Regional Variation in the Management of Metastatic Gastric Cancer in Ontario

Mahar, Alyson; Coburn, Natalie; Kagedan, Daniel J.; Viola, Raymond; Johnson, Ana

doi:10.3747/co.23.3123

Cited by 11 publications

(9 citation statements)

References 32 publications

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“…This may be due, in part, to the maturity of the HIV care infrastructure in the province. Previous studies of inter-provincial variation in HIV testing rates have suggested that coordinating all HIV care in the province through a single center may produce better outcomes, by allowing for closer monitoring of PLHIV and better control over standards of care [35], and regional variation tends to be larger when well-defined standards of care and guidelines are absent [2]. Furthermore, the small variation in ART costs among those receiving ART, is likely a result of the evolution of ART treatment, with simpler and safer regimens [36], easing some of the burden on rural health regions by lessening the requirement for highly-specialized clinics and physicians to treat PLHIV effectively [30].…”

Section: Discussionmentioning

confidence: 99%

“…Regional variation in health care costs after adjustment for demographic and clinical factors can be indicative of inequities or a lack of well-defined clinical practice [1, 2]. This topic has been the subject of considerable research in the United States and elsewhere [1, 3–5], primarily to facilitate performance-based reimbursement or identify potentially inefficient health care providers [1].…”

Section: Introductionmentioning

confidence: 99%

“…This topic has been the subject of considerable research in the United States and elsewhere [1, 3–5], primarily to facilitate performance-based reimbursement or identify potentially inefficient health care providers [1]. While many of the drivers of regional disparities (which include variation in insurance coverage, multiple care providers, and other potential barriers to access [6, 7]) may not be applicable in single-payer systems [8], regional variation was nonetheless identified among individuals with gastric cancer in Ontario [2], as well as among stroke patients in Alberta, though this was found to be diminishing over time [9]. In British Columbia, variation in healthcare costs was found to be modest in the general population after adjusting for individuals’ characteristics [8].…”

Section: Introductionmentioning

confidence: 99%

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Geographic variation in the costs of medical care for people living with HIV in British Columbia, Canada

Enns

Min

Panagiotoglou

et al. 2019

BMC Health Serv Res

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Background Regional variation in medical care costs can indicate heterogeneity in clinical practice, inequities in access, or inefficiencies in service delivery. We aimed to estimate regional variation in medical costs for people living with HIV (PLHIV), adjusting for demographics and case-mix. Methods We conducted a retrospective cohort study using linked health administrative databases of PLHIV, from 2010 to 2014, in British Columbia (BC), Canada. Quarterly health care costs (2018 CAD) were derived from inpatient, outpatient, prescription drugs, antiretroviral therapy (ART), and HIV diagnostics. We used a two-part model with a logit link for the probability of incurring costs, and a log link and gamma distribution for observations with positive costs. We also estimated quarterly utilization rates for hospitalization-, physician billing- and prescription drug-days. Primary variables were indicators of individuals’ Health Service Delivery Area (HSDA). We adjusted cost and utilization estimates for demographic characteristics, HIV-disease progression, and comorbidities. Results Our cohort included 9577 PLHIV (median age 45.5 years, 80% male). Adjusted total quarterly costs for all 16 HSDAs were within 20% of the provincial mean, 8/16 for hospitalization costs, 16/16 for physician billing costs and 10/16 for prescription drug costs. Northern Interior and Northeast HSDAs had 38 and 44% lower quarterly non-ART prescription drug costs, and 2 and 5% higher quarterly inpatient costs, respectively. Conclusions We observed limited variation in medical care costs and utilization among PLHIV in BC. However, lower levels of outpatient care and higher levels of inpatient care indicate possible barriers to accessing care among PLHIV in the most rural regions of the province. Electronic supplementary material The online version of this article (10.1186/s12913-019-4391-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Geographic variation in the costs of medical care for people living with HIV in British Columbia, Canada

Enns

Min

Panagiotoglou

et al. 2019

BMC Health Serv Res

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“…When adequately validated, these databases can provide important data such length of stay and related costs, 31 important outcomes such as adverse events 32 33 as well as variations in healthcare resource utilisation. 34 Indeed, administrative databases are readily available for the whole of Italy, whereas cancer registry data are not. Thus, our proposed validation method using a well-defined case definition can be a good alternative in settings in which cancer registries are not available in Italy.…”

Section: Discussionmentioning

confidence: 99%

Sensitivity and specificity of breast cancer ICD-9-CM codes in three Italian administrative healthcare databases: a diagnostic accuracy study

Abraha

Serraino

Montedori³

et al. 2018

BMJ Open

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ObjectivesTo assess the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in identifying patients diagnosed with incident carcinoma in situ and invasive breast cancer in three Italian administrative databases.DesignA diagnostic accuracy study comparing ICD-9-CM codes for carcinoma in situ (233.0) and for invasive breast cancer (174.x) with medical chart (as a reference standard). Case definition: (1) presence of a primary nodular lesion in the breast and (2) cytological or histological documentation of cancer from a primary or metastatic site.SettingAdministrative databases from Umbria Region, Azienda Sanitaria Locale (ASL) Napoli 3 Sud (NA) and Friuli VeneziaGiulia (FVG) Region.ParticipantsWomen with breast carcinoma in situ (n=246) or invasive breast cancer (n=384) diagnosed (in primary position) between 2012 and 2014.Outcome measuresSensitivity and specificity for codes 233.0 and 174.x.ResultsFor invasive breast cancer the sensitivities were 98% (95% CI 93% to 99%) for Umbria, 96% (95% CI 91% to 99%) for NA and 100% (95% CI 97% to 100%) for FVG. Specificities were 90% (95% CI 82% to 95%) for Umbria, 91% (95% CI 83% to 96%) for NA and 91% (95% CI 84% to 96%) for FVG.For carcinoma in situ the sensitivities were 100% (95% CI 93% to 100%) for Umbria, 100% (95% CI 95% to 100%) for NA and 100% (95% CI 96% to 100%) for FVG. Specificities were 98% (95% CI 93% to 100%) for Umbria, 86% (95% CI 78% to 92%) for NA and 90% (95% CI 82% to 95%) for FVG.ConclusionsAdministrative healthcare databases from Umbria, NA and FVG are accurate in identifying hospitalised news cases of carcinoma of the breast. The proposed case definition is a powerful tool to perform research on large populations of newly diagnosed patients with breast cancer.

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“…This will be a pragmatic, multicentre, waitlist group-controlled, investigator and analyst-blinded, 3-arm parallel-group superiority RCT with 1:1:1 allocation (figure 2). Randomisation will be stratified by recruitment site to account for differences in care across centres34 with block sizes of 6 and 9 within each stratum. Reporting of this protocol is in accordance with the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines35 (see online supplementary additional file for SPIRIT checklist).…”

Section: Methodsmentioning

confidence: 99%

Pain Squad+ smartphone app to support real-time pain treatment for adolescents with cancer: protocol for a randomised controlled trial

et al. 2020

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IntroductionPain negatively affects the health-related quality of life (HRQL) of adolescents with cancer. The Pain Squad+ smartphone-based application (app), has been developed to provide adolescents with real-time pain self-management support. The app uses a validated pain assessment and personalised pain treatment advice with centralised decision support via a registered nurse to enable real-time pain treatment in all settings. The algorithm informing pain treatment advice is evidence-based and expert-vetted. This trial will longitudinally evaluate the impact of Pain Squad+, with or without the addition of nurse support, on adolescent health and cost outcomes.Methods and analysisThis will be a pragmatic, multicentre, waitlist controlled, 3-arm parallel-group superiority randomised trial with 1:1:1 allocation enrolling 74 adolescents with cancer per arm from nine cancer centres. Participants will be 12 to 18 years, English-speaking and with ≥3/10 pain. Exclusion criteria are significant comorbidities, end-of-life status or enrolment in a concurrent pain study. The primary aim is to determine the effect of Pain Squad+, with and without nurse support, on pain intensity in adolescents with cancer, when compared with a waitlist control group. The secondary aims are to determine the immediate and sustained effect over time of using Pain Squad+, with and without nurse support, as per prospective outcome measurements of pain interference, HRQL, pain self-efficacy and cost. Linear mixed models with baseline scores as a covariate will be used. Qualitative interviews with adolescents from all trial arms will be conducted and analysed.Ethics and disseminationThis trial is approved by the Hospital for Sick Children Research Ethics Board. Results will provide data to guide adolescents with cancer and healthcare teams in treating pain. Dissemination will occur through partnerships with stakeholder groups, scientific meetings, publications, mass media releases and consumer detailing.Trial registration numberNCT03632343(ClinicalTrials.gov).

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Regional Variation in the Management of Metastatic Gastric Cancer in Ontario

Abstract: Background Geographic variation in cancer care is common when clear clinical management guidelines do not

Cited by 11 publications

References 32 publications

Geographic variation in the costs of medical care for people living with HIV in British Columbia, Canada

Geographic variation in the costs of medical care for people living with HIV in British Columbia, Canada

Sensitivity and specificity of breast cancer ICD-9-CM codes in three Italian administrative healthcare databases: a diagnostic accuracy study

Pain Squad+ smartphone app to support real-time pain treatment for adolescents with cancer: protocol for a randomised controlled trial

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