1
|
Kendzerska T, Povitz M, Gershon AS, Ryan CM, Talarico R, Saymeh M, Robillard R, Ayas NT, Pendharkar SR. Longer-term impacts of the COVID-19 pandemic on obstructive sleep apnoea (OSA)-related healthcare: a province-based study. BMJ Open Respir Res 2024; 11:e002476. [PMID: 39182928 DOI: 10.1136/bmjresp-2024-002476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 08/05/2024] [Indexed: 08/27/2024] Open
Abstract
RATIONALE Following marked reductions in sleep medicine care early in the COVID-19 pandemic, there is limited information about the recovery of these services. We explored long-term trends in obstructive sleep apnoea (OSA) health services and service backlogs during the pandemic compared with pre-pandemic levels in Ontario (the most populous province of Canada). METHODS In this retrospective population-based study using Ontario (Canada) health administrative data on adults, we compared rates of polysomnograms (PSGs), outpatient visits and positive airway pressure (PAP) therapy purchase claims during the pandemic (March 2020 to December 2022) to pre-pandemic rates (2015-2019). We calculated projected rates using monthly seasonal time series auto-regressive integrated moving-average models based on similar periods in previous years. Service backlogs were estimated from the difference between projected and observed rates. RESULTS Compared with historical data, all service rates decreased at first during March to May 2020 and subsequently increased. By December 2022, observed service rates per 100 000 persons remained lower than projected for PSGs (September to December 2022: 113 vs 141, 95% CI: 121 to 163) and PAP claims (September to December 2022: 50 vs 60, 95% CI: 51 to 70), and returned to projected for outpatient OSA visits. By December 2022, the service backlog was 193 078 PSGs (95% CI: 139 294 to 253 075) and 57 321 PAP claims (95% CI: 27 703 to 86 938). CONCLUSION As of December 2022, there was a sustained reduction in OSA-related health services in Ontario, Canada. The resulting service backlog has likely worsened existing problems with underdiagnosis and undertreatment of OSA and supports the adoption of flexible care delivery models for OSA that include portable technologies.
Collapse
Affiliation(s)
- Tetyana Kendzerska
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES, Ottawa, Toronto, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marcus Povitz
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea S Gershon
- ICES, Ottawa, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Clodagh M Ryan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sleep Research Laboratory, Toronto Rehabilitation Institute University Health Network, Toronto, Ontario, Canada
- Centre for Sleep Medicine and Circadian Biology, University of Toronto, Toronto, Ontario, Canada
| | - Robert Talarico
- ICES, Ottawa, Toronto, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mouaz Saymeh
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Najib T Ayas
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sachin R Pendharkar
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
2
|
Hathi K, Nam YSJ, Fowler J, Dishan B, Madou E, Sowerby LJ, MacNeil SD, Nichols AC, Strychowsky JE. Improving Operating Room Efficiency in Otolaryngology-Head and Neck Surgery: A Scoping Review. Otolaryngol Head Neck Surg 2024. [PMID: 38769856 DOI: 10.1002/ohn.822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/04/2024] [Accepted: 04/27/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE One minute of operating room (OR) time costs $36 to 37. However, ORs are notoriously inefficient. There is growing literature on improving OR efficiency, but no formal review of this topic within otolaryngology has been performed. This study reviews and synthesizes the current literature on improving OR efficiency within otolaryngology. DATA SOURCES MEDLINE, EMBASE, Web of Science, CINAHL, Cochrane Library, preprints.org, and medRxiv were searched on November 4, 2022. REVIEW METHODS Published English studies were included if they reported on metrics for improving OR efficiency within otolaryngology. There were no publication date restrictions. Articles were screened by 2 reviewers. Preferred Reporting Items for Systematic Reviews and Meta-analysis reporting for scoping reviews was followed. RESULTS The search yielded 9316 no-duplicate articles; 129 articles were included. Most of the studies reported on head and neck procedures (n = 52/129). The main tactics included surgical considerations: hemostatic devices, techniques, and team/simultaneous approaches; anesthetic considerations: local anesthetic and laryngeal mask airways; procedure location considerations: procedures outside of the OR and remote technologies; standardization: equipment, checklists, and personnel; scheduling considerations: use of machine learning for booking, considering patient/surgeon factors, and utilizing dedicated OR time/multidisciplinary teams for on-call cases. CONCLUSION The current literature brings to attention numerous strategies for improving OR efficiency within otolaryngology. Applying these strategies and implementing novel techniques to manage surgical cases may assist in offloading overloaded health care systems and improving access to care while facilitating patient safety and outcomes. Anticipated barriers to implementation include resistance to change, funding, and the current strain on health care systems and providers.
Collapse
Affiliation(s)
- Kalpesh Hathi
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - You Sung Jon Nam
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - James Fowler
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Canada
| | - Brad Dishan
- Corporate Academics, Health Sciences Library, London Health Sciences Center, London, Ontario, Canada
| | - Edward Madou
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Canada
| | - Julie E Strychowsky
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Canada
| |
Collapse
|
3
|
Wiebe K, Kelley S, Fecteau A, Levine M, Blajchman I, Shaul RZ, Kirsch R. Surgical waitlist management: Perspectives from surgeons on surgical prioritization at a paediatric hospital. Paediatr Child Health 2024; 29:74-80. [PMID: 38586493 PMCID: PMC10996569 DOI: 10.1093/pch/pxad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/09/2023] [Accepted: 09/27/2023] [Indexed: 04/09/2024] Open
Abstract
Globally exacerbated surgical waitlists have provided the opportunity to reflect on prioritization and resource allocation decisions. The unique circumstances of paediatric surgery and consequences of surgical delay prompted the study reported in this paper. As part of a larger project to attend to prioritization in our surgical waitlists, we conducted a Quality Improvement study, the purpose of which is to understand surgeon's perspectives regarding the ethical and practical realities of surgical prioritization at our institution. The study comprises semi-structured interviews with nine full-time paediatric surgeons from a variety of subspecialties conducted at our institution, which is a tertiary paediatric hospital with ten surgical subspecialties in a publicly funded healthcare system. Participants articulated how they prioritize their waitlists, and how they understand ethical prioritization. These findings resonate with the growing public concern for ethical practice in healthcare delivery and transparency in prioritization and resource allocation practices. Specifically, more transparency, consistency, and support is required in prioritization practices. This work highlights the importance of institutional dialogue regarding surgical case prioritization. Because quality improvement work is necessarily site-specific, concrete generalizations cannot be offered. However, the insights gleaned from these interviews and the process by which they were gleaned are a valuable knowledge-sharing resource for any institution that is interested in ongoing quality improvement work. The objectives here were to clarify the goals of prioritization within the institution, improve prioritization practices, and make them more ethical and transparent.
Collapse
Affiliation(s)
- Kayla Wiebe
- Graduate Department of Philosophy, University of Toronto, Toronto, Canada
- Clinical Research, Division of Orthopedics, Department of Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Simon Kelley
- Orthopedic Surgery, Division of Orthopedics, Department of Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Annie Fecteau
- General Surgery, Division of General Surgery, Department of Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Mark Levine
- Department of Anesthesia, The Hospital for Sick Children, Toronto, Canada
| | - Iram Blajchman
- Family and Child Centered Care Advisory Committee, The Hospital for Sick Children, Toronto, Canada
| | | | - Roxanne Kirsch
- Department of Bioethics, The Hospital for Sick Children, Toronto, Canada
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Canada
| |
Collapse
|
4
|
Yu G, Michalak S, Mishra K, Yu M, Pan C. Trends of Ophthalmic Surgery Cancellations at a County Hospital Before and During COVID-19: A 10-Year Retrospective Study. Semin Ophthalmol 2024; 39:305-311. [PMID: 38073109 DOI: 10.1080/08820538.2023.2293032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/23/2023] [Indexed: 03/28/2024]
Abstract
PURPOSE Despite several publications on ophthalmic surgical cancellations discussing preventative causes in academic institutions, there remains a paucity of similar studies for safety-net hospitals. This study analyzed cancellation rates at a county hospital over a 10-year period. METHODS This retrospective, open cohort study investigated a total of 11,350 surgeries scheduled at a tertiary-level county hospital between January 1, 2012 and December 31, 2021. Surgical cancellation reasons were collected from chart review and categorized into eight groups to allow for analyses. Cancellation rates were then calculated per year and per subspecialty. The primary statistical analyses were paired, 2-tailed t test and χ2 test. RESULTS The most common reason for cancellation overall was institution-related (1065 surgeries), which was also the most common reason per year from 2012 to 2019 (range: 37.4% - 60.6%). In 2020, during COVID-19 stay-at-home mandates, the most common reason became COVID-related rescheduling, and in 2021, it was patient-driven. The cancellation rate in 2020 was significantly higher than 2019 (+9.27%,95% CI:4.96%-13.6%,p = .05), and significantly lower from 2021 to 2020 (-22.8%,95% CI:-26.8%-(-)18.7%,p = .001). Pediatric surgery had the highest cancellation rate overall (36.4%), but oculoplastics had the highest cancellation rate in 2020 (48.9%). CONCLUSION The most common reason for cancellation over the 10-year period was institution-related, in contrast to other publications based in academic centers. The study also had a higher cancellation rate than previously reported, again suggesting the difference between county and academic centers. The COVID-19 pandemic had a significant impact on cancellations, even after the COVID-19 stay-at-home orders were eased.
Collapse
Affiliation(s)
- Gina Yu
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA USA
- Division of Ophthalmology, Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA USA
| | - Suzanne Michalak
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA USA
- Division of Ophthalmology, Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA USA
| | - Kapil Mishra
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA USA
- Division of Ophthalmology, Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA USA
| | - Michael Yu
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA USA
- Division of Ophthalmology, Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA USA
| | - Carolyn Pan
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA USA
- Division of Ophthalmology, Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA USA
| |
Collapse
|
5
|
Gouveia K, Harbour E, Gazendam A, Bhandari M. Fixation of Distal Radius Fractures Under Wide-Awake Local Anesthesia: A Systematic Review. Hand (N Y) 2024; 19:58-67. [PMID: 35880346 PMCID: PMC10786102 DOI: 10.1177/15589447221109632] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this systematic review was to analyze the available literature on fixation of distal radius fractures (DRFs) under wide-awake local anesthesia no-tourniquet (WALANT), and to examine postoperative pain scores and functional outcomes, operative data including operative time and blood loss, and the frequency of adverse events. METHODS Embase, MEDLINE, Web of Science, and SCOPUS were searched from inception until May 2022 for relevant studies. Studies were screened in duplicate, and data on pain scores, functional outcomes, and adverse events were recorded. Due to methodological and statistical heterogeneity, the results are presented in a descriptive fashion. RESULTS Ten studies were included comprising 456 patients with closed, unilateral DRFs, of whom 226 underwent fixation under WALANT. These patients had a mean age of 52.8 ± 8.3 years, were 48% female, and had a mean follow-up time of 11.6 months (range: 6-24). Operative time for WALANT patients averaged 60.4 ± 6.5 minutes, with mean postoperative pain scores of 1.4 ± 0.6 on a 10-point scale. Studies that compared WALANT to general anesthesia found shorter hospital stays with most WALANT patients being sent home the same day, decreased postoperative pain scores, and decreased costs to the healthcare system. No adverse events were reported for WALANT patients. CONCLUSIONS A growing body of literature reports that for closed, unilateral DRF, surgical fixation under WALANT is a safe and effective option. It allows patients to have surgery sooner, with improved pain scores and good functional outcomes, with a very low incidence of adverse events.
Collapse
Affiliation(s)
- Kyle Gouveia
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Eric Harbour
- School of Medicine, University of Limerick, Ireland
| | - Aaron Gazendam
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
6
|
Misan N, Wilf-Miron R, Saban M. Comparing Emergency Nursing Measures Before and During COVID-19: A Retrospective Study of Assessment, Triage, and Workflow. SAGE Open Nurs 2024; 10:23779608241274766. [PMID: 39185504 PMCID: PMC11342315 DOI: 10.1177/23779608241274766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 06/25/2024] [Accepted: 07/18/2024] [Indexed: 08/27/2024] Open
Abstract
Background The COVID-19 pandemic significantly impacted emergency department (ED) operations and patient care. Understanding its effects on nursing processes, triage accuracy, and wait times is pivotal for optimizing outcomes. Objectives This study aimed to analyze the differences in nursing processes, triage accuracy, and wait times before and during the COVID-19 pandemic. Design A retrospective cohort study. Methods The study analyzed 224 electronic medical records from a single ED, with 120 records from the pre-pandemic period (January 2019-February 2020) and 104 records from the pandemic period (March 2020-March 2021). Dependent variables included missed nursing care per validated scales, triage accuracy per Emergency Severity Index, and wait times for nursing triage and physician examination. Independent factors encompassed sociodemographic, clinical characteristics, and organization dynamics. Results Sociodemographic and clinical profiles were comparable between periods. Triage accuracy remained high except for older patients. Nursing triage wait times differed little, yet physician examination and urgent case waits decreased amidst the pandemic. Nursing documentation completeness, such as recording patient status and mental state, augmented during this crisis period. Conclusion This evaluation identified differences in triage accuracy, wait times, and documentation completeness before and during the COVID-19 pandemic period at a single institution. Patient age and clinical status influenced some metrics. Lessons from comparing precrisis benchmarks to intra-pandemic nursing performance may guide pandemic preparedness strategies. Further research is warranted to optimize emergency processes and outcomes during public health emergencies, as well as examine strategies through multicenter investigations comparing prepandemic to intra-pandemic performance to provide broader insights into challenges and inform efforts to bolster emergency care through future crises.
Collapse
Affiliation(s)
- Nofar Misan
- Department of Health Promotion, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rachel Wilf-Miron
- Department of Health Promotion, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Gertner Institute for Health Policy and Epidemiology, Ramat-Gan, Israel
| | - Mor Saban
- Nursing Department, School of Health Professions, Faculty of Medicine, Tel-Aviv University, Tel-Aviv-Yafo, Israel
| |
Collapse
|
7
|
Habbous S, Gomez D, Urbach D, Hellsten E. Scheduled and urgent inguinal hernia repair in Ontario, Canada between 2010 and 2022: Population-based cross sectional analysis of trends and outcomes. PLoS One 2023; 18:e0296258. [PMID: 38134127 PMCID: PMC10745156 DOI: 10.1371/journal.pone.0296258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION We examine trends in inguinal hernia repairs with respect to the COVID-19 pandemic and secular trends in Ontario, Canada. METHODS This was a retrospective cohort study. Hernia repairs performed January 1, 2010-December 31, 2022 were captured from health administrative inpatient and outpatient databases. Patients managed in three clinical settings were examined: public hospital in-patient, semi-private hospital in-patient (Shouldice Hospital), and public hospital out-patient. We examined the effect of the COVID-19 pandemic on surgical volumes, clinical setting, patient characteristics by setting, time from diagnosis until surgery, hospital length-of-stay, and patient outcomes (90-day readmissions, 1-year reoperations). We used multivariable logistic regression to examine whether patient outcomes were comparable between the COVID-19 period and the pre-pandemic period, adjusted sociodemographic and clinical factors. Shouldice Hospital is the only semi-private hospital in Ontario specializing in hernia repair (patients pay for the mandated admission, but not for the procedure). RESULTS During the pandemic (March 2020-December 2022), there were 8,162 fewer (15%) scheduled inguinal hernia repairs than expected, but the age-sex standardized rate of urgent repairs remained unchanged. Shouldice Hospital performed more surgeries in the COVID-19 era than pre-pandemic and had a shorter average LOS by 24 hours, despite treating more patients with older age, higher ASA score [adjusted odds ratio (aOR) 2.13 (1.93-2.35) III vs I-II] and greater comorbidity [aOR 1.36 (1.08-1.70) for 2 vs none] than pre-pandemic. Patients treated in the COVID-19 era experienced a longer time until surgery, being the longest in 2022 (median 133 days). Ninety-day readmissions and 1-year reoperations were lower in the COVID-19 era and lower for patients receiving surgery at Shouldice Hospital. CONCLUSION During the COVID-19 pandemic, there were 8,162 fewer scheduled hernia repairs than expected, longer wait-times until surgery, shorter length-of-stay, and more patients with comorbidities, but outcomes were not worse compared with the pre-pandemic period.
Collapse
Affiliation(s)
- Steven Habbous
- Ontario Health, Toronto, Ontario, Canada
- Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - David Gomez
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Surgery, St Michaels Hospital, Unity Health, Toronto, Ontario, Canada
| | - David Urbach
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women’s College Hospital, Toronto, Ontario, Canada
| | | |
Collapse
|
8
|
Ibadin S, Brindle M, Wasylak T, Robert J, Litvinchuk S, Sauro KM. Delivery and Prioritization of Surgical Care in Canada During COVID-19: An Environmental Scan. Int J Health Policy Manag 2023; 12:8007. [PMID: 38618771 PMCID: PMC10843432 DOI: 10.34172/ijhpm.2023.8007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 11/20/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND During COVID-19 healthcare systems had to make concessions to make room for the surge of COVID-19 patients requiring hospital and intensive care. Postponing surgeries was a common strategy; however, it is unclear how surgical care was delivered during this time of constraint. The objective of this study was to understand how surgical care was delivered and prioritized during the COVID-19 pandemic response. METHODS This was an environmental scan following the Canadian Agency for Drugs and Technologies in Health methodology. This study was conducted in Canada; a universal, publicly funded healthcare system. Evidence sources on policies pertaining to the provision of surgical care between January 2020 and October 2022 were obtained from ministries of health, health services agencies and publicly funded hospitals across all 10 provinces and three territories. We synthesized the evidence sources using framework analysis. RESULTS We identified 205 evidence sources that described six themes about the provision of surgical care during the COVID-19 pandemic: the cycle of postponement and resumption; guidelines for triaging and prioritizing surgical cases; Infection Prevention and Control (IPAC), and safety measures for surgical care during COVID-19, patient-centred care, and looking forward (recovery planning, leadership, and decision-making). CONCLUSION This study provides a comprehensive understanding of how surgical care was disrupted and innovated during COVID-19 which can inform future strategies for providing effective and efficient surgical care during times of healthcare constraint.
Collapse
Affiliation(s)
- Seremi Ibadin
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mary Brindle
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Surgery Strategic Clinical Networks, Alberta Health Services, Calgary, AB, Canada
| | - Tracy Wasylak
- Surgery Strategic Clinical Networks, Alberta Health Services, Calgary, AB, Canada
| | - Jill Robert
- Surgery and Bone & Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary, AB, Canada
| | - Stacey Litvinchuk
- Surgery Strategic Clinical Networks, Alberta Health Services, Calgary, AB, Canada
| | - Khara M. Sauro
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Oncology and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
9
|
Persaud N, Sabir A, Woods H, Sayani A, Agarwal A, Chowdhury M, de Leon-Demare K, Ibezi S, Jan SH, Katz A, LaFortune FD, Lewis M, McFarlane T, Oberai A, Oladele Y, Onyekwelu O, Peters L, Wong P, Lofters A. Recommandations pour des soins préventifs pour promouvoir l’équité en matière de santé. CMAJ 2023; 195:E1674-E1701. [PMID: 38081626 PMCID: PMC10718275 DOI: 10.1503/cmaj.230237-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Contexte: Malgré des investissements importants dans un système de soins de santé public qui comprend des services préventifs, on continue d’observer des disparités évitables en matière de santé au Canada. L’équipe avait pour objectif de formuler des recommandations pour des soins de santé préventifs qui puissent améliorer l’équité en matière de santé par la priorisation des interventions efficaces à l’intention des groupes défavorisés. Méthodes: La ligne directrice a été élaborée par un comité composé de spécialistes en soins primaires et de membres de la patientèle, avec la contribution d’un groupe de patientes-et patientspartenaires ayant vécu diverses expériences. Après avoir sélectionné les sujets à prioriser, nous avons recensé les revues systématiques, les essais randomisés et contrôlés récents sur les méthodes de dépistage et d’autres études pertinentes sur l’efficacité du dépistage et de la prise en charge. Nous avons utilisé l’approche GRADE (Grading of Recommendations, Assessment, Development and Evaluation) pour formuler les recommandations et avons suivi le guide AGREE II (Appraisal of Guidelines for Research and Evaluation) pour rédiger le rapport. Il en a été de même avec les principes du Guidelines International Network pour la gestion des intérêts concurrents. Les recommandations ont été passées en revue par un comité externe d’experts en contenu avant d’être distribuées à des intervenants à l’échelle nationale pour approbation. Recommandations: Nous avons formulé 15 recommandations concernant le dépistage et d’autres soins préventifs et 1 recommandation de nature politique visant à améliorer l’accès aux soins primaires. Ainsi, nous recommandons de prioriser une stratégie de communication pour le dépistage du cancer colorectal à partir de l’âge de 45 ans et pour l’évaluation du risque de maladie cardiovasculaire pour lutter contre les iniquités en matière de santé et promouvoir la santé. Les interventions particulières qui devraient être déployées pour lutter contre les iniquités comprennent l’autodépistage du virus du papillome humain (VPH) et du VIH, et le test de libération de l’interféron γ pour l’infection tuberculeuse. Le dépistage de la dépression, de la toxicomanie, de la violence conjugale et de la pauvreté devrait également permettre aux personnes touchées d’accéder plus facilement à des interventions éprouvées. Nous recommandons une prise de contact systématique avec des professionnels de la santé en soins primaires pour les personnes défavorisées. Interprétation: Les interventions préventives éprouvées peuvent aider à combattre les iniquités en matière de santé si la priorité est accordée aux personnes défavorisées. Les médecins, les organisations de santé et les gouvernements devraient adopter des mesures fondées sur des données probantes et en faire le suivi s’ils veulent promouvoir l’équité en matière de santé partout au Canada.
Collapse
Affiliation(s)
- Nav Persaud
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont.
| | - Areesha Sabir
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Hannah Woods
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Ambreen Sayani
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Arnav Agarwal
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Muna Chowdhury
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Kathleen de Leon-Demare
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Somtochukwu Ibezi
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Saadia Hameed Jan
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Alan Katz
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Frantz-Daniel LaFortune
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Melanie Lewis
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Trudy McFarlane
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Anjali Oberai
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Yinka Oladele
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Onyema Onyekwelu
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Lisa Peters
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Patrick Wong
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Aisha Lofters
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| |
Collapse
|
10
|
Jin YP, Canizares M, El-Defrawy S, Buys YM. Backlog in ophthalmic surgeries associated with the COVID-19 pandemic in Ontario 2020. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:513-522. [PMID: 35905943 PMCID: PMC9257112 DOI: 10.1016/j.jcjo.2022.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 02/22/2022] [Accepted: 06/28/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the volume of deferred ophthalmic surgeries in Ontario associated with the COVID-19 pandemic from March to December 2020 and suggest strategies and time required to clear the backlog. DESIGN Cross-sectional study. PARTICIPANTS Ontarians eligible for the Ontario Health Insurance Plan in 2017-2020. METHODS Backlog and clearance time for ophthalmic surgeries associated with the COVID-19 pandemic were estimated from time-series forecasting models and queuing theory. RESULTS From March 16 to December 31, 2020, the estimated ophthalmic surgical backlog needing operating rooms was 92,150 surgeries (95% prediction interval, 71,288-112,841). Roughly 90% of the delayed surgeries were cataract surgeries, and a concerning 4% were retinal detachment surgeries. Nearly half the provincial backlog (48%; 44,542 of 92,150) was in patients from the western health region. In addition, an estimated 23,755 (95% prediction interval, 14,656-32,497) anti-vascular endothelial growth factor injections were missed. Estimated provincial clearance time was 248 weeks (95% CI, 235-260) and 128 weeks (95% CI, 121-134) if 10% and 20% of operating room surgical capacity per week were added, respectively, based on the weekly ophthalmic surgical volume in 2019. CONCLUSIONS Ontario data demonstrate that the magnitude of the ophthalmic surgical backlog in 2020 alone raises serious concerns for meeting the ophthalmic surgical needs of patients. As the pandemic continues, the accrued backlog size is likely to increase. Planning and actions are needed urgently to better manage the collateral impacts of the pandemic on the ophthalmic surgical backlog.
Collapse
Affiliation(s)
- Ya-Ping Jin
- Department of Ophthalmology and Vision Sciences, University of Toronto; Dalla Lana School of Public Health, University of Toronto.
| | - Mayilee Canizares
- Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON
| | - Sherif El-Defrawy
- Department of Ophthalmology and Vision Sciences, University of Toronto
| | - Yvonne M Buys
- Department of Ophthalmology and Vision Sciences, University of Toronto
| |
Collapse
|
11
|
Stephenson R, Sarhangian V, Park J, Sankar A, Baxter NN, Stukel TA, Simpson AN, Wijeysundera DN, Wilton AS, de Mestral C, Hwang SW, Pincus D, Campbell RJ, Urbach DR, Irish J, Gomez D, Chan TCY. Evolution of the surgical procedure gap during and after the COVID-19 pandemic in Ontario, Canada: cross-sectional and modelling study. Br J Surg 2023; 110:1887-1889. [PMID: 37724806 PMCID: PMC10638533 DOI: 10.1093/bjs/znad289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/28/2023] [Accepted: 08/14/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Rachel Stephenson
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Vahid Sarhangian
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Jangwon Park
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Ashwin Sankar
- Unity Health Toronto, Toronto, Ontario, Canada
- Department of Anaesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Nancy N Baxter
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Therese A Stukel
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Andrea N Simpson
- Unity Health Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Duminda N Wijeysundera
- Unity Health Toronto, Toronto, Ontario, Canada
- Department of Anaesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Charles de Mestral
- Unity Health Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephen W Hwang
- Unity Health Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Daniel Pincus
- ICES, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert J Campbell
- ICES, Toronto, Ontario, Canada
- Department of Ophthalmology, Kingston Health Science Centre, Queen’s University, Kingston, Ontario, Canada
| | - David R Urbach
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Irish
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - David Gomez
- Unity Health Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Surgery, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Timothy C Y Chan
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| |
Collapse
|
12
|
van Alphen AMIA, Sülz S, Lingsma HF, Baatenburg de Jong RJ. Prioritization of surgical patients during the COVID-19 pandemic and beyond: A qualitative exploration of patients' perspectives. PLoS One 2023; 18:e0294026. [PMID: 37939138 PMCID: PMC10631689 DOI: 10.1371/journal.pone.0294026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 10/05/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION During the COVID-19 pandemic, prioritizing certain surgical patients became inevitable due to limited surgical capacity. This study aims to identify which factors patients value in priority setting, and to evaluate their perspective on a decision model for surgical prioritization. METHODS We enacted a qualitative exploratory study and conducted semi-structured interviews with N = 15 patients. Vignettes were used as guidance. The interviews were transcribed and iteratively analyzed using thematic analysis. RESULTS We unraveled three themes: 1) general attitude towards surgical prioritization: patients showed understanding for the difficult decisions to be made, but demanded greater transparency and objectivity; 2) patient-related factors that some participants considered should, or should not, influence the prioritization: age, physical functioning, cognitive functioning, behavior, waiting time, impact on survival and quality of life, emotional consequences, and resource usage; and 3) patients' perspective on a decision model: usage of such a model for prioritization decisions is favorable if the model is simple, uses trustworthy data, and its output is supervised by physicians. The model could also be used as a communication tool to explain prioritization dilemmas to patients. CONCLUSION Support for the various factors and use of a decision model varied among patients. Therefore, it seems unrealistic to immediately incorporate these factors in decision models. Instead, this study calls for more research to identify feasible avenues and seek consensus.
Collapse
Affiliation(s)
| | - Sandra Sülz
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Hester F. Lingsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | |
Collapse
|
13
|
Persaud N, Sabir A, Woods H, Sayani A, Agarwal A, Chowdhury M, de Leon-Demare K, Ibezi S, Jan SH, Katz A, LaFortune FD, Lewis M, McFarlane T, Oberai A, Oladele Y, Onyekwelu O, Peters L, Wong P, Lofters A. Preventive care recommendations to promote health equity. CMAJ 2023; 195:E1250-E1273. [PMID: 37748784 PMCID: PMC10519166 DOI: 10.1503/cmaj.230237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Avoidable disparities in health outcomes persist in Canada despite substantial investments in a publicly funded health care system that includes preventive services. Our objective was to provide preventive care recommendations that promote health equity by prioritizing effective interventions for people experiencing disadvantages. METHODS The guideline was developed by a primary care provider-patient panel, with input from a patient-partner panel with diverse lived experiences. After selecting priority topics, we searched for systematic reviews and recent randomized controlled trials of screening and other relevant studies of screening accuracy and management efficacy. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to develop recommendations and followed the Appraisal of Guidelines for Research and Evaluation (AGREE II) reporting guidance. We managed competing interests using the Guideline International Network principles. The recommendations were externally reviewed by content experts and circulated for endorsement by national stakeholders. RECOMMENDATIONS We developed 15 screening and other preventive care recommendations and 1 policy recommendation on improving access to primary care. We recommend prioritized outreach for colorectal cancer screening starting at age 45 years and for cardiovascular disease risk assessment, to help address inequities and promote health. Specific interventions that should be rolled out in ways that address inequities include human papillomavirus (HPV) self-testing, HIV self-testing and interferon-γ release assays for tuberculosis infection. Screening for depression, substance use, intimate partner violence and poverty should help connect people experiencing specific disadvantages with proven interventions. We recommend automatic connection to primary care for people experiencing disadvantages. INTERPRETATION Proven preventive care interventions can address health inequities if people experiencing disadvantages are prioritized. Clinicians, health care organizations and governments should take evidence-based actions and track progress in promoting health equity across Canada.
Collapse
Affiliation(s)
- Nav Persaud
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont.
| | - Areesha Sabir
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Hannah Woods
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Ambreen Sayani
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Arnav Agarwal
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Muna Chowdhury
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Kathleen de Leon-Demare
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Somtochukwu Ibezi
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Saadia Hameed Jan
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Alan Katz
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Frantz-Daniel LaFortune
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Melanie Lewis
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Trudy McFarlane
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Anjali Oberai
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Yinka Oladele
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Onyema Onyekwelu
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Lisa Peters
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Patrick Wong
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Aisha Lofters
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| |
Collapse
|
14
|
Zeitouny S, Cheung DC, Bremner KE, Pataky RE, Pequeno P, Matelski J, Peacock S, Del Giudice ME, Lapointe-Shaw L, Tomlinson G, Mendlowitz AB, Mulder C, Tsui TCO, Perlis N, Walker JD, Sander B, Wong WWL, Krahn MD, Kulkarni GS. The impact of the early COVID-19 pandemic on healthcare system resource use and costs in two provinces in Canada: An interrupted time series analysis. PLoS One 2023; 18:e0290646. [PMID: 37682823 PMCID: PMC10490868 DOI: 10.1371/journal.pone.0290646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/11/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION The aim of our study was to assess the initial impact of COVID-19 on total publicly-funded direct healthcare costs and health services use in two Canadian provinces, Ontario and British Columbia (BC). METHODS This retrospective repeated cross-sectional study used population-based administrative datasets, linked within each province, from January 1, 2018 to December 27, 2020. Interrupted time series analysis was used to estimate changes in the level and trends of weekly resource use and costs, with March 16-22, 2020 as the first pandemic week. Also, in each week of 2020, we identified cases with their first positive SARS-CoV-2 test and estimated their healthcare costs until death or December 27, 2020. RESULTS The resources with the largest level declines (95% confidence interval) in use in the first pandemic week compared to the previous week were physician services [Ontario: -43% (-49%,-37%); BC: -24% (-30%,-19%) (both p<0.001)] and emergency department visits [Ontario: -41% (-47%,-35%); BC: -29% (-35%,-23%) (both p<0.001)]. Hospital admissions declined by 27% (-32%,-23%) in Ontario and 21% (-26%,-16%) in BC (both p<0.001). Resource use subsequently rose but did not return to pre-pandemic levels. Only home care and dialysis clinic visits did not significantly decrease compared to pre-pandemic. Costs for COVID-19 cases represented 1.3% and 0.7% of total direct healthcare costs in 2020 in Ontario and BC, respectively. CONCLUSIONS Reduced utilization of healthcare services in the overall population outweighed utilization by COVID-19 patients in 2020. Meeting the needs of all patients across all services is essential to maintain resilient healthcare systems.
Collapse
Affiliation(s)
- Seraphine Zeitouny
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Douglas C. Cheung
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Divisions of Urology and Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karen E. Bremner
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Reka E. Pataky
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - John Matelski
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - M. Elisabeth Del Giudice
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Lapointe-Shaw
- ICES, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of General Internal Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - George Tomlinson
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Andrew B. Mendlowitz
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Carol Mulder
- Chiefs of Ontario, Toronto, Ontario, Canada
- Queen’s University, Kingston, Ontario, Canada
| | - Teresa C. O. Tsui
- ICES, Toronto, Ontario, Canada
- Child Health and Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Canadian Centre for Applied Research in Cancer Control, Ontario Health-Cancer Care Ontario, Toronto, Ontario, Canada
| | - Nathan Perlis
- Divisions of Urology and Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, Sprott Department of Surgery, University Health Network, Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jennifer D. Walker
- ICES, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - William W. L. Wong
- ICES, Toronto, Ontario, Canada
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Murray D. Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Girish S. Kulkarni
- Divisions of Urology and Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of Urology, Sprott Department of Surgery, University Health Network, Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| |
Collapse
|
15
|
Sniderman J, Khoshbin A, Wolfstadt J. The influence of the COVID-19 pandemic on total hip and knee arthroplasty in Ontario: a population-level analysis. Can J Surg 2023; 66:E485-E490. [PMID: 37734851 PMCID: PMC10521810 DOI: 10.1503/cjs.016122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The effects of the COVID-19 pandemic on elective orthopedic surgery have yet to be reported at the population level in Canada. We sought to detail the effect of the pandemic on patients who underwent total hip arthroplasty (THA) and total knee arthroplasty (TKA), and on surgeons with respect to surgical volume, wait times and health care quality. METHOD We compared patient length of hospital stay, revisions, readmissions and emergency department presentations between pre-pandemic (April 2019 to February 2020) and postpandemic (April 2020 to February 2021) cohorts of patients who underwent inpatient THAs or TKAs. Wait times for THA and TKA in Ontario were similarly collected. RESULTS Case volumes for THA and TKA decreased by 30% during the pandemic. There were significantly fewer medically complex cases during this time period (p < 0.001). Length of hospital stay was reduced from 2.2 to 1.8 days (p < 0.001). Patients were less likely to visit the emergency department within 30 days of surgery (p < 0.001). Patients who underwent TKA were also more likely to be discharged directly home (p = 0.025). There was no difference in rate of revision surgery or readmission within 30 days. The proportion of patients meeting the standard benchmark wait time in Ontario was significantly lower (p < 0.001). The corresponding wait time to treatment increased significantly (p < 0.001). CONCLUSION The effects of the COVID-19 pandemic on elective THA and TKA case volumes and wait times was significant. Patients having surgery during the pandemic were less medically complex, had shorter length of hospital stays and had significantly less health care utilization.
Collapse
Affiliation(s)
- Jhase Sniderman
- Division of Orthopedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Sniderman, Khoshbin, Wolfstadt); Institute of Health Policy, Management and Evaluation, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Sniderman, Wolfstadt); Division of Orthopedic Surgery, St. Michael's Hospital, Unity Health, Toronto, Ont. (Khoshbin); Granovsky Gluskin Division of Orthopedic Surgery, Sinai Health, Toronto, Ont. (Wolfstadt)
| | - Amir Khoshbin
- Division of Orthopedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Sniderman, Khoshbin, Wolfstadt); Institute of Health Policy, Management and Evaluation, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Sniderman, Wolfstadt); Division of Orthopedic Surgery, St. Michael's Hospital, Unity Health, Toronto, Ont. (Khoshbin); Granovsky Gluskin Division of Orthopedic Surgery, Sinai Health, Toronto, Ont. (Wolfstadt)
| | - Jesse Wolfstadt
- Division of Orthopedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Sniderman, Khoshbin, Wolfstadt); Institute of Health Policy, Management and Evaluation, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Sniderman, Wolfstadt); Division of Orthopedic Surgery, St. Michael's Hospital, Unity Health, Toronto, Ont. (Khoshbin); Granovsky Gluskin Division of Orthopedic Surgery, Sinai Health, Toronto, Ont. (Wolfstadt)
| |
Collapse
|
16
|
Xu H, Fang Y, Chou CA, Fard N, Luo L. A reinforcement learning-based optimal control approach for managing an elective surgery backlog after pandemic disruption. Health Care Manag Sci 2023; 26:430-446. [PMID: 37084163 PMCID: PMC10119544 DOI: 10.1007/s10729-023-09636-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 03/14/2023] [Indexed: 04/22/2023]
Abstract
Contagious disease pandemics, such as COVID-19, can cause hospitals around the world to delay nonemergent elective surgeries, which results in a large surgery backlog. To develop an operational solution for providing patients timely surgical care with limited health care resources, this study proposes a stochastic control process-based method that helps hospitals make operational recovery plans to clear their surgery backlog and restore surgical activity safely. The elective surgery backlog recovery process is modeled by a general discrete-time queueing network system, which is formulated by a Markov decision process. A scheduling optimization algorithm based on the piecewise decaying [Formula: see text]-greedy reinforcement learning algorithm is proposed to make dynamic daily surgery scheduling plans considering newly arrived patients, waiting time and clinical urgency. The proposed method is tested through a set of simulated dataset, and implemented on an elective surgery backlog that built up in one large general hospital in China after the outbreak of COVID-19. The results show that, compared with the current policy, the proposed method can effectively and rapidly clear the surgery backlog caused by a pandemic while ensuring that all patients receive timely surgical care. These results encourage the wider adoption of the proposed method to manage surgery scheduling during all phases of a public health crisis.
Collapse
Affiliation(s)
- Huyang Xu
- College of Management Science, Chengdu University of Technology, Chengdu, Sichuan, China
| | - Yuanchen Fang
- Department of Industrial Engineering and Management, Business School, Sichuan University, Chengdu, Sichuan, China.
| | - Chun-An Chou
- Department of Mechanical & Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Nasser Fard
- Department of Mechanical & Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Li Luo
- Department of Industrial Engineering and Management, Business School, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
17
|
Benn R, Rawson L, Phillips A. Utilising a non-surgical intervention in the knee osteoarthritis care pathway: a 6-year retrospective audit on NHS patients. Ther Adv Musculoskelet Dis 2023; 15:1759720X231187190. [PMID: 37529330 PMCID: PMC10387773 DOI: 10.1177/1759720x231187190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/22/2023] [Indexed: 08/03/2023] Open
Abstract
Background Knee osteoarthritis (OA) is a chronic, debilitating, musculoskeletal condition that affects millions. The increase in prevalence and its economic impact on healthcare and society raise the need for additional non-surgical interventions. Objective To assess the referral rates to secondary care consultation and clinical outcomes in patients with severe knee OA treated with a home-based, non-surgical intervention. Design This was a retrospective audit on 571 patients with knee OA who met the clinical criteria for total knee replacement (TKR) and received the service between October 2015 and March 2020. Methods Patients were treated with a non-surgical, home-based, biomechanical intervention that aims to reduce pain and improve function, involving a foot-worn device for gait rehabilitation. The device is adjusted to the patient based on their gait patterns and clinical symptoms. Patients are advised to use the device at home or work and continue their routine. Patients are also advised to return to follow-up appointments to readjust the device and treatment plan. The primary outcome measure was the referral rates to secondary care consultation. Secondary outcomes included patient-reported outcome measures to assess pain and function and a computerised gait test. Follow-up time was between 1 and 6 years post-treatment initiation with a mean follow-up time of 1308.1 (SD = 473.4) days (i.e. 3.5 years.). Results There were 65 (11.4%) referrals for secondary consultation with an average follow-up of 3.5 years. The mean days to referral was 480.9 (SD = 399.2) days. Of all referrals, 48% (n = 31) occurred during the first year of treatment, and 32% (n = 21) occurred during the second year. The rest were after more than 2 years of treatment.Significant improvements were seen in all clinical outcomes, including a reduction in pain and an improvement in function and gait patterns (p < 0.05 for all). Conclusion Utilising this intervention as a non-surgical option for patients with knee OA who met the clinical criteria for TKR led to a significant reduction in pain and improvement in function after 3 months that was maintained for up to 3 years. Most patients (89%) did not proceed to secondary care consultation during their time in treatment for up to 6 years.
Collapse
|
18
|
Green MA, McKee M, Hamilton OK, Shaw RJ, Macleod J, Boyd A, Katikireddi SV. Associations between self-reported healthcare disruption due to covid-19 and avoidable hospital admission: evidence from seven linked longitudinal studies for England. BMJ 2023; 382:e075133. [PMID: 37468148 PMCID: PMC10354595 DOI: 10.1136/bmj-2023-075133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVES To examine whether there is an association between people who experienced disrupted access to healthcare during the covid-19 pandemic and risk of an avoidable hospital admission. DESIGN Observational analysis using evidence from seven linked longitudinal cohort studies for England. SETTING Studies linked to electronic health records from NHS Digital from 1 March 2020 to 25 August 2022. Data were accessed using the UK Longitudinal Linkage Collaboration trusted research environment. PARTICIPANTS Individual level records for 29 276 people. MAIN OUTCOME MEASURES Avoidable hospital admissions defined as emergency hospital admissions for ambulatory care sensitive and emergency urgent care sensitive conditions. RESULTS 9742 participants (weighted percentage 35%, adjusted for sample structure of longitudinal cohorts) self-reported some form of disrupted access to healthcare during the covid-19 pandemic. People with disrupted access were at increased risk of any (odds ratio 1.80, 95% confidence interval 1.39 to 2.34), acute (2.01, 1.39 to 2.92), and chronic (1.80, 1.31 to 2.48) ambulatory care sensitive hospital admissions. For people who experienced disrupted access to appointments (eg, visiting their doctor or an outpatient department) and procedures (eg, surgery, cancer treatment), positive associations were found with measures of avoidable hospital admissions. CONCLUSIONS Evidence from linked individual level data shows that people whose access to healthcare was disrupted were more likely to have a potentially preventable hospital admission. The findings highlight the need to increase healthcare investment to tackle the short and long term implications of the pandemic, and to protect treatments and procedures during future pandemics.
Collapse
Affiliation(s)
- Mark A Green
- Geographic Data Science Lab, Department of Geography & Planning, University of Liverpool, Liverpool, UK
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Olivia Kl Hamilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Richard J Shaw
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - John Macleod
- Population Health Sciences, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Andy Boyd
- Population Health Sciences, University of Bristol, Bristol, UK
| | | |
Collapse
|
19
|
Kouzmina E, Deghan S, Robertson D, Reimer C, Zevin B. Bariatric Surgery Performed at a Tertiary Care Hospital and an Ambulatory Hospital: A 5 Year Comparison of Outcomes, OR Efficiencies and Costs. Obes Surg 2023; 33:2139-2147. [PMID: 37199831 PMCID: PMC10193341 DOI: 10.1007/s11695-023-06648-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE To explore change in 30-day post-operative complications, operative times, operating room (OR) efficiencies for bariatric surgery performed at a tertiary care hospital (TH) and an ambulatory hospital with overnight stay (AH) within one hospital network over 5 years; and to compare perioperative costs at the TH and AH. MATERIALS AND METHODS We performed a retrospective analysis of existing data from a cohort of consecutive adult patients who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG) between September 2016 and August 2021 at TH and AH. RESULTS A total of 805 patients (762 LRYGB, 43 LSG) had surgery at AH, while 109 (92 LRYGB, 17 LSG) at TH. OR times for LRYGB and LSG performed at AH were significantly shorter versus TH (150 ± 24 vs 178 ± 51 min; p < 0.01) and (123 ± 24 vs 147 ± 34 min; p = 0.01). OR turnovers (19.2 ± 6.0 min vs 28.1 ± 6.1 min; p < 0.01) and Post Anesthetic Care Unit (PACU) times (2.4 ± 0.6 h vs 3.1 ± 1.5 h; p < 0.01) were significantly faster at AH versus TH. Proportion of patients requiring transfer for a complication from AH to TH remained constant over time (range 1.5-6.2%/year; p = 0.14). 30-day complication rates were similar between AH and TH (5.5-11% vs 0-15%; p = 0.12). LRYGB and LSG costs were similar between AH and TH (8,855 ± 1,328CAD vs 8,799 ± 2,729CAD; p = 0.91 and 8,763 ± 1,449CAD vs 7,857 ± 1,825CAD; p = 0.41). CONCLUSION There was no difference in 30-day post-operative complications for LRYGB and LSG performed at AH and TH. Performing bariatric surgery at AH has the benefit of improved OR efficiency without a significant difference in total perioperative costs.
Collapse
Affiliation(s)
- Ekaterina Kouzmina
- Department of Surgery, Queen's University, Kingston, ON, K7L 2V7, Canada
| | - Shaidah Deghan
- Department of Surgery, University of Toronto, Toronto, ON, M5T 1P5, Canada
| | - David Robertson
- Department of Surgery, Queen's University, Kingston, ON, K7L 2V7, Canada
| | - Cara Reimer
- Department of Anesthesiology, Queen's University, Kingston, ON, K7L 2V7, Canada
| | - Boris Zevin
- Department of Surgery, Queen's University, Kingston, ON, K7L 2V7, Canada.
- Division of General Surgery, Kingston Health Sciences Centre, 76 Stuart Street, Burr 2, Kingston, ON, K7L 2V7, Canada.
| |
Collapse
|
20
|
Pook M, Najafi T, Lapointe-Gagner M, Nguyen-Powanda P, Elhaj H, Rajabiyazdi F, Kaneva P, Lee L, Feldman LS, Fiore JF. Patients' experiences undergoing cancer surgery during the COVID-19 pandemic: a qualitative study. Support Care Cancer 2023; 31:400. [PMID: 37335423 DOI: 10.1007/s00520-023-07861-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/04/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE This study aimed to understand patients' experiences undergoing cancer surgery during the COVID-19 pandemic. In response to COVID-19, many elective cancer surgeries were delayed creating a massive backlog of cases. Patients' experiences with surgical delays may inform healthcare systems' responses to the backlog of cases and guide preparations for future healthcare emergencies. METHODS This was a qualitative description study. Patients undergoing general surgery for cancer at two university-affiliated hospitals between March 2020 and January 2021 were invited to one-to-one interviews. Patients were purposefully selected using quota sampling until interviews produced no new information (i.e., thematic saturation). Interviews were conducted using a semi-structured guide and analyzed according to inductive thematic analysis. RESULTS Twenty patients were included [mean age 64 ± 12.9; male (n = 10); surgical delay (n = 14); cancer sites: breast (n = 8), skin (n = 4), hepato-pancreato-biliary (n = 4), colorectal (n = 2), and gastro-esophageal (n = 2)]. When determining their willingness to undergo surgery, patients weighed the risk of COVID-19 infection against the urgency of their disease. Changes to the hospital environment (e.g., COVID-19 preventative measures) and deviations from expected treatment (e.g., alternative treatments, remote consultations, rescheduled care) caused diverse psychological responses, ranging from increased satisfaction to severe distress. Patients employed several coping strategies to mitigate distress, including eliciting reassurance from care providers, seeking information from unconventional sources, and reframing care interruptions. CONCLUSIONS Changes in care during the pandemic elicited diverse psychological responses from patients undergoing cancer surgery. Coping was facilitated by consistent communication with providers, emphasizing the importance of patient-centered expectation setting as we prepare for the future within and beyond the pandemic.
Collapse
Affiliation(s)
- Makena Pook
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Tahereh Najafi
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 1650 Cedar Ave, H3G 1A4, Montreal, QC, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Hiba Elhaj
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Fateme Rajabiyazdi
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada
| | - Pepa Kaneva
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Lawrence Lee
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 1650 Cedar Ave, H3G 1A4, Montreal, QC, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Liane S Feldman
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 1650 Cedar Ave, H3G 1A4, Montreal, QC, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Julio F Fiore
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada.
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 1650 Cedar Ave, H3G 1A4, Montreal, QC, Canada.
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
- Department of Surgery, McGill University, Montreal, QC, Canada.
| |
Collapse
|
21
|
Scheuing WJ, Reginato AM, Deeb M, Acer Kasman S. The burden of osteoarthritis: Is it a rising problem? Best Pract Res Clin Rheumatol 2023; 37:101836. [PMID: 37633827 DOI: 10.1016/j.berh.2023.101836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 08/28/2023]
Abstract
The objective of this review is to provide an overview of the current status of osteoarthritis (OA) as one of the most common joint disorders worldwide. Despite being the 11th cause of disability globally, there has been an increase in the prevalence, annual incidence, and years lived with disability of OA, particularly in developed and developing countries. Erosive hand OA, which affects approximately 10% of the general population, has been associated with a higher clinical burden compared to non-erosive hand OA. Patients with knee and hip OA, but not hand OA, are also at an increased risk of cardiovascular disease and all-cause mortality. Furthermore, OA has a significant contribution to healthcare costs in most countries. The recent COVID-19 pandemic has further exacerbated the disease burden of OA patients due to limited access to medical and surgical treatment. With increasing life expectancy and the aging of the global population, the burden of OA is expected to worsen. Therefore, this review highlights the importance of improving population and policymaker awareness of risk factors, such as obesity and injury, as well as early intervention and management of OA to control the future burden of the disease.
Collapse
Affiliation(s)
| | | | - Mery Deeb
- Department of Internal Medicine, Kent Hospital/Brown University, Warwick, RI, USA.
| | - Sevtap Acer Kasman
- Marmara University School of Medicine, PMR Department, Rheumatology Division, Istanbul, Türkiye.
| |
Collapse
|
22
|
Gruescu ACS, Popoiu C, Levai MC, Tudor R, Fericean RM, Rivis M. A Cross-Sectional Assessment of Parental Concerns in the Pediatric Surgery Department during the COVID-19 Pandemic. Healthcare (Basel) 2023; 11:healthcare11091330. [PMID: 37174873 PMCID: PMC10177879 DOI: 10.3390/healthcare11091330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/21/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
The COVID-19 pandemic has impacted various aspects of healthcare, including pediatric surgery. This study aimed to assess parental concerns and stress levels in pediatric surgery during the COVID-19 pandemic, identify factors associated with increased parental anxiety or concern, and provide recommendations for healthcare providers. A cross-sectional study was conducted in a tertiary pediatric hospital in Timisoara, Romania, involving 174 parents of pediatric patients requiring elective or emergency surgery, with a mean age of 37.6 (25-47) years, out of which 89.1% of respondents were women. Parental concerns were assessed using the Parental Concerns Questionnaire (PCQ), the Hospital Anxiety and Depression Scale (HADS), and the Perceived Stress Scale (PSS-10). Parents of children undergoing emergency surgery (n = 108) reported higher levels on the practical impact domain of the PCQ scale (3.4 vs. 2.2, p < 0.001), emotional impact (2.7 vs. 2.2, p = 0.002), and total PCQ score (9.5 vs. 7.7, p < 0.001) compared to parents of children undergoing elective surgery (n = 66). Parents in the emergent surgery group also reported higher anxiety scores on the HADS questionnaire (7.9 vs. 6.5, p = 0.009) and higher perceived stress and total score on the PSS-10 survey (7.8 vs. 5.6, p = 0.046) (10.5 vs. 9.1, p = 0.047), respectively. A significantly higher proportion of parents in the emergent surgery group were concerned about restricted visitation policies (p = 0.013) and reported delaying or considering delaying their child's surgery due to the pandemic (p = 0.036). The results demonstrate heightened concerns, anxiety, and stress among parents of children undergoing emergency surgery during the COVID-19 pandemic. Healthcare providers should address parental concerns, provide clear communication, and ensure adequate support for families. Recommendations include enhancing information about COVID-19 precautions, reassuring parents about personal protective equipment availability, and facilitating family support within visitation restrictions.
Collapse
Affiliation(s)
- Ada Claudia Silvana Gruescu
- Department of Pediatrics, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Calin Popoiu
- Department of Pediatrics, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Mihaela Codrina Levai
- Research Center for Medical Communication, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Raluca Tudor
- Second Discipline of Neurology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Roxana Manuela Fericean
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Department of Infectious Diseases, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Mircea Rivis
- Department of Anesthesiology and Oral Surgery, Multidisciplinary Center for Research, Evaluation, Diagnosis and Therapies in Oral Medicine, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| |
Collapse
|
23
|
Fu R, Sutradhar R, Li Q, Hanna TP, Chan KKW, Irish JC, Coburn N, Hallet J, Dare A, Singh S, Parmar A, Earle CC, Lapointe-Shaw L, Krzyzanowska MK, Finelli A, Louie AV, Look Hong NJ, Witterick IJ, Mahar A, Urbach DR, McIsaac DI, Enepekides D, Eskander A. Association between the COVID-19 pandemic and first cancer treatment modality: a population-based cohort study. CMAJ Open 2023; 11:E426-E433. [PMID: 37160325 PMCID: PMC10174267 DOI: 10.9778/cmajo.20220102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Physicians were directed to prioritize using nonsurgical cancer treatment at the beginning of the COVID-19 pandemic. We sought to quantify the impact of this policy on the modality of first cancer treatment (surgery, chemotherapy, radiotherapy or no treatment). METHODS In this population-based study using Ontario data from linked administrative databases, we identified adults diagnosed with cancer from January 2016 to November 2020 and their first cancer treatment received within 1 year postdiagnosis. Segmented Poisson regressions were applied to each modality to estimate the change in mean 1-year recipient volume per thousand patients (rate) at the start of the pandemic (the week of Mar. 15, 2020) and change in the weekly trend in rate during the pandemic (Mar. 15, 2020, to Nov. 7, 2020) relative to before the pandemic (Jan. 3, 2016, to Mar. 14, 2020). RESULTS We included 321 535 people diagnosed with cancer. During the first week of the COVID-19 pandemic, the mean rate of receiving upfront surgery over the next year declined by 9% (rate ratio 0.91, 95% confidence interval [CI] 0.88-0.95), and chemotherapy and radiotherapy rates rose by 30% (rate ratio 1.30, 95% CI 1.23-1.36) and 13% (rate ratio 1.13, 95% CI 1.07-1.19), respectively. Subsequently, the 1-year rate of upfront surgery increased at 0.4% for each week (rate ratio 1.004, 95% CI 1.002-1.006), and chemotherapy and radiotherapy rates decreased by 0.9% (rate ratio 0.991, 95% CI 0.989-0.994) and 0.4% (rate ratio 0.996, 95% CI 0.994-0.998), respectively, per week. Rates of each modality resumed to prepandemic levels at 24-31 weeks into the pandemic. INTERPRETATION An immediate and sustained increase in use of nonsurgical therapy as the first cancer treatment occurred during the first 8 months of the COVID-19 pandemic in Ontario. Further research is needed to understand the consequences.
Collapse
Affiliation(s)
- Rui Fu
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Rinku Sutradhar
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Qing Li
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Timothy P Hanna
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Kelvin K W Chan
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Jonathan C Irish
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Natalie Coburn
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Julie Hallet
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Anna Dare
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Simron Singh
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Ambica Parmar
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Craig C Earle
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Lauren Lapointe-Shaw
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Monika K Krzyzanowska
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Antonio Finelli
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Alexander V Louie
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Nicole J Look Hong
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Ian J Witterick
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Alyson Mahar
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - David R Urbach
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Daniel I McIsaac
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Danny Enepekides
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Antoine Eskander
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont.
| |
Collapse
|
24
|
Quinn AE, Drummond R, Clement F, Columbus M, Moss SJ, Fitzgerald E, Daya R, Mastikhina L, Leigh JP, Stelfox HT. A North Star Vision: Results from a Deliberative Dialogue to Identify Policy Strategies to Improve Value in Healthcare. Healthc Policy 2023; 18:120-133. [PMID: 37486817 PMCID: PMC10370391 DOI: 10.12927/hcpol.2023.27089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
We hosted a deliberative dialogue with citizens (n = 3), policy researchers (n = 3), government decision makers (n = 3) and health system leaders (n = 3) to identify evidence-informed policy options to improve the value of Canadian healthcare. The analysis resulted in three themes: (1) the need for a vision to guide reforms, (2) community-based care and (3) community-engaged care. Results suggest the need for a new paradigm: community-focused health systems. Such a paradigm could serve as a North Star guiding healthcare transformation, improving value by aligning citizen and healthcare system goals, prioritizing spending on services that address the social determinants of health and improving quality and equity.
Collapse
Affiliation(s)
- Amity E Quinn
- Postdoctoral Fellow, Department of Medicine, Cumming School of Medicine, University of Calgary, Senior Research Associate, O'Brien Institute for Public Health, University of Calgary, Calgary, AB
| | - Rachelle Drummond
- Research Associate, O'Brien Institute for Public Health, University of Calgary, Calgary, AB
| | - Fiona Clement
- Professor, Department of Community Health Science, Cumming School of Medicine, University of Calgary, Member, O'Brien Institute for Public Health, University of Calgary, Calgary, AB
| | - Melanie Columbus
- Health Policy Manager, O'Brien Institute for Public Health, University of Calgary, Calgary, AB
| | - Stephana J Moss
- Banting Postdoctoral Fellow, Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, CRISMA Center, University of Pittsburgh, Pittsburgh, PA
| | - Emily Fitzgerald
- Research Associate, Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS
| | - Rukhsaar Daya
- Community Engagement Specialist, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, kARLA KREWULAK, PhD, Senior Research Associate, Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Liza Mastikhina
- Unit Manager, Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, Calgary, AB
| | - Jeanna Parsons Leigh
- Assistant Professor Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS
| | - Henry T Stelfox
- On behalf of the Health Policy Forum Panellists, Scientific Director, O'Brien Institute for Public Health, University of Calgary, Professor, Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB
| |
Collapse
|
25
|
Tran C, Cipriano LE, Driman DK. Impact of COVID-19-related health care disruptions on pathologic cancer staging during the first pandemic year: a retrospective cohort study from March 2018 to March 2021. CMAJ Open 2023; 11:E475-E484. [PMID: 37279981 DOI: 10.9778/cmajo.20220092] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has created major disruptions in cancer care, with reductions in diagnostic tests and treatments. We evaluated the impact of these health care-related changes on cancer staging by comparing cancers staged before and during the pandemic. METHODS We performed a retrospective cohort study at London Health Sciences Centre and St. Joseph's Health Care London, London, Ontario, Canada. We evaluated all pathologically staged breast, colorectal, prostate, endometrial and lung cancers (the 5 most common cancers by site, excluding nonmelanoma skin cancer) over a 3-year period (Mar. 15, 2018-Mar. 14, 2021). The pre-COVID-19 group included procedures performed between Mar. 15, 2018, and Mar. 14, 2020, and the COVID-19 group included procedures performed between Mar. 15, 2020, and Mar. 14, 2021. The primary outcome was cancer stage group, based on the pathologic tumour, lymph node, metastasis system. We performed univariate analyses to compare demographic characteristics, pathologic features and cancer stage between the 2 groups. We performed multivariable ordinal regression analyses using the proportional odds model to evaluate the association between stage and timing of staging (before v. during the pandemic). RESULTS There were 4055 cases across the 5 cancer sites. The average number of breast cancer staging procedures per 30 days increased during the pandemic compared to the yearly average in the pre-COVID-19 period (41.3 v. 39.6), whereas decreases were observed for endometrial cancer (15.9 v. 16.4), colorectal cancer (21.8 v. 24.3), prostate cancer (13.6 v. 18.5) and lung cancer (11.5 v. 15.9). For all cancer sites, there were no statistically significant differences in demographic characteristics, pathologic features or cancer stage between the 2 groups (p > 0.05). In multivariable regression analysis, for all cancer sites, cases staged during the pandemic were not associated with higher stage (breast: odds ratio [OR] 1.071, 95% confidence interval [CI] 0.826-1.388; colorectal: OR 1.201, 95% CI 0.869-1.661; endometrium: OR 0.792, 95% CI 0.495-1.252; prostate: OR 1.171, 95% CI 0.765-1.794; and lung: OR 0.826, 95% CI 0.535-1.262). INTERPRETATION Cancer cases staged during the first year of the COVID-19 pandemic were not associated with higher stage; this likely reflects the prioritization of cancer procedures during times of reduced capacity. The impact of the pandemic period on staging procedures varied between cancer sites, which may reflect differences in clinical presentation, detection and treatment.
Collapse
Affiliation(s)
- Christopher Tran
- Department of Pathology and Laboratory Medicine (Tran, Driman), London Health Sciences Centre (Tran Driman), Ivey Business School (Cipriano), Western University; Department of Epidemiology and Biostatistics (Cipriano), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Lauren E Cipriano
- Department of Pathology and Laboratory Medicine (Tran, Driman), London Health Sciences Centre (Tran Driman), Ivey Business School (Cipriano), Western University; Department of Epidemiology and Biostatistics (Cipriano), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - David K Driman
- Department of Pathology and Laboratory Medicine (Tran, Driman), London Health Sciences Centre (Tran Driman), Ivey Business School (Cipriano), Western University; Department of Epidemiology and Biostatistics (Cipriano), Schulich School of Medicine & Dentistry, Western University, London, Ont.
| |
Collapse
|
26
|
Murray LL, Wilson JG, Rodrigues FF, Zaric GS. Forecasting ICU Census by Combining Time Series and Survival Models. Crit Care Explor 2023; 5:e0912. [PMID: 37168689 PMCID: PMC10166346 DOI: 10.1097/cce.0000000000000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Capacity planning of ICUs is essential for effective management of health safety, quality of patient care, and the allocation of ICU resources. Whereas ICU length of stay (LOS) may be estimated using patient information such as severity of illness scoring systems, ICU census is impacted by both patient LOS and arrival patterns. We set out to develop and evaluate an ICU census forecasting algorithm using the Multiple Organ Dysfunction Score (MODS) and the Nine Equivalents of Nursing Manpower Use Score (NEMS) for capacity planning purposes. DESIGN Retrospective observational study. SETTING We developed the algorithm using data from the Medical-Surgical ICU (MSICU) at University Hospital, London, Canada and validated using data from the Critical Care Trauma Centre (CCTC) at Victoria Hospital, London, Canada. PATIENTS Adult patient admissions (7,434) to the MSICU and (9,075) to the CCTC from 2015 to 2021. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We developed an Autoregressive integrated moving average time series model that forecasts patients arriving in the ICU and a survival model using MODS, NEMS, and other factors to estimate patient LOS. The models were combined to create an algorithm that forecasts ICU census for planning horizons ranging from 1 to 7 days. We evaluated the algorithm quality using several fit metrics. The root mean squared error ranged from 2.055 to 2.890 beds/d and the mean absolute percentage error from 9.4% to 13.2%. We show that this forecasting algorithm provides a better fit when compared with a moving average or a time series model that directly forecasts ICU census. Additionally, we evaluated the performance of the algorithm using data during the global COVID-19 pandemic and found that the error of the forecasts increased proportionally with the number of COVID-19 patients in the ICU. CONCLUSIONS It is possible to develop accurate tools to forecast ICU census. This type of algorithm may be important to clinicians and managers when planning ICU capacity as well as staffing and surgical demand planning over a short time horizon.
Collapse
Affiliation(s)
- Lori L Murray
- King's University College, School of Management, Economics, and Mathematics, Western University, London, ON, Canada
| | - John G Wilson
- Ivey Business School, Western University, London, ON, Canada
| | - Felipe F Rodrigues
- King's University College, School of Management, Economics, and Mathematics, Western University, London, ON, Canada
| | - Gregory S Zaric
- Department of Epidemiology and Biostatistics, Ivey Business School, Western University, London, ON, Canada
| |
Collapse
|
27
|
Habbous S, Lambrinos A, Petersen S, Hellsten E. The effect of the COVID-19 pandemic on hospital admissions and outpatient visits in Ontario, Canada. Ann Thorac Med 2023; 18:70-78. [PMID: 37323374 PMCID: PMC10263076 DOI: 10.4103/atm.atm_376_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION The wave-over-wave effect of the COVID-19 pandemic on hospital visits for non-COVID-19-related diagnoses in Ontario, Canada remains unknown. METHODS We compared the rates of acute care hospitalizations (Discharge Abstract Database), emergency department (ED) visits, and day surgery visits (National Ambulatory Care Reporting System) during the first five "waves" of Ontario's COVID-19 pandemic with prepandemic rates (since January 1, 2017) across a spectrum of diagnostic classifications. RESULTS Patients admitted in the COVID-19 era were less likely to reside in long-term-care facilities (OR 0.68 [0.67-0.69]), more likely to reside in supportive housing (OR 1.66 [1.63-1.68]), arrive by ambulance (OR 1.20 [1.20-1.21]) or be admitted urgently (OR 1.10 [1.09-1.11]). Since the start of the COVID-19 pandemic (February 26, 2020), there were an estimated 124,987 fewer emergency admissions than expected based on prepandemic seasonal trends, representing reductions from baseline of 14% during Wave 1, 10.1% in Wave 2, 4.6% in Wave 3, 2.4% in Wave 4, and 10% in Wave 5. There were 27,616 fewer medical admissions to acute care, 82,193 fewer surgical admissions, 2,018,816 fewer ED visits, and 667,919 fewer day-surgery visits than expected. Volumes declined below expected rates for most diagnosis groups, with emergency admissions and ED visits associated with respiratory disorders exhibiting the greatest reduction; mental health and addictions was a notable exception, where admissions to acute care following Wave 2 increased above prepandemic levels. CONCLUSIONS Hospital visits across all diagnostic categories and visit types were reduced at the onset of the COVID-19 pandemic in Ontario, followed by varying degrees of recovery.
Collapse
Affiliation(s)
- Steven Habbous
- Ontario Health (Strategic Analytics), Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Anna Lambrinos
- Ontario Health (Strategic Analytics), Western University, London, Ontario, Canada
| | - Stephen Petersen
- Ontario Health (Strategic Analytics), Western University, London, Ontario, Canada
| | - Erik Hellsten
- Ontario Health (Strategic Analytics), Western University, London, Ontario, Canada
| |
Collapse
|
28
|
Lee MS, Lin VY, Mei Z, Mei J, Chan E, Shipp D, Chen JM, Le TN. Examining the Spatial Varying Effects of Sociodemographic Factors on Adult Cochlear Implantation Using Geographically Weighted Poisson Regression. Otol Neurotol 2023; 44:e287-e294. [PMID: 36962009 DOI: 10.1097/mao.0000000000003861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
OBJECTIVE To (i) demonstrate the utility of geographically weighted Poisson regression (GWPR) in describing geographical patterns of adult cochlear implant (CI) incidence in relation to sociodemographic factors in a publicly funded healthcare system, and (ii) compare Poisson regression and GWPR to fit the aforementioned relationship. STUDY DESIGN Retrospective study of provincial CI Program database. SETTING Academic hospital. PATIENTS Adults 18 years or older who received a CI from 2020 to 2021. INTERVENTIONS Cochlear implant. MAIN OUTCOME MEASURES CI incidence based on income level, education attainment, age at implantation, and distance from center, and spatial autocorrelation across census metropolitan areas. RESULTS Adult CI incidence varied spatially across Ontario (Moran's I = 0.04, p < 0.05). Poisson regression demonstrated positive associations between implantation and lower income level (coefficient = 0.0284, p < 0.05) and younger age (coefficient = 0.1075, p < 0.01), and a negative association with distance to CI center (coefficient = -0.0060, p < 0.01). Spatial autocorrelation was significant in Poisson model (Moran's I = 0.13, p < 0.05). GWPR accounted for spatial differences (Moran's I = 0.24, p < 0.690), and similar associations to Poisson were observed. GWPR further identified clusters of implantation in South Central census metropolitan areas with higher education attainment. CONCLUSIONS Adult CI incidence demonstrated a nonstationary relationship between implantation and the studied sociodemographic factors. GWPR performed better than Poisson regression in accounting for these local spatial variations. These results support the development of targeted interventions to improve access and utilization to CIs in a publicly funded healthcare system.
Collapse
Affiliation(s)
- Melissa S Lee
- Faculty of Medicine, University of British Columbia, Vancouver
| | | | | | | | - Emmanuel Chan
- Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
| | - David Shipp
- Sunnybrook Cochlear Implant Program, Sunnybrook Health Sciences Centre
| | | | | |
Collapse
|
29
|
Fu R, Sutradhar R, Li Q, Hanna TP, Chan KKW, Coburn N, Hallet J, Eskander A. Imaging and physician visits at cancer diagnosis: COVID -19 pandemic impact on cancer care. Cancer Med 2023; 12:6056-6067. [PMID: 36176264 PMCID: PMC10028129 DOI: 10.1002/cam4.5321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/09/2022] [Accepted: 09/21/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Little is known about the COVID-19 pandemic impact on the provision of diagnostic imaging and physician visits at cancer diagnosis. METHODS We used administrative databases from Ontario, Canada, to identify MRI/CT/ultrasound scans and in-person/virtual physician visits conducted with cancer patients within 91 days around the date of diagnosis in 2016-2020. In separate segmented regression procedures, we assessed the trends in weekly volume of these services per thousand cancer patients in prepandemic (June 26, 2016 to March 14, 2020), the change in mean volume at the start of the pandemic, and the additional change in weekly volume during the pandemic (March 15, 2020, to September 26, 2020). RESULTS Totally, 403,561 cancer patients were included. On March 15, 2020 (COVID-19 arrived), mean scan volume decreased by 12.3% (95% CI: 6.4%-17.9%) where ultrasound decreased the most by 31.8% (95% CI: 23.9%-37.0%). Afterward, the volume of all scans increased further by 1.6% per week (95% CI: 1.3%-2.0%), where ultrasound increased the fastest by 2.4% (95% CI: 1.8%-2.9%). Mean in-person visits dropped by 47.4% when COVID-19 started (95% CI: 41.6%-52.6%) while virtual visits rose by 55.15-fold (95% CI: 4927%-6173%). In the pandemic (until September 26, 2020), in-person visits increased each week by 2.6% (95% CI: 2.0%-3.2%), but no change was observed for virtual visits (p -value = 0.10). CONCLUSIONS Provision of diagnostic imaging and virtual visits at cancer diagnosis has been increasing since the start of COVID-19 and has exceeded prepandemic utilization levels. Future work should monitor the impact of these shifts on quality of delivered care.
Collapse
Affiliation(s)
- Rui Fu
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Qing Li
- ICES, Toronto, Ontario, Canada
| | - Timothy P Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
- Ontario Institute for Cancer Research (OICR), Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Ontario Health - Cancer Care Ontario, Toronto, Ontario, Canada
| | - Natalie Coburn
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Ontario Health - Cancer Care Ontario, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Julie Hallet
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | | |
Collapse
|
30
|
Pediatric Surgical Waitlist in Low Middle Income Countries during the COVID-19 Pandemic. J Surg Res 2023; 288:193-201. [PMID: 37018896 PMCID: PMC9970937 DOI: 10.1016/j.jss.2023.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/18/2023] [Accepted: 02/19/2023] [Indexed: 03/06/2023]
Abstract
Purpose COVID-19 led to significant reduction in surgery worldwide. Studies, however, of the effect on surgical volume for pediatric patients in low- and middle-income countries (LMICs) are limited. Methods A survey was developed to estimate waitlists in LMICs for priority surgical conditions in children. The survey was piloted and revised before it was deployed over email to 19 surgeons. Pediatric surgeons at 15 different sites in 8 countries in Sub-Saharan Africa and Ecuador completed the survey from February 2021 to June 2021. The survey included the total number of children awaiting surgery and estimates for specific conditions. Respondents were also able to add additional procedures. Results Public hospitals had longer wait times than private facilities. The median waitlist was 90 patients and the median wait time was 2 months for elective surgeries. Conclusion Lengthy surgical wait times affect surgical access in LMICs. COVID-19 had been associated with surgical delays around the world, exacerbating existing surgical backlogs. Our results revealed significant delays for elective, urgent and emergent cases across Sub-Saharan Africa. Stakeholders should consider approaches to scale the limited surgical and perioperative resources in LMICs, create mitigation strategies for future pandemics, and establish ways to monitor waitlists on an ongoing basis.
Collapse
|
31
|
Millan B, Cassim R, Uy M, Bay B, Shayegan B. First Canadian experience with same-day discharge after robot-assisted radical prostatectomy. Can Urol Assoc J 2023; 17:39-43. [PMID: 36218317 PMCID: PMC9970635 DOI: 10.5489/cuaj.7914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to evaluate the feasibility and safety of implementing a sameday discharge (SD ) protocol for robot-assisted radical prostatectomy (RARP) and pelvic lymph node dissection. METHODS We performed a prospective cohort study including all consecutive eligible patients undergoing RARP in 2021 following initiation of SDD RARP protocol in April. Baseline characteristics were compared using t-tests, Mann-Whitney U tests, and odds ratios (OR ) calculated using multiple logistic regression to assess for predictors of SD success. RESULTS A total of 117 patients underwent RARP in 2021 following initiation of the SDD protocol. Fifty-seven patients were initiated on the SD pathway and 60 patients underwent surgery as an inpatient (IP-RARP). Of those on the SD pathway (SD-RARP), 33 (58%) were successfully discharged the same day of surgery, while 24 (42%) failed SD . Baseline demographics were well-balanced between cohorts. Case order, increased patient age, and distance travelled to the hospital were factors associated with selection of patients for the IP-RARP protocol. In total, 12 SD and 12 IP patients presented to the emergency department (p=1.0), and none within 24 hours of discharge. There were no hospital admissions in the SD cohort, with four readmissions in the IP cohort (p=0.1). Multiple logistic regression revealed that case order (first case) was the only predictive factor for SD success (OR 4.08, 95% confidence interval 1.59-11.62, p=0.005). CONCLUSIONS Implementation of an SD pathway following RARP is feasible, with no increase in rates of complications, unscheduled visits, or readmissions.
Collapse
Affiliation(s)
- Braden Millan
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Raees Cassim
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Michael Uy
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Benjamin Bay
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Bobby Shayegan
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
32
|
Le Bihan-Benjamin C, Rocchi M, Putton M, Méric JB, Bousquet PJ. Estimation of Oncologic Surgery Case Volume Before and After the COVID-19 Pandemic in France. JAMA Netw Open 2023; 6:e2253204. [PMID: 36701152 PMCID: PMC9880797 DOI: 10.1001/jamanetworkopen.2022.53204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
IMPORTANCE COVID-19 has had a major effect on health care activities, especially surgery. At first, comparisons were proposed using 2019 activities as the highest standard. However, while such an approach might have been suitable during the first months of the pandemic, this might no longer be the case for a longer period. OBJECTIVE To examine approaches that may better assess the use of cancer surgeries. DESIGN, SETTING, AND PARTICIPANTS In a cross-sectional design, the nationwide French hospital facility data (Medicalised Information System Program) were used to assess cancer surgery for 6 cancer site categories in adults from January 1, 2010, to December 31, 2021. EXPOSURE Estimated cancer surgery activity during the COVID-19 pandemic. MAIN OUTCOMES AND MEASURES Three models were proposed to assess the expected number of surgical procedures between 2020 and 2021 and make a comparison with those observed in earlier years. RESULTS In France, cancer removal surgeries account for approximately 7000 hospitalizations per year for liver cancer; 4000 for pancreatic cancer; 7700 for ovarian cancer; 1300 for esophagus cancer; 23 000 for ear, nose, and throat (ENT) cancer; 78 000 for breast cancer; and 16 600 for thoracic cancers. For most cancer sites, the number of surgical procedures increased from 2010 to 2019: liver, 14%; pancreas, 38%; ovary, 14%; esophagus, 18%; breast, 8%; and thoracic, 29%. Assuming stability, these values underestimate the gap in activity observed in 2020-2021. For other procedures, a decrease was observed: stomach, -10%, and ENT, -6%. Assuming stability, these values overestimate the gap in activity observed in 2020-2021. At the end of 2021, according to the model, the gap in activity observed in 2020-2021 was estimated at between -1.4% and 1.7% for breast, -6.6% and -7.3% for thoracic, -3.1% and -2.5% for ovarian, -4.2% and -1.7% for pancreas, -6.7% and 5.9% for stomach, and -13.0% and -13.9% for esophageal cancers. For ENT, liver, and urologic cancers, because the trend was different before and after 2015, it was necessary to opt for modeling using only the most recent period. The cumulative gap in activity observed in 2020-2021 was estimated at -1.0% for ENT cancers, -5.3% for liver cancers, and -2.9% for urologic cancers. CONCLUSIONS AND RELEVANCE The findings of this study suggest that short- and medium-term trends must be considered to estimate COVID-19 cancer surgery activities. Breast cancer is the site for which the activity showed the smallest decrease during the pandemic, with almost full recovery in 2021.
Collapse
Affiliation(s)
- Christine Le Bihan-Benjamin
- Health Data and Assessment Department, Survey Data Science and Assessment Division, National Cancer Institute, Boulogne-Billancourt, France
| | - Mathieu Rocchi
- Health Data and Assessment Department, Survey Data Science and Assessment Division, National Cancer Institute, Boulogne-Billancourt, France
| | - Maxime Putton
- Care Paths Organization Department, Public Health Division, National Cancer Institute, Boulogne-Billancourt, France
| | - Jean-Baptiste Méric
- Public Health Division, National Cancer Institute, Boulogne-Billancourt, France
| | - Philippe Jean Bousquet
- Survey Data Science and Assessment Division, National Cancer Institute, Boulogne-Billancourt, France
- Aix Marseille University, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France
| |
Collapse
|
33
|
Sauro KM, Smith C, Kersen J, Schalm E, Jaworska N, Roach P, Beesoon S, Brindle ME. The impact of delaying surgery during the COVID-19 pandemic in Alberta: a qualitative study. CMAJ Open 2023; 11:E90-E100. [PMID: 36720492 PMCID: PMC9894654 DOI: 10.9778/cmajo.20210330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic overwhelmed health care systems, leading many jurisdictions to reduce surgeries to create capacity (beds and staff) to care for the surge of patients with COVID-19; little is known about the impact of this on patients whose surgery was delayed. The objective of this study was to understand the patient and family/caregiver perspective of having a surgery delayed during the COVID-19 pandemic. METHODS Using an interpretative descriptive approach, we conducted interviews between Sept. 20 and Oct. 8, 2021. Adult patients who had their surgery delayed or cancelled during the COVID-19 pandemic in Alberta, Canada, and their family/caregivers were eligible to participate. Trained interviewers conducted semistructured interviews, which were iteratively analyzed by 2 independent reviewers using an inductive approach to thematic content analysis. RESULTS We conducted 16 interviews with 15 patients and 1 family member/caregiver, ranging from 27 to 75 years of age, with a variety of surgical procedures delayed. We identified 4 interconnected themes: individual-level impacts on physical and mental health, family and friends, work and quality of life; system-level factors related to health care resources, communication and perceived accountability within the system; unique issues related to COVID-19 (maintaining health and isolation); and uncertainty about health and timing of surgery. INTERPRETATION Although the decision to delay nonurgent surgeries was made to manage the strain on health care systems, our study illustrates the consequences of these decisions, which were diffuse and consequential. The findings of this study highlight the need to develop and adopt strategies to mitigate the burden of waiting for surgery during and after the COVID-19 pandemic.
Collapse
Affiliation(s)
- Khara M Sauro
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta.
| | - Christine Smith
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta
| | - Jaling Kersen
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta
| | - Emma Schalm
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta
| | - Natalia Jaworska
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta
| | - Pamela Roach
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta
| | - Sanjay Beesoon
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta
| | - Mary E Brindle
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta
| |
Collapse
|
34
|
Cressman AM, Purohit U, Shadowitz E, Etchells E, Weinerman A, Gerson D, Shojania KG, Stroud L, Wong BM, Shadowitz S. Potentially avoidable admissions to general internal medicine at an academic teaching hospital: an observational study. CMAJ Open 2023; 11:E201-E207. [PMID: 36854457 PMCID: PMC9981162 DOI: 10.9778/cmajo.20220020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Identifying potentially avoidable admissions to Canadian hospitals is an important health system goal. With general internal medicine (GIM) accounting for 40% of hospital admissions, we sought to develop a method to identify potentially avoidable admissions and characterize patient, provider and health system factors. METHODS We conducted an observational study of GIM admissions at our institution from August 2019 to February 2020. We defined potentially avoidable admissions as admissions that could be managed in an appropriate and safe manner in the emergency department or ambulatory setting and asked staff physicians to screen admissions daily and flag candidates as potentially avoidable admissions. For each candidate, we prepared a case review and debriefed with members of the admitting team. We then reviewed each candidate with our research team, assigned an avoidability score (1 [low] to 4 [high]) and identified contributing factors for those with scores of 3 or more. RESULTS We screened 601 total admissions and staff physicians flagged 117 (19.5%) of these as candidate potential avoidable admissions. Consensus review identified 67 candidates as potentially avoidable admissions (11.1%, 95% confidence interval 8.8%-13.9%); these patients were younger (mean age 65 yr v. 72 yr), had fewer comorbidities (Canadian Institute for Health Information Case Mix Group+ 0.42 v. 1.14), had lower resource-intensity weighting scores (0.72 v. 1.50) and shorter hospital lengths of stay (29 h v. 105 h) (p < 0.01). Common factors included diagnostic and therapeutic uncertainty, perceived need for short-term monitoring, government directive of a 4-hour limit for admission decision-making and subspecialist request to admit. INTERPRETATION Our prospective method of screening, flagging and case review showed that 1 in 9 GIM admissions were potentially avoidable. Other institutions could consider adapting this methodology to ascertain their rate of potentially avoidable admissions and to understand contributing factors to inform improvement endeavours.
Collapse
Affiliation(s)
- Alex M Cressman
- Department of Medicine (Cressman, Purohit, Etchells, Weinerman, Gerson, Shojania, Stroud, Wong, S. Shadowitz), University of Toronto; Division of General Internal Medicine (Cressman, E. Shadowitz, Etchells, Weinerman, Shojania, Stroud, Wong, S. Shadowitz), Sunnybrook Health Sciences Centre; The Centre for Quality Improvement and Patient Safety (Etchells, Weinerman, Shojania, Wong); Wilson Centre for Education Research (Stroud); Toronto, Ont.
| | - Ushma Purohit
- Department of Medicine (Cressman, Purohit, Etchells, Weinerman, Gerson, Shojania, Stroud, Wong, S. Shadowitz), University of Toronto; Division of General Internal Medicine (Cressman, E. Shadowitz, Etchells, Weinerman, Shojania, Stroud, Wong, S. Shadowitz), Sunnybrook Health Sciences Centre; The Centre for Quality Improvement and Patient Safety (Etchells, Weinerman, Shojania, Wong); Wilson Centre for Education Research (Stroud); Toronto, Ont
| | - Ellen Shadowitz
- Department of Medicine (Cressman, Purohit, Etchells, Weinerman, Gerson, Shojania, Stroud, Wong, S. Shadowitz), University of Toronto; Division of General Internal Medicine (Cressman, E. Shadowitz, Etchells, Weinerman, Shojania, Stroud, Wong, S. Shadowitz), Sunnybrook Health Sciences Centre; The Centre for Quality Improvement and Patient Safety (Etchells, Weinerman, Shojania, Wong); Wilson Centre for Education Research (Stroud); Toronto, Ont
| | - Edward Etchells
- Department of Medicine (Cressman, Purohit, Etchells, Weinerman, Gerson, Shojania, Stroud, Wong, S. Shadowitz), University of Toronto; Division of General Internal Medicine (Cressman, E. Shadowitz, Etchells, Weinerman, Shojania, Stroud, Wong, S. Shadowitz), Sunnybrook Health Sciences Centre; The Centre for Quality Improvement and Patient Safety (Etchells, Weinerman, Shojania, Wong); Wilson Centre for Education Research (Stroud); Toronto, Ont
| | - Adina Weinerman
- Department of Medicine (Cressman, Purohit, Etchells, Weinerman, Gerson, Shojania, Stroud, Wong, S. Shadowitz), University of Toronto; Division of General Internal Medicine (Cressman, E. Shadowitz, Etchells, Weinerman, Shojania, Stroud, Wong, S. Shadowitz), Sunnybrook Health Sciences Centre; The Centre for Quality Improvement and Patient Safety (Etchells, Weinerman, Shojania, Wong); Wilson Centre for Education Research (Stroud); Toronto, Ont
| | - Darren Gerson
- Department of Medicine (Cressman, Purohit, Etchells, Weinerman, Gerson, Shojania, Stroud, Wong, S. Shadowitz), University of Toronto; Division of General Internal Medicine (Cressman, E. Shadowitz, Etchells, Weinerman, Shojania, Stroud, Wong, S. Shadowitz), Sunnybrook Health Sciences Centre; The Centre for Quality Improvement and Patient Safety (Etchells, Weinerman, Shojania, Wong); Wilson Centre for Education Research (Stroud); Toronto, Ont
| | - Kaveh G Shojania
- Department of Medicine (Cressman, Purohit, Etchells, Weinerman, Gerson, Shojania, Stroud, Wong, S. Shadowitz), University of Toronto; Division of General Internal Medicine (Cressman, E. Shadowitz, Etchells, Weinerman, Shojania, Stroud, Wong, S. Shadowitz), Sunnybrook Health Sciences Centre; The Centre for Quality Improvement and Patient Safety (Etchells, Weinerman, Shojania, Wong); Wilson Centre for Education Research (Stroud); Toronto, Ont
| | - Lynfa Stroud
- Department of Medicine (Cressman, Purohit, Etchells, Weinerman, Gerson, Shojania, Stroud, Wong, S. Shadowitz), University of Toronto; Division of General Internal Medicine (Cressman, E. Shadowitz, Etchells, Weinerman, Shojania, Stroud, Wong, S. Shadowitz), Sunnybrook Health Sciences Centre; The Centre for Quality Improvement and Patient Safety (Etchells, Weinerman, Shojania, Wong); Wilson Centre for Education Research (Stroud); Toronto, Ont
| | - Brian M Wong
- Department of Medicine (Cressman, Purohit, Etchells, Weinerman, Gerson, Shojania, Stroud, Wong, S. Shadowitz), University of Toronto; Division of General Internal Medicine (Cressman, E. Shadowitz, Etchells, Weinerman, Shojania, Stroud, Wong, S. Shadowitz), Sunnybrook Health Sciences Centre; The Centre for Quality Improvement and Patient Safety (Etchells, Weinerman, Shojania, Wong); Wilson Centre for Education Research (Stroud); Toronto, Ont
| | - Steve Shadowitz
- Department of Medicine (Cressman, Purohit, Etchells, Weinerman, Gerson, Shojania, Stroud, Wong, S. Shadowitz), University of Toronto; Division of General Internal Medicine (Cressman, E. Shadowitz, Etchells, Weinerman, Shojania, Stroud, Wong, S. Shadowitz), Sunnybrook Health Sciences Centre; The Centre for Quality Improvement and Patient Safety (Etchells, Weinerman, Shojania, Wong); Wilson Centre for Education Research (Stroud); Toronto, Ont
| |
Collapse
|
35
|
Habinshuti P, Nshimyiryo A, Fejfar DL, Niyigena A, Cubaka VK, Karema N, Bigirimana JB, Shyirambere C, Barnhart DA, Kateera F, Fulcher I. Impact of COVID-19 on access to cancer care in Rwanda: a retrospective time-series study using electronic medical records data. BMJ Open 2022; 12:e065398. [PMID: 36535717 PMCID: PMC9764097 DOI: 10.1136/bmjopen-2022-065398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has caused disruptions in access to routine healthcare services worldwide, with a particularly high impact on chronic care patients and low and middle-income countries. In this study, we used routinely collected electronic medical records data to assess the impact of the COVID-19 pandemic on access to cancer care at the Butaro Cancer Center of Excellence (BCCOE) in rural Rwanda. METHODS We conducted a retrospective time-series study among all Rwandan patients who received cancer care at the BCCOE between 1 January 2016 and 31 July 2021. The primary outcomes of interest included a comparison of the number of patients who were predicted based on time-series models of pre-COVID-19 trends versus the actual number of patients who presented during the COVID-19 period (between March 2020 and July 2021) across four key indicators: the number of new patients, number of scheduled appointments, number of clinical visits attended and the proportion of scheduled appointments completed on time. RESULTS In total, 8970 patients (7140 patients enrolled before COVID-19 and 1830 patients enrolled during COVID-19) were included in this study. During the COVID-19 period, enrolment of new patients dropped by 21.7% (95% prediction interval (PI): -31.3%, -11.7%) compared with the pre-COVID-19 period. Similarly, the number of clinical visits was 25.0% (95% PI: -31.1%, -19.1%) lower than expected and the proportion of scheduled visits completed on time was 27.9% (95% PI: -39.8%, -14.1%) lower than expected. However, the number of scheduled visits did not deviate significantly from expected. CONCLUSION Although scheduling procedures for visits continued as expected, our findings reveal that the COVID-19 pandemic interrupted patients' ability to access cancer care and attend scheduled appointments at the BCCOE. This interruption in care suggests delayed diagnosis and loss to follow-up, potentially resulting in a higher rate of negative health outcomes among cancer patients in Rwanda.
Collapse
Affiliation(s)
- Placide Habinshuti
- Informatics Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Alphonse Nshimyiryo
- Research and Training Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | - Anne Niyigena
- Research and Training Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Vincent K Cubaka
- Research and Training Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Nadine Karema
- Informatics Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | | | - Dale A Barnhart
- Research and Training Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Fredrick Kateera
- Clinical Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Isabel Fulcher
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
36
|
Pandit AS, Khan DZ, Hanrahan JG, Dorward NL, Baldeweg SE, Nachev P, Marcus HJ. Historical and future trends in emergency pituitary referrals: a machine learning analysis. Pituitary 2022; 25:927-937. [PMID: 36085340 PMCID: PMC9462621 DOI: 10.1007/s11102-022-01269-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Acute pituitary referrals to neurosurgical services frequently necessitate emergency care. Yet, a detailed characterisation of pituitary emergency referral patterns, including how they may change prospectively is lacking. This study aims to evaluate historical and current pituitary referral patterns and utilise state-of-the-art machine learning tools to predict future service use. METHODS A data-driven analysis was performed using all available electronic neurosurgical referrals (2014-2021) to the busiest U.K. pituitary centre. Pituitary referrals were characterised and volumes were predicted using an auto-regressive moving average model with a preceding seasonal and trend decomposition using Loess step (STL-ARIMA), compared against a Convolutional Neural Network-Long Short-Term Memory (CNN-LSTM) algorithm, Prophet and two standard baseline forecasting models. Median absolute, and median percentage error scoring metrics with cross-validation were employed to evaluate algorithm performance. RESULTS 462 of 36,224 emergency referrals were included (referring centres = 48; mean patient age = 56.7 years, female:male = 0.49:0.51). Emergency medicine and endocrinology accounted for the majority of referrals (67%). The most common presentations were headache (47%) and visual field deficits (32%). Lesions mainly comprised tumours or haemorrhage (85%) and involved the pituitary gland or fossa (70%). The STL-ARIMA pipeline outperformed CNN-LSTM, Prophet and baseline algorithms across scoring metrics, with standard accuracy being achieved for yearly predictions. Referral volumes significantly increased from the start of data collection with future projected increases (p < 0.001) and did not significantly reduce during the COVID-19 pandemic. CONCLUSION This work is the first to employ large-scale data and machine learning to describe and predict acute pituitary referral volumes, estimate future service demands, explore the impact of system stressors (e.g. COVID pandemic), and highlight areas for service improvement.
Collapse
Affiliation(s)
- A S Pandit
- High-Dimensional Neurology, Queen Square Institute of Neurology, University College London, London, UK
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - D Z Khan
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - J G Hanrahan
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - N L Dorward
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - S E Baldeweg
- Department of Diabetes and Endocrinology, University College London Hospital, London, UK
- Centre for Obesity & Metabolism, Department of Experimental & Translational Medicine, Division of Medicine, University College London, London, UK
| | - P Nachev
- High-Dimensional Neurology, Queen Square Institute of Neurology, University College London, London, UK
| | - H J Marcus
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK.
| |
Collapse
|
37
|
Hosseinzadeh S, Ketabi S, Atighehchian A, Nazari R. Hospital bed capacity management during the COVID-19 outbreak using system dynamics: A case study in Amol public hospitals, Iran. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2149083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Saeedeh Ketabi
- Department of Management, University of Isfahan, Isfahan, Iran
| | - Arezoo Atighehchian
- Department of Industrial Engineering and Futures Studies, Faculty of Engineering, University of Isfahan, Isfahan, Iran
| | - Roghieh Nazari
- Department of nursing, Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| |
Collapse
|
38
|
Dixon SN, Naylor KL, Yohanna S, McKenzie S, Belenko D, Blake PG, Coghlan C, Cooper R, Elliott L, Getchell L, Ki V, Mucsi I, Nesrallah G, Patzer RE, Presseau J, Reich M, Sontrop JM, Treleaven D, Waterman AD, Zaltzman J, Garg AX. Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD): Statistical Analysis Plan of a Registry-Based, Cluster-Randomized Clinical Trial. Can J Kidney Health Dis 2022; 9:20543581221131201. [PMID: 36438439 PMCID: PMC9693773 DOI: 10.1177/20543581221131201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/05/2022] [Indexed: 11/05/2023] Open
Abstract
BACKGROUND Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD) is a quality improvement intervention designed to enhance access to kidney transplantation and living kidney donation. We conducted a cluster-randomized clinical trial to evaluate the effect of the intervention versus usual care on completing key steps toward receiving a kidney transplant. OBJECTIVE To prespecify the statistical analysis plan for the EnAKT LKD trial. DESIGN The EnAKT LKD trial is a pragmatic, 2-arm, parallel-group, registry-based, open-label, cluster-randomized, superiority, clinical trial. Randomization was performed at the level of the chronic kidney disease (CKD) programs (the "clusters"). SETTING Twenty-six CKD programs in Ontario, Canada. PARTICIPANTS More than 10 000 patients with advanced CKD (ie, patients approaching the need for dialysis or receiving maintenance dialysis) with no recorded contraindication to receiving a kidney transplant. METHODS The trial data (including patient characteristics and outcomes) will be obtained from linked administrative health care databases (the "registry"). Stratified covariate-constrained randomization was used to allocate the 26 CKD programs (1:1) to provide the intervention or usual care from November 1, 2017, to December 31, 2021 (4.17 years). CKD programs in the intervention arm received the following: (1) support for local quality improvement teams and administrative needs; (2) tailored education and resources for staff, patients, and living kidney donor candidates; (3) support from kidney transplant recipients and living kidney donors; and (4) program-level performance reports and oversight by program leaders. OUTCOMES The primary outcome is completing key steps toward receiving a kidney transplant, where up to 4 unique steps per patient will be considered: (1) patient referred to a transplant center for evaluation, (2) a potential living kidney donor begins their evaluation at a transplant center to donate a kidney to the patient, (3) patient added to the deceased donor transplant waitlist, and (4) patient receives a kidney transplant from a living or deceased donor. ANALYSIS PLAN Using an intent-to-treat approach, the primary outcome will be analyzed using a patient-level constrained multistate model adjusting for the clustering in CKD programs. TRIAL STATUS The EnAKT LKD trial period is November 1, 2017, to December 31, 2021. We expect to analyze and report the results once the data for the trial period is available in linked administrative health care databases. TRIAL REGISTRATION The EnAKT LKD trial is registered with the U.S. National Institute of Health at clincaltrials.gov (NCT03329521 available at https://clinicaltrials.gov/ct2/show/NCT03329521). STATISTICAL ANALYTIC PLAN Version 1.0 August 26, 2022.
Collapse
Affiliation(s)
- Stephanie N. Dixon
- Lawson Health Research Institute, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
- ICES, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Kyla L. Naylor
- Lawson Health Research Institute, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
- ICES, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | | | | | - Dmitri Belenko
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Peter G Blake
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
- Division of Nephrology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Candice Coghlan
- Centre for Living Organ Donation, University Health Network, Toronto, Ontario, Canada
| | - Rebecca Cooper
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
- Trillium Gift of Life Network, Ontario Health, Toronto, Ontario, Canada
| | - Lori Elliott
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
| | - Leah Getchell
- Lawson Health Research Institute, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
- Can-SOLVE CKD Network, Vancouver, British Columbia, Canada
| | - Vincent Ki
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
- Trillium Health Partners, Mississauga, Ontario, Canada
| | - Istvan Mucsi
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
- Ajmera Transplant Center, University Health Network, Toronto, Ontario, Canada
| | - Gihad Nesrallah
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Humber River Regional Hospital, Toronto, Ontario, Canada
| | - Rachel E. Patzer
- Health Services Research Center, Emory University School of Medicine, Atlanta, Ontario, USA
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
| | - Marian Reich
- Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease, Patient Council, Vancouver, British Columbia, Canada
| | - Jessica M. Sontrop
- Lawson Health Research Institute, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Darin Treleaven
- McMaster University, Hamilton, Ontario, Canada
- Trillium Gift of Life Network, Ontario Health, Toronto, Ontario, Canada
| | - Amy D. Waterman
- Department of Surgery and J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX, USA
| | - Jeffrey Zaltzman
- Trillium Gift of Life Network, Ontario Health, Toronto, Ontario, Canada
- Division of Nephrology, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Amit X. Garg
- Lawson Health Research Institute, London, Ontario, Canada
- ICES, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
- Division of Nephrology, London Health Sciences Centre, Western University, London, Ontario, Canada
| |
Collapse
|
39
|
McNaughton CD, Austin PC, Sivaswamy A, Fang J, Abdel-Qadir H, Daneman N, Udell JA, Wodchis WP, Mostarac I, Lee DS, Atzema CL. Post-acute health care burden after SARS-CoV-2 infection: a retrospective cohort study. CMAJ 2022; 194:E1368-E1376. [PMID: 36252983 PMCID: PMC9616149 DOI: 10.1503/cmaj.220728] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The post-acute burden of health care use after SARS-CoV-2 infection is unknown. We sought to quantify the post-acute burden of health care use after SARS-CoV-2 infection among community-dwelling adults in Ontario by comparing those with positive and negative polymerase chain reaction (PCR) test results for SARS-CoV-2 infection. METHODS We conducted a retrospective cohort study involving community-dwelling adults in Ontario who had a PCR test between Jan. 1, 2020, and Mar. 31, 2021. Follow-up began 56 days after PCR testing. We matched people 1:1 on a comprehensive propensity score. We compared per-person-year rates for health care encounters at the mean and 99th percentiles, and compared counts using negative binomial models, stratified by sex. RESULTS Among 531 702 matched people, mean age was 44 (standard deviation [SD] 17) years and 51% were female. Females who tested positive for SARS-CoV-2 had a mean of 1.98 (95% CI 1.63 to 2.29) more health care encounters overall per-person-year than those who had a negative test result, with 0.31 (95% CI 0.05 to 0.56) more home care encounters to 0.81 (95% CI 0.69 to 0.93) more long-term care days. At the 99th percentile per-person-year, females who tested positive had 6.48 more days of hospital admission and 28.37 more home care encounters. Males who tested positive for SARS-CoV-2 had 0.66 (95% CI 0.34 to 0.99) more overall health care encounters per-person-year than those who tested negative, with 0.14 (95% CI 0.06 to 0.21) more outpatient encounters and 0.48 (95% CI 0.36 to 0.60) long-term care days, and 0.43 (95% CI -0.67 to -0.21) fewer home care encounters. At the 99th percentile, they had 8.69 more days in hospital per-person-year, with fewer home care (-27.31) and outpatient (-0.87) encounters. INTERPRETATION We found significantly higher rates of health care use after a positive SARS-CoV-2 PCR test in an analysis that matched test-positive with test-negative people. Stakeholders can use these findings to prepare for health care demand associated with post-COVID-19 condition (long COVID).
Collapse
Affiliation(s)
- Candace D McNaughton
- ICES Central (McNaughton, Austin, Sivaswamy, Fang, Abdel-Qadir, Daneman, Udell, Wodchis, Lee, Atzema); Sunnybrook Research Institute (McNaughton, Austin, Daneman, Mostarac, Atzema); Sunnybrook Health Sciences Centre (McNaughton, Daneman, Atzema); Department of Medicine (McNaughton, Abdel-Qadir, Daneman, Udell, Lee, Atzema), and Institute of Health Policy, Management and Evaluation (Austin, Abdel-Qadir, Udell, Wodchis, Atzema), University of Toronto; Peter Munk Cardiac Centre (Abdel-Qadir, Udell, Lee), Toronto General Hospital; Division of Cardiology (Abdel-Qadir, Udell), Women's College Hospital; Department of Medical Imaging (Lee), and Division of Cardiology (Abdel-Qadir, Udell, Lee), University Health Network, University of Toronto; Ted Rogers Centre for Heart Research (Abdel-Qadir, Lee); Institute for Better Health, Trillium Health Partners, Toronto, Ont.
| | - Peter C Austin
- ICES Central (McNaughton, Austin, Sivaswamy, Fang, Abdel-Qadir, Daneman, Udell, Wodchis, Lee, Atzema); Sunnybrook Research Institute (McNaughton, Austin, Daneman, Mostarac, Atzema); Sunnybrook Health Sciences Centre (McNaughton, Daneman, Atzema); Department of Medicine (McNaughton, Abdel-Qadir, Daneman, Udell, Lee, Atzema), and Institute of Health Policy, Management and Evaluation (Austin, Abdel-Qadir, Udell, Wodchis, Atzema), University of Toronto; Peter Munk Cardiac Centre (Abdel-Qadir, Udell, Lee), Toronto General Hospital; Division of Cardiology (Abdel-Qadir, Udell), Women's College Hospital; Department of Medical Imaging (Lee), and Division of Cardiology (Abdel-Qadir, Udell, Lee), University Health Network, University of Toronto; Ted Rogers Centre for Heart Research (Abdel-Qadir, Lee); Institute for Better Health, Trillium Health Partners, Toronto, Ont
| | - Atul Sivaswamy
- ICES Central (McNaughton, Austin, Sivaswamy, Fang, Abdel-Qadir, Daneman, Udell, Wodchis, Lee, Atzema); Sunnybrook Research Institute (McNaughton, Austin, Daneman, Mostarac, Atzema); Sunnybrook Health Sciences Centre (McNaughton, Daneman, Atzema); Department of Medicine (McNaughton, Abdel-Qadir, Daneman, Udell, Lee, Atzema), and Institute of Health Policy, Management and Evaluation (Austin, Abdel-Qadir, Udell, Wodchis, Atzema), University of Toronto; Peter Munk Cardiac Centre (Abdel-Qadir, Udell, Lee), Toronto General Hospital; Division of Cardiology (Abdel-Qadir, Udell), Women's College Hospital; Department of Medical Imaging (Lee), and Division of Cardiology (Abdel-Qadir, Udell, Lee), University Health Network, University of Toronto; Ted Rogers Centre for Heart Research (Abdel-Qadir, Lee); Institute for Better Health, Trillium Health Partners, Toronto, Ont
| | - Jiming Fang
- ICES Central (McNaughton, Austin, Sivaswamy, Fang, Abdel-Qadir, Daneman, Udell, Wodchis, Lee, Atzema); Sunnybrook Research Institute (McNaughton, Austin, Daneman, Mostarac, Atzema); Sunnybrook Health Sciences Centre (McNaughton, Daneman, Atzema); Department of Medicine (McNaughton, Abdel-Qadir, Daneman, Udell, Lee, Atzema), and Institute of Health Policy, Management and Evaluation (Austin, Abdel-Qadir, Udell, Wodchis, Atzema), University of Toronto; Peter Munk Cardiac Centre (Abdel-Qadir, Udell, Lee), Toronto General Hospital; Division of Cardiology (Abdel-Qadir, Udell), Women's College Hospital; Department of Medical Imaging (Lee), and Division of Cardiology (Abdel-Qadir, Udell, Lee), University Health Network, University of Toronto; Ted Rogers Centre for Heart Research (Abdel-Qadir, Lee); Institute for Better Health, Trillium Health Partners, Toronto, Ont
| | - Husam Abdel-Qadir
- ICES Central (McNaughton, Austin, Sivaswamy, Fang, Abdel-Qadir, Daneman, Udell, Wodchis, Lee, Atzema); Sunnybrook Research Institute (McNaughton, Austin, Daneman, Mostarac, Atzema); Sunnybrook Health Sciences Centre (McNaughton, Daneman, Atzema); Department of Medicine (McNaughton, Abdel-Qadir, Daneman, Udell, Lee, Atzema), and Institute of Health Policy, Management and Evaluation (Austin, Abdel-Qadir, Udell, Wodchis, Atzema), University of Toronto; Peter Munk Cardiac Centre (Abdel-Qadir, Udell, Lee), Toronto General Hospital; Division of Cardiology (Abdel-Qadir, Udell), Women's College Hospital; Department of Medical Imaging (Lee), and Division of Cardiology (Abdel-Qadir, Udell, Lee), University Health Network, University of Toronto; Ted Rogers Centre for Heart Research (Abdel-Qadir, Lee); Institute for Better Health, Trillium Health Partners, Toronto, Ont
| | - Nick Daneman
- ICES Central (McNaughton, Austin, Sivaswamy, Fang, Abdel-Qadir, Daneman, Udell, Wodchis, Lee, Atzema); Sunnybrook Research Institute (McNaughton, Austin, Daneman, Mostarac, Atzema); Sunnybrook Health Sciences Centre (McNaughton, Daneman, Atzema); Department of Medicine (McNaughton, Abdel-Qadir, Daneman, Udell, Lee, Atzema), and Institute of Health Policy, Management and Evaluation (Austin, Abdel-Qadir, Udell, Wodchis, Atzema), University of Toronto; Peter Munk Cardiac Centre (Abdel-Qadir, Udell, Lee), Toronto General Hospital; Division of Cardiology (Abdel-Qadir, Udell), Women's College Hospital; Department of Medical Imaging (Lee), and Division of Cardiology (Abdel-Qadir, Udell, Lee), University Health Network, University of Toronto; Ted Rogers Centre for Heart Research (Abdel-Qadir, Lee); Institute for Better Health, Trillium Health Partners, Toronto, Ont
| | - Jacob A Udell
- ICES Central (McNaughton, Austin, Sivaswamy, Fang, Abdel-Qadir, Daneman, Udell, Wodchis, Lee, Atzema); Sunnybrook Research Institute (McNaughton, Austin, Daneman, Mostarac, Atzema); Sunnybrook Health Sciences Centre (McNaughton, Daneman, Atzema); Department of Medicine (McNaughton, Abdel-Qadir, Daneman, Udell, Lee, Atzema), and Institute of Health Policy, Management and Evaluation (Austin, Abdel-Qadir, Udell, Wodchis, Atzema), University of Toronto; Peter Munk Cardiac Centre (Abdel-Qadir, Udell, Lee), Toronto General Hospital; Division of Cardiology (Abdel-Qadir, Udell), Women's College Hospital; Department of Medical Imaging (Lee), and Division of Cardiology (Abdel-Qadir, Udell, Lee), University Health Network, University of Toronto; Ted Rogers Centre for Heart Research (Abdel-Qadir, Lee); Institute for Better Health, Trillium Health Partners, Toronto, Ont
| | - Walter P Wodchis
- ICES Central (McNaughton, Austin, Sivaswamy, Fang, Abdel-Qadir, Daneman, Udell, Wodchis, Lee, Atzema); Sunnybrook Research Institute (McNaughton, Austin, Daneman, Mostarac, Atzema); Sunnybrook Health Sciences Centre (McNaughton, Daneman, Atzema); Department of Medicine (McNaughton, Abdel-Qadir, Daneman, Udell, Lee, Atzema), and Institute of Health Policy, Management and Evaluation (Austin, Abdel-Qadir, Udell, Wodchis, Atzema), University of Toronto; Peter Munk Cardiac Centre (Abdel-Qadir, Udell, Lee), Toronto General Hospital; Division of Cardiology (Abdel-Qadir, Udell), Women's College Hospital; Department of Medical Imaging (Lee), and Division of Cardiology (Abdel-Qadir, Udell, Lee), University Health Network, University of Toronto; Ted Rogers Centre for Heart Research (Abdel-Qadir, Lee); Institute for Better Health, Trillium Health Partners, Toronto, Ont
| | - Ivona Mostarac
- ICES Central (McNaughton, Austin, Sivaswamy, Fang, Abdel-Qadir, Daneman, Udell, Wodchis, Lee, Atzema); Sunnybrook Research Institute (McNaughton, Austin, Daneman, Mostarac, Atzema); Sunnybrook Health Sciences Centre (McNaughton, Daneman, Atzema); Department of Medicine (McNaughton, Abdel-Qadir, Daneman, Udell, Lee, Atzema), and Institute of Health Policy, Management and Evaluation (Austin, Abdel-Qadir, Udell, Wodchis, Atzema), University of Toronto; Peter Munk Cardiac Centre (Abdel-Qadir, Udell, Lee), Toronto General Hospital; Division of Cardiology (Abdel-Qadir, Udell), Women's College Hospital; Department of Medical Imaging (Lee), and Division of Cardiology (Abdel-Qadir, Udell, Lee), University Health Network, University of Toronto; Ted Rogers Centre for Heart Research (Abdel-Qadir, Lee); Institute for Better Health, Trillium Health Partners, Toronto, Ont
| | - Douglas S Lee
- ICES Central (McNaughton, Austin, Sivaswamy, Fang, Abdel-Qadir, Daneman, Udell, Wodchis, Lee, Atzema); Sunnybrook Research Institute (McNaughton, Austin, Daneman, Mostarac, Atzema); Sunnybrook Health Sciences Centre (McNaughton, Daneman, Atzema); Department of Medicine (McNaughton, Abdel-Qadir, Daneman, Udell, Lee, Atzema), and Institute of Health Policy, Management and Evaluation (Austin, Abdel-Qadir, Udell, Wodchis, Atzema), University of Toronto; Peter Munk Cardiac Centre (Abdel-Qadir, Udell, Lee), Toronto General Hospital; Division of Cardiology (Abdel-Qadir, Udell), Women's College Hospital; Department of Medical Imaging (Lee), and Division of Cardiology (Abdel-Qadir, Udell, Lee), University Health Network, University of Toronto; Ted Rogers Centre for Heart Research (Abdel-Qadir, Lee); Institute for Better Health, Trillium Health Partners, Toronto, Ont
| | - Clare L Atzema
- ICES Central (McNaughton, Austin, Sivaswamy, Fang, Abdel-Qadir, Daneman, Udell, Wodchis, Lee, Atzema); Sunnybrook Research Institute (McNaughton, Austin, Daneman, Mostarac, Atzema); Sunnybrook Health Sciences Centre (McNaughton, Daneman, Atzema); Department of Medicine (McNaughton, Abdel-Qadir, Daneman, Udell, Lee, Atzema), and Institute of Health Policy, Management and Evaluation (Austin, Abdel-Qadir, Udell, Wodchis, Atzema), University of Toronto; Peter Munk Cardiac Centre (Abdel-Qadir, Udell, Lee), Toronto General Hospital; Division of Cardiology (Abdel-Qadir, Udell), Women's College Hospital; Department of Medical Imaging (Lee), and Division of Cardiology (Abdel-Qadir, Udell, Lee), University Health Network, University of Toronto; Ted Rogers Centre for Heart Research (Abdel-Qadir, Lee); Institute for Better Health, Trillium Health Partners, Toronto, Ont
| |
Collapse
|
40
|
Krishnan PS, Daggumati S, Widmeyer J, Quinn KJ, Yu C, Vahidi N, Kamdar R, Kandl C. The Lasting Impact of the COVID-19 Pandemic on Surgical Key Indicator Cases for Otolaryngology Residency Education. Ann Otol Rhinol Laryngol 2022:34894221123121. [PMID: 36123958 DOI: 10.1177/00034894221123121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Early on during the COVID-19 pandemic, the US Centers for Medicare & Medicaid Services (CMS) and other government as well as medical institutions recommended that surgeons postpone nonessential surgeries. The aim of our study is to examine the impact of the COVID-19 pandemic on otolaryngology surgical training by evaluating changes in surgical volumes through various time points relative to the height of the pandemic. METHODS We performed a retrospective review of all surgical cases performed by the Otolaryngology-Head and Neck Surgery department at a tertiary care academic center from 3 time periods: July 1st, 2018, to June 30th, 2019; July 1st, 2019, to June 30th, 2020; and July 1st, 2020, to June 30th, 2021. RESULTS From the 2018-19 period to the 2020-21 period, the total number of overall cases decreased by 9.9%, from 2386 to 2148 cases. During this same time duration, the number of key indicator cases decreased by 13.4%, from 1715 to 1486 cases. Relative to other cases, ethmoidectomy, rhinoplasty, and stapes/OCR cases decreased the most during the 2019-20 period by 41.9%, 41.8%, and 29.5%, respectively. From the 2018-19 period to the 2020-21 period, thyroid/parathyroid cases decreased the most by 35.4%. Only ethmoidectomy and oral cavity cases showed increases during this period at 9.7% and 24.4%, respectively. CONCLUSIONS Although case volumes have stayed relatively constant, key indicator case volumes at the present tertiary care academic center have not yet fully recovered from the COVID-19 pandemic. Efforts must be made to determine how this has impacted residency surgical education.
Collapse
Affiliation(s)
- Pavan S Krishnan
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Srihari Daggumati
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Jonathan Widmeyer
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Kevin J Quinn
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Cheryl Yu
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Nima Vahidi
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Rushabh Kamdar
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Christopher Kandl
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| |
Collapse
|
41
|
Pre-surgical Nasal Decolonization of Staphylococcus aureus: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2022; 22:1-165. [PMID: 36160757 PMCID: PMC9470215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Staphylococcus aureus (S. aureus) is the most common cause of surgical site infections, and the nose is the most common site for S. aureus colonization. Pre-surgical (in the days prior to surgery) nasal decolonization of S. aureus may reduce the bacterial load and prevent the organisms from being transferred to the surgical site, thus reducing the risk of surgical site infection. We conducted a health technology assessment of nasal decolonization of S. aureus (including methicillin-susceptible and methicillin-resistant strains) with or without topical antiseptic body wash to prevent surgical site infection in patients undergoing scheduled surgery, which included an evaluation of effectiveness, safety, cost-effectiveness, the budget impact of publicly funding nasal decolonization of S. aureus, and patient preferences and values. METHODS We performed a systematic literature search of the clinical evidence to retrieve systematic reviews and selected and reported results from one review that was recent, of high quality, and relevant to our research question. We complemented the chosen systematic review with a literature search to identify randomized controlled trials published since the systematic review was published in 2019. We used the Risk of Bias in Systematic Reviews (ROBIS) tool to assess the risk of bias of each included systematic review and the Cochrane risk-of-bias tool for randomized controlled trials to assess the risk of bias of each included primary study. We assessed the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We performed a systematic economic literature search and conducted both cost-effectiveness and cost-utility analyses using a decision-tree model with a 1-year time horizon from the perspective of Ontario's Ministry of Health. We also analyzed the budget impact of publicly funding nasal decolonization of S. aureus in pre-surgical patients in Ontario. To contextualize the potential value of nasal decolonization, we spoke with people who had recently undergone surgery, some of whom had received nasal decolonization, and one family member of a person who had recently had surgery. We also engaged participants through an online survey. RESULTS We included one systematic review and three randomized controlled trials in the clinical evidence review. In universal decolonization, compared with placebo or no intervention, nasal mupirocin alone may result in little to no difference in the incidence of overall and S. aureus-related surgical site infections in pre-surgical patients undergoing orthopaedic, cardiothoracic, general, oncologic, gynaecologic, neurologic, or abdominal digestive surgeries, regardless of S. aureus carrier status (GRADE: Moderate to Very low). Compared with placebo, nasal mupirocin alone may result in little to no difference in the incidence of overall and S. aureus-related surgical site infections in pre-surgical patients who are S. aureus carriers undergoing cardiothoracic, vascular, orthopaedic, gastrointestinal, general, oncologic, gynaecologic, or neurologic surgery (GRADE: Moderate to Very low). In targeted decolonization, compared with placebo, nasal mupirocin combined with chlorhexidine body wash lowers the incidence of S. aureus-related surgical site infection (risk ratio: 0.32 [95% confidence interval: 0.16-0.62]) in pre-surgical patients who are S. aureus carriers undergoing cardiothoracic, vascular, orthopaedic, gastrointestinal, or general surgery (GRADE: High). Compared with no intervention, nasal mupirocin combined with chlorhexidine body wash in pre-surgical patients who are not S. aureus carriers undergoing orthopaedic surgery may have little to no effect on overall surgical site infection, but the evidence is very uncertain (GRADE: Very low). Most included studies did not separate methicillin-susceptible and methicillin-resistant strains of S. aureus. No significant antimicrobial resistance was identified in the evidence reviewed; however, the existing literature was not adequately powered and did not have sufficient follow-up time to evaluate antimicrobial resistance.Our economic evaluation found that universal nasal decolonization using mupirocin combined with chlorhexidine body wash is less costly and more effective than both targeted and no nasal decolonization. Compared with no nasal decolonization treatment, universal and targeted nasal decolonization using mupirocin combined with chlorhexidine body wash would prevent 32 and 22 S. aureus-related surgical site infections, respectively, per 10,000 patients. Universal nasal decolonization would lead to cost savings, whereas targeted nasal decolonization would increase the overall cost for the health care system since patients must first be screened for S. aureus carrier status before receiving nasal decolonization with mupirocin. The annual budget impact of publicly funding universal nasal decolonization in Ontario over the next 5 years ranges from a savings of $2.98 million in year 1 to a savings of $15.09 million in year 5. The annual budget impact of publicly funding targeted nasal decolonization ranges from an additional cost of $0.08 million in year 1 to an additional cost of $0.39 million in year 5.Our interview and survey respondents felt strongly about the value of preventing surgical site infections, and most favoured a universal approach. CONCLUSIONS Based on the best evidence available, decolonization of S. aureus using nasal mupirocin combined with chlorhexidine body wash prior to cardiothoracic, vascular, orthopaedic, gastrointestinal, or general surgery lowers the incidence of surgical site infection caused by S. aureus in patients who are S. aureus carriers (including methicillin-susceptible and methicillin-resistant strains) (i.e., targeted decolonization). However, nasal mupirocin alone may result in little to no difference in overall surgical site infections and S. aureus-related surgical site infections in pre-surgical patients prior to orthopaedic, cardiothoracic, general, oncologic, gynaecologic, neurologic, or abdominal digestive surgeries, regardless of their S. aureus carrier status (i.e., universal decolonization). No significant antimicrobial resistance was identified in the evidence reviewed.Compared with no nasal decolonization treatment, universal nasal decolonization with mupirocin combined with chlorhexidine body wash may reduce S. aureus-related surgical site infections and lead to cost savings. Targeted nasal decolonization with mupirocin combined with chlorhexidine body wash may also reduce S. aureus-related surgical site infections but increase the overall cost of treatment for the health care system. We estimate that publicly funding universal nasal decolonization using mupirocin combined with chlorhexidine body wash would result in a total cost savings of $45.08 million over the next 5 years, whereas publicly funding targeted nasal decolonization using mupirocin combined with chlorhexidine body wash would incur an additional cost of $1.17 million over the next 5 years.People undergoing surgery value treatments aimed at preventing surgical site infections.
Collapse
|
42
|
Zekveld K, Berquist R. Perioperative Nurse Recruitment: An OR Placement Program for Fourth-Year Nursing Students in Ontario. AORN J 2022; 116:133-142. [PMID: 35880925 DOI: 10.1002/aorn.13746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/17/2021] [Accepted: 01/14/2022] [Indexed: 11/08/2022]
Abstract
Nursing associations have predicted a worldwide shortage of perioperative RNs as more nurses reach retirement age. Additionally, the lack of perioperative exposure during undergraduate nursing programs is contributing to the failure to attract recently graduated nurses to this field. In 2019, multiple hospital sites within the St. Lawrence College network in Ontario, Canada, expressed difficulty recruiting perioperative RNs and expressed an interest in collaborating with the college to increase exposure to the perioperative specialty and recruit students to their ORs after graduation. The college has run a successful preceptor-supported OR placement program for fourth-year baccalaureate nursing students since 2019. Eleven out of thirteen students were hired into the OR after their 2020-2021 placement program. This article outlines the steps taken to initiate this program as well as results of a formal program evaluation conducted in 2021, including detailed feedback from participating students, preceptors, and leaders at the involved hospitals.
Collapse
|
43
|
Ghoshal S, Rigney G, Cheng D, Brumit R, Gee MS, Hodin RA, Lillemoe KD, Levine WC, Succi MD. Institutional Surgical Response and Associated Volume Trends Throughout the COVID-19 Pandemic and Postvaccination Recovery Period. JAMA Netw Open 2022; 5:e2227443. [PMID: 35980636 PMCID: PMC9389350 DOI: 10.1001/jamanetworkopen.2022.27443] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic is associated with decreased surgical procedure volumes, but existing studies have not investigated this association beyond the end of 2020, analyzed changes during the post-vaccine release period, or quantified these changes by patient acuity. OBJECTIVE To quantify changes in the volume of surgical procedures at a 1017-bed academic quaternary care center from January 6, 2019, to December 31, 2021. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, 129 596 surgical procedure volumes were retrospectively analyzed during 4 periods: pre-COVID-19 (January 6, 2019, to January 4, 2020), COVID-19 peak (March 15, 2020, to May 2, 2020), post-COVID-19 peak (May 3, 2020, to January 2, 2021), and post-vaccine release (January 3, 2021, to December 31, 2021). Surgery volumes were analyzed by subspecialty and case class (elective, emergent, nonurgent, urgent). Statistical analysis was by autoregressive integrated moving average modeling. MAIN OUTCOMES AND MEASURES The primary outcome of this study was the change in weekly surgical procedure volume across the 4 COVID-19 periods. RESULTS A total of 129 596 records of surgical procedures were reviewed. During the COVID-19 peak, overall weekly surgical procedure volumes (mean [SD] procedures per week, 406.00 [171.45]; 95% CI, 234.56-577.46) declined 44.6% from pre-COVID-19 levels (mean [SD] procedures per week, 732.37 [12.70]; 95% CI, 719.67-745.08; P < .001). This weekly volume decrease occurred across all surgical subspecialties. During the post-COVID peak period, overall weekly surgical volumes (mean [SD] procedures per week, 624.31 [142.45]; 95% CI, 481.85-766.76) recovered to only 85.8% of pre-COVID peak volumes (P < .001). This insufficient recovery was inconsistent across subspecialties and case classes. During the post-vaccine release period, although some subspecialties experienced recovery to pre-COVID-19 volumes, others continued to experience declines. CONCLUSIONS AND RELEVANCE This quaternary care institution effectively responded to the pressures of the COVID-19 pandemic by substantially decreasing surgical procedure volumes during the peak of the pandemic. However, overall surgical procedure volumes did not fully recover to pre-COVID-19 levels well into 2021, with inconsistent recovery rates across subspecialties and case classes. These declines suggest that delays in surgical procedures may result in potentially higher morbidity rates in the future. The differential recovery rates across subspecialties may inform institutional focus for future operational recovery.
Collapse
Affiliation(s)
- Soham Ghoshal
- Harvard Medical School, Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center, Massachusetts General Hospital, Boston
| | - Grant Rigney
- Harvard Medical School, Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center, Massachusetts General Hospital, Boston
| | - Debby Cheng
- Harvard Medical School, Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center, Massachusetts General Hospital, Boston
| | - Ryan Brumit
- Department of Anesthesia, Massachusetts General Hospital Boston
| | - Michael S. Gee
- Harvard Medical School, Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center, Massachusetts General Hospital, Boston
- Department of Radiology, Massachusetts General Hospital, Boston
| | - Richard A. Hodin
- Harvard Medical School, Boston, Massachusetts
- Department of Surgery, Massachusetts General Hospital, Boston
| | - Keith D. Lillemoe
- Harvard Medical School, Boston, Massachusetts
- Department of Surgery, Massachusetts General Hospital, Boston
| | - Wilton C. Levine
- Harvard Medical School, Boston, Massachusetts
- Department of Anesthesia, Massachusetts General Hospital Boston
| | - Marc D. Succi
- Harvard Medical School, Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center, Massachusetts General Hospital, Boston
- Department of Radiology, Massachusetts General Hospital, Boston
| |
Collapse
|
44
|
Habbous S, Tai X, Beca JM, Arias J, Raphael MJ, Parmar A, Crespo A, Cheung MC, Eisen A, Eskander A, Singh S, Trudeau M, Gavura S, Dai WF, Irish J, Krzyzanowska M, Lapointe-Shaw L, Naipaul R, Peacock S, Yeung L, Forbes L, Chan KKW. Comparison of Use of Neoadjuvant Systemic Treatment for Breast Cancer and Short-term Outcomes Before vs During the COVID-19 Era in Ontario, Canada. JAMA Netw Open 2022; 5:e2225118. [PMID: 35917122 PMCID: PMC9346546 DOI: 10.1001/jamanetworkopen.2022.25118] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE In response to an increase in COVID-19 infection rates in Ontario, several systemic treatment (ST) regimens delivered in the adjuvant setting for breast cancer were temporarily permitted for neoadjuvant-intent to defer nonurgent breast cancer surgical procedures. OBJECTIVE To examine the use and compare short-term outcomes of neoadjuvant-intent vs adjuvant ST in the COVID-19 era compared with the pre-COVID-19 era. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective population-based cohort study in Ontario, Canada. Patients with cancer starting selected ST regimens in the COVID-19 era (March 11, 2020, to September 30, 2020) were compared to those in the pre-COVID-19 era (March 11, 2019, to March 10, 2020). Patients were diagnosed with breast cancer within 6 months of starting systemic therapy. MAIN OUTCOMES AND MEASURES Estimates were calculated for the use of neoadjuvant vs adjuvant ST, the likelihood of receiving a surgical procedure, the rate of emergency department visits, hospital admissions, COVID-19 infections, and all-cause mortality between treatment groups over time. RESULTS Among a total of 10 920 patients included, 7990 (73.2%) started treatment in the pre-COVID-19 era and 7344 (67.3%) received adjuvant ST; the mean (SD) age was 61.6 (13.1) years. Neoadjuvant-intent ST was more common in the COVID-19 era (1404 of 2930 patients [47.9%]) than the pre-COVID-19 era (2172 of 7990 patients [27.2%]), with an odds ratio of 2.46 (95% CI, 2.26-2.69; P < .001). This trend was consistent across a range of ST regimens, but differed according to patient age and geography. The likelihood of receiving surgery following neoadjuvant-intent chemotherapy was similar in the COVID-19 era compared with the pre-COVID-19 era (log-rank P = .06). However, patients with breast cancer receiving neoadjuvant-intent hormonal therapy were significantly more likely to receive surgery in the COVID-19 era (log-rank P < .001). After adjustment, there were no significant changes in the rate of emergency department visits over time between patients receiving neoadjuvant ST, adjuvant ST, or ST only during the ST treatment period or postoperative period. Hospital admissions decreased in the COVID-19 era for patients who received neoadjuvant ST compared with adjuvant ST or ST alone (P for interaction = .01 for both) in either setting. CONCLUSIONS AND RELEVANCE In this cohort study, patients were more likely to start neoadjuvant ST in the COVID-19 era, which varied across the province and by indication. There was limited evidence to suggest any substantial impact on short-term outcomes.
Collapse
Affiliation(s)
- Steven Habbous
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Xiaochen Tai
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Jaclyn M Beca
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
| | - Jessica Arias
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Michael J. Raphael
- Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ambica Parmar
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrea Crespo
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Matthew C Cheung
- Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrea Eisen
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Simron Singh
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Maureen Trudeau
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Scott Gavura
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Wei Fang Dai
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Jonathan Irish
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Monika Krzyzanowska
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Lauren Lapointe-Shaw
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rohini Naipaul
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Stuart Peacock
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
| | - Lyndee Yeung
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Leta Forbes
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Division of Medical Oncology, RS McLaughlin Durham Regional Cancer Centre Lakeridge Health, Oshawa, Ontario, Canada
| | - Kelvin K. W. Chan
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| |
Collapse
|
45
|
Bian DJH, Sabri S, Abdulkarim BS. Interactions between COVID-19 and Lung Cancer: Lessons Learned during the Pandemic. Cancers (Basel) 2022; 14:cancers14153598. [PMID: 35892857 PMCID: PMC9367272 DOI: 10.3390/cancers14153598] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary COVID-19 is a respiratory infectious disease caused by the coronavirus SARS-CoV-2. Lung cancer is the leading cause of all cancer-related deaths worldwide. As both SARS-CoV-2 and lung cancer affect the lungs, the aim of this narrative review is to provide a consolidation of lessons learned throughout the pandemic regarding lung cancer and COVID-19. Risk factors found in lung cancer patients, such as advanced cancers, smoking, male, etc., have been associated with severe COVID-19. The cancer treatments hormonal therapy, immunotherapy, and targeted therapy have shown no association with severe COVID-19 disease, but chemotherapy and radiation therapy have shown conflicting results. Logistical changes and modifications in treatment plans were instituted during the pandemic to minimize SARS-CoV-2 exposure while maintaining life-saving cancer care. Finally, medications have been developed to treat early COVID-19, which can be highly beneficial in vulnerable cancer patients, with paxlovid being the most efficacious drug currently available. Abstract Cancer patients, specifically lung cancer patients, show heightened vulnerability to severe COVID-19 outcomes. The immunological and inflammatory pathophysiological similarities between lung cancer and COVID-19-related ARDS might explain the predisposition of cancer patients to severe COVID-19, while multiple risk factors in lung cancer patients have been associated with worse COVID-19 outcomes, including smoking status, older age, etc. Recent cancer treatments have also been urgently evaluated during the pandemic as potential risk factors for severe COVID-19, with conflicting findings regarding systemic chemotherapy and radiation therapy, while other therapies were not associated with altered outcomes. Given this vulnerability of lung cancer patients for severe COVID-19, the delivery of cancer care was significantly modified during the pandemic to both proceed with cancer care and minimize SARS-CoV-2 infection risk. However, COVID-19-related delays and patients’ aversion to clinical settings have led to increased diagnosis of more advanced tumors, with an expected increase in cancer mortality. Waning immunity and vaccine breakthroughs related to novel variants of concern threaten to further impede the delivery of cancer services. Cancer patients have a high risk of severe COVID-19, despite being fully vaccinated. Numerous treatments for early COVID-19 have been developed to prevent disease progression and are crucial for infected cancer patients to minimize severe COVID-19 outcomes and resume cancer care. In this literature review, we will explore the lessons learned during the COVID-19 pandemic to specifically mitigate COVID-19 treatment decisions and the clinical management of lung cancer patients.
Collapse
Affiliation(s)
- David J. H. Bian
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3G 2M1, Canada;
| | - Siham Sabri
- Cancer Research Program, Research Institute, McGill University Health Center Glen Site, McGill University, Montreal, QC H4A 3J1, Canada;
| | - Bassam S. Abdulkarim
- Cancer Research Program, Research Institute, and Department of Oncology, Cedars Cancer Center, McGill University Health Center Glen Site, McGill University, Montreal, QC H4A 3J1, Canada
- Correspondence:
| |
Collapse
|
46
|
Lee-Ying R, O'Sullivan DE, Gagnon R, Bosma N, Stewart RN, Railton C, Tilley D, Alimohamed N, Basappa N, Cheng T, Kolinsky M, Karim S, Ruether D, North S, Yip S, Danielson B, Heng D, Brenner D. Stage migration of testicular germ cell tumours in Alberta, Canada, during the COVID-19 pandemic: a retrospective cohort study. CMAJ Open 2022; 10:E633-E642. [PMID: 35790231 PMCID: PMC9262347 DOI: 10.9778/cmajo.20210285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND An absence of screening recommendations and the rapid progression of testicular germ cell tumours (TGCTs) offer a perspective on the potential impact of the COVID-19 pandemic on cancer presentations. We evaluated the presenting cancer stages of TGCTs in a real-world population before and during the pandemic to assess stage migration. METHODS We performed a retrospective review of all new patients with TGCT diagnoses in Alberta, Canada, from Dec. 31, 2018, to Apr. 30, 2021, using the Alberta Cancer Registry. Because potential changes in staging should not occur instantaneously, we used a 6-month lag time from Apr. 1, 2020, for seminomas, and a 3-month lag time for nonseminomas, to compare initial cancer stages at presentation before and during the pandemic. We evaluated monthly rates of presentation by stage and histology. Exploratory outcomes included the largest tumour dimension, tumour markers and, for advanced disease, risk category and treatment setting. RESULTS Of 335 patients with TGCTs, 231 were diagnosed before the pandemic and 104 during the pandemic (using a lag time). In total, 18 (7.8%) patients diagnosed before the pandemic presented with stage III disease, compared to 16 (15.4%) diagnosed during the pandemic (relative risk 1.97, 95% confidence interval [CI] 1.05-3.72). We observed no significant differences for secondary outcomes. Without a lag time, the rate ratio for a stage II presentation decreased significantly during the pandemic (0.40, 95% CI 0.21-0.72). INTERPRETATION We observed signs of TGCT stage migration during the COVID-19 pandemic, driven by a decline in stage II disease and a potential rise in stage III disease. Management of TGCTs should remain a priority, even during a global pandemic.
Collapse
Affiliation(s)
- Richard Lee-Ying
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Dylan E O'Sullivan
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Richard Gagnon
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta.
| | - Nicholas Bosma
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Rebecca N Stewart
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Cindy Railton
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Derek Tilley
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Nimira Alimohamed
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Naveen Basappa
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Tina Cheng
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Michael Kolinsky
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Safiya Karim
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Dean Ruether
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Scott North
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Steven Yip
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Brita Danielson
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Daniel Heng
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Darren Brenner
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| |
Collapse
|
47
|
Shapiro J, Axelrod C, Levy BB, Sriharan A, Bhattacharyya OK, Urbach DR. Perceptions of Ontario health system leaders on single-entry models for managing the COVID-19 elective surgery backlog: an interpretive descriptive study. CMAJ Open 2022; 10:E789-E797. [PMID: 36041777 PMCID: PMC9435514 DOI: 10.9778/cmajo.20210234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has exacerbated pre-existing challenges with respect to access to elective surgery across Canada, and a single-entry model (SEM) approach has been proposed as an equitable and efficient method to help manage the backlog. With Ontario's recent investment in centralized surgical wait-list management, we sought to understand the views of health system leaders on the role of SEMs in managing the elective surgery backlog. METHODS We used the qualitative method of interpretive description to explore participant perspectives and identify practical strategies for policy-makers, administrators and clinical leaders. We conducted semistructured interviews with health system leaders from across Ontario on Zoom between March and June 2021. We used snowball and purposive sampling. Inclusion criteria included Ontario health care leaders, fluent in English or French, in positions relevant to managing the elective surgery backlog. Exclusion criteria were individuals who work outside Ontario, or do not hold relevant roles. RESULTS Our interviews with 10 health system leaders - including hospital chief executive officers, surgeons, administrators and policy experts - resulted in 5 emergent domains: perceptions of the backlog, operationalizing and financing SEMs, barriers, facilitators, and equity and patient factors. All participants emphasized the need for clinical leaders to champion SEMs and the utility of SEMs in managing wait-lists for high-volume, low-acuity, low-complexity and low-variation surgeries. INTERPRETATION Although SEMs are no panacea, the participants in our study stated that they believe SEMs can improve quality and reduce variability in wait times when SEMs are designed to address local needs and are implemented with buy-in from champions. Health care leaders should consider SEMs for improving surgical backlog management in their local jurisdictions.
Collapse
Affiliation(s)
- Justin Shapiro
- Temerty Faculty of Medicine (Shapiro, Axelrod, Levy), University of Toronto; Department of Health Policy, Management and Evaluation (Shapiro, Levy, Sriharan, Urbach, Bhattacharyya), University of Toronto; Department of Family and Community Medicine (Bhattacharyya), University of Toronto; Department of Family Medicine and Women's College Research Institute (Bhattacharyya), Women's College Hospital; Department of Surgery, Temerty Faculty of Medicine (Urbach), University of Toronto; Department of Surgery and Women's College Research Institute (Urbach), Women's College Hospital, Toronto, Ont.
| | - Charlotte Axelrod
- Temerty Faculty of Medicine (Shapiro, Axelrod, Levy), University of Toronto; Department of Health Policy, Management and Evaluation (Shapiro, Levy, Sriharan, Urbach, Bhattacharyya), University of Toronto; Department of Family and Community Medicine (Bhattacharyya), University of Toronto; Department of Family Medicine and Women's College Research Institute (Bhattacharyya), Women's College Hospital; Department of Surgery, Temerty Faculty of Medicine (Urbach), University of Toronto; Department of Surgery and Women's College Research Institute (Urbach), Women's College Hospital, Toronto, Ont
| | - Ben B Levy
- Temerty Faculty of Medicine (Shapiro, Axelrod, Levy), University of Toronto; Department of Health Policy, Management and Evaluation (Shapiro, Levy, Sriharan, Urbach, Bhattacharyya), University of Toronto; Department of Family and Community Medicine (Bhattacharyya), University of Toronto; Department of Family Medicine and Women's College Research Institute (Bhattacharyya), Women's College Hospital; Department of Surgery, Temerty Faculty of Medicine (Urbach), University of Toronto; Department of Surgery and Women's College Research Institute (Urbach), Women's College Hospital, Toronto, Ont
| | - Abi Sriharan
- Temerty Faculty of Medicine (Shapiro, Axelrod, Levy), University of Toronto; Department of Health Policy, Management and Evaluation (Shapiro, Levy, Sriharan, Urbach, Bhattacharyya), University of Toronto; Department of Family and Community Medicine (Bhattacharyya), University of Toronto; Department of Family Medicine and Women's College Research Institute (Bhattacharyya), Women's College Hospital; Department of Surgery, Temerty Faculty of Medicine (Urbach), University of Toronto; Department of Surgery and Women's College Research Institute (Urbach), Women's College Hospital, Toronto, Ont
| | - Onil K Bhattacharyya
- Temerty Faculty of Medicine (Shapiro, Axelrod, Levy), University of Toronto; Department of Health Policy, Management and Evaluation (Shapiro, Levy, Sriharan, Urbach, Bhattacharyya), University of Toronto; Department of Family and Community Medicine (Bhattacharyya), University of Toronto; Department of Family Medicine and Women's College Research Institute (Bhattacharyya), Women's College Hospital; Department of Surgery, Temerty Faculty of Medicine (Urbach), University of Toronto; Department of Surgery and Women's College Research Institute (Urbach), Women's College Hospital, Toronto, Ont
| | - David R Urbach
- Temerty Faculty of Medicine (Shapiro, Axelrod, Levy), University of Toronto; Department of Health Policy, Management and Evaluation (Shapiro, Levy, Sriharan, Urbach, Bhattacharyya), University of Toronto; Department of Family and Community Medicine (Bhattacharyya), University of Toronto; Department of Family Medicine and Women's College Research Institute (Bhattacharyya), Women's College Hospital; Department of Surgery, Temerty Faculty of Medicine (Urbach), University of Toronto; Department of Surgery and Women's College Research Institute (Urbach), Women's College Hospital, Toronto, Ont
| |
Collapse
|
48
|
de Souza Maciel Ferreira JE, Rocha de Oliveira L, Galvão Pereira K, Marques Frota N, Frota Cavalcante T, Santos Monte A, Lopes Chaves AF. Estratégias organizacionais no centro cirúrgico diante da pandemia de COVID 19: uma revisão integrativa. REVISTA CUIDARTE 2022. [DOI: 10.15649/cuidarte.2323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Introdução: os sistemas de saúde foram desafiados a desenvolver estratégias organizacionais para a prestação de cuidados cirúrgicos. Objetivo: apresentar as estratégias dos serviços de saúde no que se refere às práticas de cuidados cirúrgicos em tempos de pandemia de COVID-19. Materiais e métodos: revisão integrativa, desenvolvida em seis etapas, cuja busca dos artigos ocorreu na Biblioteca Virtual de Saúde, SciELO, PubMed e ScienceDirect. Os descritores controlados em saúde adotados foram “Centros Cirúrgicos” e “Infecções por Coronavírus”, de acordo com os sistemas DeCS e MeSH Terms. Foram selecionados 60 artigos de 405 estudos encontrados. Resultados: as principais estratégias utilizadas pelos serviços de saúde foram: a suspensão e adiamento de cirurgias eletivas durante as ondas de contágio da doença; e a triagem cuidadosa dos pacientes para COVID-19 antes e após intervenções cirúrgicas. Discussão: a suspensão e o adiamento de cirurgias eletivas devem ser avaliados com cautela pela equipe de saúde, de forma individualizada, para cada paciente, visto que situações clínicas não urgentes podem agravar ao longo do tempo, aumentando as chances de morbimortalidade desses pacientes. Conclusão: a triagem dos pacientes e dos profissionais da saúde para COVID-19 são estratégias importantes para evitar a contaminação desses sujeitos. A suspensão e o adiamento de cirurgias eletivas, durante as ondas de contágio por COVID-19, são recomendados para aumentar a capacidade de leitos disponíveis para pacientes graves hospitalizados por essa doença. Essa recomendação também auxilia no remanejamento de profissionais desse setor para as unidades com a demanda de cuidados de saúde mais elevada.
Collapse
|
49
|
Liu M, Richard L, Campitelli MA, Nisenbaum R, Dhalla IA, Wadhera RK, Shariff SZ, Hwang SW. Hospitalizations During the COVID-19 Pandemic Among Recently Homeless Individuals: a Retrospective Population-Based Matched Cohort Study. J Gen Intern Med 2022; 37:2016-2025. [PMID: 35396658 PMCID: PMC8992790 DOI: 10.1007/s11606-022-07506-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hospitalizations fell precipitously among the general population during the COVID-19 pandemic. It remains unclear whether individuals experiencing homelessness experienced similar reductions. OBJECTIVE To examine how overall and cause-specific hospitalizations changed among individuals with a recent history of homelessness (IRHH) and their housed counterparts during the first wave of the COVID-19 pandemic, using corresponding weeks in 2019 as a historical control. DESIGN Population-based cohort study conducted in Ontario, Canada, between September 30, 2018, and September 26, 2020. PARTICIPANTS In total, 38,617 IRHH, 15,022,368 housed individuals, and 186,858 low-income housed individuals matched on age, sex, rurality, and comorbidity burden. MAIN MEASURES Primary outcomes included medical-surgical, non-elective (overall and cause-specific), elective surgical, and psychiatric hospital admissions. KEY RESULTS Average rates of medical-surgical (rate ratio: 3.8, 95% CI: 3.7-3.8), non-elective (10.3, 95% CI: 10.1-10.4), and psychiatric admissions (128.1, 95% CI: 126.1-130.1) between January and September 2020 were substantially higher among IRHH compared to housed individuals. During the peak period (March 17 to June 16, 2020), rates of medical-surgical (0.47, 95% CI: 0.47-0.47), non-elective (0.80, 95% CI: 0.79-0.80), and psychiatric admissions (0.86, 95% CI: 0.84-0.88) were significantly lower among housed individuals relative to equivalent weeks in 2019. No significant changes were observed among IRHH. During the re-opening period (June 17-September 26, 2020), rates of non-elective hospitalizations for liver disease (1.41, 95% CI: 1.23-1.69), kidney disease (1.29, 95% CI: 1.14-1.47), and trauma (1.19, 95% CI: 1.07-1.32) increased substantially among IRHH but not housed individuals. Distinct hospitalization patterns were observed among IRHH even in comparison with more medically and socially vulnerable matched housed individuals. CONCLUSIONS Persistence in overall hospital admissions and increases in non-elective hospitalizations for liver disease, kidney disease, and trauma indicate that the COVID-19 pandemic presented unique challenges for recently homeless individuals. Health systems must better address the needs of this population during public health crises.
Collapse
Affiliation(s)
- Michael Liu
- Harvard Medical School, Boston, MA, USA.
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
- ICES Central, Toronto, Ontario, Canada.
| | | | | | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Irfan A Dhalla
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
50
|
Analyzing historical and future acute neurosurgical demand using an AI-enabled predictive dashboard. Sci Rep 2022; 12:7603. [PMID: 35534601 PMCID: PMC9084272 DOI: 10.1038/s41598-022-11607-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/25/2022] [Indexed: 11/29/2022] Open
Abstract
Characterizing acute service demand is critical for neurosurgery and other emergency-dominant specialties in order to dynamically distribute resources and ensure timely access to treatment. This is especially important in the post-Covid 19 pandemic period, when healthcare centers are grappling with a record backlog of pending surgical procedures and rising acute referral numbers. Healthcare dashboards are well-placed to analyze this data, making key information about service and clinical outcomes available to staff in an easy-to-understand format. However, they typically provide insights based on inference rather than prediction, limiting their operational utility. We retrospectively analyzed and prospectively forecasted acute neurosurgical referrals, based on 10,033 referrals made to a large volume tertiary neurosciences center in London, U.K., from the start of the Covid-19 pandemic lockdown period until October 2021 through the use of a novel AI-enabled predictive dashboard. As anticipated, weekly referral volumes significantly increased during this period, largely owing to an increase in spinal referrals (p < 0.05). Applying validated time-series forecasting methods, we found that referrals were projected to increase beyond this time-point, with Prophet demonstrating the best test and computational performance. Using a mixed-methods approach, we determined that a dashboard approach was usable, feasible, and acceptable among key stakeholders.
Collapse
|