Research Interests:
Research Interests:
Research Interests:
had to. Though they had some success with RTC activities, the staff did not have the same understanding of the Hamilton et al. BMC Health Services Research 2014, 14:642
Research Interests:
Research Interests:
Research Interests:
The lowest level at which fish farmers ordinarily make management decisions is the individual holding unit. To identify factors associated with chemotherapeutic treatment initiation at the holding-unit level, we created a unit of... more
The lowest level at which fish farmers ordinarily make management decisions is the individual holding unit. To identify factors associated with chemotherapeutic treatment initiation at the holding-unit level, we created a unit of measurement called the "farm-tank-lot" (FTL), which allowed the movements and mixing of groups of fish to be followed during an entire production cycle. Each FTL was comprised of fish with a common history housed in a specific holding unit. Our 21-month prospective observational study (conducted on 14 land-based trout farms in Ontario, Canada) showed that the FTL was a biologically meaningful unit of concern and a feasible unit of measurement on land-based trout farms.Multivariable logistic and Poisson regressions revealed that fish size and growth rate both were associated negatively with the probability and frequency of treatment. FTLs that existed for longer periods of time were more likely to be treated and treated more often. There was a significant farm effect. Future field studies of disease in cultured fish should incorporate these factors into their design and analysis.
Research Interests: Biology, Fish Diseases, Medicine, Logistic Regression, Preventive Veterinary Medicine, and 12 moreAnimals, Poisson regression, Data Collection, Ontario, Longitudinal Studies, Rainbow trout, Trout, Veterinary Sciences, Observational Study, Poisson Distribution, Logistic Models, and Decision Support Techniques
Research Interests: Program Evaluation, Nursing, Medicine, Trauma, Counseling, and 13 moreHumans, The, Clinical Sciences, Urban Population, Guidance and Counseling Intervention Programs, Clinical Protocols, Wounds and Injuries, Substance-Related Disorders, Emergency Department, Trauma Centers, mass Screening, Referral and consultation, and Referral
Research Interests:
Research Interests:
Research Interests: Health Informatics, Long Term Care, Data Analysis, Case Study Research, Implementation Science, and 15 moreKnowledge Translation, Health Administration, Medicine, Case Study, Focus Group, Data Collection, Pattern Matching, Implementation, Participant Observation, Multiple Case Study, Empirical evidence, Instrument Design, Mixed Method, Minimum Data Set, and Medical and Health Sciences
Research Interests:
Research Interests:
Research Interests:
Research Interests:
OBJECTIVES To describe trends in blood glucose test strip (TS) utilization and cost in Saskatchewan. METHODS A retrospective analysis of TS use between January 1, 1996, and December 31, 2013, was conducted using population-based health... more
OBJECTIVES To describe trends in blood glucose test strip (TS) utilization and cost in Saskatchewan. METHODS A retrospective analysis of TS use between January 1, 1996, and December 31, 2013, was conducted using population-based health administrative databases in Saskatchewan. The prescription drug database was used to describe the annual number of TS dispensations, the number of strips dispensed, the number of unique beneficiaries and the total costs. A patient-level analysis was also carried out to describe the patterns of TS use (i.e. light, moderate or heavy) by the entire cohort and by diabetes treatments. Potential cost savings due to a newly implemented restriction policy were estimated based on the most recent data (2013). RESULTS TS utilization increased dramatically between 1996 and 2013 in terms of the number of users and the average number of TSs received. The percentage of TS users receiving fewer than 4 TSs per week (i.e. light users) decreased by 20%, while the percentage of heavy users (i.e. those receiving more than 8 TSs per week) increased by 19%. During the same period, the use of high-risk oral hypoglycemic medications declined by 30% among all TS users. Heavy TS use was observed in at least one-third of all users, irrespective of treatment type. CONCLUSIONS If Saskatchewan's newly imposed coverage limits had been applied in 2013, the costs of strips exceeding those limits would have totalled $2.5 million. Although TS use aligns with chronic disease care paradigms, the substantial costs and lack of evidence of patient outcomes demand better strategies to help reduce unnecessary use.
Research Interests:
| 279 rates. Health professionals and policy-makers need to be aware of the increased risk for diabetes and opportunities for prevention in women and young people belonging to specific ethnic groups. Indigenous communities and ethnicity... more
| 279 rates. Health professionals and policy-makers need to be aware of the increased risk for diabetes and opportunities for prevention in women and young people belonging to specific ethnic groups. Indigenous communities and ethnicity issues No conflict of interest
Research Interests:
PurposeOrganizational context influences the effect of facilitation efforts on research use in care settings. The interactions of these factors are complex. Therefore, the use of traditional statistical methods to examine their... more
PurposeOrganizational context influences the effect of facilitation efforts on research use in care settings. The interactions of these factors are complex. Therefore, the use of traditional statistical methods to examine their interrelationships is often impractical. Big Data analytics can automatically detect patterns within the data. We applied the chi‐squared automatic interaction detection (CHAID) algorithm and classification tree technique to explore the dynamic and interdependent relationships between the implementation science concepts—context, facilitation, and research use.DesignObservational, cross‐sectional study based on survey data collected from a representative sample of nursing homes in western Canada.MethodsWe assessed three major constructs: (a) Conceptual research utilization (CRU) using the CRU scale; (b) facilitation of research use measured by the frequency of contacts between the frontline staff and a clinical educator, or person who brings new ideas to the care unit; and (c) organizational context at the unit level using the Alberta Context Tool (ACT). CHAID analysis was performed to detect the interactions between facilitation and context variables. Results were illustrated in a classification tree to provide a straightforward visualization.FindingsData from 312 care units in three provinces were included in the final analysis. Results indicate significant multiway interactions between facilitation and various aspects of the organizational context, including leadership, culture, evaluation, structural resources, and organizational slack (staffing). Findings suggested the preconditions of the care settings where research use can be maximized.ConclusionsCHAID analysis helped transform data into usable knowledge. Our findings provide insight into the dynamic relationships of facilitators’ efforts and organizational context, and how these factors’ interplay and their interdependence together may influence research use.Clinical relevanceKnowledge of the combined effects of facilitators’ efforts and various aspects of organizational context on research use can contribute to effective strategies to narrow the evidence‐practice gap in care settings.
Research Interests:
Research Interests:
Research Interests:
Background Colorectal cancer (CRC) is one of the leading causes of cancer death globally. CRC screening can reduce the incidence and mortality of CRC. However, socially disadvantaged groups may disproportionately benefit less from... more
Background Colorectal cancer (CRC) is one of the leading causes of cancer death globally. CRC screening can reduce the incidence and mortality of CRC. However, socially disadvantaged groups may disproportionately benefit less from screening programs due to their limited access to healthcare. This poor access to healthcare services is further aggravated by intersecting, cumulative social factors associated with their sociocultural background and living conditions. This rapid review systematically reviewed and synthesized evidence on the effectiveness of Fecal Immunochemical Test (FIT) programs in increasing CRC screening in populations who do not have a regular healthcare provider or who have limited healthcare system access.Methods We used three databases: Ovid MEDLINE, Embase, and EBSCOhost CINAHL. We searched for systematic reviews, meta-analysis, and quantitative and mixed-methods studies focusing on effectiveness of FIT programs (request or receipt of FIT kit, completion rates o...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Objective COPD is a high-cost disease and results in frequent contacts with the healthcare system. The study objective was to compare the accuracy of classification models with different covariates for classifying COPD patients into cost... more
Objective COPD is a high-cost disease and results in frequent contacts with the healthcare system. The study objective was to compare the accuracy of classification models with different covariates for classifying COPD patients into cost groups. Methods Linked health administrative databases from Saskatchewan, Canada, were used to identify a cohort of newly diagnosed COPD patients (April 1, 2007 to March 31, 2011) and their episodes of healthcare encounters for disease exacerbations. Total costs of the first and follow-up episodes were computed and patients were categorized as persistently high cost, occasionally high cost, and persistently low cost based on cumulative cost distribution ranking using the 75th percentile cutoff for high-cost status. Classification accuracy was compared for seven multinomial logistic regression models containing socio-demographic characteristics (i.e., base model), and socio-demographic and prior healthcare use characteristics (i.e., comparator models...
Research Interests:
Research Interests:
The association between incretin-based drugs, such as dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagon-like peptide 1 (GLP-1) agonists, and acute pancreatitis is controversial. To determine whether the use of incretin-based drugs,... more
The association between incretin-based drugs, such as dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagon-like peptide 1 (GLP-1) agonists, and acute pancreatitis is controversial. To determine whether the use of incretin-based drugs, compared with the use of 2 or more other oral antidiabetic drugs, is associated with an increased risk of acute pancreatitis. A large, international, multicenter, population-based cohort study was conducted using combined health records from 7 participating sites in Canada, the United States, and the United Kingdom. An overall cohort of 1 532 513 patients with type 2 diabetes initiating the use of antidiabetic drugs between January 1, 2007, and June 30, 2013, was included, with follow-up until June 30, 2014. Current use of incretin-based drugs compared with current use of at least 2 oral antidiabetic drugs. Nested case-control analyses were conducted including hospitalized patients with acute pancreatitis matched with up to 20 controls on sex, age, c...
Research Interests:
Research Interests:
Research Interests:
Research Interests: Health Informatics, Long Term Care, Health Administration, Medicine, Quality of Care, and 15 moreNursing Research, Library and Information Studies, Humans, Information Quality, Systematic review, Aged, Questionnaires, Public health systems and services research, Reproducibility of Results, Geriatric Assessment, Pressure Ulcer, Observational Study, Literature Search, Minimum Data Set, and Reliability and validity
Background The overall impact of physician prescribers on population-level adherence rates are unknown. We aimed to quantify the influence of general practitioner (GP) physician prescribers on the outcome of optimal statin medication... more
Background The overall impact of physician prescribers on population-level adherence rates are unknown. We aimed to quantify the influence of general practitioner (GP) physician prescribers on the outcome of optimal statin medication adherence. Methods We conducted a retrospective cohort study using health administrative databases from Saskatchewan, Canada. Participants included physician prescribers and their patients beginning a new statin medication between January 1, 2012 and December 31, 2017. We grouped prescribers based on the prevalence of optimal adherence (i.e., proportion of days covered ≥ 80%) within their patient group. Also, we constructed multivariable logistic regression analyses on optimal statin adherence using two-level non-linear mixed-effects models containing patient and prescriber-level characteristics. An intraclass correlation coefficient was used to estimate the physician effect. Results We identified 1,562 GPs prescribing to 51,874 new statin users. The me...
Research Interests:
PRISMA-P 2015 Checklist. (DOCX 37 kb)
Research Interests:
Research Interests:
Background: Little is known about health or service use outcomes for residents of Canadian assisted living facilities. Our objectives were to estimate the incidence of admission to hospital over 1 year for residents of designated (i.e.,... more
Background: Little is known about health or service use outcomes for residents of Canadian assisted living facilities. Our objectives were to estimate the incidence of admission to hospital over 1 year for residents of designated (i.e., publicly funded) assisted living (DAL) facilities in Alberta, to compare this rate with the rate among residents of long-term care facilities, and to identify individual and facility predictors of hospital admission for DAL residents. Methods: Participants were 1066 DAL residents (mean age ± standard deviation 84.9 ± 7.3 years) and 976 longterm care residents (85.4 ± 7.6 years) from the Alberta Continuing Care Epidemiological Studies (ACCES). Research nurses completed a standardized comprehensive assessment for each resident and interviewed family caregivers at baseline (2006 to 2008) and 1 year later. We used standardized interviews with administrators to generate facility- level data. We determined hospital admissions through linkage with the Alber...
Research Interests:
Research Interests:
Over the past decade, governments and the non-profit, private, academic, and philanthropic sectors have begun thinking differently about how human and social services are organized and delivered. Across Canada, a range of integrated... more
Over the past decade, governments and the non-profit, private, academic, and philanthropic sectors have begun thinking differently about how human and social services are organized and delivered. Across Canada, a range of integrated health and social care practices are being developed, adapted, and implemented to meet local needs. The Hub (or Situation Table as it is more commonly known in Ontario) model is one such approach. The Hub model is a multi-sector, collaborative, risk-driven intervention that mobilizes multi-sectoral human services for the purpose of rapid risk mitigation focused on the immediate needs of persons experiencing acutely elevated risk of harmful safety or well-being outcomes. Over the past eight years, the model has been adopted in over 115 communities across Canada.While the model has benefited from developmental and formative evaluations, it is now timely to undertake a systematic multi-site evaluation of the generalizable impacts (e.g., clients, system, cos...
Background: In 2007, a drug benefit plan for Seniors (SDP) was launched in Saskatchewan, Canada. SDP capped out-of-pocket costs at $15 per prescription for individuals aged 65 and older. Objectives: To quantify the impact of the SDP on... more
Background: In 2007, a drug benefit plan for Seniors (SDP) was launched in Saskatchewan, Canada. SDP capped out-of-pocket costs at $15 per prescription for individuals aged 65 and older. Objectives: To quantify the impact of the SDP on chronic medication adherence. Methods: A retrospective cohort study was conducted for participants aged 65 or older who were eligible to the SPD, controlled by a younger group aged 40 to 64 who were ineligible. Adherence was measured over 365 days using medication possession ratio (MPR). MPRs were compared between age groups, and between pre and post SDP-launch periods. The odds ratio of optimal adherence (i.e., MPR≥80%) was estimated using logistic regression models with generalized estimating equations (GEE). Results: Between 2005 and 2009, 353,568 adherence observations were observed from 188,109 unique patients. Comparing the post-SDP period vs before, the increase in the odds of optimal medication adherence was significant (OR=1.08, 95% CI: 1.04...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
This study explored the effect of clinical educators as facilitators of research use and how it may be modified by organisational context in the settings. Cross-sectional observational study. A representative sample of 91 residential... more
This study explored the effect of clinical educators as facilitators of research use and how it may be modified by organisational context in the settings. Cross-sectional observational study. A representative sample of 91 residential long-term care (LTC) facilities across Western Canada. We used surveys to collect data from the frontline care aides and information about the organisational context of the care units. We assessed research use (the outcome) with the Conceptual Research Utilization (CRU) scale. Explanatory variables in the multiple regression analysis were facilitation, organisational context and the interaction terms. Facilitation was measured by the frequency of contacts between care aides and clinical educator or person who brings new ideas about resident care. Three core organisational context variables were measured using the Alberta Context Tool. We included data of 3873 care aides from 294 care units in the LTC facilities. We found significant associations between...
Hip fractures (HFs) represent an important cause of morbidity and mortality among adults in long-term care (LTC), but lack of detailed epidemiological data poses challenges to intervention planning. We aimed to determine the incidence of... more
Hip fractures (HFs) represent an important cause of morbidity and mortality among adults in long-term care (LTC), but lack of detailed epidemiological data poses challenges to intervention planning. We aimed to determine the incidence of HFs among permanent LTC residents in Saskatchewan between 2008 and 2012, using linked, provincial administrative health databases, exploring associations between outcomes and basic individual and institutional characteristics. We utilized the Ministry of Health databases to select HF cases based on ICD 10 diagnoses fracture of head and neck of femur, pertrochanteric fracture and subtrochanteric fracture of femur. HF incidence rates in LTC were compared to older adults in the general population. LTC residents were more likely to be female overall (65.5%), although this varied by age, with only 46.6% female in those under 65, but 77% female among those 90 years and older. Mean age of residents was highest in rural centres (85.2 yrs) and lowest in medi...
Research Interests:
ObjectivesWe sought to identify the most expensive hospitalized individuals in the Canadian province of Saskatchewan in fiscal year 2012/13, and determine the primary cause of their high use of health services. Our aim was to identify... more
ObjectivesWe sought to identify the most expensive hospitalized individuals in the Canadian province of Saskatchewan in fiscal year 2012/13, and determine the primary cause of their high use of health services. Our aim was to identify health problems that can be prevented or better managed in a non-hospital health care setting. Comorbid conditions are an important and confounding covariate in this population and so we used multiple correspondence analysis (MCA) to investigate the association of these conditions with each other and the most responsible diagnosis for each hospitalization. MCA is a multivariable descriptive statistical technique that displays the relationship between categorical variables in 2-dimensional graphical form. ApproachWe identified the most expensive 5% of people hospitalized between 01APR2012 and 31MAR2013. Hospital costs accounted for the majority of costs, but physician, drug, long-term care, and home care costs were added. Comorbid conditions in any of t...
ObjectiveThe objective of this research is to identify people with mental health and/or addiction (MHA) problems and determine characteristics that led to them becoming a superuser of health services (i.e., the most expensive 10% of all... more
ObjectiveThe objective of this research is to identify people with mental health and/or addiction (MHA) problems and determine characteristics that led to them becoming a superuser of health services (i.e., the most expensive 10% of all health service users). ApproachIn Saskatchewan, Canada, we used hospital and physician administrative data spanning 2005 to 2014 to identify the MHA cohort. We will calculate total health care costs for each individual and assign them to one of three groups: low cost users (<50th percentile), moderate cost users (50-<90th percentile), and superusers (90th percentile and above). For each group, we will describe sociodemographic characteristics, disease characteristics, and use of health services, and describe their trajectory towards becoming a superuser. Predictors of becoming a superuser will be identified. A novel aspect of this research is the inclusion of sociobehavioural risk factors by linking 4 population and public health administrative...
Studies evaluating the impact of integrated models of care [IMC] for inflammatory bowel disease [IBD] on disease-related outcomes are needed. We compared the risk of IBD-related outcomes and prescription medication claims between patients... more
Studies evaluating the impact of integrated models of care [IMC] for inflammatory bowel disease [IBD] on disease-related outcomes are needed. We compared the risk of IBD-related outcomes and prescription medication claims between patients exposed and non-exposed to an IMC. A retrospective population-based matched cohort study was conducted between 2009 and 2015, using administrative health data of Saskatchewan, Canada. Patients aged 18+ years with a diagnosis of IBD were identified with a validated administrative definition. Cases were classified as exposed and non-exposed to the IMC for IBD and matched based on propensity scores and disease duration. IBD-related hospitalisations, surgeries, prescription medication claims, and corticosteroid dependency [CsDep] were measured. Cox and logistic regression models evaluated differences between the groups, estimating hazard [HRs] and odds [ORs] ratios with corresponding confidence intervals [CIs]. In total, 2312 matched patients were included; 24.3% were exposed individuals. Compared with non-exposed, exposed patients had a lower risk of IBD-related surgeries [HR = 0.78, 95% CI 0.61-0.99], higher risk of prescriptions of immune modulators [HR = 1.68, 95% CI 1.42-1.99], and biologics [HR = 1.85, 95% CI 1.52-2.27], and a lower risk of 5-aminosalicylic acid prescriptions [HR = 0.81, 95% CI 0.69-0.95]. A lower risk of IBD-related hospitalisations among exposed ulcerative colitis [UC] patients [HR = 0.66, 95% CI 0.49-0.89] was identified in stratified analyses. The odds of CsDep among exposed UC patients was 0.39 [95% CI 0.15-0.98]. The observed differences in disease-related outcomes and use of steroid-sparing maintenance therapies between exposed and non-exposed individuals support the concept that enhanced quality of care can be achieved within IMC for IBD.