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  INSTITUTE FOR CLINICAL EVALUATIVE SCIENCES
APRIL 2014
 
At a Glance
  MONTHLY HIGHLIGHTS OF ICES RESEARCH FINDINGS FOR STAKEHOLDERS  
 

Cost of home care for Ontarians with colorectal cancer averages $2,180 annually

Mittmann N, Liu N, Porter J, Seung SJ, Isogai PK, Saskin R, Cheung MC, Leighl NB, Hoch JS, Trudeau M, Evans WK, Dainty KN, Earle CC. Utilization and costs of home care for patients with colorectal cancer: a population-based study. CMAJ Open. 2014; 2(1):E11–17.

ISSUE

The Ontario Ministry of Health and Long-Term Care pays for certain home care services such as nursing care, personal support and respite care. Among Ontarians with colorectal cancer, what are the utilization rates and costs of home care services associated with each stage of the disease?

STUDY

Identified 36,195 patients diagnosed with colorectal cancer in Ontario between January 2005 and December 2009 and followed them to March 31, 2010, or death, whichever came first. Types of home care services used were stratified by stage of disease, and utilization rates and costs were determined.

KEY FINDINGS

Home care services were provided to 24,641 patients (68.1%). The number of home services per patient-year was 27.5, at a cost of $2,180. The number of services provided per patient-year increased with increasing disease severity at diagnosis: 15.5 at stage I, 25.5 at stage II, 32.5 at stage III and 62.5 at stage IV. The cost of services per patient-year also increased with disease severity at diagnosis: $1,170 at stage I, $1,995 at stage II, $2,727 at stage III and $5,541 at stage IV. 

IMPLICATIONS

Other studies have shown that shifting health services to the community via home care may represent potential savings to the health care system. This study provides the information required for decision-makers to estimate the costs and resources allocation associated with such a strategy.
 
 

Wait times to see Ontario specialists longer than physician and patient surveys report

Jaakkimainen L, Glazier R, Barnsley J, Salkeld E, Lu H, Tu K. Waiting to see the specialist: patient and provider characteristics of wait times from primary to specialty care. BMC Fam Pract. 2014; 15:16.

ISSUE

In Canada, information on wait times to see a specialist after a family physician (FP) makes a referral is available only from physician or patient surveys, which are subject to response and recall bias. What are the wait times from FP referral to specialist visit? What patient and provider characteristics are associated with these wait times?

STUDY

Used the Electronic Medical Record Administrative Data Linked Database (EMRALD) to identify patients in Ontario who were alive on December 31, 2008, and had at least one visit to one of 54 participating FPs between January 1, 2008, and December 31, 2009. Linked the FP referral date to the specialist physician claims date to calculate wait times. Patient and physician factors were examined.

KEY FINDINGS

Median waits ranged from 39 to 76 days for medical specialists and from 33 to 66 days for surgical specialists. Patient factors and most physician factors were not consistently associated with wait times, except for FP practice location and practice size. Rural FP practices had longer wait times for psychiatry and urology, while urban practices had longer wait times for gastroenterology. FP practices having a higher number of patients were associated with longer wait times for dermatology, urology and ear, nose and throat referrals.

IMPLICATIONS

If wait times to see a specialist become increasingly long, primary care delivery models will have to be structured to support the care of more complex patients. Wait times from primary to specialty care need to be included in the calculation of surgical and diagnostic wait time benchmarks in Canada.
 
 

Incidence of diabetes in pregnancy doubles over 14-year period in Ontario 

Feig DS, Hwee J, Shah BR, Booth GL, Bierman AS, Lipscombe LL. Trends in incidence of diabetes in pregnancy and serious perinatal outcomes: a large, population-based study in Ontario, Canada, 1996–2010. Diabetes Care. 2014 Apr 4 [Epub ahead of print].

ISSUE

Women with diabetes in pregnancy have high rates of complications. How have incident rates of diabetes in pregnancy and associated rates of serious perinatal outcomes changed over time?

STUDY

Identified all women aged 15 to 50 who delivered in an Ontario hospital between April 1996 and March 2010 and categorized them as having gestational diabetes (GDM) (n=45,384), pre-gestational diabetes (pre-GDM) (n=13,278) or no diabetes (n=1,050,943). Calculated age-adjusted rates of diabetes in pregnancy, and compared rates of serious perinatal outcome between groups and by year.

KEY FINDINGS

Between 1996 and 2010, the prevalence of diabetes in pregnancy doubled, rising from 2.7% to 5.6% for women with GDM and from 0.7% to 1.5% for women with pre-GDM. The rate of congenital anomalies declined by 20% in women with GDM and by 23% in women with pre-GDM, but the rate of perinatal mortality did not change significantly for either group. Compared to women without diabetes, women with pre-GDM and GDM faced an increased risk of congenital anomalies (86% and 26%, respectively), and perinatal mortality remained elevated in women with pre-GDM.

IMPLICATIONS

Further efforts are needed to reverse the trend toward type 2 diabetes in women of child-bearing age, and to decrease the prevalence of serious perinatal outcomes in women with diabetes through improved preconception and perinatal care.
 
 

Average cost of treating patients varies seven-fold among Ontario heart failure clinics

Wijeysundera HC, Austin PC, Wang X, Bennell MC, Abrahamyan L, Ko DT, Tu JV, Krahn M. The effect of multidisciplinary heart failure clinic characteristics on 1-year postdischarge health care costs: a population-based study. Med Care. 2014; 52(3):272–9.

ISSUE

Although economic analyses have shown that ambulatory heart failure clinics are a cost-effective means of disease management, little is known about which patient factors and clinic characteristics are most important in reducing health care costs.

STUDY

Identified 1,216 heart failure patients who had an acute care hospitalization in Ontario between April 2006 and March 2007 and were seen at 19 heart failure clinics. Determined cumulative health care costs at the patient and clinic levels for one year after discharge.

KEY FINDINGS

The mean age of patients was 72.5 years, with 59.5% being male. The mean one-year cost per patient was $27,809, with individual costs ranging from $69 to $343,745. There was a seven-fold variation in mean costs by clinic, ranging from $14,670 to $96,524. Delays in being seen at a clinic were associated with higher costs, reinforcing the importance of early referral. The clinics had between one and eight physicians; clinics with more than three physicians had 26% lower annual costs per patient. Aggressive medication management and peer support were also associated with lower costs.

IMPLICATIONS

These findings will assist health policy makers when making resource allocation decisions with regard to heart failure clinics.
 
 

Surgical safety checklists have not improved patient outcomes in Ontario

Urbach DR, Govindarajan A, Saskin R, Wilton AS, Baxter NN. Introduction of surgical safety checklists in Ontario, Canada. N Engl J Med. 2014; 370(11):1029–38.

ISSUE

The Ontario Ministry of Health and Long-Term Care mandated public reporting of adherence to surgical safety checklists for hospitals beginning in July 2010. What impact has the implementation of these checklists had on patient outcomes? 

STUDY

Surveyed all acute care hospitals in Ontario to determine when surgical safety checklists were introduced. Compared outcomes of all surgical procedures performed in those hospitals in a three-month period before and after checklist implementation.

KEY FINDINGS

A total of 101 hospitals performed 109,341 and 106,370 procedures before and after checklist implementation, respectively. Adjusted mortality was 0.71% before implementation and 0.65% afterward. There was a statistically significant but small reduction in hospital length of stay (5.11 days before and 5.07 days after). Checklist use did not result in an improvement in surgical complications, emergency department visits or hospital readmissions within 30 days of surgery.

IMPLICATIONS

Surgical safety checklists, as implemented by hospitals in Ontario, did not translate into significant improvements in patient outcomes. A greater benefit might result from more intensive surgical team training and/or better monitoring of compliance. 
 
 
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