infirmières, Université de Montréal, Montreal, QC.
Source
Healthc Policy. 2013 Nov;9(2):30-5
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Fees, Medical - statistics & numerical data
Health Expenditures - statistics & numerical data
Humans
Income - statistics & numerical data
Models, Economic
Physicians - economics
Quebec - epidemiology
Abstract
Recent years have witnessed important public investments in physicians' compensation across Canada. The current paper uses data from Quebec to assess the impact of those investments on the volumes of services provided to the population. While total physician compensation costs, average physician compensation and average unit cost per service all rose extremely fast, the total number of services, number of services per capita and average number of services per physician either stagnated or declined. This pattern is compatible with the economic target income hypothesis and raises important policy questions.
PubMed ID
24359715 View in PubMed
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23 records – page 1 of 3.