2
|
Berthelot S, Breton M, Guertin JR, Archambault PM, Berger Pelletier E, Blouin D, Borgundvaag B, Duhoux A, Harvey Labbé L, Laberge M, Lachapelle P, Lapointe-Shaw L, Layani G, Lefebvre G, Mallet M, Matthews D, McBrien K, McLeod S, Mercier E, Messier A, Moore L, Morris J, Morris K, Ovens H, Pageau P, Paquette JS, Perry J, Schull M, Simon M, Simonyan D, Stelfox HT, Talbot D, Vaillancourt S. A Value-Based Comparison of the Management of Ambulatory Respiratory Diseases in Walk-in Clinics, Primary Care Practices, and Emergency Departments: Protocol for a Multicenter Prospective Cohort Study. JMIR Res Protoc 2021; 10:e25619. [PMID: 33616548 PMCID: PMC7939947 DOI: 10.2196/25619] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In Canada, 30%-60% of patients presenting to emergency departments are ambulatory. This category has been labeled as a source of emergency department overuse. Acting on the presumption that primary care practices and walk-in clinics offer equivalent care at a lower cost, governments have invested massively in improving access to these alternative settings in the hope that patients would present there instead when possible, thereby reducing the load on emergency departments. Data in support of this approach remain scarce and equivocal. OBJECTIVE The aim of this study is to compare the value of care received in emergency departments, walk-in clinics, and primary care practices by ambulatory patients with upper respiratory tract infection, sinusitis, otitis media, tonsillitis, pharyngitis, bronchitis, influenza-like illness, pneumonia, acute asthma, or acute exacerbation of chronic obstructive pulmonary disease. METHODS A multicenter prospective cohort study will be performed in Ontario and Québec. In phase 1, a time-driven activity-based costing method will be applied at each of the 15 study sites. This method uses time as a cost driver to allocate direct costs (eg, medication), consumable expenditures (eg, needles), overhead costs (eg, building maintenance), and physician charges to patient care. Thus, the cost of a care episode will be proportional to the time spent receiving the care. At the end of this phase, a list of care process costs will be generated and used to calculate the cost of each consultation during phase 2, in which a prospective cohort of patients will be monitored to compare the care received in each setting. Patients aged 18 years and older, ambulatory throughout the care episode, and discharged to home with one of the aforementioned targeted diagnoses will be considered. The estimated sample size is 1485 patients. The 3 types of care settings will be compared on the basis of primary outcomes in terms of the proportion of return visits to any site 3 and 7 days after the initial visit and the mean cost of care. The secondary outcomes measured will include scores on patient-reported outcome and experience measures and mean costs borne wholly by patients. We will use multilevel generalized linear models to compare the care settings and an overlap weights approach to adjust for confounding factors related to age, sex, gender, ethnicity, comorbidities, registration with a family physician, socioeconomic status, and severity of illness. RESULTS Phase 1 will begin in 2021 and phase 2, in 2023. The results will be available in 2025. CONCLUSIONS The end point of our program will be for deciders, patients, and care providers to be able to determine the most appropriate care setting for the management of ambulatory emergency respiratory conditions, based on the quality and cost of care associated with each alternative. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/25619.
Collapse
Affiliation(s)
- Simon Berthelot
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
| | - Mylaine Breton
- Department of Community Health sciences, Université de Sherbrooke, Campus de Longueuil, Longueuil, QC, Canada
- Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Longueuil, QC, Canada
| | - Jason Robert Guertin
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Department of Social and Preventive Medicine, Université Laval, Québec, QC, Canada
| | - Patrick Michel Archambault
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Elyse Berger Pelletier
- Ministère de la santé et des services sociaux, Gouvernement du Québec, Québec, QC, Canada
| | - Danielle Blouin
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - Bjug Borgundvaag
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, ON, Canada
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montréal, QC, Canada
| | - Laurie Harvey Labbé
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Maude Laberge
- Operations and Decision Systems Department, Faculty of Administrative Sciences, Université Laval, Québec, QC, Canada
| | - Philippe Lachapelle
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | | | - Géraldine Layani
- Department of Family and Emergency Medicine, Université de Montréal, Montréal, QC, Canada
| | - Gabrielle Lefebvre
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Myriam Mallet
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Deborah Matthews
- Ministry of Health and Long Term Care, Government of Ontario, Toronto, ON, Canada
| | - Kerry McBrien
- Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Shelley McLeod
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Eric Mercier
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
| | - Alexandre Messier
- Department of Family and Emergency Medicine, Université de Montréal, Montréal, QC, Canada
| | - Lynne Moore
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Department of Social and Preventive Medicine, Université Laval, Québec, QC, Canada
| | - Judy Morris
- Department of Family and Emergency Medicine, Université de Montréal, Montréal, QC, Canada
- Hôpital du Sacré-Coeur-de-Montréal, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de Montréal, Montréal, QC, Canada
| | - Kathleen Morris
- Canadian Institute for Health Information, Ottawa, ON, Canada
| | - Howard Ovens
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, ON, Canada
| | - Paul Pageau
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jean-Sébastien Paquette
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Laboratoire ARIMED, GMF-U de Saint-Charles-Borromée, Québec, QC, Canada
| | - Jeffrey Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Michael Schull
- Department of Emergency Medicine, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Mathieu Simon
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, Canada
| | - David Simonyan
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Henry Thomas Stelfox
- Department of Critical Care Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Denis Talbot
- Department of Social and Preventive Medicine, Université Laval, Québec, QC, Canada
| | - Samuel Vaillancourt
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Emergency Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| |
Collapse
|
4
|
Moore L, Evans D, Yanchar NL, Thakore J, Stelfox HT, Hameed M, Simons R, Kortbeek J, Clément J, Lauzier F, Turgeon AF. Canadian benchmarks for acute injury care. Can J Surg 2017; 60:380-387. [PMID: 28930046 DOI: 10.1503/cjs.002817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Acute care injury outcomes vary substantially across Canadian provinces and trauma centres. Our aim was to develop Canadian benchmarks to monitor mortality and hospital length of stay (LOS) for injury admissions. METHODS Benchmarks were derived using data from the Canadian National Trauma Registry on patients with major trauma admitted to any level I or II trauma centre in Canada and from the following patient subgroups: isolated traumatic brain injury (TBI), isolated thoracoabdominal injury, multisystem blunt injury, age 65 years or older. We assessed predictive validity using measures of discrimination and calibration, and performed sensitivity analyses to assess the impact of replacing analytically complex methods (multiple imputation, shrinkage estimates and flexible modelling) with simple models that can be implemented locally. RESULTS The mortality risk adjustment model had excellent discrimination and calibration (area under the receiver operating characteristic curve 0.886, Hosmer-Lemeshow 36). The LOS risk-adjustment model predicted 29% of the variation in LOS. Overall, observed:expected ratios of mortality and mean LOS generated by an analytically simple model correlated strongly with those generated by analytically complex models (r > 0.95, κ on outliers > 0.90). CONCLUSION We propose Canadian benchmarks that can be used to monitor quality of care in Canadian trauma centres using Excel (see the appendices, available at canjsurg.ca). The program can be implemented using local trauma registries, providing that at least 100 patients are available for analysis.
Collapse
Affiliation(s)
- Lynne Moore
- From the Department of Social and Preventative Medicine, Université Laval, Québec, Que. (Moore); the Axe Santé des Populations et Pratiques Optimales en Santé, Traumatologie-Urgence-Soins intensifs, Centre de Recherche du CHU de Québec, Hôpital de l'Enfant-Jésus, Université Laval, Québec, Que. (Moore, Lauzier, Turgeon); the Department of Surgery, University of Calgary, Calgary, Alta. (Yanchar); the Department of Surgery, University of British Columbia, Vancouver, BC (Evans, Thakore, Hameed); the Department of Critical Care Medicine, Medicine and Community Health Sciences (Stelfox), O'Brien Institute for Public Health, University of Calgary, Calgary, Alta. (Stelfox); the Department of Surgery, Division of General Surgery and Division of Critical Care, University of Calgary, Calgary, Alta. (Kortbeek); the Institut national d'excellence en santé et en services sociaux, Québec, Que. (Clément); the Department of Surgery, Université Laval, Québec, Que. (Clément); and the Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Que. (Lauzier, Turgeon)
| | - David Evans
- From the Department of Social and Preventative Medicine, Université Laval, Québec, Que. (Moore); the Axe Santé des Populations et Pratiques Optimales en Santé, Traumatologie-Urgence-Soins intensifs, Centre de Recherche du CHU de Québec, Hôpital de l'Enfant-Jésus, Université Laval, Québec, Que. (Moore, Lauzier, Turgeon); the Department of Surgery, University of Calgary, Calgary, Alta. (Yanchar); the Department of Surgery, University of British Columbia, Vancouver, BC (Evans, Thakore, Hameed); the Department of Critical Care Medicine, Medicine and Community Health Sciences (Stelfox), O'Brien Institute for Public Health, University of Calgary, Calgary, Alta. (Stelfox); the Department of Surgery, Division of General Surgery and Division of Critical Care, University of Calgary, Calgary, Alta. (Kortbeek); the Institut national d'excellence en santé et en services sociaux, Québec, Que. (Clément); the Department of Surgery, Université Laval, Québec, Que. (Clément); and the Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Que. (Lauzier, Turgeon)
| | - Natalie L Yanchar
- From the Department of Social and Preventative Medicine, Université Laval, Québec, Que. (Moore); the Axe Santé des Populations et Pratiques Optimales en Santé, Traumatologie-Urgence-Soins intensifs, Centre de Recherche du CHU de Québec, Hôpital de l'Enfant-Jésus, Université Laval, Québec, Que. (Moore, Lauzier, Turgeon); the Department of Surgery, University of Calgary, Calgary, Alta. (Yanchar); the Department of Surgery, University of British Columbia, Vancouver, BC (Evans, Thakore, Hameed); the Department of Critical Care Medicine, Medicine and Community Health Sciences (Stelfox), O'Brien Institute for Public Health, University of Calgary, Calgary, Alta. (Stelfox); the Department of Surgery, Division of General Surgery and Division of Critical Care, University of Calgary, Calgary, Alta. (Kortbeek); the Institut national d'excellence en santé et en services sociaux, Québec, Que. (Clément); the Department of Surgery, Université Laval, Québec, Que. (Clément); and the Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Que. (Lauzier, Turgeon)
| | - Jaimini Thakore
- From the Department of Social and Preventative Medicine, Université Laval, Québec, Que. (Moore); the Axe Santé des Populations et Pratiques Optimales en Santé, Traumatologie-Urgence-Soins intensifs, Centre de Recherche du CHU de Québec, Hôpital de l'Enfant-Jésus, Université Laval, Québec, Que. (Moore, Lauzier, Turgeon); the Department of Surgery, University of Calgary, Calgary, Alta. (Yanchar); the Department of Surgery, University of British Columbia, Vancouver, BC (Evans, Thakore, Hameed); the Department of Critical Care Medicine, Medicine and Community Health Sciences (Stelfox), O'Brien Institute for Public Health, University of Calgary, Calgary, Alta. (Stelfox); the Department of Surgery, Division of General Surgery and Division of Critical Care, University of Calgary, Calgary, Alta. (Kortbeek); the Institut national d'excellence en santé et en services sociaux, Québec, Que. (Clément); the Department of Surgery, Université Laval, Québec, Que. (Clément); and the Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Que. (Lauzier, Turgeon)
| | - Henry Thomas Stelfox
- From the Department of Social and Preventative Medicine, Université Laval, Québec, Que. (Moore); the Axe Santé des Populations et Pratiques Optimales en Santé, Traumatologie-Urgence-Soins intensifs, Centre de Recherche du CHU de Québec, Hôpital de l'Enfant-Jésus, Université Laval, Québec, Que. (Moore, Lauzier, Turgeon); the Department of Surgery, University of Calgary, Calgary, Alta. (Yanchar); the Department of Surgery, University of British Columbia, Vancouver, BC (Evans, Thakore, Hameed); the Department of Critical Care Medicine, Medicine and Community Health Sciences (Stelfox), O'Brien Institute for Public Health, University of Calgary, Calgary, Alta. (Stelfox); the Department of Surgery, Division of General Surgery and Division of Critical Care, University of Calgary, Calgary, Alta. (Kortbeek); the Institut national d'excellence en santé et en services sociaux, Québec, Que. (Clément); the Department of Surgery, Université Laval, Québec, Que. (Clément); and the Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Que. (Lauzier, Turgeon)
| | - Morad Hameed
- From the Department of Social and Preventative Medicine, Université Laval, Québec, Que. (Moore); the Axe Santé des Populations et Pratiques Optimales en Santé, Traumatologie-Urgence-Soins intensifs, Centre de Recherche du CHU de Québec, Hôpital de l'Enfant-Jésus, Université Laval, Québec, Que. (Moore, Lauzier, Turgeon); the Department of Surgery, University of Calgary, Calgary, Alta. (Yanchar); the Department of Surgery, University of British Columbia, Vancouver, BC (Evans, Thakore, Hameed); the Department of Critical Care Medicine, Medicine and Community Health Sciences (Stelfox), O'Brien Institute for Public Health, University of Calgary, Calgary, Alta. (Stelfox); the Department of Surgery, Division of General Surgery and Division of Critical Care, University of Calgary, Calgary, Alta. (Kortbeek); the Institut national d'excellence en santé et en services sociaux, Québec, Que. (Clément); the Department of Surgery, Université Laval, Québec, Que. (Clément); and the Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Que. (Lauzier, Turgeon)
| | - Richard Simons
- From the Department of Social and Preventative Medicine, Université Laval, Québec, Que. (Moore); the Axe Santé des Populations et Pratiques Optimales en Santé, Traumatologie-Urgence-Soins intensifs, Centre de Recherche du CHU de Québec, Hôpital de l'Enfant-Jésus, Université Laval, Québec, Que. (Moore, Lauzier, Turgeon); the Department of Surgery, University of Calgary, Calgary, Alta. (Yanchar); the Department of Surgery, University of British Columbia, Vancouver, BC (Evans, Thakore, Hameed); the Department of Critical Care Medicine, Medicine and Community Health Sciences (Stelfox), O'Brien Institute for Public Health, University of Calgary, Calgary, Alta. (Stelfox); the Department of Surgery, Division of General Surgery and Division of Critical Care, University of Calgary, Calgary, Alta. (Kortbeek); the Institut national d'excellence en santé et en services sociaux, Québec, Que. (Clément); the Department of Surgery, Université Laval, Québec, Que. (Clément); and the Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Que. (Lauzier, Turgeon)
| | - John Kortbeek
- From the Department of Social and Preventative Medicine, Université Laval, Québec, Que. (Moore); the Axe Santé des Populations et Pratiques Optimales en Santé, Traumatologie-Urgence-Soins intensifs, Centre de Recherche du CHU de Québec, Hôpital de l'Enfant-Jésus, Université Laval, Québec, Que. (Moore, Lauzier, Turgeon); the Department of Surgery, University of Calgary, Calgary, Alta. (Yanchar); the Department of Surgery, University of British Columbia, Vancouver, BC (Evans, Thakore, Hameed); the Department of Critical Care Medicine, Medicine and Community Health Sciences (Stelfox), O'Brien Institute for Public Health, University of Calgary, Calgary, Alta. (Stelfox); the Department of Surgery, Division of General Surgery and Division of Critical Care, University of Calgary, Calgary, Alta. (Kortbeek); the Institut national d'excellence en santé et en services sociaux, Québec, Que. (Clément); the Department of Surgery, Université Laval, Québec, Que. (Clément); and the Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Que. (Lauzier, Turgeon)
| | - Julien Clément
- From the Department of Social and Preventative Medicine, Université Laval, Québec, Que. (Moore); the Axe Santé des Populations et Pratiques Optimales en Santé, Traumatologie-Urgence-Soins intensifs, Centre de Recherche du CHU de Québec, Hôpital de l'Enfant-Jésus, Université Laval, Québec, Que. (Moore, Lauzier, Turgeon); the Department of Surgery, University of Calgary, Calgary, Alta. (Yanchar); the Department of Surgery, University of British Columbia, Vancouver, BC (Evans, Thakore, Hameed); the Department of Critical Care Medicine, Medicine and Community Health Sciences (Stelfox), O'Brien Institute for Public Health, University of Calgary, Calgary, Alta. (Stelfox); the Department of Surgery, Division of General Surgery and Division of Critical Care, University of Calgary, Calgary, Alta. (Kortbeek); the Institut national d'excellence en santé et en services sociaux, Québec, Que. (Clément); the Department of Surgery, Université Laval, Québec, Que. (Clément); and the Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Que. (Lauzier, Turgeon)
| | - François Lauzier
- From the Department of Social and Preventative Medicine, Université Laval, Québec, Que. (Moore); the Axe Santé des Populations et Pratiques Optimales en Santé, Traumatologie-Urgence-Soins intensifs, Centre de Recherche du CHU de Québec, Hôpital de l'Enfant-Jésus, Université Laval, Québec, Que. (Moore, Lauzier, Turgeon); the Department of Surgery, University of Calgary, Calgary, Alta. (Yanchar); the Department of Surgery, University of British Columbia, Vancouver, BC (Evans, Thakore, Hameed); the Department of Critical Care Medicine, Medicine and Community Health Sciences (Stelfox), O'Brien Institute for Public Health, University of Calgary, Calgary, Alta. (Stelfox); the Department of Surgery, Division of General Surgery and Division of Critical Care, University of Calgary, Calgary, Alta. (Kortbeek); the Institut national d'excellence en santé et en services sociaux, Québec, Que. (Clément); the Department of Surgery, Université Laval, Québec, Que. (Clément); and the Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Que. (Lauzier, Turgeon)
| | - Alexis F Turgeon
- From the Department of Social and Preventative Medicine, Université Laval, Québec, Que. (Moore); the Axe Santé des Populations et Pratiques Optimales en Santé, Traumatologie-Urgence-Soins intensifs, Centre de Recherche du CHU de Québec, Hôpital de l'Enfant-Jésus, Université Laval, Québec, Que. (Moore, Lauzier, Turgeon); the Department of Surgery, University of Calgary, Calgary, Alta. (Yanchar); the Department of Surgery, University of British Columbia, Vancouver, BC (Evans, Thakore, Hameed); the Department of Critical Care Medicine, Medicine and Community Health Sciences (Stelfox), O'Brien Institute for Public Health, University of Calgary, Calgary, Alta. (Stelfox); the Department of Surgery, Division of General Surgery and Division of Critical Care, University of Calgary, Calgary, Alta. (Kortbeek); the Institut national d'excellence en santé et en services sociaux, Québec, Que. (Clément); the Department of Surgery, Université Laval, Québec, Que. (Clément); and the Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Que. (Lauzier, Turgeon)
| |
Collapse
|