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Assessing process of care in rheumatoid arthritis at McGill University hospitals.

https://arctichealth.org/en/permalink/ahliterature113935
Source
J Clin Rheumatol. 2013 Jun;19(4):175-9
Publication Type
Article
Date
Jun-2013
Author
Lisa Marina Li
Basile Tessier-Cloutier
Yafei Wang
Sasha Bernatsky
Evelyne Vinet
Henri André Ménard
Pantelis Panopalis
Elizabeth Hazel
Michael Stein
Martin Cohen
Michael Starr
Christian Pineau
Marie-Ève Veilleux
Inés Colmegna
Author Affiliation
Division of Rheumatology, McGill University, Montréal, Quebec, Canada.
Source
J Clin Rheumatol. 2013 Jun;19(4):175-9
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Absorptiometry, Photon - utilization
Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - epidemiology - therapy
Blood Sedimentation
C-Reactive Protein - analysis
Clinical Audit
Diphosphonates - therapeutic use
Female
Foot Bones - radiography
Glucocorticoids - therapeutic use
Hand Bones - radiography
Humans
Male
Middle Aged
Multivariate Analysis
Pain Measurement
Physical Examination - statistics & numerical data
Prednisone - administration & dosage
Quality Indicators, Health Care
Quebec
Radiography - utilization
Referral and Consultation - statistics & numerical data
Time-to-Treatment - statistics & numerical data
Abstract
In rheumatoid arthritis (RA), quality indicators (QIs) are tools used to measure process of care. This study aimed to assess performance of selected QIs from the 2004 Arthritis Foundation's QI Set at 2 major sites of a university network of teaching hospitals.
The charts and electronic hospital records of 76 RA patients were audited to determine adherence to QIs. Logistic multivariate regression analyses were performed to investigate potential determinants of nonadherence and propose measures to facilitate better QI compliance, as a potential strategy towards RA care improvement.
We identified consistent observance of QIs mandating prescription of disease-modifying antirheumatic drug therapy for all patients, drug adjustment with disease activity, prednisone tapering, and bisphosphonate therapy if indicated for patients on glucocorticoids. However, there was either lack of documentation or true inconsistent adherence to QIs dealing with radiograph performance, functional capacity assessment, and screening for hepatitis and tuberculosis before commencement of methotrexate and biologic agents, respectively. For the specific QIs analyzed, we did not find any definite independent associations with the studied variables.
Our findings indicate that while there is frequent evidence for adherence to certain RA quality care standards at our centers, there is less compliance to others. Strategies to optimize the performance or documentation of those found most lacking, namely, functional capacity and screening for specific drug contraindications, could improve patient care. Radiographic disease monitoring, while lacking, may represent a move toward other more sensitive methods of RA progression detection, such as joint ultrasound. The inclusion of patient- and physician-derived information could help elucidate the reasons underlying nonadherence.
PubMed ID
23669798 View in PubMed
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Cancer Treatment Delays in American Indians and Alaska Natives Enrolled in Medicare.

https://arctichealth.org/en/permalink/ahliterature290092
Source
J Health Care Poor Underserved. 2017; 28(1):350-361
Publication Type
Journal Article
Date
2017
Author
Scott V Adams
Aasthaa Bansal
Andrea N Burnett-Hartman
Stacey A Cohen
Andrew Karnopp
Victoria Warren-Mears
Scott D Ramsey
Source
J Health Care Poor Underserved. 2017; 28(1):350-361
Date
2017
Language
English
Publication Type
Journal Article
Keywords
Age Factors
Age of Onset
Aged
Aged, 80 and over
Alaska - epidemiology
Alaska Natives - statistics & numerical data
Breast Neoplasms - ethnology - therapy
Colorectal Neoplasms - ethnology - therapy
Comorbidity
European Continental Ancestry Group - statistics & numerical data
Female
Humans
Indians, North American - statistics & numerical data
Lung Neoplasms - ethnology - therapy
Male
Medicare - statistics & numerical data
Neoplasm Grading
Neoplasms - ethnology - therapy
Prostatic Neoplasms - ethnology - therapy
Residence Characteristics
SEER Program
Sex
Socioeconomic Factors
Time-to-Treatment - statistics & numerical data
United States
United States Indian Health Service - statistics & numerical data
Abstract
To assess whether timing of initial post-diagnosis cancer care differs between American Indian and Alaska Native (AI/AN) and non-Hispanic White (NHW) patients, we accessed SEER-Medicare data for breast, colorectal, lung, and prostate cancers (2001-2007). Medicare claims data were examined for initiation of cancer-directed treatment. Overall, AI/ANs experienced longer median times to starting treatment than NHWs (45 and 39 days, p < .001) and lower rates of treatment initiation (HR[95%CI]: 0.86[0.79-0.93]). Differences were largest for prostate (HR: 0.80[0.71-0.89]) and smallest for breast cancer (HR: 0.96[0.83-1.11]). American Indians / Alaska Natives also had elevated odds of greater than 10 weeks between diagnosis and treatment compared with NHWs (OR[95% CI]: 1.37[1.16-1.63]), especially for prostate cancer (OR: 1.41[1.14-1.76]). Adjustment for comorbidity and socio-demographic factors attenuated associations except for prostate cancer. In this insured population, we observed evidence that AI/ANs start cancer therapy later than NHWs. The modest magnitude of delays suggests that they are unlikely to be a determinant of survival disparities.
PubMed ID
28239006 View in PubMed
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DaPeCa-2: Implementation of fast-track clinical pathways for penile cancer shortens waiting time and accelerates the diagnostic process--A comparative before-and-after study in a tertiary referral centre in Denmark.

https://arctichealth.org/en/permalink/ahliterature278566
Source
Scand J Urol. 2016;50(1):80-7
Publication Type
Article
Date
2016
Author
Jakob Kristian Jakobsen
Jørgen Bjerggaard Jensen
Source
Scand J Urol. 2016;50(1):80-7
Date
2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Carcinoma, Squamous Cell - diagnosis - therapy
Controlled Before-After Studies
Critical Pathways
Delayed Diagnosis - prevention & control
Denmark
Humans
Male
Middle Aged
Penile Neoplasms - diagnosis - therapy
Referral and Consultation
Tertiary Care Centers
Time Factors
Time-to-Treatment - statistics & numerical data
Young Adult
Abstract
The aim of this study was to examine the feasibility and impact of a fast-track referral pathway on clinical time intervals in penile cancer.
This observational study from a tertiary referral centre included 263 patients diagnosed before and after the introduction of an intervention to reduce clinical time intervals, the Cancer Patient Pathway (CPP). The CPP included fast-track referral and set time-frames for units participating in cancer diagnosis and treatment, and was introduced for penile cancer in Denmark on 1 January 2009. Median time intervals (in calendar days) with interquartile range were the main outcome measure.
A trend towards reduction was observed in all clinical time intervals, with a statistically significant reduction in the system interval (p = 0.01) and tertiary centre interval (p
PubMed ID
26313502 View in PubMed
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The effect of medical trainees on pediatric emergency department flow: a discrete event simulation modeling study.

https://arctichealth.org/en/permalink/ahliterature106127
Source
Acad Emerg Med. 2013 Nov;20(11):1112-20
Publication Type
Article
Date
Nov-2013
Author
Emerson D Genuis
Quynh Doan
Author Affiliation
Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Source
Acad Emerg Med. 2013 Nov;20(11):1112-20
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
British Columbia
Child
Clinical Competence
Crowding
Efficiency, Organizational
Emergency Service, Hospital - organization & administration
Female
Hospitals, Pediatric
Hospitals, Urban
Humans
Internship and Residency
Length of Stay - statistics & numerical data
Male
Medical Staff, Hospital - education - organization & administration
Personnel Staffing and Scheduling
Students, Medical
Time-to-Treatment - statistics & numerical data
Triage - methods
Waiting Lists
Abstract
Providing patient care and medical education are both important missions of teaching hospital emergency departments (EDs). With medical school enrollment rising, and ED crowding becoming an increasing prevalent issue, it is important for both pediatric EDs (PEDs) and general EDs to find a balance between these two potentially competing goals.
The objective was to determine how the number of trainees in a PED affects patient wait time, total ED length of stay (LOS), and rates of patients leaving without being seen (LWBS) for PED patients overall and stratified by acuity level as defined by the Pediatric Canadian Triage and Acuity Scale (CTAS) using discrete event simulation (DES) modeling.
A DES model of an urban tertiary care PED, which receives approximately 40,000 visits annually, was created and validated. Thirteen different trainee schedules, which ranged from averaging zero to six trainees per shift, were input into the DES model and the outcome measures were determined using the combined output of five model iterations.
An increase in LOS of approximately 7 minutes was noted to be associated with each additional trainee per attending emergency physician working in the PED. The relationship between the number of trainees and wait time varied with patients' level of acuity and with the degree of PED utilization. Patient wait time decreased as the number of trainees increased for low-acuity visits and when the PED was not operating at full capacity. With rising numbers of trainees, the PED LWBS rate decreased in the whole department and in the CTAS 4 and 5 patient groups, but it rose in patients triaged CTAS 3 or higher. A rising numbers of trainees was not associated with any change to flow outcomes for CTAS 1 patients.
The results of this study demonstrate that trainees in PEDs have an impact mainly on patient LOS and that the effect on wait time differs between patients presenting with varying degrees of acuity. These findings will assist PEDs in finding a balance between providing high-quality medical education and timely patient care.
PubMed ID
24238313 View in PubMed
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Geographical accessibility and duration of untreated psychosis: distance as a determinant of treatment delay.

https://arctichealth.org/en/permalink/ahliterature288039
Source
BMC Psychiatry. 2017 05 10;17(1):176
Publication Type
Article
Date
05-10-2017
Author
Erling Inge Kvig
Beate Brinchmann
Cathrine Moe
Steinar Nilssen
Tor Ketil Larsen
Knut Sørgaard
Source
BMC Psychiatry. 2017 05 10;17(1):176
Date
05-10-2017
Language
English
Publication Type
Article
Keywords
Adult
Cross-Sectional Studies
Female
Health Services Accessibility - statistics & numerical data
Humans
Logistic Models
Male
Norway
Psychotic Disorders - therapy
Referral and Consultation
Risk factors
Rural Population - statistics & numerical data
Time Factors
Time-to-Treatment - statistics & numerical data
Young Adult
Abstract
The duration of untreated psychosis is determined by both patient and service related factors. Few studies have considered the geographical accessibility of services in relation to treatment delay in early psychosis. To address this, we investigated whether treatment delay is co-determined by straight-line distance to hospital based specialist services in a mainly rural mental health context.
A naturalistic cross-sectional study was conducted among a sample of recent onset psychosis patients in northern Norway (n = 62). Data on patient and service related determinants were analysed.
Half of the cohort had a treatment delay longer than 4.5 months. In a binary logistic regression model, straight-line distance was found to make an independent contribution to delay in which we controlled for other known risk factors.
The determinants of treatment delay are complex. This study adds to previous studies on treatment delay by showing that the spatial location of services also makes an independent contribution. In addition, it may be that insidious onset is a more important factor in treatment delay in remote areas, as the logistical implications of specialist referral are much greater than for urban dwellers. The threshold for making a diagnosis in a remote location may therefore be higher. Strategies to reduce the duration of untreated psychosis in rural areas would benefit from improving appropriate referral by crisis services, and the detection of insidious onset of psychosis in community based specialist services.
Notes
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PubMed ID
28486982 View in PubMed
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Improved functional outcome after hip fracture is associated with duration of rehabilitation, but not with waiting time for rehabilitation.

https://arctichealth.org/en/permalink/ahliterature284114
Source
Dan Med J. 2017 Apr;64(4)
Publication Type
Article
Date
Apr-2017
Author
Tonny Jaeger Pedersen
Louise Nicole Bie Bogh
Jens Martin Lauritsen
Source
Dan Med J. 2017 Apr;64(4)
Date
Apr-2017
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Denmark
Female
Hip Fractures - rehabilitation
Humans
Male
Outcome and Process Assessment (Health Care) - statistics & numerical data
Recovery of Function
Statistics, nonparametric
Time Factors
Time-to-Treatment - statistics & numerical data
Abstract
The aim of this study was to explore the relationship between "waiting time to onset of municipal rehabilitation", "length of municipal rehabilitation" and the attained level of function four months after the hip fracture.
Among a consecutive series of 156 patients, the 116 patients who were recommended a municipal rehabilitation sequence after discharge were included. The expos-ures were waiting time in days and duration in hours of the municipal rehabilitation. The outcome was lower-extremity functional level as measured with the Short Physical Per-form-ance Battery. Effects were assessed with non-parametric gamma coefficients.
The median waiting time to initiation of rehabilitation was ten days. A weak and insignificant correlation was observed between waiting time and outcome at four months, and a statistically significant correlation was recorded between duration of municipal rehabilitation and outcome, also at four months. No marked differences in these results were found when subgrouped by pre-fracture level of function as assessed with the Barthel-20 index.
Waiting times from hospital discharge to initiation of municipal rehabilitation seems not to correlate with functional level four months after the hip fracture. In contrast, the amount of municipal rehabilitation time does correlate with a better functional level four months after the hip fracture. Furthermore, large-sample studies are warranted to clarify this relationship.
none.
not relevant.
PubMed ID
28385169 View in PubMed
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Influence of length of time to diagnosis and treatment on the survival of children with acute lymphoblastic leukemia: a population-based study.

https://arctichealth.org/en/permalink/ahliterature105697
Source
Leuk Res. 2014 Feb;38(2):204-9
Publication Type
Article
Date
Feb-2014
Author
Jillian M Baker
Teresa To
Joseph Beyene
Brandon Zagorski
Mark L Greenberg
Lillian Sung
Author Affiliation
Department of Pediatrics and Department of Internal Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada. Electronic address: bakerji@smh.ca.
Source
Leuk Res. 2014 Feb;38(2):204-9
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Child
Child, Preschool
Delayed Diagnosis - mortality
Female
Humans
Infant
Male
Ontario - epidemiology
Precursor Cell Lymphoblastic Leukemia-Lymphoma - diagnosis - mortality - therapy
Survival Analysis
Time-to-Treatment - statistics & numerical data
Treatment Outcome
Abstract
The objectives were to describe times to diagnosis and initiation of treatment in pediatric ALL in Ontario from 1997 to 2007, and to measure their impact on OS and EFS. In 1000 children, the median times to diagnosis and treatment were both 1 day (IQR = 1-2). Those who began treatment >3 days after diagnosis had inferior OS (AHR = 2.49; 95% CI = 1.40-4.43; p = 0.002), and inferior EFS (AHR = 1.73; 95% CI = 1.01-2.96; p = 0.047) compared to those who began treatment = 3 days after diagnosis. There was no statistically significant relationship between time to diagnosis and survival. Longer time to treatment was associated with worse survival in pediatric ALL; reasons for this relationship may be multi-factorial.
PubMed ID
24333116 View in PubMed
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Mode of entry to an early intervention service for psychotic disorders: determinants and impact on outcome.

https://arctichealth.org/en/permalink/ahliterature106357
Source
Psychiatr Serv. 2013 Nov 1;64(11):1166-9
Publication Type
Article
Date
Nov-1-2013
Author
Shamira Pira
Georges Durr
Nicole Pawliuk
Ridha Joober
Ashok Malla
Source
Psychiatr Serv. 2013 Nov 1;64(11):1166-9
Date
Nov-1-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Early Medical Intervention - statistics & numerical data
Emergency Service, Hospital - statistics & numerical data
Hospitalization - statistics & numerical data
Humans
Interview, Psychological
Kaplan-Meier Estimate
Logistic Models
Outcome and Process Assessment (Health Care) - statistics & numerical data
Outpatients - statistics & numerical data
Psychiatric Status Rating Scales - statistics & numerical data
Psychotic Disorders - prevention & control - psychology - therapy
Quebec
Referral and Consultation - statistics & numerical data
Socioeconomic Factors
Time-to-Treatment - statistics & numerical data
Young Adult
Abstract
Specialized early intervention services for first-episode psychosis should treat a proportion of patients without using inpatient beds. This study compared such service users by their initial mode of treatment before entry-inpatient (N=157) or outpatient (N=102).
On entry to a Montreal early intervention service, the groups were compared on baseline clinical and functional variables and on hospitalizations during two years of treatment.
Initial presentation at an emergency service, shorter duration of untreated psychosis, lower functioning level, and aggressive and bizarre behavior were associated with the inpatient entry mode to early intervention services. During follow-up, individuals entering as inpatients spent more days hospitalized than those entering as outpatients, and their time to rehospitalization was shorter.
Results suggest that entry into early intervention services via the hospital emergency department and presentation with behavioral and functional disturbances were more predictive than core psychotic symptoms of hospital inpatient status on referral to an early intervention service.
PubMed ID
24185539 View in PubMed
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The national program on standardized cancer care pathways in Sweden: Observations and findings half way through.

https://arctichealth.org/en/permalink/ahliterature297585
Source
Health Policy. 2018 Sep; 122(9):945-948
Publication Type
Evaluation Studies
Journal Article
Date
Sep-2018
Author
Ingrid Schmidt
Johan Thor
Thomas Davidson
Fredrik Nilsson
Christina Carlsson
Author Affiliation
Department of Evaluation and Analysis, System Analysis Unit, The National Board of Health and Welfare, Rålambsvägen 3, S-10630 Stockholm, Sweden. Electronic address: Ingrid.schmidt@socialstyrelsen.se.
Source
Health Policy. 2018 Sep; 122(9):945-948
Date
Sep-2018
Language
English
Publication Type
Evaluation Studies
Journal Article
Keywords
Comorbidity
Delivery of Health Care - methods - organization & administration
Humans
Medical Oncology - methods - organization & administration
National Health Programs
Patient satisfaction
Primary Health Care
Sweden
Time-to-Treatment - statistics & numerical data
Abstract
In 2015, the Swedish government initiated a national cancer reform program to standardize cancer care pathways. Primary aims included shortened waiting times among patients with suspected cancer, increased patient satisfaction and reduced regional variation. The implementation phase of the program is now more than half way through and both achievements and challenges have been identified. The ongoing evaluation demonstrates that professional engagement and adjustments on the meso- and micro-level of the system are essential to achieving sustainable improvements. Waiting times have shortened for the pathways launched first, and patients are satisfied with a more transparent process. Physicians in primary care are satisfied to inform patients about the pathways but point out problems with comorbidity and complicated diagnostic procedures related to unspecific symptoms. Mechanisms and ethical considerations behind possible crowding-out effects need to be thoroughly highlighted and discussed with staff and management. The results so far appear promising but meso- and micro-levels of the system need to be more involved in the design processes.
PubMed ID
30075866 View in PubMed
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Off-hours admission and quality of hip fracture care: a nationwide cohort study of performance measures and 30-day mortality.

https://arctichealth.org/en/permalink/ahliterature283067
Source
Int J Qual Health Care. 2016 Jun;28(3):324-31
Publication Type
Article
Date
Jun-2016
Author
Nina Sahlertz Kristiansen
Pia Kjær Kristensen
Bente Mertz Nørgård
Jan Mainz
Søren Paaske Johnsen
Source
Int J Qual Health Care. 2016 Jun;28(3):324-31
Date
Jun-2016
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Body mass index
Cohort Studies
Comorbidity
Denmark
Female
Hip Fractures - mortality - surgery
Hospitalization - statistics & numerical data
Humans
Length of Stay
Male
Pain Measurement - methods
Patient Admission - statistics & numerical data
Quality Indicators, Health Care
Quality of Health Care - statistics & numerical data
Sex Factors
Socioeconomic Factors
Time Factors
Time-to-Treatment - statistics & numerical data
Abstract
Higher risks of adverse outcomes have been reported for patients admitted acutely during off-hours. However, in relation to hip fracture, the evidence is inconsistent. We examined whether time of admission influenced compliance with performance measures, surgical delay and 30-day mortality in patients with hip fracture.
Cohort study.
Data from The Danish Multidisciplinary Hip Fracture Registry linked with data from Danish National Registries.
Danish patients undergoing hip fracture surgery, aged >65 years, admitted 1 March 2010 to 30 November 2013 (N = 25 305).
Off-hours: weekday evenings and nights, and weekends.
Meeting specific performance measures, surgical delay and mortality.
No differences were found in patient characteristics or in meeting performance measures (RRs from 0.99 [95% CI: 0.98-1.01] to 1.01 [95% CI: 0.99-1.02]. When comparing admission on weekdays (evenings and nights vs. days), off-hours admission was associated with a lower risk of surgical delay (adjusted OR 0.75 [95% CI: 0.66-0.85]) while no differences in 30-day mortality was found (adjusted OR 0.91 [95% CI: 0.80-1.04]. When comparing admission during weekends with admission during weekdays, off-hours admission was associated with a higher risk of surgical delay (adjusted OR 1.19 [95% CI: 1.05-1.37]) and a higher 30-day mortality risk (adjusted OR 1.13 [95% CI: 1.04-1.23]. The risk of surgical delay appeared not to explain the excess 30-day mortality.
Patients admitted off-hours and on-hours received similar quality of care. The risk of surgical delay and 30 days mortality was higher among patients admitted during weekends; explanations need to be clarified.
PubMed ID
27097886 View in PubMed
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