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81 records – page 1 of 9.

Analysis of an addictions treatment system.

https://arctichealth.org/en/permalink/ahliterature239760
Source
Eval Program Plann. 1985;8(4):331-7
Publication Type
Article
Date
1985
Author
K. Graham
R C Brook
Source
Eval Program Plann. 1985;8(4):331-7
Date
1985
Language
English
Publication Type
Article
Keywords
Alcoholism - rehabilitation
Canada
Evaluation Studies as Topic
Female
Humans
Male
Outcome and Process Assessment (Health Care) - methods
Statistics as Topic
Substance-Related Disorders - rehabilitation
Abstract
A treatment system consisting of an assessment/referral service, a detox, a mission, a hospital recovery unit, and three recovery homes was examined using a retrospective client-tracking approach over 1 year. There were 4,187 admissions to the system accounted for by 1,522 individuals; system users tended to be males, unmarried, unemployed, and in their 30s and 40s. The best predictor of readmission to the system after treatment was prior system use. Use patterns and referral data indicated that perceived gatekeepers (i.e., detoxication and assessment services) were not consistently coordinating the system and that more socially stable clients appeared to be more likely to be involved with non-addiction specific services (i.e., medical, general counselling).
PubMed ID
10317735 View in PubMed
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An integrated knowledge translation experience: use of the Network of Pediatric Audiologists of Canada to facilitate the development of the University of Western Ontario Pediatric Audiological Monitoring Protocol (UWO PedAMP v1.0).

https://arctichealth.org/en/permalink/ahliterature128523
Source
Trends Amplif. 2011 Mar-Jun;15(1):34-56
Publication Type
Article
Author
Sheila T Moodie
Marlene P Bagatto
Linda T Miller
Anita Kothari
Richard Seewald
Susan D Scollie
Author Affiliation
National Centre for Audiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada. sheila@nca.uwo.ca
Source
Trends Amplif. 2011 Mar-Jun;15(1):34-56
Language
English
Publication Type
Article
Keywords
Age Factors
Audiology
Canada
Child
Child, Preschool
Correction of Hearing Impairment
Diffusion of Innovation
Evidence-Based Practice
Hearing Aids
Hearing Disorders - diagnosis
Humans
Infant
Infant, Newborn
Knowledge Bases
Outcome and Process Assessment (Health Care) - methods
Persons With Hearing Impairments - rehabilitation
Questionnaires
Abstract
Pediatric audiologists lack evidence-based, age-appropriate outcome evaluation tools with well-developed normative data that could be used to evaluate the auditory development and performance of children aged birth to 6 years with permanent childhood hearing impairment. Bagatto and colleagues recommend a battery of outcome tools that may be used with this population. This article provides results of an evaluation of the individual components of the University of Western Ontario Pediatric Audiological Monitoring Protocol (UWO PedAMP) version 1.0 by the audiologists associated with the Network of Pediatric Audiologists of Canada. It also provides information regarding barriers and facilitators to implementing outcome measures in clinical practice. Results indicate that when compared to the Parents' Evaluation of Aural/Oral Performance of Children (PEACH) Diary, audiologists found the PEACH Rating Scale to be a more clinically feasible evaluation tool to implement in practice from a time, task, and consistency of use perspective. Results also indicate that the LittlEARS(®) Auditory Questionnaire could be used to evaluate the auditory development and performance of children aged birth to 6 years with permanent childhood hearing impairment (PCHI). The most cited barrier to implementation is time. The result of this social collaboration was the creation of a knowledge product, the UWO PedAMP v1.0, which has the potential to be useful to audiologists and the children and families they serve.
PubMed ID
22194315 View in PubMed
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An occupational health intervention programme for workers at high risk for sickness absence. Cost effectiveness analysis based on a randomised controlled trial.

https://arctichealth.org/en/permalink/ahliterature160853
Source
Occup Environ Med. 2008 Apr;65(4):242-8
Publication Type
Article
Date
Apr-2008
Author
S. Taimela
S. Justén
P. Aronen
H. Sintonen
E. Läärä
A. Malmivaara
J. Tiekso
T. Aro
Author Affiliation
Evalua International, PO Box 35, FIN-01531 Vantaa, Finland. simo.taimela@evalua.fi
Source
Occup Environ Med. 2008 Apr;65(4):242-8
Date
Apr-2008
Language
English
Publication Type
Article
Keywords
Absenteeism
Adolescent
Adult
Cost-Benefit Analysis
Female
Finland
Health Care Costs - statistics & numerical data
Health Resources - utilization
Humans
Male
Middle Aged
Occupational Health - statistics & numerical data
Occupational Health Services - economics - methods
Outcome and Process Assessment (Health Care) - methods
Risk assessment
Sick Leave - economics - statistics & numerical data
Abstract
To determine whether, from a healthcare perspective, a specific occupational health intervention is cost effective in reducing sickness absence when compared with usual care in occupational health in workers with high risk of sickness absence.
Economic evaluation alongside a randomised controlled trial. 418 workers with high risk of sickness absence from one corporation were randomised to intervention (n = 209) or to usual care (n = 209). The subjects in the intervention group were invited to occupational health service for a consultation. The intervention included, if appropriate, a referral to specialist treatment. Register data of sickness absence were available for 384 subjects and questionnaire data on healthcare costs from 272 subjects. Missing direct total cost data were imputed using a two-part regression model. Primary outcome measures were sickness absence days and direct healthcare costs up to 12 months after randomisation. Cost effectiveness (CE) was expressed as an incremental CE ratio, CE plane and CE acceptability curve with both available direct total cost data and missing total cost data imputed.
After one year, the mean of sickness absence was 30 days in the usual care group (n = 192) and 11 days less (95% CI 1 to 20 days) in the intervention group (n = 192). Among the employees with available cost data, the mean days of sickness absence were 22 and 24, and the mean total cost euro974 and euro1049 in the intervention group (n = 134) and in the usual care group (n = 138), respectively. The intervention turned out to be dominant-both cost saving and more effective than usual occupational health care. The saving was euro43 per sickness absence day avoided with available direct total cost data, and euro17 with missing total cost data imputed.
One year follow-up data show that occupational health intervention for workers with high risk of sickness absence is a cost effective use of healthcare resources.
Notes
Cites: Stat Med. 2003 Sep 15;22(17):2799-81512939787
Cites: J Occup Environ Med. 2003 May;45(5):499-50612762074
Cites: Annu Rev Public Health. 2002;23:151-6911910059
Cites: Occup Environ Med. 2004 Nov;61(11):924-915477286
Cites: Occup Environ Med. 2007 Nov;64(11):739-4617303674
Cites: Eur Spine J. 2007 Jul;16(7):919-2417186282
Cites: J Occup Rehabil. 2006 Dec;16(4):557-7817086503
Cites: Occup Environ Med. 2006 Oct;63(10):676-8216644897
Cites: Spine (Phila Pa 1976). 2006 May 1;31(10):1075-8216648740
Cites: Med Care. 2006 Apr;44(4):352-816565636
Cites: J Occup Rehabil. 2005 Dec;15(4):569-8016254756
Cites: Occup Environ Med. 2005 Feb;62(2):74-915657187
Comment In: Occup Environ Med. 2008 Apr;65(4):219-2018349154
PubMed ID
17933885 View in PubMed
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Application of multi-attribute utility theory to measure social preferences for health states.

https://arctichealth.org/en/permalink/ahliterature242825
Source
Oper Res. 1982 Nov-Dec;30(6):1043-69
Publication Type
Article
Author
G W Torrance
M H Boyle
S P Horwood
Source
Oper Res. 1982 Nov-Dec;30(6):1043-69
Language
English
Publication Type
Article
Keywords
Adolescent
Analysis of Variance
Attitude to Health
Child
Child, Preschool
Health Status Indicators
Health Surveys
Humans
Intensive Care Units, Neonatal - economics
Models, Theoretical
Ontario
Outcome and Process Assessment (Health Care) - methods
Risk
Social Perception
Abstract
A four-attribute health state classification system designed to uniquely categorize the health status of all individuals two years of age and over is presented. A social preference function defined over the health state classification system is required. Standard multi-attribute utility theory is investigated for the task, problems are identified and modifications to the standard method are proposed. The modified methods is field tested in a survey research project involving 112 home interviews. Results are presented and discussed in detail for both the social preference function and the performance of the modified method. A recommended social preference function is presented, complete with a range of uncertainty. The modified method is found to be applicable to the task--no insurmountable difficulties are encountered. Recommendations are presented, based on our experience, for other investigators who may be interested in reapplying the method in other studies.
PubMed ID
10259643 View in PubMed
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Assessment of informal services to demented people with the RUD instrument.

https://arctichealth.org/en/permalink/ahliterature196841
Source
Int J Geriatr Psychiatry. 2000 Oct;15(10):969-71
Publication Type
Article
Date
Oct-2000
Author
A. Wimo
G. Nordberg
W. Jansson
M. Grafström
Author Affiliation
Department of Clinical Neurosciences, Occupational Therapy and Elderly Research, Division of Geriatric Medicine, Karolinska Institute, Stockholm, Sweden. wimo@neurotec.ki.se
Source
Int J Geriatr Psychiatry. 2000 Oct;15(10):969-71
Date
Oct-2000
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Caregivers
Dementia - nursing
Home Nursing
Humans
Outcome and Process Assessment (Health Care) - methods
Severity of Illness Index
Sweden
Time Factors
PubMed ID
11044880 View in PubMed
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Association between hospital cardiac management and outcomes for acute myocardial infarction patients.

https://arctichealth.org/en/permalink/ahliterature147258
Source
Med Care. 2010 Feb;48(2):157-65
Publication Type
Article
Date
Feb-2010
Author
Therese A Stukel
David A Alter
Michael J Schull
Dennis T Ko
Ping Li
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. stukel@ices.on.ca
Source
Med Care. 2010 Feb;48(2):157-65
Date
Feb-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Emergency Service, Hospital
Female
Guideline Adherence
Humans
Logistic Models
Longitudinal Studies
Male
Middle Aged
Myocardial Infarction - drug therapy - mortality - therapy
Ontario - epidemiology
Outcome and Process Assessment (Health Care) - methods
Patient Readmission - statistics & numerical data
Proportional Hazards Models
Quality Indicators, Health Care
Survival Analysis
Abstract
Randomized trials have shown that medical and interventional therapies improve outcomes for acute myocardial infarction (AMI) patients. The extent to which hospital quality improvement translates into better patient outcomes is unclear.
To determine hospital cardiac management markers associated with improved outcomes. RESEARCH DESIGN, SUBJECTS: Population-based longitudinal cohort study of 98,115 adults hospitalized with first episode of AMI during 2000 to 2006 in 77 Ontario hospitals with >50 annual AMI admissions.
Rates of 30-day and 1-year mortality, readmissions for AMI or death, and major cardiac events (readmissions for AMI, angina, heart failure, or death) within 6 months, according to index hospital cardiac management markers, including appropriate initial emergency department (ED) assessment (rate of high acuity triage) high-acuity and intensity of interventional (30-day cardiac catheterization rate) and medical (discharge statin prescribing rate) therapy.
Thirty-day risk-adjusted mortality varied 2.3-fold (7.2%-16.9%) and major cardiac events rates varied 2-fold (18.2%-35.6%) across hospitals in 2006. Patients admitted to hospitals with the highest versus lowest rates of combined medical and interventional management had lower rates of 30-day mortality (adjusted relative rate [aRR] = 0.84, 95% CI, 0.78-0.91), 1-year mortality (aRR = 0.86, 0.81-0.91), AMI readmissions or death (aRR = 0.74, 0.69-0.78), and major cardiac event (aRR = 0.65, 0.61-0.68). Patients admitted to EDs with the highest rates of appropriate initial assessment had lower 30-day (aRR = 0.93, 0.88-0.98) and 1-year mortality (aRR = 0.96, 0.93-1.00).
Hospitals with higher levels of both medical and interventional management and higher quality initial ED assessment had better outcomes. Readmissions were particularly sensitive to care processes. In the face of the unwarranted variations in outcomes across hospitals, strategies that promote better ED and inpatient management of AMI patients are needed.
PubMed ID
19927014 View in PubMed
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Audit report from Greenland on nurses' tasks and perceived competency.

https://arctichealth.org/en/permalink/ahliterature118249
Source
Rural Remote Health. 2012;12:1909
Publication Type
Article
Date
2012
Author
J. Nexøe
E. Skifte
B. Niclasen
A. Munck
Author Affiliation
Research Unit for General Practice, University of Southern Denmark, Odense, Denmark. jnexoe@health.sdu.dk
Source
Rural Remote Health. 2012;12:1909
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
After-Hours Care
Clinical Audit
Clinical Competence - standards - statistics & numerical data
Data Interpretation, Statistical
Female
Greenland
Humans
Male
Middle Aged
Nurse Administrators - education - psychology - statistics & numerical data
Nurse's Practice Patterns - statistics & numerical data
Outcome and Process Assessment (Health Care) - methods - standards
Physician-Nurse Relations
Qualitative Research
Referral and Consultation - utilization
Task Performance and Analysis
Abstract
Despite all efforts, recruitment of healthcare personnel has become increasingly difficult in Greenland as in other remote areas. The aim of this observational study was to describe the extent of health care delivered by nurses in Greenland's healthcare system. Reasons for encounter, diagnostic procedures, treatments and need for a physician's assistance, as well as the nurses' self-perceived competency, were also analysed.
A total of 42 nurses registered all patient encounters for 10 days in late autumn 2006 in 14 out of 16 healthcare districts in Greenland.
Nurses treated 1117 encounters (60%) singlehandedly. The nurses felt competent in what they were doing in 1415 encounters (76%). In 525 encounters (31%), a physician's advice was sought. Either the physician was asked to come or the physician's advice was obtained by telephone. In four cases the nurses did not feel completely competent, but did not seek advice from the physician on call. Feeling competent did not depend on length of experience in Greenland.
In Greenland, nurses independently receive, diagnose and treat a substantial number of primary healthcare patients. The nurses take care of the patients and perform a number of clinical and laboratory procedures with great confidence. There has been speculation that part of the difficulty in recruiting doctors and healthcare personnel in remote areas may be due to uneasiness about professional responsibilities and, to some extent, lack of confidence. At least among the registering nurses in this study, this did not seem to be a problem.
PubMed ID
23228181 View in PubMed
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Becoming more efficient at outcomes research.

https://arctichealth.org/en/permalink/ahliterature234342
Source
Int J Technol Assess Health Care. 1988;4(4):555-71
Publication Type
Article
Date
1988
Author
L L Roos
S M Sharp
Source
Int J Technol Assess Health Care. 1988;4(4):555-71
Date
1988
Language
English
Publication Type
Article
Keywords
Cholecystectomy - adverse effects - standards
Humans
Manitoba
Models, Theoretical
Outcome and Process Assessment (Health Care) - methods
Patient Readmission
Regression Analysis
Research Design
Technology Assessment, Biomedical - methods
Abstract
This paper discusses several practical problems in research design: Is it worth doing a relatively "quick and dirty" study or is a more thorough study using all available information necessary? All the desired information may either not be available or be time-consuming to collect. What are the likely biases in going ahead and doing the research with the data base "in hand"? Such issues are important because of the limited resources for technology assessment (in terms of money, number of researchers, and research interest) and the great number of unstudied technologies.
PubMed ID
10291099 View in PubMed
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Causal inference in continuous time: an example on prostate cancer therapy.

https://arctichealth.org/en/permalink/ahliterature309737
Source
Biostatistics. 2020 01 01; 21(1):172-185
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
01-01-2020
Author
Pål Christie Ryalen
Mats Julius Stensrud
Sophie Fosså
Kjetil Røysland
Author Affiliation
Department of Biostatistics, University of Oslo, Domus Medica Gaustad, Sognsvannsveien 9, Oslo, Norway.
Source
Biostatistics. 2020 01 01; 21(1):172-185
Date
01-01-2020
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Humans
Male
Models, Statistical
Norway
Outcome and Process Assessment, Health Care - methods
Prostatic Neoplasms - therapy
Registries
Abstract
In marginal structural models (MSMs), time is traditionally treated as a discrete parameter. In survival analysis on the other hand, we study processes that develop in continuous time. Therefore, Røysland (2011. A martingale approach to continuous-time marginal structural models. Bernoulli 17, 895-915) developed the continuous-time MSMs, along with continuous-time weights. The continuous-time weights are conceptually similar to the inverse probability weights that are used in discrete time MSMs. Here, we demonstrate that continuous-time MSMs may be used in practice. First, we briefly describe the causal model assumptions using counting process notation, and we suggest how causal effect estimates can be derived by calculating continuous-time weights. Then, we describe how additive hazard models can be used to find such effect estimates. Finally, we apply this strategy to compare medium to long-term differences between the two prostate cancer treatments radical prostatectomy and radiation therapy, using data from the Norwegian Cancer Registry. In contrast to the results of a naive analysis, we find that the marginal cumulative incidence of treatment failure is similar between the strategies, accounting for the competing risk of other death.
PubMed ID
30124773 View in PubMed
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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
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81 records – page 1 of 9.