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1.
Clin Orthop Relat Res ; 480(10): 1884-1896, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-35901444

RESUMO

BACKGROUND: Patient-reported outcome measures (PROMs) are the only systematic approach through which the patient's perspective can be considered by surgeons (in determining a procedure's efficacy or appropriateness) or healthcare systems (in the context of value-based healthcare). PROMs in registries enable international comparison of patient-centered outcomes after total joint arthroplasty, but the extent to which those scores may vary between different registry populations has not been clearly defined. QUESTIONS/PURPOSES: (1) To what degree do mean change in general and joint-specific PROM scores vary across arthroplasty registries, and to what degree is the proportion of missing PROM scores in an individual registry associated with differences in the mean reported change scores? (2) Do PROM scores vary with patient BMI across registries? (3) Are comorbidity levels comparable across registries, and are they associated with differences in PROM scores? METHODS: Thirteen national, regional, or institutional registries from nine countries reported aggregate PROM scores for patients who had completed PROMs preoperatively and 6 and/or 12 months postoperatively. The requested aggregate PROM scores were the EuroQol-5 Dimension Questionnaire (EQ-5D) index values, on which score 1 reflects "full health" and 0 reflects "as bad as death." Joint-specific PROMs were the Oxford Knee Score (OKS) and the Oxford Hip Score (OHS), with total scores ranging from 0 to 48 (worst-best), and the Hip Disability and Osteoarthritis Outcome Score-Physical Function shortform (HOOS-PS) and the Knee Injury and Osteoarthritis Outcome Score-Physical Function shortform (KOOS-PS) values, scored 0 to 100 (worst-best). Eligible patients underwent primary unilateral THA or TKA for osteoarthritis between 2016 and 2019. Registries were asked to exclude patients with subsequent revisions within their PROM collection period. Raw aggregated PROM scores and scores adjusted for age, gender, and baseline values were inspected descriptively. Across all registries and PROMs, the reported percentage of missing PROM data varied from 9% (119 of 1354) to 97% (5305 of 5445). We therefore graphically explored whether PROM scores were associated with the level of data completeness. For each PROM cohort, chi-square tests were performed for BMI distributions across registries and 12 predefined PROM strata (men versus women; age 20 to 64 years, 65 to 74 years, and older than 75 years; and high or low preoperative PROM scores). Comorbidity distributions were evaluated descriptively by comparing proportions with American Society of Anesthesiologists (ASA) physical status classification of 3 or higher across registries for each PROM cohort. RESULTS: The mean improvement in EQ-5D index values (10 registries) ranged from 0.16 to 0.33 for hip registries and 0.12 to 0.25 for knee registries. The mean improvement in the OHS (seven registries) ranged from 18 to 24, and for the HOOS-PS (three registries) it ranged from 29 to 35. The mean improvement in the OKS (six registries) ranged from 15 to 20, and for the KOOS-PS (four registries) it ranged from 19 to 23. For all PROMs, variation was smaller when adjusting the scores for differences in age, gender, and baseline values. After we compared the registries, there did not seem to be any association between the level of missing PROM data and the mean change in PROM scores. The proportions of patients with BMI 30 kg/m 2 or higher ranged from 16% to 43% (11 hip registries) and from 35% to 62% (10 knee registries). Distributions of patients across six BMI categories differed across hip and knee registries. Further, for all PROMs, distributions also differed across 12 predefined PROM strata. For the EQ-5D, patients in the younger age groups (20 to 64 years and 65 to 74 years) had higher proportions of BMI measurements greater than 30 kg/m 2 than older patients, and patients with the lowest baseline scores had higher proportions of BMI measurements more than 30 kg/m 2 compared with patients with higher baseline scores. These associations were similar for the OHS and OKS cohorts. The proportions of patients with ASA Class at least 3 ranged across registries from 6% to 35% (eight hip registries) and from 9% to 42% (nine knee registries). CONCLUSION: Improvements in PROM scores varied among international registries, which may be partially explained by differences in age, gender, and preoperative scores. Higher BMI tended to be associated with lower preoperative PROM scores across registries. Large variation in BMI and comorbidity distributions across registries suggest that future international studies should consider the effect of adjusting for these factors. Although we were not able to evaluate its effect specifically, missing PROM data is a recurring challenge for registries. Demonstrating generalizability of results and evaluating the degree of response bias is crucial in using registry-based PROMs data to evaluate differences in outcome. Comparability between registries in terms of specific PROMs collection, postoperative timepoints, and demographic factors to enable confounder adjustment is necessary to use comparison between registries to inform and improve arthroplasty care internationally. LEVEL OF EVIDENCE: Level III, therapeutic study.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Osteoartrite , Adulto , Artroplastia de Quadril/métodos , Artroplastia do Joelho/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Sistema de Registros , Resultado do Tratamento , Adulto Jovem
2.
Can J Anaesth ; 66(4): 422-431, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30689134

RESUMO

PURPOSE: Deceased donation data requires standardization to enable accurate interprovincial and international comparisons of deceased donation performance. In Canada, most provincial organ donation organizations (ODOs) have developed different processes and infrastructures for referring potential donors and subsequent data collection. This has led to differing definitions of the performance measures used for each step in the donation process, from potential donor identification to consent to transplantation. The Deceased Donation Data Working Group (DDDWG), comprised of representatives from ODOs across Canada, was therefore convened by Canadian Blood Services to develop a national, comprehensive, standardized deceased donation minimum data set. METHODS: The DDDWG's scope encompassed considering all potential deceased organ donation data elements, including operational and performance data collected along the deceased donor pathway from donation potential to donation and disposition of organs. An environmental scan was conducted of other existing deceased donation registries from the Canadian and the international community. The DDDWG then engaged in regular face-to-face meetings and teleconferences to develop recommendations for the minimum data set that would satisfy key considerations, including the impact on existing ODO data collection processes, financial impact on stakeholders, the clinical and operational needs of multiple healthcare professionals involved in the deceased donation pathway, and availability of other existing national data sets that could be leveraged to reduce data collection burden. RESULTS: The key deceased donation data elements identified by the DDDWG are contained in an inverted pyramid framework that was derived from similar work conducted in other countries. CONCLUSION: The DDDWG developed recommendations for proposed definitions and data sources that should be adopted nationally to guide the collection of deceased donation data. The ultimate purpose of the final minimum data set is to harmonize and standardize donation data definitions in Canada and align with international standards; inform the development of operational and clinical practice standards at the provincial and national levels; develop a framework for deceased donation performance measures; and advance the science of deceased donation.


RéSUMé: OBJECTIF: Les données concernant les dons d'organes de personnes décédées doivent être normalisées pour permettre des comparaisons précises de l'efficacité de ces dons entre provinces et entre pays. Au Canada, la majorité des organismes provinciaux de dons d'organes (ODO) ont élaboré divers processus et infrastructures pour l'orientation des donneurs potentiels et la collecte subséquente des données. Cela a abouti à des définitions différentes des mesures de performances utilisées pour chaque étape du processus de don, de l'identification du donneur potentiel au consentement à la transplantation. Le Groupe de travail sur les données de donneurs décédés (DDDWG), constitué de représentants des ODO de tout le Canada a donc été réuni par la Société canadienne du sang (SCS) pour élaborer un ensemble national et complet de données minimums standardisées de dons d'organes de personnes décédées. MéTHODES: Le DDDWG avait pour mission d'envisager tous les éléments de données de dons d'organes potentiels de personnes décédées, y compris les données opérationnelles et de performance collectées le long du parcours du donneur décédé, depuis le don potentiel jusqu'à l'utilisation des organes. Une analyse environnementale des autres registres existants (canadiens et internationaux) de dons d'organes de personnes décédées a été effectuée. Le DDDWG a alors entrepris des entretiens en face à face et des téléconférences pour élaborer ses recommandations pour un ensemble minimum de données qui répondraient aux problèmes clés, y compris : leur impact sur les processus de collecte de données des ODO existants, l'impact financier pour les différents acteurs, les besoins cliniques et opérationnels des multiples professionnels de santé impliqués tout au long du parcours de don de la personne décédée, et la disponibilité d'autres ensembles de données qui pourraient être utilisés pour réduire le fardeau de la collecte des données. RéSULTATS: Les principales données de don d'organes de donneur décédé, identifiées par le DDDWG, tiennent dans un cadre en pyramide inversée tiré d'un travail semblable mené dans d'autres pays. CONCLUSION: Le DDDWG a élaboré des recommandations pour les définitions proposées et les sources de données qui devraient être adoptées à l'échelon national pour guider la collecte des données de dons d'organes de personnes décédées. Le but ultime de l'ensemble minimum final de données est d'harmoniser et standardiser les définitions des données concernant les dons au Canada et de s'aligner sur les normes internationales; d'informer le développement de normes opérationnelles et de pratique clinique au niveau des provinces et au niveau national; de développer un cadre pour la mesure des performances concernant les dons de donneurs décédés; et de faire progresser les connaissances sur ce type de dons.


Assuntos
Coleta de Dados/métodos , Conjuntos de Dados como Assunto/normas , Doadores de Tecidos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/organização & administração , Canadá , Morte , Humanos , Obtenção de Tecidos e Órgãos/estatística & dados numéricos
3.
Acta Orthop ; 87 Suppl 1: 24-30, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27167849

RESUMO

Background and purpose - There is no consensus about the outcome of simultaneous vs. staged bilateral total knee arthroplasty (TKA). We examined this issue by analyzing 238,373 patients. Patients and methods - Demographic, clinical, and outcome data were evaluated for TKA patients (unilateral: 206,771; simultaneous bilateral: 6,349; staged bilateral: 25,253) from the Canadian Hospital Morbidity Database for fiscal years 2006-2007 to 2012-2013. Outcomes were adjusted for age, sex, comorbidities, and hospital TKA volume. Results - Simultaneous bilateral TKA patients were younger than staged bilateral TKA patients (median 64 years vs. 66 years), were more likely to be male (41% vs. 39%), and had a lower frequency of having ≥1 comorbid condition (2.9% vs. 4.2%). They also had a higher frequency of blood transfusions (41% vs. 19%), a shorter median length of stay (6 days vs. 8 days), a higher frequency of transfer to a rehabilitation facility (46% vs. 9%), and a lower frequency of knee infection (0.5% vs. 0.9%) than staged bilateral TKA patients, but they had higher rate of cardiac complications within 90 days (2.0% vs. 1.7%). Simultaneous patients had higher in-hospital mortality compared to the second TKA in staged patients (0.16% vs. 0.06%), but they had similar rates of in-hospital mortality compared to unilateral patients (0.16% vs. 0.14%). The cumulative 3-year revision rate was highest in the unilateral group (2.3%), but it was similar in the staged and simultaneous bilateral groups (1.4%). Interpretation - We found important differences between the outcomes of simultaneous and staged bilateral TKA. Further clarification of outcomes would be best determined in an adequately powered randomized trial, which would remove the selection bias inherent in this retrospective study design.


Assuntos
Artroplastia do Joelho/efeitos adversos , Osteoartrite do Joelho/cirurgia , Complicações Pós-Operatórias/epidemiologia , Idoso , Canadá , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/mortalidade , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
4.
Healthc Q ; 16(2): 9-12, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24863443

RESUMO

Updated primary healthcare (PHC) indicators are now available for use across Canada. The Canadian Institute for Health Information identified and updated two sets of priority indicators - a policy set to meet the needs of policy makers and a provider set to meet the needs of providers of PHC at the practice and organization levels. A total of 51 indicator definitions were updated to ensure that they are measurable and operational, align with clinical practice guidelines and available data sources and reflect important dimensions of PHC performance in Canada.


Assuntos
Atenção Primária à Saúde/normas , Indicadores de Qualidade em Assistência à Saúde , Canadá
5.
Fam Pract ; 29(4): 427-32, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22223743

RESUMO

BACKGROUND: Prescription medication use increases with age. Seniors face an increased risk of adverse drug reactions from medications, partly because the kidneys and liver can lose functional ability with increasing age, resulting in the need for changes in dosage. OBJECTIVE: To use population survey data to understand the extent and impact of multiple medication use and adverse drug events among Canadian seniors. METHODS: This study consists of analysis of data from the Canadian Survey of Experiences with Primary Health Care, which was conducted through telephone by Statistics Canada in 2008. These analyses focussed on the 3132 respondents who were ≥ 65 years of age. RESULTS: Twenty-seven per cent of seniors reported taking five or more medications on a regular basis. Within the past year, 12% of seniors taking five or more medications experienced a side effect that required medical attention compared with 5% of seniors taking only one or two medications. Even when controlling for age and number of chronic conditions, the number of prescription medications was associated with the rate of emergency department use. Less than half of all seniors reported having received medication reviews and having the possible side effects of their prescription medications explained to them by their physician. CONCLUSIONS: Many Canadian seniors have an elevated risk of adverse events due to taking a high number of prescription medications and not having the potential side effects and drug interactions explained to them. There are interventions that can potentially reduce polypharmacy and adverse events, including routine medication reviews.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Polimedicação , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Canadá/epidemiologia , Doença Crônica , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Erros de Medicação/efeitos adversos , Erros de Medicação/estatística & dados numéricos
6.
Inform Prim Care ; 20(4): 233-40, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23890334

RESUMO

BACKGROUND: Major initiatives are underway in Canada which are designed to increase electronic medical record (EMR) implementation and maximise its use in primary health care. These developments need to be supported by sufficient evidence from the literature, particularly relevant research conducted in the Canadian context. OBJECTIVES: This study sought to quantify this lack of research by: (1) identifying and describing the primary health care EMR literature; and (2) comparing the Canadian and international primary healthcare EMR literature on the basis of content and publication levels. METHODS: Seven bibliographic databases were searched using primary health care and EMR keywords. Publication abstracts were reviewed and categorised. First author affiliation was used to identify country of origin. Proportions of Canadian- and non-Canadian-authored publications were compared using Fisher's exact test. For countries having 10 or more primary healthcare EMR publications, publications per 10 000 researchers were calculated. RESULTS: After exclusions, 750 publications were identified. More than one-third used primary healthcare EMRs as a study data source. Twenty-two (3%) were Canadian-authored. There were significantly different publication levels in three categories between Canadian- and non-Canadian-authored publications. Based on publications per researchers, the Netherlands ranked first, while Canada ranked eighth of nine countries with 10 or more publications. CONCLUSIONS: A relatively small body of literature focused on EMRs in primary health care exists; publications by Canadian authors were low. This study highlights the need to develop a strong evidence base to support the effective implementation and use of EMRs in Canadian primary health care.


Assuntos
Bibliometria , Coleta de Dados/métodos , Coleta de Dados/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Canadá , Confidencialidade , Registros Eletrônicos de Saúde/organização & administração , Humanos , Capacitação em Serviço , Atenção Primária à Saúde/organização & administração
7.
Stud Health Technol Inform ; 164: 367-71, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21335738

RESUMO

Primary Health Care (PHC) is the most common health care experienced by Canadians and is an important source of chronic disease prevention and management; however, PHC providers say they have little information about their patient populations, especially groups of patients with multiple conditions. The Canadian Institute for Health Information in collaboration with 50 PHC providers examined the ability to extract and use a subset of PHC EMR data from four disparate environments in an agreed and privacy sensitive manner. Findings describing the feasibility of clinician engagement, EMR data extraction, EMR content standards and data utility gaps, information system requirements, and systemic enablers and barriers are described in this paper. Ability to collect and use discrete and standardized clinical and administrative information is fundamental to improving practice efficiency, optimal use of information, and patient quality of care. Improving quality of EMR data captured at the point of service will considerably enable our ability to measure and understand PHC across Canada; promote dialogue to identify priority information needs; and support health system information uses for clinical program and health system management, research, and population surveillance.


Assuntos
Registros Eletrônicos de Saúde , Atenção Primária à Saúde , Garantia da Qualidade dos Cuidados de Saúde , Canadá , Estudos de Viabilidade , Humanos , Assistência Centrada no Paciente
8.
Stud Health Technol Inform ; 164: 385-91, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21335741

RESUMO

In collaboration with a broad range of stakeholders, the Canadian Institute for Health Information (CIHI) led the development of the draft pan-Canadian primary health care (PHC) electronic medical record (EMR) content standard to be used in EMR applications across the country to support PHC data capture and information use and improved health system management. To achieve this goal, CIHI initiated the following activities: stakeholder engagement, information requirements gathering and adoption and implementation promotion of the common content standard for wide-spread use. The resulting pan-Canadian standardized data set will allow consistent data capture that will improve understanding and ability to report on PHC utilization and access, chronic disease prevention and management, health promotion, medication usage, patient safety, quality of care including patient safety and outcomes. The standard will improve patient care information by providing the structured comparable information needed to care for patients over time and across the continuum of care. Standards support clinical practice reminders and alerts, improvements in operating efficiencies, onscreen feedback reports to PHC providers and the ability to look at clinical trends over time. This standard will improve the flow of information by providing standardized information to providers at points on the continuum of care leading to better coordination of care and a reduction of repeat tests. Lastly, a common content standard will improve the health system use of data; by enabling aggregation and analysis of comparable standardized health information, clinicians, jurisdictions, and regions can benefit from using this data for more effective planning and policy decisions. The jurisdictions and clinicians, supported by CIHI and Canada Health Infoway will continue to work together with other key stakeholders, such as vendors to support the adoption and implementation of this standard into future jurisdictional EMR vendor specifications.


Assuntos
Registros Eletrônicos de Saúde/normas , Atenção Primária à Saúde , Canadá , Difusão de Inovações
9.
Healthc Q ; 14(1): 18-21, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21301232

RESUMO

The prevalence of diabetes in Canada is expected to more than double by 2030. Additionally, the costs associated with diabetes have nearly doubled between 2000 and 2010 and will continue to rise unless improvements are made. Fortunately, more effective policies and programs can reduce both the prevalence of diabetes and the complications associated with the disease. We used responses from the Canadian Community Health Survey to assess whether Canadians with diabetes report (1) receiving from healthcare professionals the recommended tests to screen for complications, (2) performing sufficient self-care for their diabetes and, (3) for those in lower-income households, receiving less recommended care. The results show that only one in three (32%) Canadian adults with diabetes reported having received all four recommended tests during the previous year. Lower-income Canadians were more likely to report having diabetes and less likely to report receiving the four diabetes care tests. Only half of adults with diabetes reported checking their blood sugar levels daily, and only two in five reported checking their feet for injuries and ulcers. Improvements to adherence to diabetes care guidelines are needed to reduce the likelihood that Canadians, especially lower-income Canadians, will develop complications from diabetes. Bending the cost curve downward is possible through more effective policies and programs that prevent diabetes in the first place and that ensure Canadians with diabetes get both recommended care from their healthcare providers and enough support for effective self-care.


Assuntos
Diabetes Mellitus/prevenção & controle , Prevenção Primária , Garantia da Qualidade dos Cuidados de Saúde , Adolescente , Adulto , Idoso , Canadá/epidemiologia , Diabetes Mellitus/epidemiologia , Pesquisas sobre Atenção à Saúde , Política de Saúde , Humanos , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Autocuidado , Adulto Jovem
10.
Healthc Q ; 14(3): 19-22, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21841372

RESUMO

Which has more impact on health status and the use of healthcare services among seniors: age or the number of chronic conditions? To answer this question, we used responses from the 2008 Canadian Survey of Experiences with Primary Health Care to assess the effect of these two factors on seniors' self-perceived health status, prescription medication use and healthcare service use. We discovered that seniors with at least three chronic conditions were more likely to report poor health, take more prescription medications and use more healthcare services than seniors with two or fewer chronic conditions. The number of chronic conditions is better than age as a predictor of self-reported health status, prescription medication use and healthcare service use by seniors. Seniors with at least three conditions represented 24% of all seniors, but they accounted for 40% of the use of healthcare services. Health policies and programs focused on the prevention and improved management of co-morbidities among seniors could have a significant and positive impact on seniors' health (including self-perceived health status) and their use of healthcare services.


Assuntos
Doença Crônica/epidemiologia , Serviços de Saúde/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Canadá/epidemiologia , Comorbidade , Pesquisas sobre Atenção à Saúde , Nível de Saúde , Humanos , Pessoa de Meia-Idade , Adulto Jovem
11.
J Patient Rep Outcomes ; 5(Suppl 2): 94, 2021 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-34636980

RESUMO

PROMs are essential to delivering patient-centred health care, and when applied routinely they can enhance communication between patients and providers, inform decisions for value-based health system improvements and improve overall patient care experiences and outcomes. The use of patient-reported outcome measures (PROMs) across Canada varies across provinces and territories, partly because of differences in health care delivery models across these jurisdictions. A national program that coordinates uses of PROMs is needed to ensure that this information is comparable across jurisdictions. This commentary provides a summary look at the development of national PROMs data standards and reporting for hip and knee replacement surgery, including the selection of survey tools, building consensus, developing and promoting standards, and reporting on the results nationally and internationally as well as outlining recent learnings from regional implementation of data standards. In 2017, the Canadian Institute for Health Information published national PROMs data collection standards for hip and knee arthroplasty that included guidelines for survey time points, the minimum data set and PROMs instruments. This broad-scale PROMs collection initiative had stakeholder engagement and support from multiple levels within the health system, including administrators, clinic managers, patients, and health system decision-makers. Learnings from regional implementation of the standards demonstrated the importance of assessing existing infrastructure and information technology requirements, mapping clinical workflows, planning for human and information technology resources, navigating local legislation and hospital policies and ensuring data linkage capabilities. This initiative showed the need for a common regional approach for PROMs collection to be efficient and effective. The learnings from implementation of the national Canadian PROMs program for hip and knee arthroplasty can be used as an example for other jurisdictions and clinical areas such as renal care and mental health. Common data standards allow for secondary use of this data that is valuable for reporting and informing policy and guidelines as well as meeting care delivery goals to further the shift in health care systems becoming more patient-centred to improve the quality-of-life of patients.

12.
Stud Health Technol Inform ; 143: 161-6, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19380931

RESUMO

The Canadian Institute for Health Information (CIHI), in collaboration with diverse stakeholders, led the development of pan-Canadian indicators to measure primary health care. In 2006, CIHI released a set of 105 pan-Canadian Primary Health Care (PHC) indicators that were developed with the assistance of national, provincial and territorial representatives, clinicians and researchers. Additionally, data gaps were identified in a series of reports. In 2006 and 2007, CIHI assessed options for closing the data gaps so that the indicators could be measured and reported. CIHI then began a program to build the data infrastructure needed for the PHC indicators. The program included the development of content standards for electronic medical records, a prototype of a voluntary reporting system, enhancements to surveys, and the development of reports. In 2006, fewer than 10% of the 105 indicators could be calculated with existing data sources. Now, four projects have begun and over 50% of the indicators are being captured. Important relationships have been established with key collaborators. These relationships will lead to the development of a reporting system prototype and to the refinement of PHC indicators and electronic medical record (EMR) content standards. The project for pan-Canadian PHC indicators has encouraged consultation and synergy. It has motivated CIHI to establish an information program to fill data gaps and to make PHC indicators available.


Assuntos
Atenção Primária à Saúde/normas , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Canadá , Coleta de Dados/métodos , Programas Nacionais de Saúde
13.
Stud Health Technol Inform ; 143: 167-73, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19380932

RESUMO

In 2006 the Canadian Institute for Health Information (CIHI) released a set of 105 pan-Canadian Primary Health Care (PHC) indicators. This was followed by an assessment of data gaps, which prevented the calculation of the indicators, and the data collection options available to close the gaps. A quality review of Electronic Medical Record (EMR) data indicated a requirement for content standards. In order to assist the provinces as they developed requests for proposal for PHC-based EMRs, the EMR content standards project was born. Considerable effort was made to identify standards for the Electronic Health Record (EHR) including existing national and international EHR content. As well, CIHI attempted to align the content standards with those of other projects such as the Physician Office System Requirements (POSR). The outcome of this project was a set of EMR content standards for 12 pan-Canadian PHC indicators. The standards will be used to develop a prototype of a PHC reporting system that collects and analyzes data to generate clinical quality indicators for regional and longitudinal comparisons. In late 2008, CIHI will release the pan-Canadian PHC Core Reporting Data Set. This project has developed EMR content standards to better understand PHC in Canada.


Assuntos
Sistemas Computadorizados de Registros Médicos/normas , Atenção Primária à Saúde , Indicadores de Qualidade em Assistência à Saúde , Canadá
14.
Healthc Pap ; 8(4): 26-36; discussion 69-75, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18667868

RESUMO

In 2005, the Canadian Institute for Health Information (CIHI) began a methodological journey to develop a Canadian version of the hospital standardized mortality ratio (HSMR). For two years, CIHI worked with hospitals, regional authorities and measurement experts to define the most appropriate methodology given Canadian datasets and systems of care. In November 2007, we made the findings publicly available for regional health authorities and larger facilities. In their lead article, Penfold et al. discuss their views regarding some methodological issues and potential limitations of the HSMR to monitor quality of care and, in particular, as a patient safety indicator. Here we respond to their specific concerns and maintain that the HSMR remains an important tool in the arsenal of information hospitals can use to focus the discussion of patient safety/quality improvement, monitor the provision of care over time and identify opportunities for improvement.


Assuntos
Administração Hospitalar/normas , Mortalidade Hospitalar , Indicadores de Qualidade em Assistência à Saúde/normas , Gestão da Segurança/normas , Canadá , Humanos , Tempo de Internação , Cuidados Paliativos/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Reprodutibilidade dos Testes , Risco Ajustado , Suspensão de Tratamento
15.
Healthc Q ; 11(1): 20-2, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18326375

RESUMO

In summary, there are important differences among patients admitted via the ED versus those admitted via other means in terms of both utilization and patient characteristics. When compared with patients admitted via other means, patients admitted via the ED are more likely to fall into the medical patient group, to be older and to have more complex and more diseases or health conditions. Medical patients admitted via the ED are more likely to become ALC patients than are other types of patients. As hospitals, health regions and policy makers focus on improving patient flow through Canada's EDs, it is important to consider the volume and characteristics of the patient population admitted via the ED.


Assuntos
Serviços Médicos de Emergência/organização & administração , Admissão do Paciente/estatística & dados numéricos , Planejamento de Assistência ao Paciente/organização & administração , Canadá , Serviços Médicos de Emergência/estatística & dados numéricos , Humanos
16.
BMC Health Serv Res ; 6: 77, 2006 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-16776836

RESUMO

BACKGROUND: Health administrative data are frequently used for health services and population health research. Comparative research using these data has been facilitated by the use of a standard system for coding diagnoses, the International Classification of Diseases (ICD). Research using the data must deal with data quality and validity limitations which arise because the data are not created for research purposes. This paper presents a list of high-priority methodological areas for researchers using health administrative data. METHODS: A group of researchers and users of health administrative data from Canada, the United States, Switzerland, Australia, China and the United Kingdom came together in June 2005 in Banff, Canada to discuss and identify high-priority methodological research areas. The generation of ideas for research focussed not only on matters relating to the use of administrative data in health services and population health research, but also on the challenges created in transitioning from ICD-9 to ICD-10. After the brain-storming session, voting took place to rank-order the suggested projects. Participants were asked to rate the importance of each project from 1 (low priority) to 10 (high priority). Average ranks were computed to prioritise the projects. RESULTS: Thirteen potential areas of research were identified, some of which represented preparatory work rather than research per se. The three most highly ranked priorities were the documentation of data fields in each country's hospital administrative data (average score 8.4), the translation of patient safety indicators from ICD-9 to ICD-10 (average score 8.0), and the development and validation of algorithms to verify the logic and internal consistency of coding in hospital abstract data (average score 7.0). CONCLUSION: The group discussions resulted in a list of expert views on critical international priorities for future methodological research relating to health administrative data. The consortium's members welcome contacts from investigators involved in research using health administrative data, especially in cross-jurisdictional collaborative studies or in studies that illustrate the application of ICD-10.


Assuntos
Doença/classificação , Controle de Formulários e Registros/normas , Prioridades em Saúde , Pesquisa sobre Serviços de Saúde/métodos , Classificação Internacional de Doenças , Cooperação Internacional , Algoritmos , Austrália , Canadá/epidemiologia , China , Doença Crônica/epidemiologia , Comorbidade , Humanos , Administradores de Registros Médicos/educação , Qualidade da Assistência à Saúde , Suíça , Reino Unido , Estados Unidos , Listas de Espera
17.
Environ Health Perspect ; 113(3): 290-6, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15743717

RESUMO

This study is part of a larger research program to examine the relationship between ambient air quality and health in Windsor, Ontario, Canada. We assessed the association between air pollution and daily respiratory hospitalization for different age and sex groups from 1995 to 2000. The pollutants included were nitrogen dioxide, sulfur dioxide, carbon monoxide, ozone, particulate matter 10 microm in diameter (PM10), coefficient of haze (COH), and total reduced sulfur (TRS). We calculated relative risk (RR) estimates using both time-series and case-crossover methods after controlling for appropriate confounders (temperature, humidity, and change in barometric pressure). The results of both analyses were consistent. We found associations between NO2, SO2, CO, COH, or PM10 and daily hospital admission of respiratory diseases especially among females. For females 0-14 years of age, there was 1-day delayed effect of NO2 (RR = 1.19, case-crossover method), a current-day SO2 (RR = 1.11, time series), and current-day and 1- and 2-day delayed effects for CO by case crossover (RR = 1.15, 1.19, 1.22, respectively). Time-series analysis showed that 1-day delayed effect of PM10 on respiratory admissions of adult males (15-64 years of age), with an RR of 1.18. COH had significant effects on female respiratory hospitalization, especially for 2-day delayed effects on adult females, with RRs of 1.15 and 1.29 using time-series and case-crossover analysis, respectively. There were no significant associations between O3 and TRS with respiratory admissions. These findings provide policy makers with current risks estimates of respiratory hospitalization as a result of poor ambient air quality in a government designated "area of concern."


Assuntos
Poluentes Atmosféricos/intoxicação , Hospitalização/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Estudos Epidemiológicos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Ontário , Tamanho da Partícula , Medição de Risco , Fatores Sexuais
18.
Can J Public Health ; 96(1): 29-33, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-15682690

RESUMO

OBJECTIVE: To examine the role that ambient air pollution plays in exacerbating cardiovascular disease hospitalization in Windsor, Ontario. METHODS: The number of daily cardiac hospital admissions was obtained from all Windsor hospitals from April 1, 1995 to December 31, 2000 and linked to concentrations of ambient air pollutants and weather variables. The logarithm of daily counts of hospitalization was regressed on the levels of pollutants, after adjusting for seasonal, weekly cycles, and weather variables using time series analysis with natural splines as smoothing functions. RESULTS: Of all the pollutants considered, sulphur dioxide (SO2) had the strongest effect on cardiac hospitalization among the > or = 65 age group. The percentage increase in daily admission was 2.6% for current day sulphur dioxide level (95% CI: 0.5-6.4), 4.0% for 2-day mean level (95% CI: 0.1-6.9), and 5.6% (95% CI: 1.5-9.9) for 3-day mean level for an increase in interquartile range of 19.3 ppb. When particulate PM10 was included in the model, the contributing effect of sulphur dioxide remained significant for the > or = 65 age group for all three levels. CONCLUSIONS: Short-term effects of sulphur dioxide are associated significantly to daily cardiac hospital admissions for people > or = 65 years of age living in Windsor. Since Windsor is a border city, additional monitoring and assessment is recommended to determine if air quality and resultant health effects have deteriorated since traffic congestion at the border has increased following the events of September 11, 2001.


Assuntos
Poluição do Ar/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Hospitalização/estatística & dados numéricos , Adolescente , Adulto , Idoso , Poluição do Ar/análise , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Ontário/epidemiologia , Fatores Desencadeantes , Risco , Dióxido de Enxofre/efeitos adversos , Tempo (Meteorologia)
19.
Adolescence ; 37(145): 55-67, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12003291

RESUMO

Although the effect of low socioeconomic status on the health of adolescents has been documented, the mechanism by which this occurs is not well understood. Furthermore, improving adolescent health through public health policy typically requires the presence of one or more modifiable risk factors which can be targeted for intervention. In spite of the well-documented negative associations between poverty and health, few modifiable risk factors have been identified. This study used the Evans-Stoddart Model of Health and Well-Being as a framework to examine data on 1,759 adolescents, aged 12 to 19, collected as part of the 1994 National Population Health Survey. Results not only confirm the relationship between income and health, but suggest how the pathway operates through the social environment, lifestyle differences, access to health care, and a reduced sense of self-esteem and self-mastery. Bivariate and multivariate analyses found positive associations between physical activity levels and self-esteem and mastery. We interpret these findings as preliminary evidence that it might be possible to buffer the impact of poverty on health through policies which increase physical activity levels among those living in poverty. Such policies could also include a secondary goal of increasing the activity levels among inactive adolescents who are not living in poverty, as they will derive benefits from this increase, both psychologically and physiologically.


Assuntos
Nível de Saúde , Modelos Psicológicos , Pobreza , Adolescente , Análise de Variância , Canadá , Atenção à Saúde , Meio Ambiente , Exercício Físico/psicologia , Acessibilidade aos Serviços de Saúde , Humanos , Individualidade , Autoimagem , Meio Social
20.
Healthc Policy ; 10(1): 46-59, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25410695

RESUMO

While the barriers to electronic medical record (EMR) adoption by physicians are well-known, we have much less knowledge about the broader challenges regarding EMR use faced by primary healthcare (PHC) EMR stakeholders in Canada. Therefore, we conducted interviews (from June 2009 to September 2010) and consultation sessions (in October and November 2009) with these stakeholders, as well as carrying out a research capacity assessment, to identify, describe and prioritize gaps in PHC EMR knowledge and research. Twelve thematic gaps emerged; four were identified as the most important: the need to ascertain the value of EMRs, the need to better understand elements of EMR implementation and adoption, the need to develop innovative data entry and extraction procedures, and a lack of agreement and understanding of data sharing. To advance EMR use, Canada needs to address these gaps; yet, we currently have a lack of research capacity with which to accomplish this.


Assuntos
Registros Eletrônicos de Saúde , Pesquisa sobre Serviços de Saúde/normas , Atenção Primária à Saúde , Atitude do Pessoal de Saúde , Canadá , Coleta de Dados , Registros Eletrônicos de Saúde/normas , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa
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