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The cost of lower respiratory tract infections hospital admissions in the Canadian Arctic.

https://arctichealth.org/en/permalink/ahliterature107892
Source
Pages 658-665 in N. Murphy and A. Parkinson, eds. Circumpolar Health 2012: Circumpolar Health Comes Full Circle. Proceedings of the 15th International Congress on Circumpolar Health, Fairbanks, Alaska, USA, August 5-10, 2012. International Journal of Circumpolar Health 2013;72 (Suppl 1):658-665
Publication Type
Article
Date
2013
  1 document  
Author
Anna Banerji
Val Panzov
Joan Robinson
Michael Young
Kaspar Ng
Muhammad Mamdani
Author Affiliation
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. Anna.banerji@utoronto.ca
Source
Pages 658-665 in N. Murphy and A. Parkinson, eds. Circumpolar Health 2012: Circumpolar Health Comes Full Circle. Proceedings of the 15th International Congress on Circumpolar Health, Fairbanks, Alaska, USA, August 5-10, 2012. International Journal of Circumpolar Health 2013;72 (Suppl 1):658-665
Date
2013
Language
English
Geographic Location
Canada
Publication Type
Article
Digital File Format
Text - PDF
Physical Holding
University of Alaska Anchorage
Keywords
Arctic Regions - epidemiology
Canada - epidemiology
Health Expenditures - statistics & numerical data
Hospitalization - economics
Humans
Infant
Infant, Newborn
Inuits
Length of Stay
Prospective Studies
Respiratory Tract Infections - economics - ethnology
State Medicine - statistics & numerical data
Abstract
Inuit infants who reside in the Nunavut (NU) regions of Arctic Canada have extremely high rates of lower respiratory tract infections (LRTIs) associated with significant health expenditures, but the costs in other regions of Arctic Canada have not been documented.
This prospective surveillance compares, across most of Arctic Canada, the rates and costs associated with LRTI admissions in infants less than 1 year of age, and the days of hospitalization and costs adjusted per live birth.
This was a hospital-based surveillance of LRTI admissions of infants less than 1 year of age, residing in Northwest Territories (NT), the 3 regions of Nunavut (NU); [Kitikmeot (KT), Kivalliq (KQ) and Qikiqtani (QI)] and Nunavik (NK) from 1 January 2009 to 30 June 2010. Costs were obtained from the territorial or regional governments and hospitals, and included transportation, hospital stay, physician fees and accommodation costs. The rates of LRTI hospitalizations, days of hospitalization and associated costs were calculated per live birth in each of the 5 regions.
There were 513 LRTI admissions during the study period. For NT, KT, KQ, QI and NK, the rates of LRTI hospitalization per 1000 live births were 38, 389, 230, 202 and 445, respectively. The total days of LRTI admission per live birth were 0.25, 3.3, 2.6, 1.7 and 3 for the above regions. The average cost per live birth for LRTI admission for these regions was $1,412, $22,375, $14,608, $8,254 and $10,333. The total cost for LRTI was $1,498,232 in NT, $15,662,968 in NU and $3,874,881 in NK. Medical transportation contributed to a significant proportion of the costs.
LRTI admission rates in NU and Nunavik are much higher than that in NT and remain among the highest rates globally. The costs of these admissions are exceptionally high due to the combination of very high rates of admission, very expensive medical evacuations and prolonged hospitalizations. Decreasing the rates of LRTI in this population could result in substantial health savings.
Notes
Cites: CMAJ. 2001 Jun 26;164(13):1847-5011450280
Cites: Int J Circumpolar Health. 2001 Aug;60(3):375-911590877
Cites: J Pediatr. 1997 Jul;131(1 Pt 1):113-79255201
Cites: Pediatr Infect Dis J. 2009 Aug;28(8):702-619461555
Cites: Can J Public Health. 2006 Sep-Oct;97(5):362-817120873
Cites: Pediatr Infect Dis J. 2009 Aug;28(8):697-70119461554
Cites: Int J Circumpolar Health. 2005 Feb;64(1):38-4515776991
PubMed ID
23967411 View in PubMed
Documents
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Economic incentives and diagnostic coding in a public health care system.

https://arctichealth.org/en/permalink/ahliterature296711
Source
Int J Health Econ Manag. 2017 Mar; 17(1):83-101
Publication Type
Journal Article
Date
Mar-2017
Author
Kjartan Sarheim Anthun
Johan Håkon Bjørngaard
Jon Magnussen
Author Affiliation
Department of Public Health and General Practice, NTNU, Norwegian University of Science and Technology, 7491, Trondheim, Norway. Kjartan.Anthun@ntnu.no.
Source
Int J Health Econ Manag. 2017 Mar; 17(1):83-101
Date
Mar-2017
Language
English
Publication Type
Journal Article
Keywords
Clinical Coding - economics - statistics & numerical data
Female
Humans
Length of Stay
Male
Middle Aged
Motivation
Norway
Reimbursement Mechanisms
Retrospective Studies
State Medicine - statistics & numerical data
Abstract
We analysed the association between economic incentives and diagnostic coding practice in the Norwegian public health care system. Data included 3,180,578 hospital discharges in Norway covering the period 1999-2008. For reimbursement purposes, all discharges are grouped in diagnosis-related groups (DRGs). We examined pairs of DRGs where the addition of one or more specific diagnoses places the patient in a complicated rather than an uncomplicated group, yielding higher reimbursement. The economic incentive was measured as the potential gain in income by coding a patient as complicated, and we analysed the association between this gain and the share of complicated discharges within the DRG pairs. Using multilevel linear regression modelling, we estimated both differences between hospitals for each DRG pair and changes within hospitals for each DRG pair over time. Over the whole period, a one-DRG-point difference in price was associated with an increased share of complicated discharges of 14.2 (95 % confidence interval [CI] 11.2-17.2) percentage points. However, a one-DRG-point change in prices between years was only associated with a 0.4 (95 % CI [Formula: see text] to 1.8) percentage point change of discharges into the most complicated diagnostic category. Although there was a strong increase in complicated discharges over time, this was not as closely related to price changes as expected.
PubMed ID
28477294 View in PubMed
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Geographical variation in use of intensive care: a nationwide study.

https://arctichealth.org/en/permalink/ahliterature275057
Source
Intensive Care Med. 2015 Nov;41(11):1895-902
Publication Type
Article
Date
Nov-2015
Author
Anne Høy Seemann Vestergaard
Christian Fynbo Christiansen
Henrik Nielsen
Steffen Christensen
Søren Paaske Johnsen
Source
Intensive Care Med. 2015 Nov;41(11):1895-902
Date
Nov-2015
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Cities - statistics & numerical data
Critical Care - methods - statistics & numerical data
Cross-Sectional Studies
Databases, Factual
Denmark
Female
Geography - statistics & numerical data
Humans
Intensive Care Units - statistics & numerical data
Length of Stay - statistics & numerical data
Male
Middle Aged
Patient Admission - statistics & numerical data
Registries
Sex Distribution
State Medicine - statistics & numerical data
Abstract
To examine whether there is geographical variation in the use of intensive care resources in Denmark concerning both intensive care unit (ICU) admission and use of specific interventions. Substantial variation in use of intensive care has been reported between countries and within the US, however, data on geographical variation in use within more homogenous tax-supported health care systems are sparse.
We conducted a population-based cross-sectional study based on linkage of national medical registries including all Danish residents between 2008 and 2012 using population statistics from Statistics Denmark. Data on ICU admissions and interventions, including mechanical ventilation, noninvasive ventilation, acute renal replacement therapy, and treatment with inotropes/vasopressors, were obtained from the Danish Intensive Care Database. Data on patients' residence at the time of admission were obtained from the Danish National Registry of Patients.
The overall age- and gender standardized number of ICU patients per 1000 person-years for the 5-year period was 4.3 patients (95 % CI, 4.2; 4.3) ranging from 3.7 (95 % CI, 3.6; 3.7) to 5.1 patients per 1000 person-years (95 % CI, 5.0; 5.2) in the five regions of Denmark and from 2.8 (95 % CI, 2.8; 3.0) to 23.1 patients per 1000 person-years (95 % CI, 13.0; 33.1) in the 98 municipalities. The age-, gender-, and comorbidity standardized proportion of use of interventions among ICU patients also differed across regions and municipalities.
There was only minimal geographical variation in the use of intensive care admissions and interventions at the regional level in Denmark, but more pronounced variation at the municipality level.
PubMed ID
26239728 View in PubMed
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Geographic variation in the rate of carotid endarterectomy in Canada.

https://arctichealth.org/en/permalink/ahliterature193025
Source
Stroke. 2001 Oct;32(10):2417-22
Publication Type
Article
Date
Oct-2001
Author
T E Feasby
H. Quan
W A Ghali
Author Affiliation
Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada. feasby@ucalgary.ca
Source
Stroke. 2001 Oct;32(10):2417-22
Date
Oct-2001
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada
Databases, Factual - statistics & numerical data
Endarterectomy, Carotid - utilization
Female
Geography
Health Care Surveys
Humans
Male
Middle Aged
Patient Discharge
Physician's Practice Patterns - statistics & numerical data
Regional Medical Programs - statistics & numerical data
State Medicine - statistics & numerical data
Stroke - prevention & control
Utilization Review
Abstract
Background and Purpose-- Carotid endarterectomy (CEA) is an important method of stroke prevention, but its usage in Canada is not well known. The indications for CEA have been well informed by the recent clinical trials, but the impact of this information on the rate and regional variation in the rate of CEA is unknown. This study sought to determine the rate and the regional variation in the rate of CEA in Canada, its provinces, and census divisions for 1994-1997.
Discharge data from all hospitals in Canada except Quebec were obtained from the Canadian Institute for Health Information for 1994-1997 and were searched for CEA by residential site. Rates and variations in rates were calculated.
The national age- and sex-adjusted rate per 100 000 people of CEA for those aged >/=40 years rose from 31.7 in 1994 to 40.5 in 1997. Provincial rates in 1997 varied from a low of 25.7 in Saskatchewan to high of 82.8 in Prince Edward Island. The census division rates varied even more, from a low of 0 in several divisions to a high of 179.
The recent slight increase in CEA rates may reflect the release of new efficacy results for CEA, especially for asymptomatic carotid stenosis, but the rates are still far below US levels. The marked regional variation in rates may reflect differing views on the appropriateness of indications such as asymptomatic carotid stenosis for CEA and the inconsistency of published clinical practice guidelines.
PubMed ID
11588335 View in PubMed
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How Do Intensity and Duration of Rehabilitation Services Affect Outcomes From Severe Traumatic Brain Injury? A Natural Experiment Comparing Health Care Delivery Systems in 2 Developed Nations.

https://arctichealth.org/en/permalink/ahliterature283699
Source
Arch Phys Med Rehabil. 2016 Dec;97(12):2045-2053
Publication Type
Article
Date
Dec-2016
Author
Tessa Hart
John Whyte
Ingrid Poulsen
Karin Spangsberg Kristensen
Annette M Nordenbo
Inna Chervoneva
Monica J Vaccaro
Source
Arch Phys Med Rehabil. 2016 Dec;97(12):2045-2053
Date
Dec-2016
Language
English
Publication Type
Article
Keywords
Adult
Brain Injuries, Traumatic - rehabilitation
Denmark
Developed Countries
Disabled Persons - rehabilitation
Female
Glasgow Outcome Scale
Humans
Inpatients - statistics & numerical data
Male
Middle Aged
Outpatients - statistics & numerical data
Physical Therapy Modalities - statistics & numerical data
Prospective Studies
Quality of Life
Recovery of Function
State Medicine - statistics & numerical data
Trauma Severity Indices
United States
Abstract
To determine the effects of inpatient and outpatient treatment intensity on functional and emotional well-being outcomes at 1 year after severe traumatic brain injury (TBI).
Prospective, quasiexperimental study comparing outcomes in a U.S. TBI treatment center with those in a Denmark (DK) center providing significantly greater intensity and duration of rehabilitation.
Inpatient and outpatient TBI rehabilitation.
Persons with severe TBI (N=274).
Inpatient rehabilitation interventions were counted daily by discipline. Outpatient treatments were estimated per discipline using a structured interview administered to patients, caregivers, or both, at 12 months.
FIM, Glasgow Outcome Scale-Extended, Disability Rating Scale, Participation Assessment with Recombined Tools-Objective, Perceived Quality of Life, Medical Outcomes Study 12-Item Short-Form Health Survey, Brief Symptom Inventory-18-item version.
Despite identical inclusion criteria, patient severity on admission was greater at the DK site. After adjustment for patient/injury characteristics, there were no site differences in either functional or emotional outcome at 12 months. Significantly more inpatient plus outpatient treatment was administered to DK patients than to those in the U.S. For functional but not emotional treatments, more severely impaired patients received higher doses. One-year outcomes were predicted by admission severity, age, employment, and other baseline characteristics.
Contrary to expectation, DK patients who received significantly more rehabilitation services during the year after severe TBI did not differ in outcome from their less intensively treated U.S. counterparts, after adjusting for initial severity. The negative association of functional treatment dose with extent of early disability suggests that dose was driven by unmeasured factors reflecting need for services. Improved measures of injury-related factors driving treatment allocation are needed to model the independent effects of treatment on outcomes.
PubMed ID
27497825 View in PubMed
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Osteoporosis medication prescribing in British Columbia and Ontario: impact of public drug coverage.

https://arctichealth.org/en/permalink/ahliterature131481
Source
Osteoporos Int. 2012 Apr;23(4):1475-80
Publication Type
Article
Date
Apr-2012
Author
S M Cadarette
G. Carney
D. Baek
N. Gunraj
J M Paterson
C R Dormuth
Author Affiliation
Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, M5S 3M2, ON, Canada. s.cadarette@utoronto.ca
Source
Osteoporos Int. 2012 Apr;23(4):1475-80
Date
Apr-2012
Language
English
Publication Type
Article
Keywords
Aged
Bone Density Conservation Agents - therapeutic use
British Columbia
Diphosphonates - therapeutic use
Drug Prescriptions - statistics & numerical data
Drug Utilization - statistics & numerical data - trends
Female
Humans
Insurance Coverage
Male
Ontario
Osteoporosis - drug therapy
Osteoporosis, Postmenopausal - drug therapy
Physician's Practice Patterns - statistics & numerical data - trends
Sex Factors
State Medicine - statistics & numerical data
Abstract
We compared the patterns of osteoporosis medication prescribing between two provinces in Canada with different public drug coverage policies. Oral bisphosphonates were the primary drugs used, yet access to the second-generation oral bisphosphonates (alendronate, risedronate) was limited in one region. Implications of differential access to oral bisphosphonates warrants further study.
Approved therapies for treating osteoporosis in Canada include bisphosphonates, calcitonin, denosumab, raloxifene, and teriparatide. However, significant variation in access to these medications through public drug coverage exists across Canada. We sought to compare patterns of osteoporosis medication prescribing between British Columbia (BC) and Ontario.
Using dispensing data from BC (PharmaNet) and Ontario (Ontario Drug Benefits), we identified all new users of osteoporosis medications aged 66 or more years from 1995/1996 to 2008/2009. We summarized the number of new users by fiscal year, sex, and index drug for each province. BC data were also stratified by whether drugs were dispensed within or outside public PharmaCare.
We identified 578,254 (n?=?122,653 BC) eligible new users. Overall patterns were similar between provinces: (1) most patients received an oral bisphosphonate (93% in BC and 99% in Ontario); (2) etidronate prescribing declined after 2001/2002, reaching a low of 41% in BC and 10% in Ontario in 2008/2009; and (3) the proportion of males treated increased over time, from 7% in 1996/1997 to 25% in 2008/2009. However, we note major differences within versus outside the BC PharmaCare system. In particular,
Notes
Cites: Endocr Rev. 2002 Aug;23(4):570-812202472
Cites: CMAJ. 2002 Nov 12;167(10 Suppl):S1-3412427685
Cites: CMAJ. 1996 Oct 15;155(8):1113-338873639
Cites: Osteoporos Int. 2011 May;22(5):1335-4220577872
Cites: Osteoporos Int. 2007 Dec;18(12):1595-60017767369
Cites: Ann Intern Med. 2008 Feb 5;148(3):197-21318087050
Cites: CMAJ. 2010 Nov 23;182(17):1864-7320940232
Cites: J Obstet Gynaecol Can. 2006 Feb;28(2 Suppl 1):S95-11216626523
PubMed ID
21901476 View in PubMed
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Political or dental power in private and public service provision: a study of municipal expenditures for child dental care.

https://arctichealth.org/en/permalink/ahliterature258598
Source
Health Econ Policy Law. 2012 Jul;7(3):327-42
Publication Type
Article
Date
Jul-2012
Author
Lotte Bøgh Andersen
Mickael Bech
Jørgen Lauridsen
Source
Health Econ Policy Law. 2012 Jul;7(3):327-42
Date
Jul-2012
Language
English
Publication Type
Article
Keywords
Child
Cost Control
Denmark
Dental Care for Children - economics
Dentists
Health Expenditures - statistics & numerical data
Humans
Politics
Private Sector - statistics & numerical data
Public Sector - statistics & numerical data
State Medicine - statistics & numerical data
Abstract
Both professionals and politicians may affect expenditures for highly professional services provided in the public and private sector. We investigated Danish publicly financed child dental care with a special focus on the influence of politicians and dentists on the expenditure level. By studying spatial patterns in expenditure levels across municipalities, we are able to test the influences of these two main actors and the networks through which learning is achieved. Four hypotheses on the existence of different spatial spillover effects are tested. The empirical analysis is based on annual data from 1996 to 2001 for 226 Danish municipalities, thus allowing for the control for heterogeneity between municipalities and for intra-municipal correlations across time. The results point to differences in expenditures between municipalities with privately and publicly produced dental care. Furthermore, dentists appear to be the most important actors for the spatial spillover effects, and these effects are especially strong for municipalities situated in the same county that use private dental clinics. There is no evidence of political spatial spillover effects between municipalities.
PubMed ID
21819644 View in PubMed
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A prescription for safer care: medication reconciliation.

https://arctichealth.org/en/permalink/ahliterature116770
Source
Can J Neurosci Nurs. 2012;34(3):5-6
Publication Type
Article
Date
2012
Author
Liane Craig
Author Affiliation
communications@accreditation.ca
Source
Can J Neurosci Nurs. 2012;34(3):5-6
Date
2012
Language
English
French
Publication Type
Article
Keywords
Canada
Humans
Medication Errors - prevention & control
Quality of Health Care - statistics & numerical data
Safety Management - statistics & numerical data
State Medicine - statistics & numerical data
PubMed ID
23362582 View in PubMed
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Retention in a public healthcare system with free access to treatment: a Danish nationwide HIV cohort study.

https://arctichealth.org/en/permalink/ahliterature128938
Source
AIDS. 2012 Mar 27;26(6):741-8
Publication Type
Article
Date
Mar-27-2012
Author
Marie Helleberg
Frederik N Engsig
Gitte Kronborg
Carsten S Larsen
Gitte Pedersen
Court Pedersen
Jan Gerstoft
Niels Obel
Author Affiliation
Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark. mhelleberg@sund.ku.dk
Source
AIDS. 2012 Mar 27;26(6):741-8
Date
Mar-27-2012
Language
English
Publication Type
Article
Keywords
Adult
Delivery of Health Care - utilization
Denmark - epidemiology
Female
Follow-Up Studies
HIV Infections - drug therapy - mortality
Humans
Male
Middle Aged
Patient Dropouts - statistics & numerical data
Risk factors
State Medicine - statistics & numerical data
Abstract
We aimed to assess retention of HIV-infected individuals in the Danish healthcare system over a 15-year period.
Loss to follow-up (LTFU) was defined as 365 days without contact to the HIV care system. Data were obtained from the nationwide Danish HIV Cohort study, The Danish National Hospital Registry and The Danish Civil Registration System. Incidence rates, risk factors for LTFU and return to care and mortality rate ratios (MRRs) were estimated using Poisson regression analyses.
We included 4745 HIV patients who were followed for 36,692 person-years. Patients were retained in care 95.0% of person-years under observation, increasing to 98.1% after initiation of highly active antiretroviral treatment (HAART). The overall incidence rate/100 person-years for first episode of LTFU was 2.6 [95% confidence interval (CI) 2.5-2.8] and was significantly lower after initiation of HAART [1.2 (95% CI 1.0-1.3)]. Five years after LTFU the probability of return to care was 0.87 (95% CI 0.84-0.90). The risk of death was significantly increased after LTFU [MRR 1.9 (95% CI 1.6-2.6)] and 6 months or less after return to care [MRR 10.9 (95% CI 5.9-19.9)].
Retention in care of Danish HIV patients is high, especially after initiation of HAART. Absence from HIV care is associated with increased mortality. We conclude that high rates of retention can be achieved in a healthcare system with free access to treatment and is associated with a favorable outcome.
PubMed ID
22156974 View in PubMed
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13 records – page 1 of 2.