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Antipsychotic drug use and mortality in older adults with dementia.

https://arctichealth.org/en/permalink/ahliterature163191
Source
Ann Intern Med. 2007 Jun 5;146(11):775-86
Publication Type
Article
Date
Jun-5-2007
Author
Sudeep S Gill
Susan E Bronskill
Sharon-Lise T Normand
Geoffrey M Anderson
Kathy Sykora
Kelvin Lam
Chaim M Bell
Philip E Lee
Hadas D Fischer
Nathan Herrmann
Jerry H Gurwitz
Paula A Rochon
Author Affiliation
Queen's University, Kingston, Ontario, Canada.
Source
Ann Intern Med. 2007 Jun 5;146(11):775-86
Date
Jun-5-2007
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Antipsychotic Agents - therapeutic use
Dementia - drug therapy - mortality
Female
Humans
Male
Matched-Pair Analysis
Ontario - epidemiology
Risk assessment
Sensitivity and specificity
Time Factors
Abstract
Antipsychotic drugs are widely used to manage behavioral and psychological symptoms in dementia despite concerns about their safety.
To examine the association between treatment with antipsychotics (both conventional and atypical) and all-cause mortality.
Population-based, retrospective cohort study.
Ontario, Canada.
Older adults with dementia who were followed between 1 April 1997 and 31 March 2003.
The risk for death was determined at 30, 60, 120, and 180 days after the initial dispensing of antipsychotic medication. Two pairwise comparisons were made: atypical versus no antipsychotic use and conventional versus atypical antipsychotic use. Groups were stratified by place of residence (community or long-term care). Propensity score matching was used to adjust for differences in baseline health status.
A total of 27,259 matched pairs were identified. New use of atypical antipsychotics was associated with a statistically significant increase in the risk for death at 30 days compared with nonuse in both the community-dwelling cohort (adjusted hazard ratio, 1.31 [95% CI, 1.02 to 1.70]; absolute risk difference, 0.2 percentage point) and the long-term care cohort (adjusted hazard ratio, 1.55 [CI, 1.15 to 2.07]; absolute risk difference, 1.2 percentage points). Excess risk seemed to persist to 180 days, but unequal rates of censoring over time may have affected these results. Relative to atypical antipsychotic use, conventional antipsychotic use was associated with a higher risk for death at all time points. Sensitivity analysis revealed that unmeasured confounders that increase the risk for death could diminish or eliminate the observed associations.
Information on causes of death was not available. Many patients did not continue their initial treatments after 1 month of therapy. Unmeasured confounders could affect associations.
Atypical antipsychotic use is associated with an increased risk for death compared with nonuse among older adults with dementia. The risk for death may be greater with conventional antipsychotics than with atypical antipsychotics.
Notes
Comment In: Evid Based Ment Health. 2008 May;11(2):5418441143
SummaryForPatientsIn: Ann Intern Med. 2007 Jun 5;146(11):I5217548405
PubMed ID
17548409 View in PubMed
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Antipsychotics and mortality in Parkinsonism.

https://arctichealth.org/en/permalink/ahliterature127644
Source
Am J Geriatr Psychiatry. 2012 Feb;20(2):149-58
Publication Type
Article
Date
Feb-2012
Author
Connie Marras
Andrea Gruneir
Xuesong Wang
Hadas Fischer
Sudeep S Gill
Nathan Herrmann
Geoffrey M Anderson
Christopher Hyson
Paula A Rochon
Author Affiliation
Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, ON, Canada. cmarras@uhnresearch.ca
Source
Am J Geriatr Psychiatry. 2012 Feb;20(2):149-58
Date
Feb-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Antipsychotic Agents - adverse effects - therapeutic use
Benzodiazepines - adverse effects - therapeutic use
Case-Control Studies
Cohort Studies
Dibenzothiazepines - adverse effects - therapeutic use
Female
Humans
Male
Ontario - epidemiology
Parkinsonian Disorders - complications - drug therapy - mortality
Psychotic Disorders - drug therapy - etiology - mortality
Retrospective Studies
Risk
Risperidone - adverse effects - therapeutic use
Abstract
: The use of antipsychotic medications is associated with an increased risk of death in older adults with dementia. The risk of death in patients with preexisting parkinsonism who receive antipsychotic drugs is not known.
: Using a nested case-control design, we examined the risk of death within 30 days of newly starting antipsychotic medications among people with Parkinsonism aged 70 years and older in Ontario, Canada. Data were obtained from Ontario's healthcare administrative databases.
: Among 5,391 individuals with parkinsonism who died during the study period (2002-2008) and a matched comparison group of 25,937 who were still alive, individuals exposed to atypical antipsychotic drugs had a higher risk of death (unadjusted odds ratio [OR] = 2.8, 95% CI: 2.1-3.8, adjusted OR: 2.0, 95% CI: 1.4-2.7). Results were similar for quetiapine use compared with no antipsychotic use (unadjusted OR: 2.5, 95% CI: 1.6-4.0, adjusted OR = 1.8, 95% CI: 1.1-3.0). Typical antipsychotics were associated with an increased odds of death compared with atypical antipsychotics (unadjusted OR = 2.4, 95% CI 1.1-5.2, adjusted OR = 2.4, 95% CI: 1.1-5.7).
: Individuals with parkinsonism who are newly prescribed antipsychotic medications have a higher risk of death within 30 days than those who do not start these medications. Although it is not possible to establish causality, the results suggest an increased risk. It is important to be vigilant for accompanying serious medical conditions that may increase mortality in individuals requiring treatment with antipsychotics and to consider alternative approaches to treating psychosis, agitation, and aggression in this population.
PubMed ID
22273735 View in PubMed
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Association between evidence-based standardized protocols in emergency departments with childhood asthma outcomes: a Canadian population-based study.

https://arctichealth.org/en/permalink/ahliterature122760
Source
Arch Pediatr Adolesc Med. 2012 Sep;166(9):834-40
Publication Type
Article
Date
Sep-2012
Author
Patricia Li
Teresa To
Patricia C Parkin
Geoffrey M Anderson
Astrid Guttmann
Author Affiliation
Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Source
Arch Pediatr Adolesc Med. 2012 Sep;166(9):834-40
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Asthma - therapy
Child
Child, Preschool
Clinical Protocols
Emergency Service, Hospital - statistics & numerical data
Emergency Treatment - methods
Evidence-Based Medicine
Female
Hospitalization - statistics & numerical data
Humans
Male
Ontario
Patient Acceptance of Health Care - statistics & numerical data
Retrospective Studies
Abstract
To determine whether children treated in emergency departments (EDs) with evidence-based standardized protocols (EBSPs) containing evidence-based content and format had lower risk of hospital admission or ED return visit and greater follow-up than children treated in EDs with no standardized protocols in Ontario, Canada.
Retrospective population-based cohort study of children with asthma. We used multivariable logistic regression to estimate risk of outcomes.
All EDs in Ontario (N = 146) treating childhood asthma from April 2006 to March 2009.
Thirty-one thousand one hundred thirty-eight children (aged 2 to 17 years) with asthma. MAIN EXPOSURE Type of standardized protocol (EBSPs, other standardized protocols, or none).
Hospital admission, high-acuity 7-day return visit to the ED, and 7-day outpatient follow-up visit. RESULTS The final cohort made 46 510 ED visits in 146 EDs. From the index ED visit, 4211 (9.1%) were admitted to the hospital. Of those discharged, 1778 (4.2%) and 7350 (17.4%) had ED return visits and outpatient follow-up visits, respectively. The EBSPs were not associated with hospitalizations, return visits, or follow-up (adjusted odds ratio, 1.17 [95% CI, 0.91-1.49]; adjusted odds ratio, 1.10 [95% CI, 0.86-1.41]; and adjusted odds ratio, 1.08 [95% CI, 0.87-1.35], respectively).
The EBSPs were not associated with improvements in rates of hospital admissions, return visits to the ED, or follow-up. Our findings suggest the need to address gaps linking improved processes of asthma care with outcomes.
PubMed ID
22776991 View in PubMed
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Benzodiazepine use among older adults with chronic obstructive pulmonary disease: a population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature116701
Source
Drugs Aging. 2013 Mar;30(3):183-92
Publication Type
Article
Date
Mar-2013
Author
Nicholas T Vozoris
Hadas D Fischer
Xuesong Wang
Geoffrey M Anderson
Chaim M Bell
Andrea S Gershon
Anne L Stephenson
Sudeep S Gill
Paula A Rochon
Author Affiliation
Division of Respirology, Department of Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. nick.vozoris@utoronto.ca
Source
Drugs Aging. 2013 Mar;30(3):183-92
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Benzodiazepines - therapeutic use
Cohort Studies
Drug Utilization - statistics & numerical data
Female
Humans
Logistic Models
Male
Ontario
Pulmonary Disease, Chronic Obstructive - drug therapy
Abstract
Patients with chronic obstructive pulmonary disease (COPD) may receive benzodiazepines for a variety of reasons, including as treatment for insomnia, as treatment for depression and anxiety, and to help relieve refractory dyspnoea. However, benzodiazepines have been linked to adverse physiological respiratory outcomes in individuals with COPD. The potential adverse respiratory effects of benzodiazepines in COPD may also be heightened in older adults given their altered pharmacokinetics that increase benzodiazepine half-life. There is minimal information on the scope and nature of benzodiazepine use in the older adult COPD population.
The purpose of this study was to describe patterns of benzodiazepine use among older adults with COPD.
A validated algorithm was applied to Ontario healthcare administrative data to identify older adults with COPD. Incident oral benzodiazepine receipt between 1 April 2004 and 31 March 2009, defined as no benzodiazepines dispensed in the year prior to incident prescription, was examined. Regression techniques were used to identify patient characteristics associated with new benzodiazepine use. Descriptive statistics were performed to describe benzodiazepine use among new users. The analysis was stratified by COPD severity defined by COPD exacerbation frequency (less severe COPD: 0 exacerbations in the year prior; more severe COPD: 1 or more exacerbations in the year prior).
Among 111,445 older adults with COPD, 35,311 (31.7 %) received a new benzodiazepine. New benzodiazepine receipt was higher among individuals with more severe COPD (adjusted odds ratio 1.43, 95 % CI 1.38-1.48). Among new benzodiazepine users, there was a relatively high frequency of receipt of long-acting agents (14.6 %), dispensations for greater than 30 days (32.6 %), second dispensations (22.0 % or 30.6 % for occurrence within 120 % or 200 % days of the index prescription, respectively), early refills (11.6 %), and benzodiazepine receipt during COPD exacerbations (9.0 %). Among individuals with more severe COPD, 35.4 % of incident use occurred during a COPD exacerbation.
Almost one-third of older individuals with COPD received a new benzodiazepine, and rates were higher among those with more severe COPD. Important safety and quality of care issues are potentially raised by the degree and pattern of benzodiazepine use in this older and respiratory-vulnerable population.
PubMed ID
23371396 View in PubMed
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Case selection for statins was similar in two Canadian provinces: BC and Ontario.

https://arctichealth.org/en/permalink/ahliterature166136
Source
J Clin Epidemiol. 2007 Jan;60(1):73-8
Publication Type
Article
Date
Jan-2007
Author
J Michael Paterson
Greg Carney
Geoffrey M Anderson
Ken Bassett
Gary Naglie
Andreas Laupacis
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. paterson@ices.on.ca
Source
J Clin Epidemiol. 2007 Jan;60(1):73-8
Date
Jan-2007
Language
English
Publication Type
Article
Keywords
Aged
British Columbia - epidemiology
Coronary Disease - epidemiology - etiology - prevention & control
Drug Prescriptions - statistics & numerical data
Drug Utilization - statistics & numerical data
Epidemiologic Methods
Female
Hospitalization - statistics & numerical data
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage - therapeutic use
Hyperlipidemias - complications - drug therapy - epidemiology
Male
Ontario - epidemiology
Patient Selection
Physician's Practice Patterns - statistics & numerical data
Abstract
Though statins are fully reimbursed by the public drug programs for seniors in British Columbia (BC) and Ontario, Canada, population-based rates of statin prescription are markedly higher in Ontario. We aimed to assess whether new statin users in BC and Ontario differ in terms of their risk for future coronary heart disease (CHD) events.
We collected information for 1998-2001 on demographics, outpatient prescriptions, physician visits, hospital admissions, and vital status from administrative databases to compare the proportions of new statin users aged 66 years and older who had evidence of an acute coronary syndrome (ACS), chronic CHD, neither ACS nor CHD but diabetes, or none of the above.
Approximately 15% and 20% of BC and Ontario seniors, respectively, had filled a statin prescription by 2001. Among new statin users in the two provinces, virtually identical proportions had evidence of ACS (8%), chronic CHD (25%), and diabetes (14%), for an overall proportion of roughly 50% at high risk for CHD events.
New statin users in BC and Ontario were at similar risk for future CHD events. Poorer case selection is unlikely to explain the relatively higher rates of statin prescription in Ontario.
PubMed ID
17161757 View in PubMed
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Changes in rates of upper gastrointestinal hemorrhage after the introduction of cyclooxygenase-2 inhibitors in British Columbia and Ontario.

https://arctichealth.org/en/permalink/ahliterature166254
Source
CMAJ. 2006 Dec 5;175(12):1535-8
Publication Type
Article
Date
Dec-5-2006
Author
Muhammad Mamdani
Leanne Warren
Alex Kopp
J Michael Paterson
Andreas Laupacis
Ken Bassett
Geoffrey M Anderson
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Source
CMAJ. 2006 Dec 5;175(12):1535-8
Date
Dec-5-2006
Language
English
Publication Type
Article
Keywords
Aged
Anti-Inflammatory Agents, Non-Steroidal - adverse effects - therapeutic use
British Columbia - epidemiology
Cross-Sectional Studies
Cyclooxygenase Inhibitors - adverse effects - therapeutic use
Female
Gastrointestinal Hemorrhage - chemically induced - epidemiology
Health Policy
Hospitalization - statistics & numerical data
Humans
Male
Ontario - epidemiology
Prevalence
Retrospective Studies
Abstract
Population rates of upper gastrointestinal (GI) hemorrhage have been observed to increase with the introduction and rapid uptake of selective cyclooxygenase-2 (COX-2) inhibitors. Changes in COX-2 inhibitor use and upper GI bleeding rates in regions with relatively restrictive drug policies (e.g., British Columbia) have not been compared with changes in regions with relatively less restrictive drug policies (e.g., Ontario).
We collected administrative data for about 1.4 million people aged 66 years and older in British Columbia and Ontario for the period January 1996 to November 2002. We examined temporal changes in the prevalence of NSAID use and admissions to hospital because of upper GI hemorrhage in both provinces using cross-sectional time series analysis.
During the period studied, the prevalence of NSAID use in British Columbia's population of older people increased by 25% (from 8.7% to 10.9%; p
Notes
Cites: N Engl J Med. 2000 Nov 23;343(21):1520-8, 2 p following 152811087881
Cites: BMJ. 2002 Sep 21;325(7365):62412242172
Cites: Epidemiology. 1996 Jan;7(1):101-48664388
Cites: Pharmacoepidemiol Drug Saf. 2004 Mar;13(3):153-715072114
Cites: BMJ. 2004 Jun 12;328(7453):1415-615138157
Cites: CMAJ. 2002 Nov 12;167(10):1125-612427703
PubMed ID
17146090 View in PubMed
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Comparative ability of comorbidity classification methods for administrative data to predict outcomes in patients with chronic obstructive pulmonary disease.

https://arctichealth.org/en/permalink/ahliterature119243
Source
Ann Epidemiol. 2012 Dec;22(12):881-7
Publication Type
Article
Date
Dec-2012
Author
Peter C Austin
Matthew B Stanbrook
Geoffrey M Anderson
Alice Newman
Andrea S Gershon
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. peter.austin@ices.on.ca
Source
Ann Epidemiol. 2012 Dec;22(12):881-7
Date
Dec-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cause of Death
Comorbidity
Comparative Effectiveness Research
Databases, Factual
Diagnosis-Related Groups
Female
Hospitalization - statistics & numerical data
Humans
Incidence
Logistic Models
Male
Middle Aged
Mortality - trends
Ontario - epidemiology
Predictive value of tests
Prevalence
Prognosis
Pulmonary Disease, Chronic Obstructive - epidemiology
ROC Curve
Retrospective Studies
Abstract
Administrative healthcare databases are used for health services research, comparative effectiveness studies, and measuring quality of care. Adjustment for comorbid illnesses is essential to such studies. Validation of methods to account for comorbid illnesses in administrative data for patients with chronic obstructive pulmonary disease (COPD) has been limited. Our objective was to compare the ability of the Charlson index, the Elixhauser method, and the Johns Hopkins' Aggregated Diagnosis Groups (ADGs) to predict outcomes in patients with COPD.
Retrospective cohorts constructed using population-based administrative data of patients with incident (n = 216,735) and prevalent (n = 638,926) COPD in Ontario, Canada, were divided into derivation and validation datasets. The primary outcome was all-cause death within 1 year. Secondary outcomes included all-cause hospitalization, COPD-specific hospitalization, non-COPD hospitalization, and COPD exacerbations.
In both the incident and prevalent COPD cohorts, the three methods had comparable discrimination for predicting mortality (c-statistics in the validation sample of incident patients of 0.819 for the Charlson method versus 0.822 for the Elixhauser method versus 0.830 for the ADG method). All three methods had lower predictive accuracy for predicting nonfatal outcomes.
In a disease-specific cohort of COPD patients, all three methods allowed for accurate prediction of mortality, with the Johns Hopkins ADGs having marginally higher discrimination.
PubMed ID
23121992 View in PubMed
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Current prescription patterns and safety profile of irreversible monoamine oxidase inhibitors: a population-based cohort study of older adults.

https://arctichealth.org/en/permalink/ahliterature147770
Source
J Clin Psychiatry. 2009 Dec;70(12):1681-6
Publication Type
Article
Date
Dec-2009
Author
Kenneth I Shulman
Hadas D Fischer
Nathan Herrmann
Cindy Yan Huo
Geoffrey M Anderson
Paula A Rochon
Author Affiliation
Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, M4N 3M5, Canada. ken.shulman@sunnybrook.ca
Source
J Clin Psychiatry. 2009 Dec;70(12):1681-6
Date
Dec-2009
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Antidepressive Agents - adverse effects - therapeutic use
Cohort Studies
Depressive Disorder - drug therapy - psychology
Depressive Disorder, Major - drug therapy - psychology
Drug Interactions
Drug Prescriptions - statistics & numerical data
Drug Therapy, Combination
Drug Utilization - statistics & numerical data
Emergency Service, Hospital - statistics & numerical data
Female
Hospitalization - statistics & numerical data
Humans
Hypertension - chemically induced
Longitudinal Studies
Male
Monoamine Oxidase Inhibitors - adverse effects - therapeutic use
Ontario
Physician's Practice Patterns - statistics & numerical data
Safety
Serotonin Syndrome - chemically induced
Abstract
To determine the prescription pattern and safety profile for irreversible monoamine oxidase inhibitors (MAOIs) in older adults over the past decade.
A population-based observational cohort study of older adults was conducted from January 1, 1997, to April 14, 2007, utilizing large administrative health care databases in Ontario, Canada. We examined the prevalence and incidence of irreversible MAOI use, as well as the frequency of coprescribing of MAOIs with contraindicated medications such as serotonergic and sympathomimetic drugs. We reviewed the most responsible diagnosis of emergency department (ED) visits and acute care admissions to assess for serious adverse events that may occur during MAOI treatment (ie, serotonin syndrome and hypertensive crisis).
Over a 10-year period, there were 348 new users of irreversible MAOIs. The majority of patients showed a previous treatment pattern consistent with recurrent major depressive disorder, including prior use of antidepressant treatment and electroconvulsive therapy. The yearly incidence of MAOI prescriptions remained low and decreased from a rate of 3.1/100,000 to 1.4/100,000. Concomitant exposure to at least 1 serotonergic drug occurred in 18.1% of patients treated with an MAOI. No ED visits or acute care admissions for serotonin syndrome or hypertensive crisis were identified.
The low prescription rate of MAOIs is not consistent with the continued recommendation of MAOIs by expert opinion leaders and consensus guidelines for use in atypical depression and treatment-refractory depression. While their use appeared safe, heightened awareness of the potential risk of concomitant use of serotonergic agents is necessary. Relative underuse of the MAOIs for a significant subgroup of depressed patients with atypical and treatment-refractory depression remains a concern.
PubMed ID
19852903 View in PubMed
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Demographic characteristics and healthcare use of centenarians: a population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature105434
Source
J Am Geriatr Soc. 2014 Jan;62(1):86-93
Publication Type
Article
Date
Jan-2014
Author
Paula A Rochon
Andrea Gruneir
Wei Wu
Sudeep S Gill
Susan E Bronskill
Dallas P Seitz
Chaim M Bell
Hadas D Fischer
Anne L Stephenson
Xuesong Wang
Andrea S Gershon
Geoffrey M Anderson
Author Affiliation
Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Source
J Am Geriatr Soc. 2014 Jan;62(1):86-93
Date
Jan-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Demography
Emergency Service, Hospital - utilization
Female
Health Services for the Aged - utilization
Hospitalization - statistics & numerical data
Humans
Male
Ontario
Primary Health Care - utilization
Retrospective Studies
Socioeconomic Factors
Abstract
To better understand how centenarians use the healthcare system as an important step toward improving their service delivery.
Population-based retrospective cohort study using linked health administrative data.
Ontario--Canada's largest province.
All individuals living in Ontario aged 65 and older on April 1 of each year between 1995 and 2010 were identified and divided into three age groups (65-84, 85-99, = 100). A detailed description was obtained on 1,842 centenarians who were alive on April 1, 2010.
Sociodemographic characteristics and use of health services.
The number of centenarians increased from 1,069 in 1995 to 1,842 in 2010 (72.3%); 6.7% were aged 105 and older. Over the same period, the number of individuals aged 85 to 99 grew from 119,955 to 227,703 (89.8%). Women represented 85.3% of all centenarians and 89.4% of those aged 105 and older. Almost half of centenarians lived in the community (20.0% independently, 25.3% with publicly funded home care). Preventive drug therapies (bisphosphonates and statins) were frequently dispensed. In the preceding year, 18.2% were hospitalized and 26.6% were seen in an emergency department. More than 95% saw a primary care provider, and 5.3% saw a geriatrician.
The number of centenarians in Ontario increased by more than 70% over the last 15 years, with even greater growth among older people who could soon become centenarians. Almost half of centenarians live in the community, most are women, and almost all receive care from a primary care physician.
PubMed ID
24383610 View in PubMed
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Development of measures of the quality of emergency department care for children using a structured panel process.

https://arctichealth.org/en/permalink/ahliterature168484
Source
Pediatrics. 2006 Jul;118(1):114-23
Publication Type
Article
Date
Jul-2006
Author
Astrid Guttmann
Asma Razzaq
Patty Lindsay
Brandon Zagorski
Geoffrey M Anderson
Author Affiliation
Institute for Clinical Evaluative Sciences, G Wing, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5. astrid.guttmann@ices.on.ca
Source
Pediatrics. 2006 Jul;118(1):114-23
Date
Jul-2006
Language
English
Publication Type
Article
Keywords
Adolescent
Ankle Injuries - epidemiology
Asthma - epidemiology
Bronchiolitis - epidemiology
Child
Child, Preschool
Consensus
Delphi Technique
Diabetes Mellitus - epidemiology
Emergency Service, Hospital - standards - utilization
Female
Gastroenteritis - epidemiology
Humans
Infant
Male
Ontario
Outcome and Process Assessment (Health Care)
Quality Indicators, Health Care
Urinary Tract Infections - epidemiology
Abstract
Performance measures are essential components of public reporting and quality improvement. To date, few such measures exist to provide a comprehensive assessment of the quality of emergency department services for children.
Our goal was to use a systematic process to develop measures of emergency department care for children (0-19 years) that are (1) based on research evidence and expert opinion, (2) representative of a range of conditions treated in most emergency departments, (3) related to links between processes and outcomes, and (4) feasible to measure.
We presented a panel of providers and managers data from emergency department use to identify common conditions across levels of patient acuity, which could be targets for quality improvement. We used a structured panel process informed by a literature review to (1) identify condition-specific links between processes of care and defined outcomes and (2) select indicators to assess these process-outcome links. We determined the feasibility of calculating these indicators using an administrative data set of emergency department visits for Ontario, Canada.
The panel identified 18 clinical conditions for indicator development and 61 condition-specific links between processes of care and outcomes. After 2 rounds of ratings, the panel defined 68 specific clinical indicators for the following conditions: adolescent mental health problems, ankle injury, asthma, bronchiolitis, croup, diabetes, fever, gastroenteritis, minor head injury, neonatal jaundice, seizures, and urinary tract infections. Visits for these conditions account for 23% of all pediatric emergency department use. Using an administrative data set, we were able to calculate 19 indicators, covering 9 conditions, representing 20% of all emergency department visits by children.
Using a structured panel process, data on emergency department use, and literature review, it was possible to define indicators of emergency department care for children. The feasibility of these indicators will depend on the availability of high-quality data.
PubMed ID
16818556 View in PubMed
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39 records – page 1 of 4.