Browsing by Author "McBrien, Kerry Alison"

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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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    Cost-effectiveness of screening and treatment for schistosomiasis among refugees coming to Canada
    (2019-01-14) Webb, John Angus; McBrien, Kerry Alison; Spackman, David Eldon; Vaughan, Stephen; Heitman, Steven James; Fabreau, Gabriel E.
    Background: Depending on their countries of origin, between 12% and 73% of resettled refugees and asylum seekers from endemic countries are infected with schistosomiasis when they arrive in Canada. Many are asymptomatic, but they are at risk for complications that may develop decades later. In Canada, clinicians previously practiced watchful waiting, treating patients if they developed symptoms; but in 2011 new guidelines recommended screening and treatment instead. In the United States, refugees from Africa are presumptively treated for schistosomiasis before they leave their country of origin. The cost-effectiveness of screening or presumptive treatment for schistosomiasis has never been studied. Methods: We constructed a decision-tree model to examine the cost-effectiveness of three management strategies: watchful waiting; screening and treatment; and presumptive treatment. We obtained model data from the literature and other sources, predicting deaths and chronic complications caused by schistosomiasis; as well as costs, and net monetary benefit. Results: Presumptive treatment was cost-saving if the prevalence of schistosomiasis in the target population was greater than 2.4%. In our base case analysis, presumptive treatment was associated with an increase of 0.15 quality-adjusted life years and a cost savings of $383 per person, compared to watchful waiting. It was also more effective and less costly than screening and treatment. Interpretation: Presumptive treatment for schistosomiasis among recently resettled refugees and asylum claimants to Canada is less costly and more effective than watchful waiting or screening and treatment, in groups with prevalence greater than 2.4%. Our results support a revision of the current Canadian guidelines.
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    Enhancing Primary Care Electronic Medical Record (EMR) Data in Alberta by Quality Assessment, Data Processing, and Linkage to Administrative Data
    (2020-07-01) Garies, Stephanie; Quan, Hude; Williamson, Tyler S.; Drummond, Neil A.; McBrien, Kerry Alison
    The growth of electronic medical record (EMR) systems in healthcare settings has created opportunities for EMR data to be reused for secondary purposes. Since EMR data are generated from clinical and administrative processes, the suitability for other uses (e.g. surveillance or research) is questionable. Assessing data quality is important for understanding the database contents, identifying potential limitations or biases, and determining how ‘fit for purpose’ the data are. This thesis focused on evaluating and improving the quality of primary care EMR data in Alberta. Data quality, which is highly contextual, was examined from the perspective of use for hypertension surveillance, as hypertension is a prevalent chronic condition associated with poor health outcomes and high cost implications. The first part of this thesis involved developing a comprehensive description of EMR data capture, extraction, and processing by the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) in Alberta. The second section presented a data quality assessment using CPCSSN data elements relevant to hypertension surveillance. The third part explored multiple imputation and a pattern-matching algorithm for improving smoking status records in the EMR data. Lastly, EMR and administrative data for a cohort of hypertensive patients were linked and described. The CPCSSN process documentation and data quality assessment created novel, useful, and comprehensive information for data users. CPCSSN data appear to be suitable for hypertension surveillance, though caution is warranted for several variables of inconsistent quality. Multiple imputation improved completeness of patient smoking statuses, but the lack of an appropriate external reference source made confirming accuracy difficult. The pattern-matching algorithm demonstrated high accuracy for categorizing smoking status; however, it missed classifying 24% of patients. Lastly, EMR data for 6,307 hypertensive patients were successfully linked to five administrative databases. Although this linked sample is relatively small and may be subject to selection bias (limiting the generalizability for surveillance purposes), the cohort could be useful for health outcomes research or validating elements in the EMR or administrative databases. This work has informed the development of more efficient processes for EMR-administrative linkages. Data quality assessment outcomes will be made available to inform various types of CPCSSN data users.
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    Forecasting the Future: A Trek through the Changing Landscape of Inflammatory Bowel Disease
    (2019-06-06) Coward, Stephanie; Kaplan, Gilaad G.; Clement, Fiona M.; McBrien, Kerry Alison; Hazlewood, Glen S.; Congly, Stephen E.
    Inflammatory bowel disease (IBD) is an immune-mediated disease of the gastrointestinal tract. It imparts a lifelong burden once diagnosed, which can lead to medication reliance, hospitalizations, and surgeries. Previous research has elucidated the current state of knowledge on IBD, but what is missing from the field are analyses of IBD-related outcomes within a specific population, and analyses of what these outcomes mean for the future of IBD in that population.1,2 Therefore, the aim of this thesis is to give an overarching understanding of the current burden of IBD; forecast the future burden; and, illustrate what these findings mean for the future of Canadians and our healthcare systems. Administrative data were used to identify prevalent cases from seven provinces (95% of the Canadian population). In Alberta specifically, prevalent and incident cases were isolated and data on hospitalizations, surgeries, medications, and all-cause mortality data were obtained. Using regression analyses, temporal trends of prevalence, incidence, hospitalization (total, IBD-related, and IBD-specific), surgery, biologics (an expensive medication increasing in popularity for the treatment of IBD), and mortality were analyzed. Data on prevalence from all seven provinces were analyzed and forecasted to 2030. Alberta-specific data were used to forecast incidence to 2030, and hospitalizations and surgeries to 2021. Overall, the prevalence of IBD in Canada is significantly increasing. By 2030, an estimated 402,853 Canadians will be living with IBD. In Alberta, incidence is forecasted to continue to significantly decrease from 2015 through to 2030. Hospitalizations and surgeries have also been significantly decreasing in Alberta and are forecasted to continue decreasing through to 2021. The proportion of patients dispensed biologics has been significantly increasing, which is indicative of an increasing utilization of this medication. Finally, the mortality rate has remained stable. While the decrease of adverse IBD-related outcomes (e.g., hospitalization and surgery) prove to be beneficial for patients with IBD and healthcare systems, the significant increase in the number of people with the disease may still overwhelm the system and inhibit patients from receiving necessary care.