Browsing by Author "Ghali, William"

Now showing 1 - 14 of 14
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    Administrative Coding of Type 1 and Type 2 Diabetes: Assessment of Validity and Implications of Coding Practices ob Outcome Evaluation
    (2013-10-01) Burs, Simona; Rabi, Doreen; Ghali, William
    Rationale: Administrative coding of diabetes mellitus is a difficult task. Objectives: to evaluate misclassification of diabetes status and type, examine contributors to classification uncertainty and explore how difficult cases are perceived by health professionals. Methods: A chart review was performed to validate coding of diabetes type in two data sources. The presence or absence of key clinical information and documentation deficiencies were evaluated. Health professionals were surveyed regarding classification of uncertain cases. Results: 1) Misclassification of diabetes status and type were higher in APPROACH (7.1% and 6.4%) than in ICD-10 (3.6% and 4.3%); 2) treatment with insulin was associated with classification uncertainty (Χ2=36.16; p<0.001); 3) documentation deficiencies were prevalent and were higher in the uncertain classification group (30% vs. 18%). Conclusions: This thesis highlights some elements related to diabetes misclassification. Clear documentation by physicians is required to improve administrative coding of diabetes. Improving administrative data quality may lead to improved outcomes. Keywords: administrative coding, diabetes mellitus, misclassification, insulin
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    An Economic Evaluation of a Novel Electronic Discharge Communication Tool
    (2017) Sevick, Laura; Clement, Fiona; Ghali, William; Santana, Maria
    The transition from acute-care hospitalization to community-based care is a vulnerable period in healthcare delivery due to potential for post-discharge adverse events. This vulnerability has been attributed to the miscommunication between acute and community-based physicians, as current systems do not control for legibility, completeness or timeliness of the discharge summary. One potential approach to bridging this communication gap is the use of electronic discharge communication tools, which can be designed to ensure the consistent and timely transfer of information. Given the limited healthcare budget, the costs and benefits of these tools should be considered prior to large scale implementation. Thus, the goal of this thesis is to establish the cost-effectiveness of electronic discharge communication tools. To achieve this, a systematic review of published literature was conducted (Chapter 2), a prospective economic evaluation of a novel electronic discharge communication tool was completed (Chapter 3), and policy options/considerations were presented (Chapter 4).
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    An assessment of the efficacy of searching in biomedical databases beyond MEDLINE in identifying studies for a systematic review on ward closures as an infection control intervention to control outbreaks
    (BioMed Central, 2014-11-11) Kwon, Yoojin; Powelson, Susan; Wong, Holly; Ghali, William; Conly, John
    Background The purpose of our study is to determine the value and efficacy of searching biomedical databases beyond MEDLINE for systematic reviews. Methods We analyzed the results from a systematic review conducted by the authors and others on ward closure as an infection control practice. Ovid MEDLINE including In-Process & Other Non-Indexed Citations, Ovid Embase, CINAHL Plus, LILACS, and IndMED were systematically searched for articles of any study type discussing ward closure, as were bibliographies of selected articles and recent infection control conference abstracts. Search results were tracked, recorded, and analyzed using a relative recall method. The sensitivity of searching in each database was calculated. Results Two thousand ninety-five unique citations were identified and screened for inclusion in the systematic review: 2,060 from database searching and 35 from hand searching and other sources. Ninety-seven citations were included in the final review. MEDLINE and Embase searches each retrieved 80 of the 97 articles included, only 4 articles from each database were unique. The CINAHL search retrieved 35 included articles, and 4 were unique. The IndMED and LILACS searches did not retrieve any included articles, although 75 of the included articles were indexed in LILACS. The true value of using regional databases, particularly LILACS, may lie with the ability to search in the language spoken in the region. Eight articles were found only through hand searching. Conclusions Identifying studies for a systematic review where the research is observational is complex. The value each individual study contributes to the review cannot be accurately measured. Consequently, we could not determine the value of results found from searching beyond MEDLINE, Embase, and CINAHL with accuracy. However, hand searching for serendipitous retrieval remains an important aspect due to indexing and keyword challenges inherent in this literature.
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    Evaluating geographic access to cardiac catheterization facilities to inform regionalized models of care for acute myocardial infarction
    (2012-09-13) Patel, Alka; Ghali, William
    Research has shown that regional acute myocardial infarction (AMI) care models reduce the time to treatment for percutaneous coronary intervention (PCI). By evaluating the areas with timely access it is possible to develop an evidence-based argument for the direct transfer of AMI patients in these areas to hospitals with specialized cardiac care. This program of research will show how applied geography using Geographic Information Systems (GIS), and administrative data can be used to describe current access to urgent, invasive, cardiac care in Canada and to understand the best practices when applying geographic tools to aid in health services planning through four sub-studies. Our results using administrative data suggest changing care over time and trends towards improved outcomes. These findings are in a context of clinical trial evidence in the published literature demonstrating the benefits of early procedural intervention for AMI patients. At the time of our study, we found that approximately 64% of the adult population had access to PCI across Canada, but that the proportion with access varied across provinces based on the distribution of the population and the number of existing facilities. This research also provided evidence that the addition of new facilities could increase the populations with access if placed appropriately. However, the modeling assumptions used for these estimates may not have been ideal for application in a Canadian context. The Canadian emergency medical services (EMS) on-scene intervals and response time intervals in rural areas were longer than those reported and incorporated from US studies. The application of the revised assumptions reduced the population proportion estimated to have access but still appropriately identified the larger areas with gaps in service. This program of research provides support that GIS is a valuable tool for evaluating those areas where regional care models could be implemented based on a specified pre-hospital time constraints. In light of our findings, we encourage researchers to use setting specific assumptions when possible and recognize the importance of understanding how the variations in modeling pre-hospital times can affect the estimated population access.
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    Hospitalizations for Uncomplicated Hypertension: An Ambulatory Care Sensitive Condition
    (2015-12-16) Walker, Robin; Quan, Hude; Ghali, William; Rabi, Doreen; Dixon, Elijah; Jette, Nathalie
    With high-quality community-based primary care, hospitalizations for ambulatory care sensitive conditions (ACSC) are considered avoidable. ACSC are promising healthcare quality indicators widely used internationally, potentially creating opportunity for health care system quality improvement. The overall aim of this thesis was to explore, assess and evaluate ACSC hospitalization as a healthcare quality indicator for one condition, uncomplicated hypertension. We conducted three studies to achieve the aim. Our first study explored ACSC hospitalization rates for uncomplicated hypertension, taking into account important patient characteristics among hypertensive patients. Using population-based data in four provinces we found that the rate of hospitalizations for uncomplicated hypertension has decreased over time, potentially indicating improvement in community care. We found geographic variations in the rate of hospitalizations, potentially signifying disparity among the provinces and those residing in rural versus urban regions. Our second study examined the association between ACSC hospitalizations for uncomplicated hypertension and previous primary care physician (PCP) utilization. Among this population-based cohort of hypertensive patients we found as the frequency of hypertension-related PCP visits increased the adjusted rate of ACSC hospitalizations also increased, even when stratified by demographic and clinical variables. This suggests that hospitalization for uncomplicated hypertension is not reduced with increasing frequency of PCP visits and may not be an appropriate indicator to measure and evaluate patients’ access to primary care. Our final study tested inter-physician reliability of judgments of avoidable hospitalizations for uncomplicated hypertension derived from medical chart review. We found a low proportion of ACSC hospitalizations were rated as avoidable, with poor agreement between physician raters. These findings point either to a need to abandon the use of the ACSC entirely; or alternatively a need to develop explicit criteria for judging avoidability. This research has provided crucial information for the interpretation of ACSC findings for uncomplicated hypertension. The results indicate that the use of this health quality indicator is questionable and may not provide information that is applicable for interventions to improve quality of primary care. At present, ACSC are most appropriately used as a starting point for assessing potential issues in the community which would then require further, more in-depth analysis.
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    Obesity and cardiovascular disease: a multi-modality approach
    (2012) Martin, Billie-Jean; Anderson, Todd J.; Ghali, William
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    Subjective social status and its associations with social vulnerabilities and health
    (2017) Tang, Karen; Ghali, William; Manns, Braden; Rabi, Doreen; Santana, Maria
    BACKGROUND: Subjective social status (SSS) is the perception of where one stands in a social hierarchy, distinct from one’s actual, objective position in this hierarchy. SSS may influence health through behavioral and psychosocial mechanisms. METHODS: We conducted three sub-studies to examine whether SSS affects risk of and outcomes in chronic disease, and to explore the role of health care access and experience of social vulnerabilities in the SSS-health pathway. RESULTS: We found that low SSS is associated with increased risk of 1) cardiovascular disease; 2) hospital readmissions and barriers to health care access; and 3) social vulnerabilities that affect health care access. Having high perceived status in the community appears to mitigate the experience of social vulnerabilities through the ability to mobilize social supports. CONCLUSION: Subjective social status has important associations with health and clinical outcomes. These findings have implications to the development of interventions that aim to reduce disparities.
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    Visualization of reasoning and clinical diagnostic decision making
    (2013-01-09) Altabbaa, Ghazwan; Ghali, William; McLaughlin, Kevin; Hemmelgarn, Brenda; Flemons, Ward
    Background: There is little evidence regarding the effects of reasoning visualization decision support aids on the quality of clinicians’ diagnostic decisions. Methods: To address this evidence gap, we conducted a randomized-controlled study involving 30 participating clinicians from three levels of experience: medical students, residents, and physicians. Two interventions designed to improve the diagnostic approach to pulmonary embolism were assessed: a visualization reasoning task model vs. more traditional didactic lecture. All participants were requested to solve paper-based clinical scenarios. The primary outcome of diagnostic pathway concordance (derived as a ratio of the number of correct diagnostic decision steps divided by the ideal number of diagnostic decision steps in diagnostic algorithms) was measured at baseline (5 clinical scenarios) and after either intervention. Results: The mean of diagnostic pathway concordance improved in both study groups: baseline mean= 0.73, post mean (scenarios 1-10) for the decision support group = 0.90 (p < 0.001, 95% CI: 0.08-0.24); baseline mean= 0.70, post mean (scenarios 1-10) for didactic review group = 0.85 (p < 0.001, 95% CI: 0.06-0.2). There was no statistically significant difference between the two study groups, or between the three levels of participants. Conclusions: Clinical decision support aids that are designed with an evidence-based visual reasoning interface can improve clinicians’ diagnostic pathway concordance. To the extent that such decision support aids can feasibly be implemented in clinical settings, while didactic lectures at crucial moments in patient care cannot, they have potential advantages over the latter.
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    Visualization of reasoning and clinical diagnostic decision making
    (2012) Altabbaa, Ghazwan; Ghali, William
    Background: There is little evidence regarding the effects of reasoning visualization decision support aids on the quality of clinicians' diagnostic decisions. Methods: To address this evidence gap, we conducted a randomized-controlled study involving 30 participating clinicians from three levels of experience: medical students, residents, and physicians. Two interventions designed to improve the diagnostic approach to pulmonary embolism were assessed: a visualization reasoning task model vs. more traditional didactic lecture. All participants were requested to solve paper-based clinical scenarios. The primary outcome of diagnostic pathway concordance ( derived as a ratio of the number of correct diagnostic decision steps divided by the ideal number of diagnostic decision steps in diagnostic algorithms) was measured at baseline (5 clinical scenarios) and after either intervention. Results: The mean of diagnostic pathway concordance improved in both study groups: baseline mean= 0.73, post mean (scenarios 1-10) for the decision support group = 0.90 (p < 0.001, 95% CI: 0.08-0.24); baseline mean= 0.70, post mean (scenarios 1-10) for didactic review group= 0.85 (p < 0.001, 95% CI: 0.06-0.2). There was no statistically significant difference between the two study groups, or between the three levels of participants. Conclusions: Clinical decision support aids that are designed with an evidence­based visual reasoning interface can improve clinicians' diagnostic pathway concordance. To the extent that such decision support aids can feasibly be implemented in clinical settings, while didactic lectures at crucial moments in patient care cannot, they have potential advantages over the latter.