Browsing by Author "Manns, Braden J."

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    Association between routine and standardized blood pressure measurements and left ventricular hypertrophy among patients on hemodialysis
    (BioMed Central, 2010-06-24) Khangura, Jaspreet; Culleton, Bruce F.; Manns, Braden J.; Zhang, Jianguo; Barnieh, Lianne; Walsh, Michael; Klarenbach, Scott W.; Tonelli, Marcello; Sarna, Magdalena; Hemmelgarn, Brenda R.
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    A comparison between alternative primary care physician payment models: A systematic review and policy analysis
    (2020-09-24) Souri, Sepideh; McBrien, Kerry Alison; Chuck, Anderson W.; Manns, Braden J.; Quinn, Amity E.
    Objective: Alternative models of primary care physician payment are being considered by policy-makers as a potential way to contain healthcare expenditures. The purpose of this thesis was to synthesize the evidence for alternative primary care physician payment models on quality and economic outcomes worldwide and to make recommendations with respect to payment models that may improve chronic disease management in Canada. Methods: We first conducted a systematic review, searching selected databases from inception to October 2018, for studies that compared primary care physician payment models. There were no restrictions on language, country, or publication date, however studies were restricted to specific study designs (randomized controlled trial, controlled cohort and interrupted time series). A gray literature search was also conducted. The outcomes considered were quality and access to care, patient and physician satisfaction, clinical outcomes, healthcare utilization and costs. Thirteen studies were selected for synthesis, comparing fee-for-service, capitation, incentive payments, and mixed models. We then identified primary care payment methods currently used in Canada through an environmental scan. We applied evidence from the systematic review to evaluate the impact of the three most promising models on quality, utilization, cost, and implementation feasibility, and made a recommendation. Conclusion: Primary care payment models have moved toward incentive payments and mixed models in recent years, and mixed models have promising effects on cost and utilization overall and for managing chronic disease in primary care in Canada. Incentive payments show low sustainability in quality improvements, and a gap in incentivized and non-incentivized aspects of care. Mixed models have been introduced in primary care in Canada. Based on current evidence, the recommended payment model for Canadian primary care physicians that is most likely to optimize chronic disease management is blended capitation. Future studies should focus on long-term quality improvements and improving the quality of non-incentivized activities in incentive models. Further study would help to elucidate the potential benefit of mixed models, in particular their effect on patient-oriented aspects of care: access, continuity, and quality. More studies are needed to understand how blended capitation payment models affect costs and utilization.
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    A Cost-Effectiveness Analysis of a Decolonization Protocol for Staphylococcus aureus Prior to Hip and Knee Arthroplasty in Alberta, Canada
    (2019-04-30) Rennert-May, Elissa; Manns, Braden J.; Conly, John M.; Smith, Stephanie Wrenn; Puloski, Shannon K. T.; Henderson, Elizabeth Ann; Loeb, Mark
    There are over 100,000 knee/hip replacements yearly in Canada. While these procedures improve mobility and quality of life, approximately 1% develop complex surgical site infections (SSIs) after surgery. Detailed costing analysis of these infections, particularly in Canada, is lacking. We assessed incidence and cost of complex SSIs following primary hip/knee arthroplasty in patients across Alberta. We then evaluated the cost-effectiveness of an evidence-based decolonization protocol in patients prior to hip/knee arthroplasty in Alberta, compared with standard care (no decolonization) using decision analysis. Among 24,667 operations, 1.04% developed a complex SSI. The most common causative pathogen was Staphylococcus aureus (38%). Mean first-year costs for the infected and non-infected cohort were CAN $95,321 (IQR49,623 – 120,636) and $19,893 (IQR12,610 – 19,723), respectively. The decolonization protocol was associated with lower risk of complex SSI and cost savings of $153/person. A decolonization protocol should be considered for implementation in Alberta to reduce infections and save costs.
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    Exploring patient perspectives on the impact of resuming cost sharing: a qualitative analysis
    (2024-11-09) Tran, Sophia H. N.; Fletcher, Jane M.; McSweeney, Breanna; Saunders-Smith, Terry; Manns, Braden J.; Campbell, David J. T.
    Abstract Introduction The ACCESS trial showed that those who received a copayment elimination benefit had a modest improvement in their adherence to medications, but no improvement in clinical outcomes. This is consistent with other studies that have demonstrated that time-limited copayment elimination was welcomed by participants. However, the removal of such benefits can be problematic, as participants may have become accustomed to receiving the benefit, and made changes to their spending that would need to be reconsidered. We aimed to explore participants’ experience with resuming cost sharing for their medications at the end of the ACCESS trial and if this experience influenced their willingness to participate in future trials like ACCESS. Methods We conducted semi-structured interviews with 21 former participants of the ACCESS trial who were receiving the copayment elimination intervention, with discussions focused on the loss of the copayment elimination. The interviews were recorded, transcribed, and analyzed in duplicate using thematic analysis. Results Four primary themes emerged from the analysis, including emotionality regarding loss of benefits; notification of benefit termination, describing tangible losses from coverage ending, but resistance to acknowledging negative impacts; and acceptability of receiving a temporary financial benefit. Many participants described negative emotions around the loss of coverage and concern about affording care for their chronic diseases. Despite negative emotions about the end of their study benefit, participants generally had a positive view of the study and would participate again in a future study of this nature. Conclusion The positive tangible and emotional benefits of the copayment elimination over 3 years outweighed the negative emotions and impacts associated with having to become reaccustomed to life without it. Patient and public contribution Within the ACCESS trial, participants were involved in the design, modification, and implementation of the program using multiple focus groups. The current study aimed to engage patients to provide input on their experience and engagement with the copayment elimination program.
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    Mortality and cardiovascular events in adults with kidney failure after major non-cardiac surgery: a population-based cohort study
    (2021-11-04) Harrison, Tyrone G.; Ronksley, Paul E.; James, Matthew T.; Ruzycki, Shannon M.; Tonelli, Marcello; Manns, Braden J.; Zarnke, Kelly B.; McCaughey, Deirdre; Schneider, Prism; Wick, James; Hemmelgarn, Brenda R.
    Abstract Background People with kidney failure have a high incidence of major surgery, though the risk of perioperative outcomes at a population-level is unknown. Our objective was to estimate the proportion of people with kidney failure that experience acute myocardial infarction (AMI) or death within 30 days of major non-cardiac surgery, based on surgery type. Methods In this retrospective population-based cohort study, we used administrative health data to identify adults from Alberta, Canada with major surgery between April 12,005 and February 282,017 that had preoperative estimated glomerular filtration rates (eGFRs) < 15 mL/min/1.73m2 or received chronic dialysis. The index surgical procedure for each participant was categorized within one of fourteen surgical groupings based on Canadian Classification of Health Interventions (CCI) codes applied to hospitalization administrative datasets. We estimated the proportion of people that had AMI or died within 30 days of the index surgical procedure (with 95% confidence intervals [CIs]) following logistic regression, stratified by surgery type. Results Overall, 3398 people had a major surgery (1905 hemodialysis; 590 peritoneal dialysis; 903 non-dialysis). Participants were more likely male (61.0%) with a median age of 61.5 years (IQR 50.0–72.7). Within 30 days of surgery, 272 people (8.0%) had an AMI or died. The probability was lowest following ophthalmologic surgery at 1.9% (95%CI: 0.5, 7.3) and kidney transplantation at 2.1% (95%CI: 1.3, 3.2). Several types of surgery were associated with greater than one in ten risk of AMI or death, including retroperitoneal (10.0% [95%CI: 2.5, 32.4]), intra-abdominal (11.7% [8.7, 15.5]), skin and soft tissue (12.1% [7.4, 19.1]), musculoskeletal (MSK) (12.3% [9.9, 15.5]), vascular (12.6% [10.2, 15.4]), anorectal (14.7% [6.3, 30.8]), and neurosurgical procedures (38.1% [20.3, 59.8]). Urgent or emergent procedures had the highest risk, with 12.1% experiencing AMI or death (95%CI: 10.7, 13.6) compared with 2.6% (1.9, 3.5) following elective surgery. Conclusions After major non-cardiac surgery, the risk of death or AMI for people with kidney failure varies significantly based on surgery type. This study informs our understanding of surgery type and risk for people with kidney failure. Future research should focus on identifying high risk patients and strategies to reduce these risks.
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    Online clinical pathway for chronic kidney disease management in primary care: a retrospective cohort study
    (2021-10-06) Donald, Maoliosa; Smekal, Michelle D.; Elliott, Meghan J.; McBrien, Kerry; Weaver, Robert G.; Manns, Braden J.; Tonelli, Marcello; Bello, Aminu; Straus, Sharon E.; Scott-Douglas, Nairne; Jindal, Kailash; Hemmelgarn, Brenda R.
    Abstract Background Clinical pathways aim to improve patient care. We sought to determine whether an online chronic kidney disease (CKD) clinical pathway was associated with improvements in CKD management. Methods We conducted a retrospective pre/post population-based cohort study using linked health data from Alberta, Canada. We included adults 18 years or older with mean estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2. The primary outcome was measurement of an outpatient urine albumin creatinine ratio (ACR) in a 28-day period, among people without a test in the prior year. Secondary outcomes included use of guideline-recommended drug therapies (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and statins). Results The study period spanned October 2010 to March 2017. There were 84 independent 28-day periods (53 pre, 31 post pathway implementation) including 345,058 adults. The population was predominantly female (56%) with median age 77 years; most had category 3A CKD (67%) and hypertension (82%). In adjusted segmented regression models, the increase in the rate of change of ACR testing was greatest in Calgary zone (adjusted OR 1.19 per year, 95% CI 1.16–1.21), where dissemination of the pathway was strongest; this increase was more pronounced in those without diabetes (adjusted OR 1.25 per year, 95% CI 1.21–1.29). Small improvements in guideline-concordant medication use were also observed. Conclusions Following implementation of an online CKD clinical pathway, improvements in ACR testing were evident in regions where the pathway was most actively used, particularly among individuals without diabetes.
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    Overview of the Alberta Kidney Disease Network
    (BioMed Central, 2009-10-19) Hemmelgarn, Brenda; Clement, Fiona; Manns, Braden J.; Klarenbach, Scott; James, Matthew T.; Ravani, Pietro; Pannu, Neesh; Ahmed, Sofia B; MacRae, Jennifer; Scott-Douglas, Nairne; Jindal, Kailash; Quinn, Robert; Culleton, Bruce F.; Wiebe, Natasha; Krause, Richard; Thorlacius, Laurel; Tonelli, Marcello
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    Prediction of major postoperative events after non-cardiac surgery for people with kidney failure: derivation and internal validation of risk models
    (2023-03-10) Harrison, Tyrone G.; Hemmelgarn, Brenda R.; James, Matthew T.; Sawhney, Simon; Manns, Braden J.; Tonelli, Marcello; Ruzycki, Shannon M.; Zarnke, Kelly B.; Wilson, Todd A.; McCaughey, Deirdre; Ronksley, Paul E.
    Abstract Background People with kidney failure often require surgery and experience worse postoperative outcomes compared to the general population, but existing risk prediction tools have excluded those with kidney failure during development or exhibit poor performance. Our objective was to derive, internally validate, and estimate the clinical utility of risk prediction models for people with kidney failure undergoing non-cardiac surgery. Design, setting, participants, and measures This study involved derivation and internal validation of prognostic risk prediction models using a retrospective, population-based cohort. We identified adults from Alberta, Canada with pre-existing kidney failure (estimated glomerular filtration rate [eGFR] < 15 mL/min/1.73m2 or receipt of maintenance dialysis) undergoing non-cardiac surgery between 2005–2019. Three nested prognostic risk prediction models were assembled using clinical and logistical rationale. Model 1 included age, sex, dialysis modality, surgery type and setting. Model 2 added comorbidities, and Model 3 added preoperative hemoglobin and albumin. Death or major cardiac events (acute myocardial infarction or nonfatal ventricular arrhythmia) within 30 days after surgery were modelled using logistic regression models. Results The development cohort included 38,541 surgeries, with 1,204 outcomes (after 3.1% of surgeries); 61% were performed in males, the median age was 64 years (interquartile range [IQR]: 53, 73), and 61% were receiving hemodialysis at the time of surgery. All three internally validated models performed well, with c-statistics ranging from 0.783 (95% Confidence Interval [CI]: 0.770, 0.797) for Model 1 to 0.818 (95%CI: 0.803, 0.826) for Model 3. Calibration slopes and intercepts were excellent for all models, though Models 2 and 3 demonstrated improvement in net reclassification. Decision curve analysis estimated that use of any model to guide perioperative interventions such as cardiac monitoring would result in potential net benefit over default strategies. Conclusions We developed and internally validated three novel models to predict major clinical events for people with kidney failure having surgery. Models including comorbidities and laboratory variables showed improved accuracy of risk stratification and provided the greatest potential net benefit for guiding perioperative decisions. Once externally validated, these models may inform perioperative shared decision making and risk-guided strategies for this population.
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    Validation of a case definition to define chronic dialysis using outpatient administrative data
    (BioMed Central, 2011-03-01) Clement, Fiona M.; James, Matthew T; Chin, Rick; Klarenbach, Scott W.; Manns, Braden J.; Quinn, Robert R.; Ravani, Pietro; Tonelli, Marcello; Hemmelgarn, Brenda R.; Alberta Kidney Disease Network