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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
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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
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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
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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.
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| 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
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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.
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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...
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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...
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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...
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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...
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PRISMA-P 2015 Checklist. (DOCX 37 kb)
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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...
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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...
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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...
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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.
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The objectives of the study were to assess differences in utilization of maternal serum screening (MSS) and prenatal diagnostic testing between population subgroups and to determine the impact on chromosomal anomaly birth rates. This... more
The objectives of the study were to assess differences in utilization of maternal serum screening (MSS) and prenatal diagnostic testing between population subgroups and to determine the impact on chromosomal anomaly birth rates. This population-based cohort study included all female residents from Saskatchewan, Canada, who delivered a baby, experienced a fetal loss, or had a pregnancy termination between 2000 and 2005. In total, 93 171 women were included in the study dataset, with a subset (n = 35 527) evaluated to identify predictors of screening and diagnostic testing. Incidence and live birth prevalence of Down syndrome were compared across populations. MSS uptake was lower in First Nations (FN) women (9.6% vs 28.4%), and living in a rural health region moderated the difference (p &amp;amp;lt; 0.001). Consequently, fewer chromosomal anomalies were prenatally diagnosed in FN women than in the rest of the population (8.3% vs 27%). Terminations of pregnancy for fetal anomaly occurred at a lower frequency amongst FN women (0.64 vs 1.34, per 1000 pregnancies), resulting in a smaller effect on Down syndrome birth rates. Utilization of MSS and diagnostic testing was lower in FN and rural populations. Further research will be necessary to understand the relevance of value preferences and access barriers. © 2016 John Wiley &amp;amp;amp; Sons, Ltd.
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Original studies published over the last decade regarding time trends in dementia report mixed results. The aims of the present study were to use linked administrative health data for the province of Saskatchewan for the period 2005/2006... more
Original studies published over the last decade regarding time trends in dementia report mixed results. The aims of the present study were to use linked administrative health data for the province of Saskatchewan for the period 2005/2006 to 2012/2013 to: (1) examine simultaneous temporal trends in annual age- and sex-specific dementia incidence and prevalence among individuals aged 45 and older, and (2) stratify the changes in incidence over time by database of identification. Using a population-based retrospective cohort study design, data were extracted from seven provincial administrative health databases linked by a unique anonymized identification number. Individuals 45 years and older at first identification of dementia between April 1, 2005 and March 31, 2013 were included, based on case definition criteria met within any one of four administrative health databases (hospital, physician, prescription drug, and long-term care). Between 2005/2006 and 2012/2013, the 12-month age-...
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The Health Quality Council and the Saskatchewan Association of Health Organizations convened a committee to develop evidence-based best practice guidelines for pressure ulcer prevention and management in the province of Saskatchewan,... more
The Health Quality Council and the Saskatchewan Association of Health Organizations convened a committee to develop evidence-based best practice guidelines for pressure ulcer prevention and management in the province of Saskatchewan, Canada. The Health Quality Council designed a pilot project to 1) implement these guidelines in long-term care facilities using an evidence-based strategy and 2) evaluate the impact of the guidelines on the incidence and prevalence of residents with pressure ulcers. Seven long-term care facilities in Saskatchewan participated in the project, which ran from November 2004 to September 2005. Data from 753 patients were collected and analyzed. Following guideline implementation, the incidence of residents with pressure ulcers decreased from 6.0% to 0.2% and the prevalence rate decreased from 8.8% to 3.7%. The greater decline in incidence compared to prevalence suggests that process improvements occurred primarily in the prevention of new pressure ulcers. These results suggest that organizational commitment to improving skin and wound care followed by the facilitated implementation of evidence-based guidelines can result in improved clinical outcomes for long-term care residents.
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Isotretinoin, a teratogen, is widely used to treat cystic acne. Although the risks of pregnancy during isotretinoin therapy are well recognized, there are doubts about the level of adherence with the pregnancy prevention program in... more
Isotretinoin, a teratogen, is widely used to treat cystic acne. Although the risks of pregnancy during isotretinoin therapy are well recognized, there are doubts about the level of adherence with the pregnancy prevention program in Canada. Our objective was to evaluate the effectiveness of the Canadian pregnancy prevention program in 4 provinces: British Columbia, Saskatchewan, Manitoba and Ontario. Using administrative data, we identified 4 historical cohorts of female users of isotretinoin (aged 12-48 yr) for the period 1996 to 2011. We defined pregnancy using International Statistical Classification of Diseases and billing codes. One definition included only cases with documented pregnancy outcomes (high-specificity definition); the other definition also included individuals recorded as receiving prenatal care (high-sensitivity definition). We studied new courses of isotretinoin and detected pregnancies in 2 time windows: during isotretinoin treatment only and up to 42 weeks afte...
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Determining the epidemiology of dementia among the population as a whole in specific jurisdictions - including the long-term care population-is essential to providing appropriate care. The objectives of this study were to use linked... more
Determining the epidemiology of dementia among the population as a whole in specific jurisdictions - including the long-term care population-is essential to providing appropriate care. The objectives of this study were to use linked administrative databases in the province of Saskatchewan to determine the 12-month incidence and prevalence of dementia for the 2012/13 period (1) among individuals aged 45 and older in the province of Saskatchewan, (2) according to age group and sex, and (3) according to diagnosis code and other case definition criteria. We used a population-based retrospective cohort study design and extracted data from 10 provincial health databases linked by a unique health services number. The cohort included individuals 45 years and older at first identification of dementia between April 1, 2001 and March 31, 2013 based on case definitions met within any one of four administrative health databases (Hospital Discharge Abstracts, Physician Service Claims, Prescriptio...
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Prescription medication use, which is common among long-term care facility (LTCF) residents, is routinely used to describe quality of care and predict health outcomes. Data sources that capture medication information, which include... more
Prescription medication use, which is common among long-term care facility (LTCF) residents, is routinely used to describe quality of care and predict health outcomes. Data sources that capture medication information, which include surveys, medical charts, administrative health databases, and clinical assessment records, may not collect concordant information, which can result in comparable prevalence and effect size estimates. The purpose of this research was to estimate agreement between two population-based electronic data sources for measuring use of several medication classes among LTCF residents: outpatient prescription drug administrative data and the Resident Assessment Instrument Minimum Data Set (RAI-MDS) Version 2.0. Prescription drug and RAI-MDS data from the province of Saskatchewan, Canada (population 1.1 million) were linked for 2010/11 in this cross-sectional study. Agreement for anti-psychotic, anti-depressant, and anti-anxiety/hypnotic medication classes was examin...
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The author calls for a critical assessment of the impact of investments made in the measurement of quality and safety, and reflects on whether a reorientation of some of this investment is required to realize the healthcare quality and... more
The author calls for a critical assessment of the impact of investments made in the measurement of quality and safety, and reflects on whether a reorientation of some of this investment is required to realize the healthcare quality and safety improvement the system seeks. This article also reflects on several Canadian initiatives that have been typical and draws on the experience of health systems that have used measurement to great effect to suggest how investments in healthcare quality and safety measurement should be focused in the future.
Diabetic First Nations people (FN) have higher ESRD rates than other Canadians but the reasons remain unclear. We sought to better understand this disparity by comparing demographic, laboratory and survival features of diabetic FN and... more
Diabetic First Nations people (FN) have higher ESRD rates than other Canadians but the reasons remain unclear. We sought to better understand this disparity by comparing demographic, laboratory and survival features of diabetic FN and other Saskatchewan residents (OSK) by renal function stage. Prevalent diabetes cases in 2005/06 were identified in Saskatchewan's two largest health regions using administrative databases, and linked with centralized laboratory tests. They were sub-divided into five stages of renal function using estimated glomerular filtration rates (eGFR) that were determined in 992 of 2,321 FN (42.7%) and 14,054 of 21,886 OSK (64.2%). Age, sex, urine microalbumin (MA), glycosylated hemoglobin (A1C), low density lipoprotein cholesterol (LDL-C) and two year mortality risk was compared for all subjects. Diabetic FN were younger (mean age 52.7 vs. 64.2, p < 0.0001), more likely to be female (59.6% vs.45.4%, p < 0.001), had increased MA (56.6% vs. 48.4%, p <...
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The Health Quality Council and the Saskatchewan Association of Health Organizations convened a committee to develop evidence-based best practice guidelines for pressure ulcer prevention and management in the province of Saskatchewan,... more
The Health Quality Council and the Saskatchewan Association of Health Organizations convened a committee to develop evidence-based best practice guidelines for pressure ulcer prevention and management in the province of Saskatchewan, Canada. The Health Quality Council designed a pilot project to 1) implement these guidelines in long-term care facilities using an evidence-based strategy and 2) evaluate the impact of the guidelines on the incidence and prevalence of residents with pressure ulcers. Seven long-term care facilities in Saskatchewan participated in the project, which ran from November 2004 to September 2005. Data from 753 patients were collected and analyzed. Following guideline implementation, the incidence of residents with pressure ulcers decreased from 6.0% to 0.2% and the prevalence rate decreased from 8.8% to 3.7%. The greater decline in incidence compared to prevalence suggests that process improvements occurred primarily in the prevention of new pressure ulcers. Th...
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Assessment of older people rarely includes functional domains critical for ensuring optimum outcome of treatment in acute hospital care. We report the development of a new assessment instrument, and illustrate how differences between... more
Assessment of older people rarely includes functional domains critical for ensuring optimum outcome of treatment in acute hospital care. We report the development of a new assessment instrument, and illustrate how differences between pre-hospital and hospital admission status can be systematically evaluated using the Minimum Data Set for Acute Care (MDS-AC). Content was developed by literature review and consultation with professionals working in acute areas. Dual independent assessments were conducted on hospital in-patients in 4 countries. Inter-assessor reliability coefficients were calculated for each item. Kappa was calculated for all binary and multi-level nominal variables. Quadratically weighted Kappa was estimated for all ordinal multi-level variables. Where one level of the variable contained 90% or more of the subjects, total observed agreement is reported. Separate reliability estimates were calculated for pre-hospitalization and inpatient items. Subjects had a mean age ...
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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... more
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. 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 Alberta Inpatient Discharg...
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Methods: The Collaborative design was similar to the Breakthrough Series developed by the Institute for Healthcare Improvement. Each unit formed a quality improvement team, which integrated evidence based guidelines into their practice.... more
Methods: The Collaborative design was similar to the Breakthrough Series developed by the Institute for Healthcare Improvement. Each unit formed a quality improvement team, which integrated evidence based guidelines into their practice. Application of guidelines was customized using plan-do-study-act cycles. Four units focused on prevention of VTE. Quality of care measures were: percent of patients assessed for VTE risk upon
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Although administrative health care databases have long been used to evaluate adverse drug effects, responses to drug safety signals have been slow and uncoordinated. We describe the establishment of the Canadian Network for Observational... more
Although administrative health care databases have long been used to evaluate adverse drug effects, responses to drug safety signals have been slow and uncoordinated. We describe the establishment of the Canadian Network for Observational Drug Effect Studies (CNODES), a collaborating centre of the Drug Safety and Effectiveness Network (DSEN). CNODES is a distributed network of investigators and linked databases in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec and Nova Scotia. Principles of operation are as follows: (1) research questions are prioritized by the coordinating office of DSEN; (2) the linked data stay within the provinces; (3) for each question, a study team formulates a detailed protocol enabling consistent analyses in each province; (4) analyses are "blind" to results obtained elsewhere; (5) protocol deviations are permitted for technical reasons only; (6) analyses using multivariable methods are lodged centrally with a methods team, whic...
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To quantify an association between acute kidney injury and use of high potency statins versus low potency statins. Retrospective observational analysis of administrative databases, using nine population based cohort studies and... more
To quantify an association between acute kidney injury and use of high potency statins versus low potency statins. Retrospective observational analysis of administrative databases, using nine population based cohort studies and meta-analysis. We performed as treated analyses in each database with a nested case-control design. Rate ratios for different durations of current and past statin exposure to high potency or low potency statins were estimated using conditional logistic regression. Ratios were adjusted for confounding by high dimensional propensity scores. Meta-analytic methods estimated overall effects across participating sites. Seven Canadian provinces and two databases in the United Kingdom and the United States. 2,067,639 patients aged 40 years or older and newly treated with statins between 1 January 1997 and 30 April 2008. Each person hospitalized for acute kidney injury was matched with ten controls. A dispensing event was new if no cholesterol lowering drug or niacin ...
Research Interests: Patient Safety, Acute kidney injury, Humans, Hospitalization, Female, and 15 moreMale, Confidence intervals, Hypercholesterolemia, Incidence, British Columbia, Aged, Great Britain, Middle Aged, Adult, Public health systems and services research, Odds ratio, Retrospective Studies, BMJ, Logistic Models, and Cohort Studies
To evaluate the incremental increase in new onset diabetes from higher potency statins compared with lower potency statins when used for secondary prevention. Eight population based cohort studies and a meta-analysis. Six Canadian... more
To evaluate the incremental increase in new onset diabetes from higher potency statins compared with lower potency statins when used for secondary prevention. Eight population based cohort studies and a meta-analysis. Six Canadian provinces and two international databases from the UK and US. 136,966 patients aged ≥ 40 years newly treated with statins between 1 January 1997 and 31 March 2011. Within each cohort of patients newly prescribed a statin after hospitalisation for a major cardiovascular event or procedure, we performed as-treated, nested case-control analyses to compare diabetes incidence in users of higher potency statins with incidence in users of lower potency statins. Rate ratios of new diabetes events were estimated using conditional logistic regression on different lengths of exposure to higher potency versus lower potency statins; adjustment for confounding was achieved using high dimensional propensity scores. Meta-analytic methods were used to estimate overall effe...
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We aimed to describe trends in the prevalence and incidence of diabetes mellitus and also report the overall use of diabetes medications among patients newly admitted to a long-term care facility (LTCF). A retrospective cohort study was... more
We aimed to describe trends in the prevalence and incidence of diabetes mellitus and also report the overall use of diabetes medications among patients newly admitted to a long-term care facility (LTCF). A retrospective cohort study was done using health administrative databases in Saskatchewan. Eligible patients were newly admitted to LTCF in Saskatchewan between 2003 and 2011 and maintained LTCF residency for at least 6 months. Prevalence of diabetes was defined with physician or hospital claims in the 2 years preceding admission. Antihyperglycemic medication use was estimated from prescription claims data during the first 6 months after LTCF admission. All data were descriptively analyzed. The validated case definition for diabetes (≥2 diagnostic claims) in the 2 years before or 6 months after admission was met by 16.9% of patients (2471 of 14,624). An additional 965 patients (6.6%) had a single diabetes diagnostic claim or antihyperglycemic prescriptions only. Among patients rec...
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Research Interests: Anthropology, Long Term Care, Evidence Based Medicine, Evidence Based Practice, Focus Groups, and 15 moreKnowledge Translation, Learning, Knowledge, Humans, Absorptive Capacity, Nursing Homes, Focus Group, Ontario, Multiple Case Study, Aged, Multiple, Organizational Innovation, Homes for the Aged, Guideline Adherence, and Interviews as topic
Background: There is a lack of standardized mobility measures specific to the long-term care (LTC) population. Therefore, the Continuing Care Activity Measure (CCAM) was developed.Objective: This study determined levels of reliability,... more
Background: There is a lack of standardized mobility measures specific to the long-term care (LTC) population. Therefore, the Continuing Care Activity Measure (CCAM) was developed.Objective: This study determined levels of reliability, validity for clinical utilization, and sensitivity to change of this measure.Design: This was a prospective longitudinal cohort study among elderly people with primarily physical or medical impairments who were residing in LTC institutions that provide nursing home and more-complex care, with access to physical therapy services.Method: The CCAM, the Clinical Outcome Variables Scale (COVS), the Social Engagement Scale (SES) of the Resident Assessment Instrument—Minimum Data Set (RAI-MDS) 2.0 instrument, and the Resource Utilization Groups, version 3, (RUG-III) were administered by clinical and research physical therapists, with timing dictated by the study purpose.Results: The participants were 136 residents of LTC institutions and 21 physical therapis...
Research Interests: Long Term Care, Physical Therapy, Activities of Daily Living, Prospective studies, Humans, and 12 moreFemale, Male, Clinical Sciences, Aged, Longitudinal Studies, Reproducibility of Results, Geriatric Assessment, Sensitivity and Specificity, Continuity of Patient Care, Cross Sectional Studies, Frail elderly, and Disability Evaluation
The performance of five comorbidity measures, including the Charlson and Elixhauser indices, was investigated for predicting mortality, hospitalization, and fracture outcomes in two osteoporosis cohorts defined from administrative... more
The performance of five comorbidity measures, including the Charlson and Elixhauser indices, was investigated for predicting mortality, hospitalization, and fracture outcomes in two osteoporosis cohorts defined from administrative databases. The optimal comorbidity measure depended on the outcome of interest, although overall the Elixhauser index performed well. Studies that use administrative data to investigate population-based health outcomes often adopt risk-adjustment models that include comorbidities, conditions that coexist with the index disease. There has been limited research about the measurement of comorbidity in osteoporotic populations. The study purpose was to compare the performance of comorbidity measures for predicting mortality, fracture, and health service utilization outcomes in two cohorts with diagnosed or treated osteoporosis. Administrative data were from the province of Saskatchewan, Canada. Osteoporosis cohorts were identified from diagnoses in hospital and physician data and prescriptions for osteo-protective medications using case definitions with high sensitivity or high specificity. Five diagnosis- and medication-based comorbidity measures and five 1-year outcomes, including mortality, hospitalization (two measures), osteoporotic-related fracture, and hip fracture, were defined. Performance of the comorbidity measures was assessed using the c-statistic (discrimination) and Brier score (prediction error) for multiple logistic regression models. In the specific cohort (n = 9,849) for the mortality outcome, the Elixhauser index resulted in the largest improvement (8.96%) in the c-statistic and lowest Brier score compared to a model that contained demographic and socioeconomic variables, followed by the Charlson index (6.06%). For hospitalization, the number of different diagnoses resulted in the largest improvement (14.01%) in the c-statistic. The Elixhauser index resulted in significant improvements in the c-statistic for osteoporosis-related and hip fractures. Similar results were observed for the sensitive cohort (n = 28,068). Recommendations about the optimal comorbidity measure will vary with the outcome under investigation. Overall, the Elixhauser index performed well.
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Although both quality and cost are important concerns for long term care (LTC) facility management and policy, the relationship between cost and quality is poorly understood. Such knowledge is necessary to guide facility management and... more
Although both quality and cost are important concerns for long term care (LTC) facility management and policy, the relationship between cost and quality is poorly understood. Such knowledge is necessary to guide facility management and policy action. We sought to determine the net effect of quality on cost in LTC hospital settings. A 4-year panel dataset from April 1997 through March 2002 comprising observations from 99 LTC hospitals were included in this analysis. We examined the relationship between direct resident costs and 7 indicators of quality for long-stay residents. We used panel data methods to control for unobserved facility-level characteristics. We found that increases in restraint use and incident pressure/skin ulcers were associated with lower per diem costs, whereas incontinence prevalence was associated with higher per diem costs. Our results point to different implications regarding cost and quality for different quality indicators. Although facilities have a strong internal business case to improve quality in incontinence, policy-makers may need to provide financial incentives to encourage reductions in restraint use and incident skin ulcers so as to defray potential higher costs associated with improving quality in these areas.
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Over 20 countries currently use the Minimum Data Set Resident Assessment Instrument (MDS) in long-term care settings for care planning, policy, and research purposes. A full assessment of the quality of the diagnostic information recorded... more
Over 20 countries currently use the Minimum Data Set Resident Assessment Instrument (MDS) in long-term care settings for care planning, policy, and research purposes. A full assessment of the quality of the diagnostic information recorded on the MDS is lacking. The primary goal of this study was to examine the quality of diagnostic coding on the MDS. Subjects for this study were admitted to Ontario Complex Continuing Care Hospitals (CCC) directly from acute hospitals between April 1, 1997 and March 31, 2005 (n = 80,664). Encrypted unique identifiers, common across acute and CCC administrative databases, were used to link administrative records for patients in the sample. After linkage, each resident had 2 sources of diagnostic information: the acute discharge abstract database and the MDS. Using the discharge abstract database as the reference standard, we calculated the sensitivity for each of 43 MDS diagnoses. Compared with primary diagnoses coded in acute care abstracts, 12 of 43 MDS diagnoses attained a sensitivity of at least 0.80, including 7 of the 10 diagnoses with the highest prevalence as an acute care primary diagnosis before CCC admission. Although the sensitivity was high for many of the most prevalent conditions, important diagnostic information is missed increasing the potential for suboptimal clinical care. Emphasis needs to be put on improving information flow across care settings during patient transitions. Researchers should exercise caution when using MDS diagnoses to identify patient populations, particularly those shown to have low sensitivity in this study.
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The provision of preventive services and continuity of care are important aspects of long-term care (LTC). A proposed quality indicator of such care is the rate of hospitalizations due to ambulatory care sensitive conditions (ACSCs). As... more
The provision of preventive services and continuity of care are important aspects of long-term care (LTC). A proposed quality indicator of such care is the rate of hospitalizations due to ambulatory care sensitive conditions (ACSCs). As the ACSC approach to identifying potentially avoidable hospitalizations (PAH) was developed for younger community-dwelling adults in the United States, we sought to examine its applicability as a quality indicator for older institutionalized residents in Canada. ACSCs were identified in a linked hospital-based LTC and acute care administrative database at the Institute for Clinical Evaluative Sciences in Ontario, Canada. An expert panel was then convened to assess the applicability of existing ACSCs to an older institutionalized population in Canada and to develop consensus-based revisions appropriate to this setting. The revised definition of PAH was then applied to the same linked database. The proportion of hospitalizations categorized as a PAH using the original ACSCs was 47% (4177 of 8885). The panel suggested the inclusion of 2 new conditions (septicemia and falls/fractures) coupled with the deletion of 4 of the original ACSCs (immunization-preventable conditions; nutritional deficiency; severe ear, nose and throat infections; tuberculosis) that were rare hospital diagnoses in this population. Using the revised definition, 55% of hospitalizations (4874) were identified as potentially avoidable. Changes to the original list of ACSCs led to more hospitalizations being categorized as potentially avoidable. Significant variation between LTC facilities and over time in our PAH indicator may identify areas for improvement in preventive services and continuity of care for LTC residents.
Research Interests: Long Term Care, Applied Economics, Heart Failure, Humans, Diabetes mellitus, and 15 morePneumonia, Sepsis, Urinary Tract Infections, Ontario, Patient Admission, Medical Care, Aged, Public health systems and services research, Utilization review, Cross Sectional Studies, Preventive Health Services, Reference standards, Hospital Admission, Accidental falls, and Fractures Bone
Research Interests: Epidemiology, Psychometrics, Public Health, Mortality, Comorbidity, and 15 moreActivities of Daily Living, Canada, Humans, Older people, Chronic Disease, Female, Male, Aged, Middle Aged, Institutionalization, Geriatric Assessment, Proportional Hazards Models, Severity of Illness Index, Frail elderly, and Medical and Health Sciences
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In the province of Saskatchewan, Canada, stroke is the third leading cause of death as well as the major cause of adult disability. Once a person suffers a stroke or transient ischemic attack (TIA), they are at high risk for having a... more
In the province of Saskatchewan, Canada, stroke is the third leading cause of death as well as the major cause of adult disability. Once a person suffers a stroke or transient ischemic attack (TIA), they are at high risk for having a secondary stroke. Hypertension (elevated blood pressure) is the single most important modifiable risk factor for both first and recurrent stroke, and is thus an important risk factor to be controlled. According to the Canadian Stroke Strategy (CSS) Best Practice Recommendations, blood pressure lowering treatment should be initiated before discharge from hospital for all stroke/TIA patients. The purpose of this study was to examine the quality of medically driven secondary stroke prevention care in Saskatchewan as applied to hypertension control. The objectives of the study were to: (1) develop methodology and calculate a secondary stroke process of care measure using available data in Saskatchewan, based on an appropriate hypertension therapy indicator recommendation from the CSS Performance Measurement Manual; (2) examine variation in secondary stroke prevention hypertensive care among the Saskatchewan Regional Health Authorities; and (3) investigate factors associated with receiving evidence-based hypertensive secondary stroke prevention. This multi-year cross-sectional study was an analysis of deidentified health data derived from linkage of administrative health data. A select indicator from the CSS Performance Measurement Manual that measures adherence to a CSS Best Practice Guidelines concerning use of antihypertensive medications for secondary stroke prevention was calculated. Logistic regression was used to quantify the association of patient demographic and socioeconomic characteristics and geographic location of care with receipt of guideline-recommended hypertensive secondary stroke prevention. The target population was all Saskatchewan residents who were hospitalized in Saskatchewan for a stroke or TIA between April 1, 2001 and March 31, 2008. The results of this study indicate that the management of hypertension for secondary stroke prevention is sub-optimal in Saskatchewan. Although there was some improvement over the time period, approximately 40% of patients were not taking antihypertensives at 90 days after discharge from acute care. The correlates, urban/non-urban, previous use of antihypertensive drugs and effect of age modified by sex, were found to be significantly associated with receiving hypertensive secondary stroke prevention, suggesting there are modifiable factors that contribute to variations in this form of secondary stroke care quality in Saskatchewan. The results of this study suggest that there is a need for province-wide improvement to secondary stroke prevention in Saskatchewan, Canada.
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Research Interests: Long Term Care, Data Analysis, Case Study Research, Implementation Science, Knowledge Translation, and 15 moreTranslational Research, Case Study, Focus Group, Data Collection, Pattern Matching, Implementation, Participant Observation, Multiple Case Study, Stable Set, Empirical evidence, Stratified Random Sampling, Instrument Design, Mixed Method, Minimum Data Set, and Medical and Health Sciences
There is a growing need for an integrated health information system to be used in community, institutional and hospital based settings. For example, changes in the structure, process and venues of service delivery mean that individuals... more
There is a growing need for an integrated health information system to be used in community, institutional and hospital based settings. For example, changes in the structure, process and venues of service delivery mean that individuals with similar needs may be cared for in a variety of different settings. Moreover, as people make transitions from one sector of the healthcare system to another, there is a need for comparable information to ensure continuity of care and reduced assessment burden. The RAI/MDS series of assessment instruments comprise an integrated health information system because they have consistent terminology, common core items, and a common conceptual basis in a clinical approach that emphasizes the identification of functional problems.
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This paper reviews the reliability and validity of the Minimum Data Set (MDS) assessment, which is being used increasingly in Canadian nursing homes and continuing care facilities. The central issues that surround the development and... more
This paper reviews the reliability and validity of the Minimum Data Set (MDS) assessment, which is being used increasingly in Canadian nursing homes and continuing care facilities. The central issues that surround the development and implementation of a standardized assessment such as the MDS are presented, including implications for health care managers in how to approach data quality concerns. With other sectors such as home care and inpatient psychiatry using MDS for national reporting, these issues have importance in and beyond residential care management.
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ABSTRACT Accurate predictive models of costs for episodes of healthcare utilization associated with acute and chronic conditions can be used to develop non-fee-for-service provider remuneration systems. We examined the performance of... more
ABSTRACT Accurate predictive models of costs for episodes of healthcare utilization associated with acute and chronic conditions can be used to develop non-fee-for-service provider remuneration systems. We examined the performance of eight predictive models for costs associated with episodes of care for chronic obstructive pulmonary disease (COPD) exacerbations: ordinary least squares (OLS) regression on untransformed costs, OLS regression on log-transformed costs with Duan’s retransformation, OLS regression on log-transformed costs with heteroscedastic retransformation, OLS regression on log-transformed costs with normal retransformation, robust regression, generalized linear model (GLM) with a Poisson distribution and log link function, GLM with a Gamma distribution and identity link function and GLM with a Gamma distribution and log link function. Administrative health data from Saskatchewan, Canada, including hospital records, physician billing claims, prescription drug records and home care service records were linked to identify individuals with diagnosed COPD and measure their episodes of health service utilization and costs. Cross-validation results showed that none of the models consistently resulted in the best prediction; the OLS regression model on log-transformed costs with normal retransformation had the highest R 2, but the OLS model on untransformed costs and the robust regression model had the best prediction accuracy based on root mean square error and mean absolute prediction error, respectively. Based on these findings, we recommend that researchers consider adopting one of these three models for predicting costs of healthcare use in episodes of care, but also emphasize that further comparisons of model performance are warranted.
Research Interests: Organizational Learning, Organizational Culture, Long Term Care, Evidence Based Medicine, Health Care, and 15 moreQuality of Mental Health Care, Knowledge Transfer, Capacity Building, Health Care Management, Learning, Humans, Business and Management, Nursing Homes, Diffusion of Innovation, Ontario, Public health systems and services research, Organizational Innovation, Innovation Adoption, Guideline Adherence, and Quality of health care
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A key component in assessing the performance of rehabilitation services is the client&amp;amp;amp;amp;amp;amp;amp;amp;#39;s perspective. The purpose of this paper is to report on the development of a publicly available measure of... more
A key component in assessing the performance of rehabilitation services is the client&amp;amp;amp;amp;amp;amp;amp;amp;#39;s perspective. The purpose of this paper is to report on the development of a publicly available measure of client-centred rehabilitation (CCRQ) that can be used for discriminative and evaluative purposes. Mixed qualitatative and quantitative methods were used. Phase 1: Identification of seven domains of client-centred rehabilitation based on a literature review, focus groups with clients, and review by content experts. Phase 2: Item generation for the seven conceptually derived subscales and cognitive interviews with inpatient rehabilitation patients. Phase 3: Psychometric testing for internal reliability, test-retest reliability and discriminative construct validity using data from a mailed, self-administered survey to 1,568 patients discharged from two large inpatient rehabilitation facilities. The seven conceptually derived subscales all have strong internal (0.72 - 0.87) and test-retest reliability (0.74 - 0.85). Discriminative construct validity is demonstrated by the ability of subscales to identify significant differences between programs within two rehabilitation facilities. The results for the reliability and validity of this measure support its value for use in clinical and quality improvement work as well as research.
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Research Interests: Traumatic Brain Injury, Forecasting, Adolescent, Employment, Disability, and 15 moreMultivariate Analysis, Humans, Female, Male, Regression Analysis, Pennsylvania, Aged, Middle Aged, Adult, Retrospective Studies, Age Factors, Work Capacity Evaluation, Brain injuries, Severity of Illness Index, and Medical and Health Sciences
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RÉSUMÉLes maisons de soins infirmiers sont devenues des environnements offrant des soins complexes, dont les habitants ont des besoins importants et la plupart souffrent de la démence liée a l’âge. S’appuyant sur les recherches de Hirdes... more
RÉSUMÉLes maisons de soins infirmiers sont devenues des environnements offrant des soins complexes, dont les habitants ont des besoins importants et la plupart souffrent de la démence liée a l’âge. S’appuyant sur les recherches de Hirdes et al. (2011), nous décrivons un profil des résidents dans un échantillon représentatif de 30 maisons de soins infirmiers en milieu urbain dans les provinces des Prairies, en utilisant des données de L’Instrument d’évaluation des résidents/le recueil de données minimum (Resident Assistant Instrument – Minimum Data Set 2.0) de 5 196 évaluations résidents accomplies entre le 1ier octobre et le 31ieme décembre 3011. Les résidents avaient principalement plus de 85 ans, étaient des femmes, et souffraient d’une démence liée à l’âge. Nous avons comparé le soutien et les services connexes des établissements et les caractéristiques des résidents par province, par les modèles du propriétaire-gérant, et par le nombre d’unités dans une installation. Nous avons ...
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Research Interests: Long Term Care, Quality of Care, Urinary incontinence, Library and Information Studies, Humans, and 15 moreInformation Quality, Weight Loss, United States, Urinary tract infection, 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
Research Interests: Home Care, Activities of Daily Living, Clinical Practice, Library and Information Studies, Humans, and 9 moreDisability and Health, Health Professionals, Public health systems and services research, Clinical Assessment, International Classification of Functioning, Disabled Persons, Disability Evaluation, quality assurance in health care, and Environmental factor
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Research Interests: Benchmarking, Comorbidity, Library and Information Studies, Humans, Health Service utilization, and 15 moreHospitalization, Female, Male, Confidence intervals, Prescription drugs, Middle Aged, Odds ratio, Administrative Data, Indexation, Hospital Mortality, Logistic Regression Model, Logistic Models, General Population, Health Outcome, and health status indicators
Research Interests: Long Term Care, Comorbidity, Library and Information Studies, Humans, Diabetes mellitus, and 11 moreNursing Homes, Female, Male, Aged, Prevalence, Public health systems and services research, Retrospective Studies, Reproducibility of Results, Sensitivity and Specificity, Saskatchewan, and Decision Support Techniques
Research Interests: Nursing, Comorbidity, Activities of Daily Living, Humans, Discharge, and 15 moreFemale, Regression, Male, Regression Analysis, Cohort Study, Nursing Home, Nurse, Clinical Sciences, Aged, Intensity, Public health systems and services research, Retrospective Studies, Prognosis, Multicenter Studies as Topic, and Patient discharge
BackgroundPublished reports suggest that there is considerable variation in improvement capacity and capability among participants in quality improvement collaboratives. Generating knowledge about why these complex initiatives do or do... more
BackgroundPublished reports suggest that there is considerable variation in improvement capacity and capability among participants in quality improvement collaboratives. Generating knowledge about why these complex initiatives do or do not work in different contexts requires both qualitative and quantitative approaches. Time-series analysis using line graphs and statistical process control is a rigorous quantitative approach with relatively unexplored potential in evaluating