Skip header and navigation

Refine By

33 records – page 1 of 4.

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
Less detail

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
Less detail

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
Less detail

The disconnect between the data and the headlines.

https://arctichealth.org/en/permalink/ahliterature197335
Source
CMAJ. 2000 Aug 22;163(4):411-2
Publication Type
Article
Date
Aug-22-2000
Author
N P Roos
Author Affiliation
Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg. ouelette@ms.umanitoba.ca
Source
CMAJ. 2000 Aug 22;163(4):411-2
Date
Aug-22-2000
Language
English
Publication Type
Article
Keywords
Canada
Health Facility Closure
Health services needs and demand
Health Services for the Aged - utilization
Hospital Restructuring
Humans
Mass Media
Personnel Downsizing
Public Opinion
Notes
Cites: Med Care. 1999 Jun;37(6 Suppl):JS135-5010409005
Cites: CMAJ. 2000 Aug 22;163(4):397-40110976254
Comment In: CMAJ. 2001 Feb 6;164(3):325; author reply 325-711232131
Comment In: CMAJ. 2001 Feb 6;164(3):324-5; author reply 325-711232130
Comment On: CMAJ. 2000 Aug 22;163(4):397-40110976254
PubMed ID
10976256 View in PubMed
Less detail

Does a small minority of elderly account for a majority of health care expenditures? A sixteen-year perspective.

https://arctichealth.org/en/permalink/ahliterature231945
Source
Milbank Q. 1989;67(3-4):347-69
Publication Type
Article
Date
1989
Author
N P Roos
E. Shapiro
R. Tate
Author Affiliation
Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
Source
Milbank Q. 1989;67(3-4):347-69
Date
1989
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cohort Studies
Female
Health Expenditures - statistics & numerical data
Health Services - utilization
Hospitals - utilization
Humans
Length of Stay
Male
Manitoba
Nursing Homes - utilization
Abstract
Canadian and American analysts commonly find that a small proportion of the elderly is responsible for a large share of health care expenditures. Data on a representative cohort in Manitoba indicate that the longer the time frame studied, the less health care usage concentrates in a single small group of elderly people. Over the sixteen-year period treated, the average older person's risks of using hospital and nursing home services is nevertheless notably higher than reported to date; yet, one-half of the elderly make relatively minimal demands on the health care system. The results reinforce calls for targeting the needs of intensive consumers of health care services and highlight the variability of cumulative usage patterns among older Manitobans.
PubMed ID
2517569 View in PubMed
Less detail
Source
Med Care. 1987 Jan;25(1):1-8
Publication Type
Article
Date
Jan-1987
Author
E. Shapiro
R B Tate
N P Roos
Source
Med Care. 1987 Jan;25(1):1-8
Date
Jan-1987
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Female
Hospitalization
Humans
Longitudinal Studies
Male
Manitoba
Mortality
Nursing Homes
Sex Factors
Abstract
This study applies data from the Manitoba Longitudinal Study on Aging for two purposes. First examined were the hospital-utilization patterns of elderly nursing home admissions during the 2 years before and 2 years after entrance into a facility. In addition, use of the hospital by these new admissions and by long-term nursing home residents was compared with that of the use by the elderly living in the community. When age, sex, and mortality rate are taken into account, the results indicate that, although both new admissions and long-term nursing home residents are sicker than their community counterparts, they are significantly less frequently hospitalized.
PubMed ID
3807446 View in PubMed
Less detail

Elderly nonusers of health care services. Their characteristics and their health outcomes.

https://arctichealth.org/en/permalink/ahliterature239090
Source
Med Care. 1985 Mar;23(3):247-57
Publication Type
Article
Date
Mar-1985
Author
E. Shapiro
N P Roos
Source
Med Care. 1985 Mar;23(3):247-57
Date
Mar-1985
Language
English
Publication Type
Article
Keywords
Aged
Ambulatory Care - utilization
Educational Status
Female
Health Services - utilization
Health status
Hospitalization
Humans
Length of Stay
Male
Manitoba
Mental Disorders - epidemiology
Models, Theoretical
Office Visits
Physicians - utilization
Regression Analysis
Risk
Abstract
Sociodemographic, health, and health care utilization data on a large representative sample of elderly and multiple logistic regression were used to compare persons making no visits to physicians for 2 years with those making few (one to three) visits but in contact with health practitioners. Results suggest that elderly nonusers are more likely than low users to be single, to have some degree of mental impairment, and to have low educational attainment. Using Cox's proportional hazards model to compare outcomes over the next 7 years, no differences were found in the subsequent hospitalization rate of the two groups, but nonusers were at greater risk of a hospitalization episode of 16+ days and appeared to die sooner than low users. However, they were at no greater risk of poor health outcomes than elderly making four or more physician visits in 2 years. The policy implications of the findings are discussed.
PubMed ID
3982105 View in PubMed
Less detail

Factors influencing the frequency of visits by hypertensive patients to primary care physicians in Winnipeg.

https://arctichealth.org/en/permalink/ahliterature204042
Source
CMAJ. 1998 Oct 6;159(7):777-83
Publication Type
Article
Date
Oct-6-1998
Author
N P Roos
K C Carrière
D. Friesen
Author Affiliation
Canadian Institute for Advanced Research. ouelette@ms.umanitoba.ca
Source
CMAJ. 1998 Oct 6;159(7):777-83
Date
Oct-6-1998
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Family Practice - statistics & numerical data
Female
Health services needs and demand
Health status
Hospitalization - statistics & numerical data
Humans
Hypertension - therapy
Income - classification
Male
Manitoba
Mental Recall
Middle Aged
Office Visits - statistics & numerical data - utilization
Physician's Practice Patterns - statistics & numerical data
Registries
Regression Analysis
Reproducibility of Results
Retrospective Studies
Urban Population
Utilization Review
Abstract
As part of a recent project focused on needs-based planning for generalist physicians, the authors documented the variety of practice styles of primary care physicians for managing patients with hypertension. They investigated the validity of various explanations for these different styles and the relative contributions of physician and patient characteristics to the rates at which hypertensive patients contact physicians.
Retrospective descriptive study using regression analyses to simultaneously adjust for the influence of key patient and physician characteristics. Hypertensive patients in Winnipeg were identified using Manitoba physician claims data for fiscal years 1993/94 and 1994/95. Patients were included if they were 25 years of age or more and had at least one physician contact in both 1993/94 and 1994/95 during which hypertension was diagnosed. In addition, the primary care physician had to be the physician that the patient contacted most frequently in 1993/94 and 1994/95 and with whom she or he had at least 2 visits during this period. Only patients of family practitioners whose practice included at least 50 hypertensive patients were included.
To control for the effects of large samples and to validate the results, the authors conducted all analyses for half (6282) the sample of hypertensive patients who met the study criteria (12,563). A total of 132 primary care physicians who met the study criteria were identified. The patients made on average 9.3 ambulatory visits to physicians (both general practitioners and specialists) in 1994/95. Those who had more complex medical conditions (i.e., were formally referred to a specialist), those who had 3 or more serious medical problems and those who had been admitted to hospital made more visits to their primary care physician than those without these characteristics. After these and other key patient characteristics were controlled for, a primary care physician's patient recall rate in 1993/94 was strongly related to the number of visits his or her hypertensive patients made to all doctors for any reason in 1994/95. Physicians with high patient recall rates (i.e., who saw their hypertensive patients on average 8 or more times) in 1993/94 also had high recall rates in 1994/95.
Because patient characteristics most strongly associated with high visit rates were those reflecting patient illness, policy measures aimed at patients (e.g., user fees and deinsurance) do not appear to be the appropriate policy tool for dealing with high visit rates. Given the influence of a physician's patient recall rate on patient visit patterns, physician profiling and feedback may prove more appropriate.
Notes
Cites: Med Care. 1991 Aug;29(8):799-8121875746
Cites: Med Care. 1979 Jun;17(6):551-65449431
Cites: Health Serv Res. 1988 Feb;22(6):857-773126165
Cites: Am J Prev Med. 1988 Nov-Dec;4(6):315-263228527
Cites: Annu Rev Public Health. 1990;11:297-3182112916
Cites: JAMA. 1991 Jun 12;265(22):2998-30022033774
Cites: J Clin Epidemiol. 1997 Jun;50(6):711-89250269
Cites: JAMA. 1992 Mar 18;267(11):1478-831538538
Cites: N Engl J Med. 1992 Sep 10;327(11):776-811501654
Cites: N Engl J Med. 1994 Mar 3;330(9):607-128302344
Cites: CMAJ. 1994 Mar 15;150(6):917-218131124
Cites: CMAJ. 1995 Jul 1;153(1):37-427796374
Cites: J Gen Intern Med. 1995 Sep;10(9):495-5038523152
Comment On: CMAJ. 1998 Oct 6;159(7):795-69805026
PubMed ID
9805023 View in PubMed
Less detail

The geriatric long-stay hospital patient: a Canadian case study.

https://arctichealth.org/en/permalink/ahliterature245080
Source
J Health Polit Policy Law. 1981;6(1):49-61
Publication Type
Article
Date
1981
Author
E. Shapiro
N P Roos
Source
J Health Polit Policy Law. 1981;6(1):49-61
Date
1981
Language
English
Publication Type
Article
Keywords
Aged
Home Care Services - utilization
Hospitals - utilization
Humans
Length of Stay - trends
Long-Term Care - organization & administration
Manitoba
Nursing Homes - utilization
Abstract
This article examines the use of acute beds by the elderly in Manitoba over the five-year period, 1972--1976. The analysis reveals that transfers of long-stay (greater than 90 day) elderly to long-term care facilities took longer in 1976 than in 1972 despite major provincial initiatives which included construction of additional long-term treatment beds, expansion of home care resources, and extension of universal insurance coverage to long-term institutional and home care. Analyses of means to reduce long hospital stays prior to transfer suggests that building more long-term beds may be the least desirable policy alternative.
PubMed ID
6790601 View in PubMed
Less detail

Good news about difficult decisions: the Canadian approach to hospital cost control.

https://arctichealth.org/en/permalink/ahliterature204346
Source
Health Aff (Millwood). 1998 Sep-Oct;17(5):239-46
Publication Type
Article

33 records – page 1 of 4.