Browsing by Author "Ronksley, Paul E"

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    Clinical factors contributing to high cost hospitalizations in a Canadian tertiary care centre
    (BioMed Central, 2017-11-25) Rashidi, Babak; Kobewka, Daniel M; Campbell, David J T; Forster, Alan J; Ronksley, Paul E
    Background Like much of the developed world, healthcare costs in Canada are rising. A small proportion of patients account for a large proportion of healthcare spending and much of this spending occurs in acute care settings. The purpose of our study was to determine potentially modifiable factors related to care processes that contribute to high-cost admissions. Methods Using a mixed-methods study design, factors contributing to high-cost admissions were identified from literature and case review. We defined pre- and post-admission factors contributing to high-cost admissions. Pre-admission factors included reason for admission (e.g. complex medical, elective surgery, trauma, etc.). Post-admission factors included medical complications, disposition delays, clinical services delays, and inefficient clinical decision-making. We selected a random sample of admissions in the top decile of inpatient cost from the Ottawa Hospital between January 1 and December 31, 2010. A single reviewer classified cases based on the pre- and post-admission factors. We combined this information with data derived from the Ottawa Hospital Data Warehouse to describe patient-level clinical and demographic characteristics and costs incurred. Results We reviewed 200 charts which represents ~5% of all high cost admissions within the Ottawa Hospital in 2010. Post-admission factors contributing to high-cost admissions were: complications (60%), disposition delays (53%), clinical service delays (39%), and inefficient clinical decision-making (13%). Further, these factors varied substantially across service delivery lines. The mean (standard deviation (SD)) cost per admission was $49,923 CDN ($45,773). The most common reason for admission was “complex medical” (49%) and the overall median (IQR) length of stay was 27 (18–48) days. Approximately 1 in 3 high cost admissions (29%) included time in the intensive care unit (ICU). Conclusions While high cost admissions often include time in ICU and have long lengths of stay, a substantial proportion of costs were attributable to complications and potentially preventable delays in care processes. These findings suggest opportunities exist to improve outcomes and reduce costs for this diverse patient population.
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    Clinical factors contributing to high cost hospitalizations in a Canadian tertiary care centre
    (2017-11-25) Rashidi, Babak; Kobewka, Daniel M; Campbell, David J T; Forster, Alan J; Ronksley, Paul E
    Abstract Background Like much of the developed world, healthcare costs in Canada are rising. A small proportion of patients account for a large proportion of healthcare spending and much of this spending occurs in acute care settings. The purpose of our study was to determine potentially modifiable factors related to care processes that contribute to high-cost admissions. Methods Using a mixed-methods study design, factors contributing to high-cost admissions were identified from literature and case review. We defined pre- and post-admission factors contributing to high-cost admissions. Pre-admission factors included reason for admission (e.g. complex medical, elective surgery, trauma, etc.). Post-admission factors included medical complications, disposition delays, clinical services delays, and inefficient clinical decision-making. We selected a random sample of admissions in the top decile of inpatient cost from the Ottawa Hospital between January 1 and December 31, 2010. A single reviewer classified cases based on the pre- and post-admission factors. We combined this information with data derived from the Ottawa Hospital Data Warehouse to describe patient-level clinical and demographic characteristics and costs incurred. Results We reviewed 200 charts which represents ~5% of all high cost admissions within the Ottawa Hospital in 2010. Post-admission factors contributing to high-cost admissions were: complications (60%), disposition delays (53%), clinical service delays (39%), and inefficient clinical decision-making (13%). Further, these factors varied substantially across service delivery lines. The mean (standard deviation (SD)) cost per admission was $49,923 CDN ($45,773). The most common reason for admission was “complex medical” (49%) and the overall median (IQR) length of stay was 27 (18–48) days. Approximately 1 in 3 high cost admissions (29%) included time in the intensive care unit (ICU). Conclusions While high cost admissions often include time in ICU and have long lengths of stay, a substantial proportion of costs were attributable to complications and potentially preventable delays in care processes. These findings suggest opportunities exist to improve outcomes and reduce costs for this diverse patient population.
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    Data enhancement for co-morbidity measurement among patients referred for sleep diagnostic testing: an observational study
    (BioMed Central, 2009-07-15) Ronksley, Paul E; Tsai, Willis H; Quan, Hude; Faris, Peter; Hemmelgarn, Brenda
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    Evaluation of interventions to improve electronic health record documentation within the inpatient setting: a protocol for a systematic review
    (2019-02-13) Otero Varela, Lucia; Wiebe, Natalie; Niven, Daniel J; Ronksley, Paul E; Iragorri, Nicolas; Robertson, Helen L; Quan, Hude
    Abstract Background Electronic health records (EHRs) are increasing in popularity across national and international healthcare systems. Despite their augmented availability and use, the quality of electronic health records is problematic. There are various reasons for poor documentation quality within the EHR, and efforts have been made to address these areas. Previous systematic reviews have assessed intervention effectiveness within the outpatient setting or within paper documentation. This systematic review aims to assess the effectiveness of different interventions seeking to improve EHR documentation within an inpatient setting. Methods We will employ a comprehensive search strategy that encompasses four distinct themes: EHR, documentation, interventions, and study design. Four databases (MEDLINE, EMBASE, CENTRAL, and CINAHL) will be searched along with an in-depth examination of the grey literature and reference lists of relevant articles. A customized hybrid study quality assessment tool has been designed, integrating components of the Downs and Black and Newcastle-Ottawa Scales, into a REDCap data capture form to facilitate data extraction and analysis. Given the predicted high heterogeneity between studies, it may not be possible to standardize data for a quantitative comparison and meta-analysis. Thus, data will be synthesized in a narrative, semi-quantitative manner. Discussion This review will summarize the current level of evidence on the effectiveness of interventions implemented to improve inpatient EHR documentation, which could ultimately enhance data quality in administrative health databases. Systematic review registration PROSPERO CRD42017083494
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    Identification of validated case definitions for chronic disease using electronic medical records: a systematic review protocol
    (2017-02-23) Souri, Sepideh; Symonds, Nicola E; Rouhi, Azin; Lethebe, Brendan C; Garies, Stephanie; Ronksley, Paul E; Williamson, Tyler S; Fabreau, Gabriel E; Birtwhistle, Richard; Quan, Hude; McBrien, Kerry A
    Abstract Background Primary care electronic medical record (EMR) data are being used for research, surveillance, and clinical monitoring. To broaden the reach and usability of EMR data, case definitions must be specified to identify and characterize important chronic conditions. The purpose of this study is to identify all case definitions for a set of chronic conditions that have been tested and validated in primary care EMR and EMR-linked data. This work will provide a reference list of case definitions, together with their performance metrics, and will identify gaps where new case definitions are needed. Methods We will consider a set of 40 chronic conditions, previously identified as potentially important for surveillance in a review of multimorbidity measures. We will perform a systematic search of the published literature to identify studies that describe case definitions for clinical conditions in EMR data and report the performance of these definitions. We will stratify our search by studies that use EMR data alone and those that use EMR-linked data. We will compare the performance of different definitions for the same conditions and explore the influence of data source, jurisdiction, and patient population. Discussion EMR data from primary care providers can be compiled and used for benefit by the healthcare system. Not only does this work have the potential to further develop disease surveillance and health knowledge, EMR surveillance systems can provide rapid feedback to participating physicians regarding their patients. Existing case definitions will serve as a starting point for the development and validation of new case definitions and will enable better surveillance, research, and practice feedback based on detailed clinical EMR data. Systematic review registration PROSPERO CRD42016040020
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    Physical Activity and Psychiatric Hospitalizations among Canadian Adolescents and Young Adults: A Longitudinal Study Utilizing Record Linkage
    (2022-12-14) Fahim, Mina; Patten, Scott B; Ronksley, Paul E; Fidler-Benaoudia, Miranda M
    Background: Overwhelming evidence suggests that physical activity in adolescence promotes mental health and prevents mental illness; however, fewer studies have examined these effects in young adults. Furthermore, there is a paucity of research exploring the relationship between physical activity and utilization of mental health services. This study aimed to address these gaps and provide meaningful information for the promotion of physical activity in Canada.Objective: To utilize nationally linked datasets and explore the longitudinal associations between physical activity among Canadian adolescents and young adults (AYAs; 12-24 years) and incidence of psychiatric hospitalizations.Methods: We used data from the Canadian Community Health Survey (CCHS; 2001-2014) linked to the Discharge Abstract Database (DAD; 1999-2018). Physical activity was measured among AYAs from the CCHS, and psychiatric hospitalizations were identified in the DAD. Negative binomial regression analyses were performed on each CCHS cycle to obtain incidence rate ratios (IRRs) for psychiatric hospitalizations by level of physical activity, which were subsequently meta-analyzed to obtain pooled estimates.Results: In total, 96,100 participants were recruited across eleven survey cycles. Adolescents were more physically active (52%) compared to young adults (39%). The incidence rate of psychiatric hospitalizations was 1.10 per 100,000 person-days in the 2001 cycle and 1.46 in the 2014 cycle. The most common reason for a psychiatric hospitalization was for mood or anxiety disorders (38%). Crude analyses showed no significant differences between levels of physical activity; however, fully adjusted models found that moderately active (IRR= 1.30; 95% CI: 1.02-1.66; p= 0.01) and inactive (IRR= 1.33; 95% CI: 1.06-1.66; p= 0.01) participants had significantly higher rates of psychiatric hospitalizations compared to active participants. Conclusions: These results suggest that lower levels of physical activity during adolescence and young adulthood may increase rates of subsequent psychiatric hospitalizations. This provides valuable information to policy makers looking to implement mental illness prevention strategies through physical activity and lays the foundation for future studies with similar aims.
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    Use of Electronic Data and Existing Screening Tools to Identify Clinically Significant Obstructive Sleep Apnea
    (2015-01-01) Severson, Carl A; Pendharkar, Sachin R; Ronksley, Paul E; Tsai, Willis H
    OBJECTIVES: To assess the ability of electronic health data and existing screening tools to identify clinically significant obstructive sleep apnea (OSA), as defined by symptomatic or severe OSA.METHODS: The present retrospective cohort study of 1041 patients referred for sleep diagnostic testing was undertaken at a tertiary sleep centre in Calgary, Alberta. A diagnosis of clinically significant OSA or an alternative sleep diagnosis was assigned to each patient through blinded independent chart review by two sleep physicians. Predictive variables were identified from online questionnaire data, and diagnostic algorithms were developed. The performance of electronically derived algorithms for identifying patients with clinically significant OSA was determined. Diagnostic performance of these algorithms was compared with versions of the STOP-Bang questionnaire and adjusted neck circumference score (ANC) derived from electronic data.RESULTS: Electronic questionnaire data were highly sensitive (>95%) at identifying clinically significant OSA, but not specific. Sleep diagnostic testing-determined respiratory disturbance index was very specific (specificity ≥95%) for clinically relevant disease, but not sensitive (ud_less_than35%). Derived algorithms had similar accuracy to the STOP-Bang or ANC, but required fewer questions and calculations.CONCLUSIONS: These data suggest that a two-step process using a small number of clinical variables (maximizing sensitivity) and objective diagnostic testing (maximizing specificity) is required to identify clinically significant OSA. When used in an online setting, simple algorithms can identify clinically relevant OSA with similar performance to existing decision rules such as the STOP-Bang or ANC.