101
|
Barber CE, Lix LM, Lacaille D, Marshall DA, Kroeker K, Benseler S, Twilt M, Schmeling H, Barnabe C, Hazlewood GS, Bykerk V, Homik J, Thorne JC, Burt J, Mosher D, Katz S, Shiff NJ. Testing population-based performance measures identifies gaps in juvenile idiopathic arthritis (JIA) care. BMC Health Serv Res 2019; 19:572. [PMID: 31412858 PMCID: PMC6694666 DOI: 10.1186/s12913-019-4379-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 07/30/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The study evaluates Performance Measures (PMs) for Juvenile Idiopathic Arthritis (JIA): The percentage of patients with new onset JIA with at least one visit to a pediatric rheumatologist in the first year of diagnosis (PM1); and the percentage of patients with JIA under rheumatology care seen in follow-up at least once per year (PM2). METHODS Validated JIA case ascertainment algorithms were used to identify cases from provincial health administrative databases in Manitoba, Canada in patients < 16 years between 01/04/2005 and 31/03/2015. PM1: Using a 3-year washout period, the percentage of incident JIA patients with ≥1 visit to a pediatric rheumatologist in the first year was calculated. For each fiscal year, the proportion of patients expected to be seen in follow-up who had a visit were calculated (PM2). The proportion of patients with gaps in care of > 12 and > 14 months between consecutive visits were also calculated. RESULTS One hundred ninety-four incident JIA cases were diagnosed between 01/04/2008 and 03/31/2015. The median age at diagnosis was 9.1 years and 71% were female. PM1: Across the years, 51-81% of JIA cases saw a pediatric rheumatologist within 1 year. PM2: Between 58 and 78% of patients were seen in yearly follow-up. Gaps > 12, and > 14, months were observed once during follow-up in 52, and 34%, of cases, and ≥ twice in 11, and 5%, respectively. CONCLUSIONS Suboptimal access to pediatric rheumatologist care was observed which could lead to diagnostic and treatment delays and lack of consistent follow-up, potentially negatively impacting patient outcomes.
Collapse
Affiliation(s)
- Claire E.H. Barber
- Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
| | - Lisa M. Lix
- University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB R3E 0W3 Canada
| | - Diane Lacaille
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
- Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Deborah A. Marshall
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada
| | - Kristine Kroeker
- George & Fay Yee Centre for Healthcare Innovation, 3rd floor, 753 McDermot Ave, Winnipeg, MB R3E 0T6 Canada
| | - Susanne Benseler
- Alberta Children’s Hospital, 28 Oki Drive, Calgary, T3B 6A8 AB Canada
| | - Marinka Twilt
- Alberta Children’s Hospital, 28 Oki Drive, Calgary, T3B 6A8 AB Canada
| | | | - Cheryl Barnabe
- Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
| | - Glen S. Hazlewood
- Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
| | - Vivian Bykerk
- Hospital for Special Surgery, 535 E 70th St, New York, NY USA
| | - Joanne Homik
- 3A Medicine Clinic, Third Floor, Edmonton Clinic, 11400 University Ave, Edmonton, AB T6G 1Z1 Canada
| | | | - Jennifer Burt
- Rheumatology Services, St. Clare’s Mercy Hospital, 154 LeMarchant Road, St. John’s, NL A1C 5B8 Canada
| | - Dianne Mosher
- Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Steven Katz
- Third Floor, Edmonton Clinic, 11400 University Ave, Edmonton, AB T6G 1Z1 Canada
| | - Natalie J. Shiff
- Department of Community Health & Epidemiology, University of Saskatchewan, Box 7, 107 Wiggins Road, Saskatoon, SK S7N 5E5 Canada
| |
Collapse
|
102
|
Ostermann J, Brown DS, van Til JA, Bansback N, Légaré F, Marshall DA, Bewtra M. Support Tools for Preference-Sensitive Decisions in Healthcare: Where Are We? Where Do We Go? How Do We Get There? Patient 2019; 12:439-443. [DOI: 10.1007/s40271-019-00372-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
103
|
Marshall DA, Ferrusi IL, Trudeau M, Leighl NB, Hoch JS, Grazziotin LR, Khong H, Pullenayegum E, Earle CC. Adherence to human epidermal growth factor receptor-2 testing and adjuvant trastuzumab treatment guidelines in Ontario. J Oncol Pharm Pract 2019; 26:379-385. [PMID: 31156051 DOI: 10.1177/1078155219850299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES We evaluated adherence of human epidermal growth factor receptor-2 testing using immunohistochemistry and fluorescence in situ hybridization, as well as adjuvant trastuzumab treatment according to Canadian guidelines, and predictors of trastuzumab use in early-stage breast cancer in Ontario. METHODS Retrospective cohort of early-stage breast cancer patients identified in the Ontario Cancer Registry. Human epidermal growth factor receptor-2 test type, sequence, result(s), tumor grade, and hormone receptor status were abstracted from Ontario Cancer Registry pathology reports. Trastuzumab treatment was determined from provincial cancer agency records. Other variables were determined from administrative data sources. Logistic regression models were used to estimate adjusted odds ratios for factors associated with guideline adherence. RESULTS The first human epidermal growth factor receptor-2 test result was the strongest predictor of confirmatory testing (p < 0.05). Human epidermal growth factor receptor-2 testing by immunohistochemistry accounted for the majority of documented first tests (94%; n = 8249). Overall, 27% (n = 2360) of tested patients received a second test by fluorescence in situ hybridization (46%) or immunohistochemistry (49%) assay. Most human epidermal growth factor receptor-2 equivocal patients (89%; n = 784) received a confirmatory test. Among human epidermal growth factor receptor-2-positive patients, only 57% (n = 385) received trastuzumab treatment within the study period. Human epidermal growth factor receptor-2 status was the strongest predictor of trastuzumab use. Younger patients (<70 years at diagnosis) and negative hormone receptor status had higher odds of trastuzumab treatment (p < 0.05) compared to older and positive hormone receptor status patients. CONCLUSIONS Immunohistochemistry use as a first test was largely consistent with Canadian guidelines; however, immunohistochemistry was frequently used as a confirmatory test, which is not guideline-concordant. Monitoring these testing and treating patterns is necessary to optimize health outcomes associated with trastuzumab.
Collapse
Affiliation(s)
- Deborah A Marshall
- Centre for Evaluation of Medicines, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada
| | - Ilia L Ferrusi
- Centre for Evaluation of Medicines, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada.,Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada
| | - Maureen Trudeau
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Natasha B Leighl
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jeffrey S Hoch
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada.,Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Luiza R Grazziotin
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Hoa Khong
- Alberta Bone & Joint Health Institute, Calgary, Alberta, Canada
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Craig C Earle
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| |
Collapse
|
104
|
Carr ECJ, Patel JN, Ortiz MM, Miller JL, Teare SR, Barber CEH, Marshall DA. Co-design of a patient experience survey for arthritis central intake: an example of meaningful patient engagement in healthcare design. BMC Health Serv Res 2019; 19:355. [PMID: 31164176 PMCID: PMC6549374 DOI: 10.1186/s12913-019-4196-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 05/28/2019] [Indexed: 01/18/2023] Open
Abstract
Background To describe the process of patient engagement to co-design a patient experience survey for people with arthritis referred to central intake. Methods We used a participatory design to engage with patients to co-design a patient experience survey that comprised three connected phases: 1) Identifying the needs of patients with arthritis, 2) Developing a set of key performance indicators, and 3) Determining the survey items for the patient experience survey. Results Patient recommendations for high quality healthcare care means support to manage arthritis, to live a meaningful life by providing the right knowledge, professional support, and professional relationship. The concept of integrated care was a core requirement from the patients’ perspective for the delivery of high quality arthritis care. Patients experience with care was ranked in the top 10 of 28 Key Performance Indicators for the evaluation of central intake, with 95% of stakeholders rating it as 9/10 for importance. A stakeholder team, including Patient and Community Engagement Researchers (PaCER), mapped and rated 41 survey items from four validated surveys. The final patient experience survey had 23 items. Conclusion The process of patient engagement to co-design a patient experience survey, for people with arthritis, identified aspects of care that had not been previously recognized. The linear organization of frameworks used to report patient engagement in research does not always capture the complexity of reality. Additional resources of cost, time and expertise for patient engagement in co-design activity are recognized and should be included, where possible, to ensure high quality data is captured. Electronic supplementary material The online version of this article (10.1186/s12913-019-4196-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Eloise C J Carr
- Faculty of Nursing, University of Calgary, PF2237, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.
| | - Jatin N Patel
- Pan-SCN Manager, Strategic Clinical Networks™, Alberta Health Services, 10030 - 107 Street NW, Edmonton, Alberta, T5J 3E4, Canada
| | - Mia M Ortiz
- Faculty of Nursing, University of Calgary, PF2237, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - Jean L Miller
- O'Brien Institute for Public Health, University of Calgary, 3280, Hospital Dr. NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Sylvia R Teare
- O'Brien Institute for Public Health, University of Calgary, 3280, Hospital Dr. NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Claire E H Barber
- Arthritis Research Center, University of Calgary, HRIC 3AA20, 3280, Hospital Dr. NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Deborah A Marshall
- Cumming School of Medicine, University of Calgary, Health Research Innovation Centre (HRIC) - 3C56, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| |
Collapse
|
105
|
Jin X, Al Sayah F, Ohinmaa A, Marshall DA, Johnson JA. Responsiveness of the EQ-5D-3L and EQ-5D-5L in patients following total hip or knee replacement. Qual Life Res 2019; 28:2409-2417. [PMID: 31089988 DOI: 10.1007/s11136-019-02200-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE To examine the responsiveness of the EQ-5D-3L and EQ-5D-5L among total hip/knee replacement (THR/TKR) patients. METHODS The EQ-5D (3L or 5L) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) have been routinely administered to all THR/TKR patients before and at 3 months after surgery in Alberta, Canada, since 2010. Patients were included in this analysis if they completed the WOMAC and the same version of EQ-5D at baseline and 3-month follow-up. The WOMAC was used as an anchor to categorize patients into 9 subgroups according to the relative change from baseline, i.e., no change, and 4 categories each for the amount of deterioration or improvement: large (≥ 70%), moderate (50% ≤ change < 70%), small but important (20% ≤ change < 50%), and very mild (0 < change ≤ 20%). The responsiveness of the EQ-5D-3L and EQ-5D-5L for each subgroup was assessed using effect size, standardized response mean, and Guyatt's Responsiveness Index. RESULTS A total of 1594 patients completed the EQ-5D-3L and WOMAC (60% females, mean age 66 years, N = 646 [41%] THR), and 3180 completed the EQ-5D-5L and WOMAC (60% females, mean age 66 years, N = 1352 [43.2%] THR) at baseline and 3-month follow-up. For both THR and TKR patients with "small but important" improvement, the EQ-5D-5L was consistently more responsive than the EQ-5D-3L. CONCLUSION Our study demonstrated that the EQ-5D-5L is more responsive than the EQ-5D-3L in identifying health-related quality of life changes in THR/TKR patients. We recommend using the EQ-5D-5L in longitudinal studies in this patient population.
Collapse
Affiliation(s)
- Xuejing Jin
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| | - Fatima Al Sayah
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, HRIC Building Room 3C58, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Alberta Bone and Joint Health Institute, Calgary, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada.
| |
Collapse
|
106
|
Kip MMA, Currie G, Marshall DA, Grazziotin Lago L, Twilt M, Vastert SJ, Swart JF, Wulffraat N, Yeung RSM, Benseler SM, IJzerman MJ. Seeking the state of the art in standardized measurement of health care resource use and costs in juvenile idiopathic arthritis: a scoping review. Pediatr Rheumatol Online J 2019; 17:20. [PMID: 31060557 PMCID: PMC6501309 DOI: 10.1186/s12969-019-0321-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to describe current practice in identifying and measuring health care resource use and unit costs in economic evaluations or costing studies of juvenile idiopathic arthritis (JIA). METHODS A scoping review was conducted (in July 2018) in PubMed and Embase to identify economic evaluations, costing studies, or resource utilization studies focusing on patients with JIA. Only English language peer-reviewed articles reporting primary research were included. Data from all included full-text articles were extracted and analysed to identify the reported health care resource use items. In addition, the data sources used to obtain these resource use and unit costs were identified for all included articles. RESULTS Of 1176 unique citations identified by the search, 20 full-text articles were included. These involved 4 full economic evaluations, 5 cost-outcome descriptions, 8 cost descriptions, and 3 articles reporting only resource use. The most commonly reported health care resource use items involved medication (80%), outpatient and inpatient hospital visits (80%), laboratory tests (70%), medical professional visits (70%) and other medical visits (65%). Productivity losses of caregivers were much more often incorporated than (future) productivity losses of patients (i.e. 55% vs. 15%). Family borne costs were not commonly captured (ranging from 15% for school costs to 50% for transportation costs). Resource use was mostly obtained from family self-reported questionnaires. Estimates of unit costs were mostly based on reimbursement claims, administrative data, or literature. CONCLUSIONS Despite some consistency in commonly included health care resource use items, variability remains in including productivity losses, missed school days and family borne costs. As these items likely substantially influence the full cost impact of JIA, the heterogeneity found between the items reported in the included studies limits the comparability of the results. Therefore, standardization of resource use items and unit costs to be collected is required. This standardization will provide guidance to future research and thereby improve the quality and comparability of economic evaluations or costing studies in JIA and potentially other childhood diseases. This would allow better understanding of the burden of JIA, and to estimate how it varies across health care systems.
Collapse
Affiliation(s)
- Michelle M. A. Kip
- 0000 0004 0399 8953grid.6214.1Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands
| | - Gillian Currie
- 0000 0004 1936 7697grid.22072.35Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada ,0000 0004 1936 7697grid.22072.35Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Deborah A. Marshall
- 0000 0004 1936 7697grid.22072.35Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Luiza Grazziotin Lago
- 0000 0004 1936 7697grid.22072.35Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Marinka Twilt
- 0000 0004 1936 7697grid.22072.35Division of Rheumatology, Department of Pediatrics, Alberta Children’s Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Sebastiaan J. Vastert
- 0000 0004 0620 3132grid.417100.3Division of Paediatrics, Department of Paediatric Rheumatology, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Joost F. Swart
- 0000 0004 0620 3132grid.417100.3Division of Paediatrics, Department of Paediatric Rheumatology, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Nico Wulffraat
- 0000 0004 0620 3132grid.417100.3Division of Paediatrics, Department of Paediatric Rheumatology, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Rae S. M. Yeung
- 0000 0001 2157 2938grid.17063.33Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario Canada
| | - Susanne M. Benseler
- 0000 0004 1936 7697grid.22072.35Division of Rheumatology, Department of Pediatrics, Alberta Children’s Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Maarten J. IJzerman
- 0000 0004 0399 8953grid.6214.1Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands
| | | |
Collapse
|
107
|
Barber CEH, Sandhu N, Rankin JA, MacMullan P, Marshall DA, Barnabe C, Hazlewood GS, Emrick A, Stevenson M, Then KL, Benseler S, Twilt M, Mosher D. Rheum4U: Development and testing of a web-based tool for improving the quality of care for patients with rheumatoid arthritis. Clin Exp Rheumatol 2019; 37:385-392. [PMID: 30183602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/18/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To develop a web-based tool (Rheum4U) to capture clinically meaningful data to direct treatment. Rheum4U integrates longitudinal clinical data capture of rheumatoid arthritis (RA) disease activity measures and patient-reported outcomes measures (PROMs). This study tests the feasibility, acceptability and efficiency of Rheum4U among patients and healthcare providers. METHODS Rheum4U was developed in two phases: P1 design and development; and P2 pilot testing. P1: A working group of rheumatologists and researchers (n=13) performed a prioritisation exercise to determine data elements to be included in the platform. The specifications were finalised and supplied to the platform developer. Alpha testing was performed to correct initial software bugs. 18 testers (physicians, nurses and recruited non-patient lay-testers) beta tested Rheum4U for usability. P2: Rheum4U was piloted in 2 rheumatology clinics and evaluated for feasibility, efficiency and acceptability using interviews, observation and questionnaires with patients and healthcare providers. RESULTS 110 RA patients, 9 rheumatologists and 9 allied health providers participated in the pilot. Mean patient age was 53 years and 74% were female. The majority (86%) were satisfied or very satisfied with online data entry and 79% preferred it to paper entry. Healthcare providers found Rheum4U easy and clear to use (90%), and they perceived that it improved their job performance (91%). Completeness and easy availability of the patient information improved clinic efficiency. CONCLUSIONS Rheum4U highlights the benefits of a web-based tool for clinical care, quality improvement and research in the clinic and this study provides valuable information to inform full platform implementation.
Collapse
Affiliation(s)
- Claire E H Barber
- Div.of Rheumatology, Department of Medicine; Department of Community Health Sciences University of Calgary, Cumming School of Medicine, Alberta; Arthritis Research Canada; and McCaig Inst. for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Namneet Sandhu
- Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, Alberta, Canada
| | - James A Rankin
- Faculty of Nursing, University of Calgary & Alberta Health Services, Alberta, Canada
| | - Paul MacMullan
- Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, Alberta, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences University of Calgary, Cumming School of Medicine, Alberta; Arthritis Research Canada; and McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Div.of Rheumatology, Department of Medicine; Department of Community Health Sciences University of Calgary, Cumming School of Medicine, Alberta; Arthritis Research Canada; and McCaig Inst. for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Glen S Hazlewood
- Div.of Rheumatology, Department of Medicine; Department of Community Health Sciences University of Calgary, Cumming School of Medicine, Alberta; Arthritis Research Canada; and McCaig Inst. for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Andrea Emrick
- Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, Alberta, Canada
| | - Martina Stevenson
- Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, Alberta, Canada
| | - Karen L Then
- Faculty of Nursing, University of Calgary & Alberta Health Services, Alberta, Canada
| | - Susanne Benseler
- Department of Pediatrics, University of Calgary, Cumming School of Medicine, Alberta, Canada
| | - Marinka Twilt
- Department of Pediatrics, University of Calgary, Cumming School of Medicine, Alberta, Canada
| | - Dianne Mosher
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
| |
Collapse
|
108
|
Durand C, Eldoma M, Marshall DA, Bansback N, Hazlewood GS. Patient Preferences for Disease-modifying Antirheumatic Drug Treatment in Rheumatoid Arthritis: A Systematic Review. J Rheumatol 2019; 47:176-187. [DOI: 10.3899/jrheum.181165] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2019] [Indexed: 11/22/2022]
Abstract
Objective.To summarize patients’ preferences for disease-modifying antirheumatic drug (DMARD) therapy in rheumatoid arthritis (RA).Methods.We conducted a systematic review to identify English-language studies of adult patients with RA that measured patients’ preferences for DMARD or health states and treatment outcomes relevant to DMARD decisions. Study quality was assessed using a published quality assessment tool. Data on the importance of treatment attributes and associations with patient characteristics were summarized across studies.Results.From 7951 abstracts, we included 36 studies from a variety of countries. Most studies were in patients with established RA and were rated as medium- (n = 19) or high-quality (n = 12). The methods to elicit preferences varied, with the most common being discrete choice experiment (DCE; n = 13). Despite the heterogeneity of attributes in DCE studies, treatment benefits (disease improvement) were usually more important than both non-serious (6 of 8 studies) and serious adverse events (5 of 8), and route of administration (7 of 9). Among the non-DCE studies, some found that patients placed high importance on treatment benefits, while others (in patients with established RA) found that patients were quite risk averse. Subcutaneous therapy was often but not always preferred over intravenous therapy. Patient preferences were variable and commonly associated with the sociodemographic characteristics.Conclusion.Overall, the results showed that many patients place a high value on treatment benefits over other treatment attributes, including serious or minor side effects, cost, or route of administration. The variability in patient preferences highlights the need to individualize treatment choices in RA.
Collapse
|
109
|
Goh ESY, Miller FA, Marshall DA, Ungar WJ. Genetic counselors' preferences for coverage of preimplantation genetic diagnosis: A discrete choice experiment. Clin Genet 2019; 95:684-692. [PMID: 30859557 DOI: 10.1111/cge.13531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 11/28/2022]
Abstract
Preimplantation genetic diagnosis (PGD) allows couples to test for a genetically affected embryo prior to implantation. Patient access to this ethically complex and expensive technology differs markedly across jurisdictions, with differences in private/public insurance coverage and variations in patient inclusion and diagnostic criteria. The objective of the study was to identify trade-offs regarding PGD coverage decisions amongst genetic counselors. To quantify stated preferences for PGD coverage, we conducted a discrete choice experiment with Canadian genetic counselors (GC) considering attributes regarding the scope of testing (PGD indication, risk of the condition and number of cycles covered) and patient inclusion criteria (fertility status and family history). Multinomial logit regression was used to estimate trade-offs amongst attributes using part-worth utilities and importance scores. The completed response rate was 41% with 126 GC completing the survey. Risk of the genetic condition was the most important attribute. Overall, GC were more responsive to the scope of testing criteria including the condition's risk (importance score of 42%) and PGD indication (31%) rather than family history (11%) and fertility status (8%). Based on this study's attributes and levels, condition characteristics are prioritized even above patient characteristics for PGD coverage.
Collapse
Affiliation(s)
- Elaine Suk-Ying Goh
- Trillium Health Partners, Department of Laboratory Medicine and Genetics, Mississauga, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Wendy J Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children (Sickkids) Research Institute, Toronto, Ontario, Canada
| |
Collapse
|
110
|
Bansback N, Trenaman L, MacDonald KV, Hawker G, Johnson JA, Stacey D, Marshall DA. An individualized patient-reported outcome measure (PROM) based patient decision aid and surgeon report for patients considering total knee arthroplasty: protocol for a pragmatic randomized controlled trial. BMC Musculoskelet Disord 2019; 20:89. [PMID: 30797238 PMCID: PMC6387514 DOI: 10.1186/s12891-019-2434-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 01/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While the rates of total knee arthroplasty (TKA) continue to rise worldwide, there are concerns about whether all surgeries are appropriate. Guidelines for appropriateness suggest that patients should have realistic expectations for total knee arthroplasty (TKA), and that the patient and their surgeon should agree that the potential benefits outweigh the potential harms. The objective of this study is to evaluate whether routinely collected pre- and post-TKA patient-reported outcome measures (PROMs) could be integrated into a patient decision aid to better inform these appropriateness criteria. This randomised trial will evaluate the preliminary efficacy of a tailored PROM-based patient decision aid and surgeon report (compared to usual care) for patients considering TKA on decision quality. METHODS This is a pragmatic, randomised controlled trial conducted at one site in Alberta, Canada. Adults over the age of 30 years, who have been scheduled for a TKA consultation at the Edmonton Bone and Joint Centre with a participating surgeon, who understand, speak, and read English, and can provide informed consent, are eligible to participate. Participants will be randomised to receive a PROM-based patient decision aid and surgeon report before their surgical consultation or usual care. The decision aid will provide patients with information on their expected outcomes based on the EQ-5D-5L PROM, and these estimates are individualized based on clinical and demographic characteristics. The primary outcome of this trial is decision quality. Analysis will consider outcomes intention to treat, and feasibility outcomes for implementing the trial to routine practise. DISCUSSION This patient decision aid and surgeon report intervention could contribute to improved treatment decision-making for patients considering total knee arthroplasty. TRIAL REGISTRATION (REGISTRY AND NUMBER) ClinicalTrials.gov : NCT03240913. Registered on August 1, 2017.
Collapse
Affiliation(s)
- Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, BC Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC Canada
- Arthritis Research Canada, Richmond, BC Canada
| | - Logan Trenaman
- School of Population and Public Health, University of British Columbia, Vancouver, BC Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC Canada
- Arthritis Research Canada, Richmond, BC Canada
| | - Karen V. MacDonald
- Department of Community Health Sciences, University of Calgary, Calgary, AB Canada
| | - Gillian Hawker
- Department of Medicine, University of Toronto, Toronto, ON Canada
| | | | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, ON Canada
- Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Deborah A. Marshall
- Arthritis Research Canada, Richmond, BC Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB Canada
| |
Collapse
|
111
|
Swamy G, Lopatina E, Thomas KC, Marshall DA, Johal HS. The cost effectiveness of minimally invasive spine surgery in the treatment of adult degenerative scoliosis: a comparison of transpsoas and open techniques. Spine J 2019; 19:339-348. [PMID: 29859350 DOI: 10.1016/j.spinee.2018.05.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 04/10/2018] [Accepted: 05/24/2018] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Surgical treatment improves quality of life in patients with adult degenerative scoliosis (ADS). However, open ADS surgeries are complex, large magnitude operations associated with a high rate of complications. The lateral transpsoas interbody fusion technique is a less invasive alternative to open ADS surgery, but less invasive techniques tend to be more expensive. The objective of this study was to evaluate the cost effectiveness of the transpsoas technique for patients with ADS over a 12-month time horizon from a public payer perspective. METHODS A cost-effectiveness analysis was performed based on a consecutive case series of patients who underwent ADS surgeries between 2006 and 2012. Effectiveness was expressed as the difference in patient reported preoperative and 12-month postoperative health-related quality of life (HRQOL), which was measured in quality-adjusted life years. Health-care resource use was tabulated based on a clinical chart review on an item-by-item basis. Unit cost data were obtained from published provincial costs in Alberta, Canada. All costs were adjusted to 2015 Canadian dollars. The base case analysis included costs for the surgery, initial hospitalization, and treatment for complications over a 12-month follow-up period. The uncomplicated case analysis included costs for the surgery and initial hospitalization only. The joint uncertainty surrounding the cost and HRQOL differences was estimated using bootstrapping with 10,000 replicates. RESULTS A total of 10 open technique and 12 transpsoas technique T11-pelvis fusions were included in the analysis. In the base case analysis, the transpsoas technique was less costly compared with the open technique, total cost of $83,513 (95% CI: $72,772-$94,253) versus $111,381 (95% CI: $36,340-$186,423), respectively (incremental cost $27,869), and was associated with 0.06 more quality-adjusted life years and/or patient. However, in the uncomplicated case, the open technique was less costly compared with the transpsoas technique ($47,795 [95% CI: $39,003-$56,586] vs $76,510 [95% CI: $72,273-$80,746]), respectively, with an incremental cost of $28,715. Based on the probabilistic analysis of 10,000 bootstrap iterations for the base case analysis, the transpsoas technique was more effective and less costly compared with the open technique 57% of time. One-way deterministic sensitivity analysis by adjusting bone-morphogenetic protein-2 dosage further improved cost effectiveness of the transpsoas technique by lowering overall costs. CONCLUSIONS Transpsoas surgeries were associated with better outcomes in terms of HRQOL and lower costs over 1-year follow-up period compared with more invasive open technique. This study should be viewed as a pilot evaluation and should be replicated in a larger prospective multicenter controlled study.
Collapse
Affiliation(s)
- Ganesh Swamy
- University of Calgary Spine Program, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta , Canada, T2N 4N1.
| | - Elena Lopatina
- University of Calgary, Room 3C60, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6.
| | - Ken C Thomas
- University of Calgary Spine Program, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta , Canada, T2N 4N1.
| | - Deborah A Marshall
- University of Calgary, Room 3C60, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6.
| | - Herman S Johal
- Division of Orthopaedic Surgery, McMaster University, Center for Evidence Based Orthopedics, 293 Wellington Street North, Hamilton, Ontario, Canada L8L 8E7.
| |
Collapse
|
112
|
Barber T, Sharif B, Teare S, Miller J, Shewchuk B, Green LA, Marlett N, Cibere J, Mrklas K, Wasylak T, Li LC, Campbell-Scherer D, Marshall DA. Qualitative study to elicit patients' and primary care physicians' perspectives on the use of a self-management mobile health application for knee osteoarthritis. BMJ Open 2019; 9:e024016. [PMID: 30782723 PMCID: PMC6361338 DOI: 10.1136/bmjopen-2018-024016] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To elicit perspectives of family physicians and patients with knee osteoarthritis (KOA) on KOA, its treatment/management and the use of a mobile health application (app) to help patients self-manage their KOA. DESIGN A qualitative study using Cognitive Task Analysis for physician interviews and peer-to-peer semistructured interviews for patients according to the Patient and Community Engagement Research (PaCER) method. SETTING Primary care practices and patient researchers at an academic centre in Southern Alberta. PARTICIPANTS Intentional sampling of family physicians (n=4; 75% women) and patients with KOA who had taken part in previous PaCER studies and had experienced knee pain on most days of the month at any time in the past (n=5; 60% women). RESULTS Physician and patient views about KOA were starkly contrasting. Patient participants expressed that KOA seriously impacted their lives and lifestyles, and they wanted their knee pain to be considered as important as other health problems. In contrast, physicians uniformly conceptualised KOA as a relatively minor health problem, although they still recognised it as a painful condition that often limits patients' activities. Consequently, physicians did not regard KOA as a condition to be proactively and aggressively managed. The gap between physicians' and patients' conceptualisation of KOA and its treatment extended to the use of an app for self-management. While patients were supportive of the app, physicians were sceptical of its use and focused more on accountability and patient resources. CONCLUSIONS The clear discord between physicians' mental models and patients' lived experience and perceived needs around KOA emphasised a gap in understanding and communication about treatment and management of KOA. As such, this preliminary and formative research will inform a codesign approach to develop an app that will act as a communications tool between patients and physicians, enabling patient-physician discussions regarding modifiable self-management options based on a patient's perspectives and needs.
Collapse
Affiliation(s)
- Tanya Barber
- Enhancing Alberta Primary Care Research Networks (EnACt), Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Behnam Sharif
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sylvia Teare
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Jean Miller
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Brittany Shewchuk
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lee A Green
- Enhancing Alberta Primary Care Research Networks (EnACt), Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
- Department of Family Medicine, Univeristy of Alberta, Edmonton, Alberta, Canada
| | - Nancy Marlett
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jolanda Cibere
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelly Mrklas
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Strategic Clinical Networks, Research and Innovation Analytics, Alberta Health Services, Calgary, Alberta, Canada
| | - Tracy Wasylak
- Strategic Clinical Networks, Alberta Health Services, Edmonton, Alberta, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Deborah A Marshall
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
113
|
Greenwood-Lee J, Jewett L, Woodhouse L, Marshall DA. A categorisation of problems and solutions to improve patient referrals from primary to specialty care. BMC Health Serv Res 2018; 18:986. [PMID: 30572898 PMCID: PMC6302393 DOI: 10.1186/s12913-018-3745-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 11/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving access to specialty care has been identified as a critical issue in the delivery of health services, especially given an increasing burden of chronic disease. Identifying and addressing problems that impact access to specialty care for patients referred to speciality care for non-emergent procedures and how these deficiencies can be managed via health system delivery interventions is important to improve care for patients with chronic conditions. However, the primary-specialty care interface is complex and may be impacted by a variety of potential health services delivery deficiencies; with an equal range of interventions developed to correct them. Consequently, the literature is also diverse and difficult to navigate. We present a narrative review to identify existing literature, and provide a conceptual map that categorizes problems at the primary-specialty care interface with linkages to corresponding interventions aimed at ensuring that patient transitions across the primary-specialty care interface are necessary, appropriate, timely and well communicated. METHODS We searched MEDLINE and EMBASE databases from January 1, 2005 until Dec 31, 2014, grey literature and reference lists to identify articles that report on interventions implemented to improve the primary-specialty care interface. Selected articles were categorized to describe: 1) the intervention context, including the deficiency addressed, and the objective of the intervention 2) intervention activities, and 3) intervention outcomes. RESULTS We identified 106 articles, producing four categories of health services delivery deficiencies based in: 1) clinical decision making; 2) information management; 3) the system level management of patient flows between primary and secondary care; and 4) quality-of-care monitoring. Interventions were divided into seven categories and fourteen sub-categories based on the deficiencies addressed and the intervention strategies used. Potential synergies and trade-offs among interventions are discussed. Little evidence exists regarding the synergistic and antagonistic interactions of alternative intervention strategies. CONCLUSION The categorization acts as an aid in identifying why the primary-specialty care interface may be failing and which interventions may produce improvements. Overlap and interconnectedness between interventions creates potential synergies and conflicts among co-implemented interventions.
Collapse
Affiliation(s)
- James Greenwood-Lee
- Centre for Science, Athabasca University, 6th Floor, 345 6 Avenue SE, Calgary, Alberta, T2G 4V1, Canada
| | - Lauren Jewett
- Geography & Planning, University of Toronto, Sidney Smith Hall, Rm 594, 100 St George St., Toronto, Ontario, M5S 3G3, Canada
| | - Linda Woodhouse
- Faculty of Rehabilitation Medicine, University of Alberta, 3-10 Corbett Hall, 8205 114 Street, Edmonton, Alberta, T6G 2G4, Canada
| | - Deborah A Marshall
- Canada Research Chair, Health Services and Systems Research, Arthur J.E. Child Chair in Rheumatology Outcomes Research, Department of Community Health Sciences, University of Calgary, Calgary, Canada.
- 3C56 Health Research Innovation Centre (HRIC), 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.
| |
Collapse
|
114
|
Lopatina E, Miller JL, Teare SR, Marlett NJ, Patel J, Barber CEH, Mosher DP, Wasylak T, Woodhouse LJ, Marshall DA. The voice of patients in system redesign: A case study of redesigning a centralized system for intake of referrals from primary care to rheumatologists for patients with suspected rheumatoid arthritis. Health Expect 2018; 22:348-363. [PMID: 30520175 PMCID: PMC6543166 DOI: 10.1111/hex.12855] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/24/2018] [Accepted: 11/14/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The published literature demands examples of health-care systems designed with the active engagement of patients to explore the application of this complex phenomenon in practice. METHODS This case study explored how the voice of patients was incorporated into the process of redesigning an element of the health-care system, a centralized system for intake of referrals from primary care to rheumatologists for patients with suspected rheumatoid arthritis (RA)-centralized intake. The phenomenon of patient engagement using "patient and community engagement researchers" (PaCERs) in research and the process of redesigning centralized intake were selected as the case. In-depth evaluation of the case was undertaken through the triangulation of findings from the document review and participants' reflection on the case. RESULTS In this case, patients and PaCERs participated in multiple activities including an initial meeting of key stakeholders to develop the project vision; a patient-to-patient PaCERs study to gather perspectives of patients with RA on the challenges they face in accessing and navigating the health-care system, and what they see as key elements of an effective system that would be responsive to their needs; the development of an evaluation framework for future centralized intake; and the choice of candidate centralized intake strategies to be evaluated. CONCLUSIONS The described feasible multistep approach to active patient engagement in health-care system redesign contributes to an understanding of the application of this complex phenomenon in practice. Therefore, the manuscript serves as one more step towards a patient-centred health-care system that is redesigned with active patient engagement.
Collapse
Affiliation(s)
- Elena Lopatina
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Jean L Miller
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Sylvia R Teare
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Nancy J Marlett
- Community Rehabilitation and Disability Studies, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jatin Patel
- Strategic Clinical Networks™, Alberta Health Services, Edmonton, Alberta, Canada
| | - Claire E H Barber
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Dianne P Mosher
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tracy Wasylak
- Strategic Clinical Networks™, Alberta Health Services, Edmonton, Alberta, Canada.,Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Linda J Woodhouse
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Calgary, Alberta, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Strategic Clinical Networks™, Alberta Health Services, Edmonton, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Calgary, Alberta, Canada.,Alberta Bone and Joint Health Institute, Calgary, Alberta, Canada
| |
Collapse
|
115
|
Vik S, Sharif B, Seidel J, Marshall DA. A big data analytics platform to support simulation modeling for osteoarthritis care pathways. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.1024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
IntroductionTechnical solutions have been used in industry settings for many years to facilitate efficient management and analyses of big data sources. An initiative to apply a business solution to support development of simulation models for health systems research using nearly two decades of provincial administrative health data is described.
Objectives and ApproachAdministrative data including practitioner claims, hospitalizations and ambulatory care visits for patients with a diagnosis of osteoarthritis were obtained from Alberta Health for the period 1994/95 to 2012/13. These data were incorporated into a multidimensional data cube using Microsoft SQL Server Analysis Services. Initial steps required dimensional modeling to restructure the data into a star schema format. This involved appending several data sets and defining additional reference tables to contain stratification variables and denominator data for rate calculations. The modeling expert worked closely with the information technology team throughout the process and assessed validity of the output.
ResultsDevelopment and validation of the multidimensional cube occurred in iterations over approximately 12 months. The final solution resulted in an analytics platform that compiled data from approximately 400 million records obtained from four different administrative data sources. Ten dimension tables containing 102 variables provided enhanced flexibility to conduct ad hoc stratified analyses in a fraction of the time that would be required using conventional methods. For example, some analyses that previously required a day of analyst time could be performed in less than 15 minutes. The efficiencies in analytic time were achieved by the pre-aggregated measures and slice and dice capability of the data cube, which negated many intermediary steps for data extraction and time consuming iterative analyses required for development of the simulation models.
Conclusion/ImplicationsThis project demonstrated how a technical solution applied in industry can be utilized to address challenges encountered by researchers related to managing and analyzing large administrative health data sets. The methods could be applied in many other research settings to facilitate access to and analyses of information using big data.
Collapse
|
116
|
Marshall DA, Barber C, Zhang S, Patel J, Chen G, Faris P. Linking Clinical and Administrative Data to Inform Performance Measures Regarding Access to Specialist Care for Patients with Rheumatoid Arthritis. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
IntroductionRheumatoid arthritis (RA) is the most prevalent type of chronic adult inflammatory arthritis and requires timely diagnosis and subsequent access to specialist care and treatment from a rheumatologist. We developed a set of key performance indicators (KPIs) to evaluate access, effectiveness, acceptability, appropriateness and efficiency of care.
Objectives and ApproachThe overall objective was to measure performance of a central intake system for referral to rheumatology against the KPIs. We report on one accessibility KPIs: the percentage of patients with new onset RA with at least one visit to a rheumatologist in the first 365 days since diagnosis. We identified a cohort of RA patients using a validated case definition: >16 years, at least 1 RA related hospitalization (ICD-10-CA:M05.x-M06.x) or two RA related physician visits ≥ eight weeks apart within two years (ICD-9: 714.x). The incident case date was date of hospitalization or second physician visit (whichever came first).
ResultsThis KPI assessed the proportion of patients seen by a rheumatologist within one year of first RA visit by patients in the RA cohort. 13,914 cases of RA were diagnosed between April 1 2010 and March 31 2016. The percentage of patients with new onset RA with at least one visit to a rheumatologist in the first 365 days since diagnosis increased between fiscal years 2011 and 2015. Of the 2851 incident RA cases in fiscal year 2011, 1490 (53%) met the performance measure compared to 1710 of 2710 (63%) who met the definition in fiscal year 2015. Other KPIs, including wait times, are being evaluated using both clinical and administrative data.
Conclusion/ImplicationsBy linking multiple administrative datasets, we are able to measure system performance against a defined KPI and identify opportunities for system improvement. This is the first initiative in Alberta for patients with RA where data from different multi-custodial data repositories have been extracted, linked and analyzed for this purpose.
Collapse
|
117
|
Michaels-Igbokwe C, Lee R, Marshall DA, Currie G. Economic evaluations of strategies to prevent sports and recreational injury among children and adolescents: a systematic review. Inj Prev 2018; 25:340-347. [DOI: 10.1136/injuryprev-2018-042846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/13/2018] [Accepted: 07/18/2018] [Indexed: 11/04/2022]
Abstract
ObjectiveTo identify, summarise and critically assess studies reporting costs and consequences of sport and recreation injury prevention strategies among children and adolescents.DesignSystematic review.Methods and data sourcesWe searched MEDLINE (Ovid), EMBASE, CINAHL, Pubmed, Econlit and SPORTDiscus and PEDE. Included studies were peer reviewed full economic evaluations or cost analyses of sport/recreation injury prevention among children and adolescents≤18 years of age. The Pediatric Quality Appraisal Questionnaire was used for quality assessment.ResultsThe initial search yielded 1896 unique records; eight studies met inclusion criteria. Six studies were related to injury prevention in the context of recreation, two were related to sports. For recreation studies in cycling and swimming: costs per head injury averted was US$3109 to $228 197; costs per hospitalisation avoided was US$3526 to 872 794; cost per life saved/death avoided was US$3531 to $103 518 154. Sport interventions in hockey and soccer were cost saving (fewer injuries and lower costs). Global quality assessments ranged from poor to good. Important limitations included short time horizons and intermediate outcome measures.ConclusionsFew rigorous economic evaluations related to sport and recreation injury prevention have been conducted. The range of estimates and variation in outcomes used preclude specific conclusions; however, where strategies both improve health and are cost saving, implementation should be prioritised. Future economic evaluations should incorporate time horizons sufficient to capture changes in long-term health and use utility-based outcome measures in order to capture individual preferences for changes in health states and facilitate comparison across intervention types.
Collapse
|
118
|
Collins KH, Sharif B, Reimer RA, Sanmartin C, Herzog W, Chin R, Marshall DA. Association of Metabolic Markers with self-reported osteoarthritis among middle-aged BMI-defined non-obese individuals: a cross-sectional study. BMC Obes 2018; 5:23. [PMID: 30186613 PMCID: PMC6120068 DOI: 10.1186/s40608-018-0201-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 05/24/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Osteoarthritis (OA) is a chronic degenerative joint disease. While it is well-established that obesity affects OA through increased axial loading on the joint cartilage, the indirect effect of obesity through metabolic processes among the body mass index (BMI)-defined non-obese population, i.e., BMI < 30 kg/m2, is less known. Our goal was to evaluate the association of metabolic markers including body fat percentage (BF%), waist circumference, maximum weight gain during adulthood and serum creatinine with self-reported OA to establish if such measures offer additional information over BMI among the non-obese population between 40 and 65 years of age. METHODS Cross-sectional data from two cycles of the Canadian Health Measures Survey (CHMS) in 2007-2009 and 2009-2011 were analyzed. Sex-specific logistic regression models were developed to evaluate the association of self-reported OA with metabolic markers. Models were separately adjusted for age, BMI categories and serum creatinine, and a stratified analysis across BM categories was performed. In a secondary analysis, we evaluated the association of self-reported OA, cardiovascular diseases and hypertension across BF% categories. RESULTS Of 2462 individuals, 217 (8.8%) self-reported OA. After adjusting for age and BMI, those within BF%-defined overweight/obese category had 2.67 (95% CI: 1.32-3.51) and 2.11(95% CI: 1.38-3.21) times higher odds of reporting self-reported OA compared to those within BF%-defined athletic/acceptable category for females and males, respectively. BF% was also significantly associated with self-reported OA after adjusting for age and serum creatinine only among females (OR: 1.47, 95%CI: 1.12-1.84). Furthermore, among the BMI-defined overweight group, the age-adjusted odds of self-reported OA was significantly higher for overweight/obese BF% compared to athletic/acceptable BF% in both females and males. In a secondary analysis, we showed that the association of self-reported OA and hypertension/cardiovascular diseases is significantly higher among BF% overweight/obese (OR: 1.37, 95%CI: 1.19-3.09) compared to BF% athletic/acceptable (OR: 1.13, 95%CI: 0.87-2.82). CONCLUSION Our results provide corroborating evidence for a relationship between body fat and OA in a population-based study, while no significant independent correlates were found between other metabolic markers and OA prevalence. Future investigation on the longitudinal relationship between BF and OA among this sub-population may inform targeted prevention opportunities.
Collapse
Affiliation(s)
- Kelsey H. Collins
- Human Performance Laboratory, University of Calgary, Calgary, AB Canada
| | - Behnam Sharif
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada
| | - Raylene A. Reimer
- Faculty of Kinesiology and Department of Biochemistry and Molecular Biology, University of Calgary, Calgary, AB Canada
| | | | - Walter Herzog
- Human Performance Laboratory, University of Calgary, Calgary, AB Canada
| | - Rick Chin
- Department of Medicine, University of Calgary, Calgary, AB Canada
| | - Deborah A. Marshall
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada
| |
Collapse
|
119
|
Wordsworth S, Doble B, Payne K, Buchanan J, Marshall DA, McCabe C, Regier DA. Using "Big Data" in the Cost-Effectiveness Analysis of Next-Generation Sequencing Technologies: Challenges and Potential Solutions. Value Health 2018; 21:1048-1053. [PMID: 30224108 DOI: 10.1016/j.jval.2018.06.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 06/27/2018] [Indexed: 05/27/2023]
Abstract
Next-generation sequencing (NGS) is considered to be a prominent example of "big data" because of the quantity and complexity of data it produces and because it presents an opportunity to use powerful information sources that could reduce clinical and health economic uncertainty at a patient level. One obstacle to translating NGS into routine health care has been a lack of clinical trials evaluating NGS technologies, which could be used to populate cost-effectiveness analyses (CEAs). A key question is whether big data can be used to partially support CEAs of NGS. This question has been brought into sharp focus with the creation of large national sequencing initiatives. In this article we summarize the main methodological and practical challenges of using big data as an input into CEAs of NGS. Our focus is on the challenges of using large observational datasets and cohort studies and linking these data to the genomic information obtained from NGS, as is being pursued in the conduct of large genomic sequencing initiatives. We propose potential solutions to these key challenges. We conclude that the use of genomic big data to support and inform CEAs of NGS technologies holds great promise. Nevertheless, health economists face substantial challenges when using these data and must be cognizant of them before big data can be confidently used to produce evidence on the cost-effectiveness of NGS.
Collapse
Affiliation(s)
- Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Oxford National Institute for Health Research, Biomedical Research Centre, Oxford, UK.
| | - Brett Doble
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Oxford National Institute for Health Research, Biomedical Research Centre, Oxford, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
| | - James Buchanan
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Oxford National Institute for Health Research, Biomedical Research Centre, Oxford, UK
| | | | - Christopher McCabe
- Institute of Health Economics, Alberta, Canada; Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada
| | - Dean A Regier
- Canadian Centre for Applied Research in Cancer Control (ARCC), Cancer Control Research, BC Cancer, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada
| |
Collapse
|
120
|
Crown W, Buyukkaramikli N, Sir MY, Thokala P, Morton A, Marshall DA, Tosh JC, Ijzerman MJ, Padula WV, Pasupathy KS. Application of Constrained Optimization Methods in Health Services Research: Report 2 of the ISPOR Optimization Methods Emerging Good Practices Task Force. Value Health 2018; 21:1019-1028. [PMID: 30224103 DOI: 10.1016/j.jval.2018.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/13/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Constrained optimization methods are already widely used in health care to solve problems that represent traditional applications of operations research methods, such as choosing the optimal location for new facilities or making the most efficient use of operating room capacity. OBJECTIVES In this paper we illustrate the potential utility of these methods for finding optimal solutions to problems in health care delivery and policy. To do so, we selected three award-winning papers in health care delivery or policy development, reflecting a range of optimization algorithms. Two of the three papers are reviewed using the ISPOR Constrained Optimization Good Practice Checklist, adapted from the framework presented in the initial Optimization Task Force Report. The first case study illustrates application of linear programming to determine the optimal mix of screening and vaccination strategies for the prevention of cervical cancer. The second case illustrates application of the Markov Decision Process to find the optimal strategy for treating type 2 diabetes patients for hypercholesterolemia using statins. The third paper (described in Appendix 1) is used as an educational tool. The goal is to describe the characteristics of a radiation therapy optimization problem and then invite the reader to formulate the mathematical model for solving it. This example is particularly interesting because it lends itself to a range of possible models, including linear, nonlinear, and mixed-integer programming formulations. From the case studies presented, we hope the reader will develop an appreciation for the wide range of problem types that can be addressed with constrained optimization methods, as well as the variety of methods available. CONCLUSIONS Constrained optimization methods are informative in providing insights to decision makers about optimal target solutions and the magnitude of the loss of benefit or increased costs associated with the ultimate clinical decision or policy choice. Failing to identify a mathematically superior or optimal solution represents a missed opportunity to improve economic efficiency in the delivery of care and clinical outcomes for patients. The ISPOR Optimization Methods Emerging Good Practices Task Force's first report provided an introduction to constrained optimization methods to solve important clinical and health policy problems. This report also outlined the relationship of constrained optimization methods relative to traditional health economic modeling, graphically illustrated a simple formulation, and identified some of the major variants of constrained optimization models, such as linear programming, dynamic programming, integer programming, and stochastic programming. The second report illustrates the application of constrained optimization methods in health care decision making using three case studies. The studies focus on determining optimal screening and vaccination strategies for cervical cancer, optimal statin start times for diabetes, and an educational case to invite the reader to formulate radiation therapy optimization problems. These illustrate a wide range of problem types that can be addressed with constrained optimization methods.
Collapse
Affiliation(s)
| | - Nasuh Buyukkaramikli
- Institute of Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Mustafa Y Sir
- Health Care Policy and Research, Information & Decision Engineering, Mayo Clinic Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | | | - Alec Morton
- Department of Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, Scotland, UK
| | - Deborah A Marshall
- Health Services & Systems Research, University of Calgary, Calgary, Alberta, Canada; Alberta Bone & Joint Health Institute, Department Community Health Sciences, Faculty of Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Maarten J Ijzerman
- University of Twente, Department Health Technology & Services Research, Enschede, The Netherlands; Luxembourg Institute of Health, Health Economics and Evidence Synthesis Unit, Strassen, Luxembourg
| | - William V Padula
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kalyan S Pasupathy
- Health Care Policy and Research, Information & Decision Engineering, Mayo Clinic Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.
| |
Collapse
|
121
|
Phillips KA, Deverka PA, Marshall DA, Wordsworth S, Regier DA, Christensen KD, Buchanan J. Methodological Issues in Assessing the Economic Value of Next-Generation Sequencing Tests: Many Challenges and Not Enough Solutions. Value Health 2018; 21:1033-1042. [PMID: 30224106 PMCID: PMC6159915 DOI: 10.1016/j.jval.2018.06.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 06/11/2018] [Indexed: 05/05/2023]
Abstract
BACKGROUND Clinical use of next-generation sequencing (NGS) tests has been increasing, but few studies have examined their economic value. Several studies have noted that there are methodological challenges to conducting economic evaluations of NGS tests. OBJECTIVE Our objective was to examine key methodological challenges for conducting economic evaluations of NGS tests, prioritize these challenges for future research, and identify how studies have attempted solutions to address these challenges. METHODS We identified challenges for economic evaluations of NGS tests using prior literature and expert judgment of the co-authors. We used a modified Delphi assessment to prioritize challenges, based on importance and probability of resolution. Using a structured literature review and article extraction we then assessed whether published economic evaluations had addressed these challenges. RESULTS We identified 11 challenges for conducting economic evaluations of NGS tests. The experts identified three challenges as the top priorities for future research: complex model structure, timeframe, and type of analysis and comparators used. Of the 15 published studies included in our literature review, four studies described specific solutions relevant to five of the 11 identified challenges. CONCLUSIONS Major methodological challenges to economic evaluations of NGS tests remain to be addressed. Our results can be used to guide future research and inform decision-makers on how to prioritize research on the economic assessment of NGS tests.
Collapse
Affiliation(s)
- Kathryn A Phillips
- Department of Clinical Pharmacy; Center for Translational and Policy Research on Personalized Medicine (TRANSPERS); UCSF Philip R. Lee Institute for Health Policy; and UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
| | | | - Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Wordsworth
- Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Dean A Regier
- Cancer Control BC, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - James Buchanan
- Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
| |
Collapse
|
122
|
Regier DA, Weymann D, Buchanan J, Marshall DA, Wordsworth S. Valuation of Health and Nonhealth Outcomes from Next-Generation Sequencing: Approaches, Challenges, and Solutions. Value Health 2018; 21:1043-1047. [PMID: 30224107 DOI: 10.1016/j.jval.2018.06.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/11/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Next-generation sequencing (NGS) technologies have seen variable adoption in the clinic. This is partly due to a lack of clinical and economic studies, with the latter increasingly challenged to examine patient preferences for health and nonhealth outcomes (e.g., false-positive rate). OBJECTIVES To conduct a structured review of studies valuing patients' preference-based utility for NGS outcomes, to highlight identified methodological challenges, and to consider how studies addressed identified challenges. METHODS We searched MEDLINE (PubMed), Embase (Ovid), and Web of Science for published studies examining outcomes from health care decisions informed by NGS. We focused our search on direct elicitations of preference-based utility. We reviewed included studies and qualitatively grouped and summarized stated challenges and solutions by theme. RESULTS Eleven studies were included. Most of them (n = 6) used discrete choice experiments to value utility. We categorized challenges into four themes: 1) valuing the full range of NGS outcomes, 2) accounting for accuracy and uncertainty surrounding effectiveness, 3) allowing for simultaneous multiple and cascading risks, and 4) incorporating downstream consequences. Studies found strong evidence of utility for NGS information, regardless of health improvement. Investigators addressed challenges by simplifying complex choices, by including health outcomes alongside nonhealth outcomes, and by using multiple elicitation techniques. CONCLUSIONS The breadth and complexity of NGS-derived information makes the technology a unique and challenging application for utility valuation. Failing to account for the utility or disutility of NGS-related nonhealth outcomes may lead to overinvestment or underinvestment in NGS, and so there is a need for research addressing unresolved challenges.
Collapse
Affiliation(s)
- Dean A Regier
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Deirdre Weymann
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
| | - James Buchanan
- Health Economics Research Centre, University of Oxford, Oxford, United Kingdom
| | - Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Wordsworth
- Health Economics Research Centre, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
123
|
Miller FA, Patton SJ, Dobrow M, Marshall DA, Berta W. Public involvement and health research system governance: a qualitative study. Health Res Policy Syst 2018; 16:87. [PMID: 30165889 PMCID: PMC6117957 DOI: 10.1186/s12961-018-0361-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 08/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interest in public involvement in health research projects has led to increased attention on the coordination of public involvement through research organisations, networks and whole systems. We draw on previous work using the 'health research system' framework to explore organisational actors and stewardship functions relevant to governance for public involvement. METHODS To inform efforts in Ontario, Canada, to mobilise public involvement across the provincial health research enterprise, we conducted an exploratory, qualitative descriptive study of efforts in two jurisdictions (England, United Kingdom, and Alberta, Canada) where there were active policy efforts to support public involvement, alongside jurisdiction-wide efforts to mobilise health research. Focusing on the efforts of public sector organisations with responsibility for funding health research, enabling public involvement, and using research results, we conducted in-depth, semi-structured interviews with 26 expert informants and used a qualitative thematic approach to explore how the involvement of publics in health research has been embedded and supported. RESULTS We identified three sets of common issues in efforts to advance public involvement. First, the initial aim to embed public involvement leveraged efforts to build self-conscious research 'systems', and mobilised policy guidance, direction, investment and infrastructure. Second, efforts to sustain public involvement aimed to deepen involvement activity and tackle diversity limitations, while managing the challenges of influencing research priorities and forging common purpose on the evaluation of public involvement. Finally, public involvement was itself an influential force, with the potential to reinforce - or complicate - the ties that link actors within research systems, and to support - or constrain - the research system's capacity to serve and strengthen health systems. CONCLUSIONS Despite differences in the two jurisdictions analysed and in the organisation of public involvement within them, the supporters and stewards of public involvement sought to leverage research systems to advance public involvement, anticipated similar opportunities for improvement in involvement processes and identified similar challenges for future involvement activities. This suggests the value of a health research system framework in governance for public involvement, and the importance of public involvement for the success of health research systems and the health systems they aim to serve.
Collapse
Affiliation(s)
- Fiona Alice Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M6, Canada.
| | - Sarah J Patton
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Mark Dobrow
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, 3rd Floor, Calgary, AB, T2N 4Z6, Canada
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M6, Canada
| |
Collapse
|
124
|
Barber CEH, Thorne JC, Ahluwalia V, Burt J, Lacaille D, Marshall DA, Hazlewood GS, Mosher D, Denning L, Szamko I, Chin R, Hamilton S, Benseler S, Twilt M, Shiff NJ, Bykerk V, Homik J, Barnabe C. Feasibility of Measurement and Adherence to System Performance Measures for Rheumatoid Arthritis in 5 Models of Care. J Rheumatol 2018; 45:1501-1508. [PMID: 29907674 DOI: 10.3899/jrheum.171284] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To test the feasibility of reporting on 4 national performance measures for patients with rheumatoid arthritis (RA) in 5 different models of care. METHODS The following performance measures were evaluated in 5 models of care: waiting time (WT) to rheumatologist consultation, percentage of patients seen in yearly followup (FU), percentage taking disease-modifying antirheumatic drugs (DMARD), and time to starting DMARD. All models aimed to improve early access and care for patients with RA. RESULTS A number of feasibility issues were encountered in performance measure evaluation because of differences in site data collection and/or the duration of the model of care. For example, while 4/5 programs maintained clinical or research databases, chart reviews were still required to report on WT. Median WT for care in 2015 varied by site between 21 and 75 days. Yearly FU rates could only be calculated in 2 sites (combined owing to small numbers) and varied between 83% and 100%. Percentage of patients taking a DMARD and time to DMARD could be calculated in 3 models, and rates of DMARD use were between 90% and 100%, with median time to DMARD of 0 days in each. CONCLUSION Our review has shown that even in models of care designed to improve access to care and early treatment, data to document improvements are often lacking. Where data were available for measuring, deficits in WT performance were noted for some centers. Our results highlight a need to improve reporting processes to drive quality improvement.
Collapse
Affiliation(s)
- Claire E H Barber
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada. .,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada.
| | - J Carter Thorne
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Vandana Ahluwalia
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Jennifer Burt
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Diane Lacaille
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Deborah A Marshall
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Glen S Hazlewood
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Dianne Mosher
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Lisa Denning
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Ildiko Szamko
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Ricky Chin
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Sean Hamilton
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Susanne Benseler
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Marinka Twilt
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Natalie J Shiff
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Vivian Bykerk
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Joanne Homik
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Cheryl Barnabe
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| |
Collapse
|
125
|
Barber CEH, Schieir O, Lacaille D, Marshall DA, Barnabe C, Hazlewood G, Thorne JC, Ahluwalia V, Bartlett SJ, Boire G, Haraoui B, Hitchon C, Keystone E, Tin D, Pope JE, Denning L, Bykerk VP. High Adherence to System-Level Performance Measures for Rheumatoid Arthritis in a National Early Arthritis Cohort Over Eight Years. Arthritis Care Res (Hoboken) 2018; 70:842-850. [PMID: 29450976 PMCID: PMC6001563 DOI: 10.1002/acr.23439] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/26/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess adherence to 3 system-level performance measures in a national early rheumatoid arthritis (RA) cohort. METHODS Patients enrolled in the Canadian Early Arthritis Cohort (2007-2015) who met 1987 or 2010 American College of Rheumatology/European League Against Rheumatism criteria with <1 year of symptom duration and ≥1 year of followup after enrollment were included. Performance measures assessed were the percentage of RA patients seen in yearly followup, and the number of gaps between visits of >12 or >14 months, the percentage of RA patients treated with a disease-modifying antirheumatic drug (DMARD), and days from RA diagnosis to initiation of a DMARD. Results are shown stratified by enrollment year to assess for temporal changes in performance. RESULTS A total of 1,763 early RA patients were included (mean age 54 years, 73% female, and 82% white). At enrollment, mean ± SD disease duration was 6 ± 3 months, and Disease Activity Score in 28 joints was 5.1 ± 1.5. Over 8 years, the proportion of patients seen in annual followup declined from 100% to 91%. Over followup, 42% of patients had 0 gaps in care of >12 months, and 64% had 0 gaps >14 months. The percentage of DMARD-treated early RA patients was and remained high (95-87%), and the percentage receiving DMARDs within 14 days of diagnosis was 75%. Median time-to-DMARD therapy was 1 day, indicating DMARDs were initiated at diagnosis (90th percentile 93 days). CONCLUSION There was evidence of high adherence to system-level performance measures in this early RA cohort following a protocol. Small declines in performance were noted with increasing length of patient followup. Our findings are useful for performance measure benchmarking.
Collapse
Affiliation(s)
- Claire E. H. Barber
- University of Calgary, Calgary, Alberta, Canadaand Arthritis Research CanadaRichmondBritish ColumbiaCanada
| | | | - Diane Lacaille
- Arthritis Research Canada, Richmondand University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Deborah A. Marshall
- University of Calgary, Calgary, Alberta, Canadaand Arthritis Research CanadaRichmondBritish ColumbiaCanada
| | - Cheryl Barnabe
- University of Calgary, Calgary, Alberta, Canadaand Arthritis Research CanadaRichmondBritish ColumbiaCanada
| | - Glen Hazlewood
- University of Calgary, Calgary, Alberta, Canadaand Arthritis Research CanadaRichmondBritish ColumbiaCanada
| | | | | | | | | | | | | | | | - Diane Tin
- Southlake Regional Health CentreNewmarketOntarioCanada
| | | | - Lisa Denning
- William Osler Health SystemEtobicokeOntarioCanada
| | - Vivian P. Bykerk
- Arthritis Research Canada, Richmond, British Columbia, Canadaand Hospital for Special SurgeryNew YorkNew York
| |
Collapse
|
126
|
Westby MD, Marshall DA, Jones CA. Development of quality indicators for hip and knee arthroplasty rehabilitation. Osteoarthritis Cartilage 2018; 26:370-382. [PMID: 29292095 DOI: 10.1016/j.joca.2017.10.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop quality indicators (QIs) reflecting the minimum acceptable standard of rehabilitation care before and after elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) for osteoarthritis (OA). METHODS Informed by high quality evidence and using a modified RAND-UCLA Delphi approach, an 18-member Canadian panel of clinicians, researchers and patients considered 81 proposed QIs (40 for THA, 42 for TKA) addressing rehabilitation before and after elective THA and TKA. Panelists rated QIs for their importance and validity on a 9-point Likert scale through two rounds of online rating interspersed with a moderated and anonymous online discussion forum. Those QIs with median ratings of ≥7 for importance and validity with no disagreement based on the inter-percentile range adjusted for symmetry were included in the final sets. RESULTS Fifteen panelists from seven provinces and varied practice settings completed the Delphi process. Of the 81 plus one additional QIs (total of 82), 67 (82%) were rated as both important and valid (31 for THA, 36 for TKA). For THA, 14 pre-op, six acute and eight post-acute QIs were accepted. For TKA, 16 pre-op, 10 acute and eight post-acute indicators were accepted. Two of three 'across-continuum' QIs were rated appropriate for both procedures. CONCLUSION This work represents the first QIs with which to measure, report and benchmark quality of care in patients receiving rehabilitation before and after THA/TKA surgery. The QIs will be further tested for reliability and feasibility before being widely disseminated in clinical settings and used to assess care gaps.
Collapse
Affiliation(s)
- M D Westby
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, 2635 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada.
| | - D A Marshall
- Department of Community Health Sciences, Arthur JE Child Chair in Rheumatology Research, University of Calgary, Calgary, Alberta, Canada
| | - C A Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
127
|
Lacny S, Wilson T, Clement F, Roberts DJ, Faris P, Ghali WA, Marshall DA. Kaplan–Meier survival analysis overestimates cumulative incidence of health-related events in competing risk settings: a meta-analysis. J Clin Epidemiol 2018; 93:25-35. [DOI: 10.1016/j.jclinepi.2017.10.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 08/15/2017] [Accepted: 10/10/2017] [Indexed: 02/03/2023]
|
128
|
Damani Z, MacKean G, Bohm E, Noseworthy T, Wang JMH, DeMone B, Wright B, Marshall DA. Insights from the design and implementation of a single-entry model of referral for total joint replacement surgery: Critical success factors and unanticipated consequences. Health Policy 2017; 122:165-174. [PMID: 29289415 DOI: 10.1016/j.healthpol.2017.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Single-entry models (SEMs) in healthcare allow patients to see the next-available provider and have been shown to improve waiting times, access and patient flow for preference-sensitive, scheduled services. The Winnipeg Central Intake Service (WCIS) for hip and knee replacement surgery was implemented to improve access in the Winnipeg Regional Health Authority. This paper describes the system's design/implementation; successes, challenges, and unanticipated consequences. METHODS On two occasions, during and following implementation, we interviewed all members of the WCIS project team, including processing engineers, waiting list coordinators, administrators and policy-makers regarding their experiences. We used semi-structured telephone interviews to collect data and qualitative thematic analysis to analyze and interpret the findings. RESULTS Respondents indicated that the overarching objectives of the WCIS were being met. Benefits included streamlined processes, greater patient access, improved measurement and monitoring of outcomes. Challenges included low awareness, change readiness, and initial participation among stakeholders. Unanticipated consequences included workload increases, confusion around stakeholder expectations and under-reporting of data by surgeons' offices. Critical success factors for implementation included a requirement for clear communication, robust data collection, physician leadership and patience by all, especially implementation teams. CONCLUSIONS Although successfully implemented, key lessons and critical success factors were learned related to change management, which if considered and applied, can reduce unanticipated consequences, improve uptake and benefit new models of care.
Collapse
Affiliation(s)
- Zaheed Damani
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3rd Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Gail MacKean
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3rd Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Eric Bohm
- Department of Surgery, University of Manitoba, AE101-820 Sherbrook Street, Winnipeg, MB R3T 2N2, Canada
| | - Tom Noseworthy
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3rd Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | | | - Brie DeMone
- Manitoba Health, Healthy Living and Seniors, Acute, Tertiary and Specialty Care/Regional Policy and Programs, 2061- 300 Carlton Street, Winnipeg, MB R3B 3M9, Canada
| | - Brock Wright
- Winnipeg Regional Health Authority, 4th Floor, 650 Main Street, Winnipeg, MB R3B 1E2, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3rd Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
| |
Collapse
|
129
|
Janssen EM, Marshall DA, Hauber AB, Bridges JFP. Improving the quality of discrete-choice experiments in health: how can we assess validity and reliability? Expert Rev Pharmacoecon Outcomes Res 2017; 17:531-542. [DOI: 10.1080/14737167.2017.1389648] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Ellen M. Janssen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Deborah A. Marshall
- Department of Community Health Sciences, University of Calgary, Health Research Innovation Centre (HRIC), Calgary, AB, Canada
| | | | - John F. P. Bridges
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
130
|
Jensen KE, Soril LJJ, Stelfox HT, Clement FM, Lin Y, Marshall DA. Side Effects Associated with the Use of Intensity-Modulated Radiation Therapy in Breast Cancer Patients Undergoing Adjuvant Radiation Therapy: A Systematic Review and Meta-Analysis. J Med Imaging Radiat Sci 2017; 48:402-413. [PMID: 31047476 DOI: 10.1016/j.jmir.2017.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/07/2017] [Accepted: 09/12/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of the study was to establish the efficacy and safety of breast intensity-modulated radiation therapy (IMRT) compared with non-IMRT standard wedge radiation therapy (RT) for the treatment of adjuvant breast cancer. METHODS A systematic review and meta-analysis were completed using STATA and a random effects model. A total of 1,499 citations were identified from the literature search. Of those, 1,475 were excluded based on abstract review. Full texts of 24 remaining articles were reviewed and 11 articles were included in the final analysis. Side effects were analysed as the primary outcomes of interest. We calculated individual odds ratios and 95% confidence intervals for 17 classifications of side effects reported. The data for eight classifications of side effects were then pooled for meta-analyses to obtain more precise estimates of the relationships between adjuvant RT and a particular side effect. RESULTS The pooled analyses revealed potential protective associations between adjuvant IMRT and two acute side effects: dermatitis and moist desquamation. The remaining pooled estimates suggest that the odds of developing edema, hyperpigmentation, fat necrosis, pain, induration were no worse, nor better among those treated with IMRT compared with those treated with non-IMRT standard wedge RT. CONCLUSION The pooled estimates from this meta-analysis are in line with the existing evidence. When the outcome of interest is reduction of the acute side effects: dermatitis and moist desquamation IMRT is a viable treatment option for women undergoing external beam RT after breast-conserving surgery.
Collapse
Affiliation(s)
- Katherine E Jensen
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Radiation Oncology, Central Alberta Cancer Center, Alberta Health Services, Red Deer, Alberta, Canada.
| | - Lesley J J Soril
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fiona M Clement
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yongtao Lin
- Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
131
|
Barber CEH, Mosher DP, Ahluwalia V, Zummer M, Marshall DA, Choquette D, Lacaille D, Bombardier C, Lyddiatt A, Chandran V, Khodyakov D, Dao E, Barnabe C. Development of a Canadian Core Clinical Dataset to Support High-quality Care for Canadian Patients with Rheumatoid Arthritis. J Rheumatol 2017; 44:1813-1822. [PMID: 28966205 DOI: 10.3899/jrheum.170421] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To develop a Canadian Rheumatoid Arthritis Core Clinical Dataset (CAN-RACCD) to standardize documentation encouraging high-quality care. METHODS A set of candidate elements was drafted through meetings with 27 rheumatologists, researchers, and patients, and supplemented with focused literature reviews. A 3-round online-modified Delphi consensus process was held with rheumatologists (n = 26), allied health professionals (n = 7), and patients (n = 4); for the remainder there was no demographic information. Participants rated both the importance and feasibility of documenting candidate elements on a Likert scale of 1-9, contributed to an online moderated discussion, and re-rated the elements for inclusion in the CAN-RACCD. Elements were included in the final set if importance and feasibility ratings had a median score of ≥ 6.5 and there was no disagreement among participants. RESULTS Fifty-five individual elements in 10 subgroups were proposed to the Delphi participants: measures of RA disease activity; dates to calculate waiting times, disease duration, and disease-modifying antirheumatic drug start; comorbidities; smoking status; patient-reported pain and fatigue; physical function; laboratory and radiographic investigations; medications; clinical characteristics; and vaccines. All groups were included in the final set, with the exception of vaccination status. Additionally, 3 individual elements from the smoking subgroup were eliminated with a recommendation to record smoking status as never/ever/current, and 2 elements relating to coping and effect of fatigue were eliminated due to low feasibility and importance ratings. CONCLUSION The CAN-RACCD stands as a national recommendation on which data elements should be routinely collected in clinical practice to monitor and support high-quality RA care.
Collapse
Affiliation(s)
- Claire E H Barber
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA. .,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary.
| | - Dianne P Mosher
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Vandana Ahluwalia
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Michel Zummer
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Deborah A Marshall
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Denis Choquette
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Diane Lacaille
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Claire Bombardier
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Anne Lyddiatt
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Vinod Chandran
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Dmitry Khodyakov
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Emily Dao
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | | | | |
Collapse
|
132
|
Lopatina E, Damani Z, Bohm E, Noseworthy TW, Conner-Spady B, MacKean G, Simpson CS, Marshall DA. Single-entry models (SEMs) for scheduled services: Towards a roadmap for the implementation of recommended practices. Health Policy 2017; 121:963-970. [PMID: 28830624 DOI: 10.1016/j.healthpol.2017.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 07/31/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Long waiting times for elective services continue to be a challenging issue. Single-entry models (SEMs) are used to increase access to and flow through the healthcare system. This paper provides a roadmap for healthcare decision-makers, managers, physicians, and researchers to guide implementation and management of successful and sustainable SEMs. METHODS The roadmap was informed by an inductive qualitative synthesis of the findings from a deliberative process (a symposium on SEMs, with clinicians, researchers, senior policy-makers, healthcare managers, and patient representatives) and focus groups with the symposium participants. RESULTS SEMs are a promising strategy to improve the management of referrals and represent one approach to reduce waiting times. The SEMs roadmap outlines current knowledge about SEMs and critical success factors for SEMs' implementation and management. CONCLUSIONS This SEM roadmap is intended to help clinicians, decision-makers, managers, and researchers interested in developing new or strengthening existing SEMs. We consider this roadmap to be a living document that will continue to evolve as we learn more about implementing and managing sustainable SEMs.
Collapse
Affiliation(s)
- Elena Lopatina
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre (HRIC), 3C60, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
| | - Zaheed Damani
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Teaching, Research and Wellness (TRW) building, 3rd floor, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
| | - Eric Bohm
- Concordia Joint Replacement Group, University of Manitoba, 1155 Concordia Ave, Winnipeg, MB, R2K 4L5, Canada.
| | - Tom W Noseworthy
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Teaching, Research and Wellness (TRW) building, 3D14B, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
| | - Barbara Conner-Spady
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Teaching, Research and Wellness (TRW) building, 3rd floor, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
| | - Gail MacKean
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Teaching, Research and Wellness (TRW) building, 3rd floor, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
| | - Chris S Simpson
- Division of Cardiology, Department of Medicine, Queen's University; and, Cardiac Programs, Kingston General Hospital and Hotel Dieu Hospital, 166 Brock Street, Kingston, ON, K7L 5G2, Canada.
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; Alberta Bone & Joint Health Institute; and, McCaig Institute for Bone and Joint Health, Health Research Innovation Centre (HRIC), 3C58, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
| |
Collapse
|
133
|
Shklarov S, Marshall DA, Wasylak T, Marlett NJ. "Part of the Team": Mapping the outcomes of training patients for new roles in health research and planning. Health Expect 2017; 20:1428-1436. [PMID: 28660732 PMCID: PMC5689226 DOI: 10.1111/hex.12591] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2017] [Indexed: 11/30/2022] Open
Abstract
Background A patient research internship (Patient and Community Engagement Research program—PaCER) was created to support a provincial commitment by Alberta Health Services’ Strategic Clinical Networks™ to find new ways to engage patients in a new interdisciplinary organization to support evidence‐informed improvements in clinical outcomes across the health system. Objective Implement and test a new research method and training curriculum to build patient capacity for engagement in health through peer‐to‐peer research. Design Programme evaluation using Outcome Mapping and the grounded theory method. Setting and Participants Twenty‐one patients with various chronic conditions completed one year of training in adapted qualitative research methods, including an internship where they designed and conducted five peer‐to‐peer inquiries into a range of health experiences. Main Outcome Measures Outcomes were continually monitored and evaluated using an Outcome Mapping framework, in combination with grounded theory analysis, based on data from focus groups, observation, documentation review and semi‐structured interviews (21 patient researchers, 15 professional collaborators). Results Key stakeholders indicated the increased capacity of patients to engage in health‐care research and planning, and the introduction and acceptance of new, collaborative roles for patients in health research. The uptake of new patient roles in health‐care planning began to impact attitudes and practices. Conclusions Patient researchers become “part of the team” through cultural and relationship changes that occur in two convergent directions: (i) building the capacity of patients to engage confidently in a dialogue with clinicians and decision makers, and (ii) increasing the readiness for patient engagement uptake within targeted organizations.
Collapse
Affiliation(s)
- Svetlana Shklarov
- Patient and Community Engagement Research (PaCER) Program, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.,Community Rehabilitation and Disability Studies Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Tracy Wasylak
- Strategic Clinical Networks, Alberta Health Services, Calgary, AB, Canada
| | - Nancy J Marlett
- Patient and Community Engagement Research (PaCER) Program, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
134
|
Marshall DA, MacDonald KV, Robinson JO, Barcellos LF, Gianfrancesco M, Helm M, McGuire A, Green RC, Douglas MP, Goldman MA, Phillips KA. The price of whole-genome sequencing may be decreasing, but who will be sequenced? Per Med 2017; 14:203-211. [PMID: 28993792 DOI: 10.2217/pme-2016-0075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM Since whole-genome sequencing (WGS) information can have positive and negative personal utility for individuals, we examined predictors of willingness to pay (WTP) for WGS. PATIENTS & METHODS We surveyed two independent populations: adult patients (n = 203) and college seniors (n = 980). Ordinal logistic regression models were used to characterize the relationship between predictors and WTP. RESULTS Sex, age, education, income, genomic knowledge and knowing someone who had genetic testing or having had genetic testing done personally were associated with significantly higher WTP for WGS. After controlling for income and education, males were willing to pay more for WGS than females. CONCLUSION Differences in WTP may impact equity, coverage, affordability and access, and should be anticipated by public dialog about related health policy.
Collapse
Affiliation(s)
- Deborah A Marshall
- Department of Community Health Sciences, Room 3C56 Health Research Innovation Centre, University of Calgary, Calgary, Alberta, Canada
| | - Karen V MacDonald
- Department of Community Health Sciences, Room 3C56 Health Research Innovation Centre, University of Calgary, Calgary, Alberta, Canada
| | - Jill Oliver Robinson
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, USA
| | - Lisa F Barcellos
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Milena Gianfrancesco
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Monica Helm
- Center for Clinical Genetics and Genomics at Providence Health & Services Southern California, 181 South Buena Vista Street - Suite 240, Burbank, CA 91505, USA
| | - Amy McGuire
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham & Women's Hospital, Broad Institute & Harvard Medical School, Boston, MA, USA
| | - Michael P Douglas
- Department of Clinical Pharmacy, Center for Translational & Policy Research on Personalized Medicine (TRANSPERS), University of California, San Francisco, CA, USA
| | - Michael A Goldman
- Department of Biology, College of Science & Engineering, San Francisco State University, San Francisco, CA, USA
| | - Kathryn A Phillips
- Department of Clinical Pharmacy, Center for Translational & Policy Research on Personalized Medicine (TRANSPERS), University of California, San Francisco, CA, USA.,UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| |
Collapse
|
135
|
Lopatina E, Donald F, DiCenso A, Martin-Misener R, Kilpatrick K, Bryant-Lukosius D, Carter N, Reid K, Marshall DA. Economic evaluation of nurse practitioner and clinical nurse specialist roles: A methodological review. Int J Nurs Stud 2017; 72:71-82. [PMID: 28500955 DOI: 10.1016/j.ijnurstu.2017.04.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/21/2017] [Accepted: 04/28/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Advanced practice nurses (e.g., nurse practitioners and clinical nurse specialists) have been introduced internationally to increase access to high quality care and to tackle increasing health care expenditures. While randomised controlled trials and systematic reviews have demonstrated the effectiveness of nurse practitioner and clinical nurse specialist roles, their cost-effectiveness has been challenged. The poor quality of economic evaluations of these roles to date raises the question of whether current economic evaluation guidelines are adequate when examining their cost-effectiveness. OBJECTIVE To examine whether current guidelines for economic evaluation are appropriate for economic evaluations of nurse practitioner and clinical nurse specialist roles. METHODS Our methodological review was informed by a qualitative synthesis of four sources of information: 1) narrative review of literature reviews and discussion papers on economic evaluation of advanced practice nursing roles; 2) quality assessment of economic evaluations of nurse practitioner and clinical nurse specialist roles alongside randomised controlled trials; 3) review of guidelines for economic evaluation; and, 4) input from an expert panel. RESULTS The narrative literature review revealed several challenges in economic evaluations of advanced practice nursing roles (e.g., complexity of the roles, variability in models and practice settings where the roles are implemented, and impact on outcomes that are difficult to measure). The quality assessment of economic evaluations of nurse practitioner and clinical nurse specialist roles alongside randomised controlled trials identified methodological limitations of these studies. When we applied the Guidelines for the Economic Evaluation of Health Technologies: Canada to the identified challenges and limitations, discussed those with experts and qualitatively synthesized all findings, we concluded that standard guidelines for economic evaluation are appropriate for economic evaluations of nurse practitioner and clinical nurse specialist roles and should be routinely followed. However, seven out of 15 current guideline sections (describing a decision problem, choosing type of economic evaluation, selecting comparators, determining the study perspective, estimating effectiveness, measuring and valuing health, and assessing resource use and costs) may require additional role-specific considerations to capture costs and effects of these roles. CONCLUSION Current guidelines for economic evaluation should form the foundation for economic evaluations of nurse practitioner and clinical nurse specialist roles. The proposed role-specific considerations, which clarify application of standard guidelines sections to economic evaluation of nurse practitioner and clinical nurse specialist roles, may strengthen the quality and comprehensiveness of future economic evaluations of these roles.
Collapse
Affiliation(s)
- Elena Lopatina
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, 3C60, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Faith Donald
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.
| | - Alba DiCenso
- School of Nursing and Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Ruth Martin-Misener
- School of Nursing, Dalhousie University, Box 15000, 5869 University Avenue, Halifax, NS, B3H 4R2, Canada.
| | - Kelley Kilpatrick
- Faculty of Nursing, Université de Montréal, Research Centre Hôpital Maisonneuve-Rosemont, CSA - RC - Aile bleue - Room F121, 5415 boul. l'Assomption, Montréal, QC, H1T 2M4, Canada.
| | - Denise Bryant-Lukosius
- School of Nursing, McMaster University, 1280 Main Street West, HSC-3N28G, Hamilton, ON, L8S 4L8, Canada.
| | - Nancy Carter
- School of Nursing, McMaster University, 1280 Main Street West, HSC-3N28H, Hamilton, ON, L8S 4L8, Canada.
| | - Kim Reid
- KJResearch, Rosemere, QC, Canada.
| | - Deborah A Marshall
- Department of Community Health Sciences and Faculty of Medicine, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, Room 3C58, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| |
Collapse
|
136
|
Khodyakov D, Grant S, Barber CEH, Marshall DA, Esdaile JM, Lacaille D. Acceptability of an online modified Delphi panel approach for developing health services performance measures: results from 3 panels on arthritis research. J Eval Clin Pract 2017; 23:354-360. [PMID: 27619536 DOI: 10.1111/jep.12623] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 01/23/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Online modified Delphi (OMD) panel approaches can be used to engage large and diverse groups of clinical experts and stakeholders in developing health services performance measures. Such approaches are increasing in popularity among health researchers. However, information about their acceptability to participating experts and stakeholders is lacking but important to determine before recommending widespread use of online approaches. Therefore, the objective of this paper is to explore acceptability of the OMD panel approach from the participants' perspective. METHOD We use data from participants in three OMD panels designed to develop performance measures for use in arthritis research and quality improvement efforts. At the end of each online panel, we surveyed clinical experts and stakeholders who shared their experiences with the OMD process by answering 13 close-ended questions using 7-point Likert-type scales. A mean of 5 or higher on a given question was treated as an indication of acceptability. RESULTS Ninety-eight clinical experts and stakeholders (92% participation rate) answered survey questions about the online process. They considered the OMD panel approach to be acceptable, particularly the ease of using the online system (mean = 5.3, standard deviation = 1.3) and the understanding gained from online discussions (mean = 5.2, standard deviation = 1.0). Participants also felt that participation in the Delphi study was interesting (mean = 5.6, standard deviation =1.1). CONCLUSION These findings illustrate likely acceptability and a potential for a more widespread use of OMD panel approaches by stakeholders in developing health services performance measures.
Collapse
Affiliation(s)
| | | | - Claire E H Barber
- University of Calgary; Arthritis Research Centre Canada, Calgary, Canada
| | - Deborah A Marshall
- University of Calgary; Arthritis Research Centre Canada, Calgary, Canada
| | | | | |
Collapse
|
137
|
Sampson BJ, Marshall DA, Smith BJ, Stringer SJ, Werle CT, Magee DJ, Adamczyk JJ. Erythritol and Lufenuron Detrimentally Alter Age Structure of Wild Drosophila suzukii (Diptera: Drosophilidae) Populations in Blueberry and Blackberry. J Econ Entomol 2017; 110:530-534. [PMID: 28334255 DOI: 10.1093/jee/tow307] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Indexed: 06/06/2023]
Abstract
We report on the efficacy of 0.5 M (61,000 ppm) erythritol (E) in Truvia Baking Blend, 10 ppm lufenuron (L), and their combination (LE) to reduce egg and larval densities of wild populations of Drosophila suzukii (Matsumura) infesting fields of rabbiteye blueberries (Vaccinium virgatum) and blackberries (Rubus sp.). Formulations included the active ingredients (lufenuron, erythritol, or both), sugar (in control and erythritol treatments), and Dawn hand-soap applied to plants with pressurized 3-gallon garden spray tanks. The three chemical treatments (E, L, and LE) had no effect on D. suzukii ovipositing in blackberry and blueberry fruit, but they did reduce larval infestation by 75%, particularly densities of first and second instars. Erythritol and lufenuron were equally efficacious compounds as a D. suzukii ovicide and larvicide, but they did not display additive or synergistic activity. Extremely high larval mortality in control fruits show an age structure heavily skewed toward egg output.
Collapse
Affiliation(s)
- B J Sampson
- USDA-ARS Thad Cochran Southern Horticultural Laboratory, 810 Hwy., 26 West, Poplarville, MS 39470 (; ; ; ; ; ; )
| | - D A Marshall
- USDA-ARS Thad Cochran Southern Horticultural Laboratory, 810 Hwy., 26 West, Poplarville, MS 39470 (; ; ; ; ; ; )
| | - B J Smith
- USDA-ARS Thad Cochran Southern Horticultural Laboratory, 810 Hwy., 26 West, Poplarville, MS 39470 (; ; ; ; ; ; )
| | - S J Stringer
- USDA-ARS Thad Cochran Southern Horticultural Laboratory, 810 Hwy., 26 West, Poplarville, MS 39470 (; ; ; ; ; ; )
| | - C T Werle
- USDA-ARS Thad Cochran Southern Horticultural Laboratory, 810 Hwy., 26 West, Poplarville, MS 39470 (; ; ; ; ; ; )
| | - D J Magee
- USDA-ARS Thad Cochran Southern Horticultural Laboratory, 810 Hwy., 26 West, Poplarville, MS 39470 (; ; ; ; ; ; )
| | - J J Adamczyk
- USDA-ARS Thad Cochran Southern Horticultural Laboratory, 810 Hwy., 26 West, Poplarville, MS 39470 (; ; ; ; ; ; )
| |
Collapse
|
138
|
Collins KH, Sharif B, Sanmartin C, Reimer RA, Herzog W, Chin R, Marshall DA. Association of body mass index (BMI) and percent body fat among BMI-defined non-obese middle-aged individuals: Insights from a population-based Canadian sample. Can J Public Health 2017; 107:e520-e525. [PMID: 28252369 DOI: 10.17269/cjph.107.5652] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 10/24/2016] [Accepted: 09/09/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To evaluate the association between percent body fat (%BF) and body mass index (BMI) among BMI-defined non-obese individuals between 40 and 69 years of age using a population-based Canadian sample. DATA AND METHODS Cross-sectional data from the Canadian Health Measures Survey (2007 and 2009) was used to select all middle-aged individuals with BMI < 30 kg/m2 (n = 2,656). %BF was determined from anthropometric skinfolds and categorized according to sex-specific equations. Association of other anthropometry measures and metabolic markers were evaluated across different %BF categories. Significance of proportions was evaluated using chi-squared and Bonferroni-adjusted Wald test. Diagnostic performance measures of BMI-defined overweight categories compared to those defined by %BF were reported. RESULTS The majority (69%) of the sample was %BF-defined overweight/obese, while 55% were BMI-defined overweight. BMI category was not concordant with %BF classification for 30% of the population. The greatest discordance between %BF and BMI was observed among %BF-defined overweight/obese women (32%). Sensitivity and specificity of BMI-defined overweight compared to %BF-defined overweight/obese were (58%, 94%) among females and (82%, 59%) among males respectively. According to the estimated negative predictive value, if an individual is categorized as BMI-defined non-obese, he/she has a 52% chance of being in the %BF-defined overweight/obese category. CONCLUSION Middle-aged individuals classified as normal by BMI may be overweight/obese based on measures of %BF. These individuals may be at risk for chronic diseases, but would not be identified as such based on their BMI classification. Quantifying %BF in this group could inform targeted strategies for disease prevention.
Collapse
Affiliation(s)
- Kelsey H Collins
- Human Performance Laboratory, University of Calgary, Calgary, AB.
| | | | | | | | | | | | | |
Collapse
|
139
|
Crown W, Buyukkaramikli N, Thokala P, Morton A, Sir MY, Marshall DA, Tosh J, Padula WV, Ijzerman MJ, Wong PK, Pasupathy KS. Constrained Optimization Methods in Health Services Research-An Introduction: Report 1 of the ISPOR Optimization Methods Emerging Good Practices Task Force. Value Health 2017; 20:310-319. [PMID: 28292475 DOI: 10.1016/j.jval.2017.01.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/17/2017] [Indexed: 05/26/2023]
Abstract
Providing health services with the greatest possible value to patients and society given the constraints imposed by patient characteristics, health care system characteristics, budgets, and so forth relies heavily on the design of structures and processes. Such problems are complex and require a rigorous and systematic approach to identify the best solution. Constrained optimization is a set of methods designed to identify efficiently and systematically the best solution (the optimal solution) to a problem characterized by a number of potential solutions in the presence of identified constraints. This report identifies 1) key concepts and the main steps in building an optimization model; 2) the types of problems for which optimal solutions can be determined in real-world health applications; and 3) the appropriate optimization methods for these problems. We first present a simple graphical model based on the treatment of "regular" and "severe" patients, which maximizes the overall health benefit subject to time and budget constraints. We then relate it back to how optimization is relevant in health services research for addressing present day challenges. We also explain how these mathematical optimization methods relate to simulation methods, to standard health economic analysis techniques, and to the emergent fields of analytics and machine learning.
Collapse
Affiliation(s)
| | - Nasuh Buyukkaramikli
- Scientific Researcher, Institute of Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Alec Morton
- Professor of Management Science, Department of Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, Scotland, UK
| | - Mustafa Y Sir
- Assistant Professor, Health Care Policy & Research, Information and Decision Engineering, Mayo Clinic Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Deborah A Marshall
- Canada Research Chair, Health Services & Systems Research; Arthur J.E. Child Chair in Rheumatology Research; Director, HTA, Alberta Bone & Joint Health Institute; Associate Professor, Department Community Health Sciences, Faculty of Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jon Tosh
- Senior Health Economist, DRG Abacus, Manchester, UK
| | - William V Padula
- Assistant Professor, Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maarten J Ijzerman
- Professor of Clinical Epidemiology & Health Technology Assessment (HTA); Head, Department of Health Technology & Services Research, University of Twente, Enschede, The Netherlands
| | - Peter K Wong
- Vice President and Chief Performance Improvement Officer, Illinois Divisions and HSHS Medical Group, Hospital Sisters Health System (HSHS), Belleville, IL. USA
| | - Kalyan S Pasupathy
- Associate Professor - Healthcare Policy & Research, Lead, Information and Decision Engineering, Mayo Clinic Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.
| |
Collapse
|
140
|
Abstract
BACKGROUND Single-entry models (SEMs) for the management of patients awaiting elective surgical services are designed to increase access and flow through the system of care. We assessed scope of use and influence of SEMs on access (waiting times/throughput) and patient-centredness (patient/provider acceptability). METHODS Systematic review of articles published in 6 relevant electronic databases included studies from database inception to July 2016. Included studies needed to (1) report on the nature of the SEM; (2) specify elective service and (3) address at least 1 of 3 research questions related to (1) scope of use of SEMs; (2) influence on timeliness and access; (3) patient-centredness and acceptability. Article quality was assessed using a modified Downs and Black checklist. RESULTS 11 studies from Canada, Australia and the UK were included with mostly weak observational design-2 simulations, 5 before-after, 2 descriptive and 2 cross-sectional studies. 9 studies showed a decrease in patient waiting times; 6 showed that more patients were meeting benchmark waiting times; and 5 demonstrated that waiting lists decreased using an SEM as compared with controls. Patient acceptability was examined in 6 studies, with high levels of satisfaction reported. Acceptability among general practitioners/surgeons was mixed, as reported in 1 study. Research varied widely in design, scope, reported outcomes and overall quality. CONCLUSIONS This is the first review to assess the influence of SEMs on access to elective surgery for adults. This review demonstrates a potential ability for SEMs to improve timeliness and patient-centredness of elective services; however, the small number of low-quality studies available does not support firm conclusions about the effectiveness of SEMs to improve access. Further evaluation with higher quality designs and rigour is required.
Collapse
Affiliation(s)
- Zaheed Damani
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Barbara Conner-Spady
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tina Nash
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Henry Tom Stelfox
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tom W Noseworthy
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
141
|
Garner S, Lopatina E, Rankin JA, Marshall DA. Nurse-led Care for Patients with Rheumatoid Arthritis: A Systematic Review of the Effect on Quality of Care. J Rheumatol 2017; 44:757-765. [DOI: 10.3899/jrheum.160535] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Abstract
Objective.In the nurse-led care (NLC) model, nurses take on the primary responsibility for patient management. We systematically assessed the effect of NLC for patients with rheumatoid arthritis (RA) on multiple dimensions of quality of care from the Alberta Quality of Care Matrix for Health.Methods.We searched MEDLINE, EMBASE, and CINAHL from 1950 to January 2015. English-language studies were included if they reported on NLC for patients with RA and assessed 1 or more dimensions of quality (effectiveness, acceptability, efficiency, accessibility, appropriateness, and safety). Data were synthesized using narrative analysis.Results.We included 10 studies. The NLC models varied in terms of nurses’ professional designation (clinical nurse specialists or nurse practitioners); however, their role in the clinic was fairly consistent. Disease activity was the most common measure of effectiveness, with NLC being equal (n = 2) or superior (n = 3) to the comparator. NLC was equal (n = 1) or superior (n = 5) versus the comparator in terms of patient satisfaction (i.e., acceptability of care). NLC was equally safe as other models (n = 2). Regarding efficiency, results varied across studies (n = 6) and did not allow for conclusions about models’ cost-effectiveness. In qualitative studies, patients found NLC to be superior in terms of accessibility [i.e., continuity of care (n = 3) and appropriateness measured with education and support (n = 4)]; however, no quantitative measures were found.Conclusion.NLC for patients with RA is effective, acceptable, and safe as compared with other models. However, current evidence is insufficient to draw conclusions about its efficiency, accessibility, and appropriateness.
Collapse
|
142
|
Sharif B, Garner R, Hennessy D, Sanmartin C, Flanagan WM, Marshall DA. Productivity costs of work loss associated with osteoarthritis in Canada from 2010 to 2031. Osteoarthritis Cartilage 2017; 25:249-258. [PMID: 27666512 DOI: 10.1016/j.joca.2016.09.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 09/06/2016] [Accepted: 09/18/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To estimate and project the productivity costs of work loss (PCWL) associated with osteoarthritis (OA) in Canada using the Population Health Model (POHEM). DESIGN We integrated an employment module based on 2006 Canadian Census into the previously developed microsimulation model of OA. The Canadian Community Health Survey (CCHS) Cycle 2.1 with an OA sample aged 25-64 (n = 7067) was used to calibrate the results of the employment module and to estimate the fraction of non-employment associated with OA. Probabilities of non-employment together with attributable fractions were then implemented in POHEM to estimate PCWL associated with OA from 2010 to 2031. RESULTS Among the OA population, 44.4% and 59.4% of non-employment due to illness was associated with OA for those not working full-year and part-year, respectively. According to POHEM projections, the size of the working age population with OA increased from 1.5 million in 2010 to 1.7 million in 2031. The PCWL associated with OA increased from $12 billion to $17.5 billion in constant 2008 Canadian dollars. Around 38% of this increase was due to the increase in OA prevalence and changes in demographics, while the rest was due to increase in real wage growth. Male and female OA patients between 55 and 64 years of age had the highest total projected PCWL, respectively. CONCLUSIONS The total PCWL associated with OA in Canada is estimated to be substantial and increasing in future years. Results of this study could be used to inform policies aiming to increase employment sustainability among individuals with OA.
Collapse
Affiliation(s)
- B Sharif
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.
| | - R Garner
- Health Analysis Division, Statistics Canada, Ottawa, Canada.
| | - D Hennessy
- Health Analysis Division, Statistics Canada, Ottawa, Canada.
| | - C Sanmartin
- Health Analysis Division, Statistics Canada, Ottawa, Canada.
| | - W M Flanagan
- Health Analysis Division, Statistics Canada, Ottawa, Canada.
| | - D A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.
| |
Collapse
|
143
|
Marshall DA, Gonzalez JM, MacDonald KV, Johnson FR. Estimating Preferences for Complex Health Technologies: Lessons Learned and Implications for Personalized Medicine. Value Health 2017; 20:32-39. [PMID: 28212966 PMCID: PMC5319756 DOI: 10.1016/j.jval.2016.08.737] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 08/26/2016] [Indexed: 05/09/2023]
Abstract
We examine key study design challenges of using stated-preference methods to estimate the value of whole-genome sequencing (WGS) as a specific example of genomic testing. Assessing the value of WGS is complex because WGS provides multiple findings, some of which can be incidental in nature and unrelated to the specific health concerns that motivated the test. In addition, WGS results can include actionable findings (variants considered to be clinically useful and can be acted on), findings for which evidence for best clinical action is not available (variants considered clinically valid but do not meet as high of a standard for clinical usefulness), and findings of unknown significance. We consider three key challenges encountered in designing our national study on the value of WGS-layers of uncertainty, potential downstream consequences with endogenous aspects, and both positive and negative utility associated with testing information-and potential solutions as strategies to address these challenges. We conceptualized the decision to acquire WGS information as a series of sequential choices that are resolved separately. To determine the value of WGS information at the initial decision to undergo WGS, we used contingent valuation questions, and to elicit respondent preferences for reducing risks of health problems and the consequences of taking the steps to reduce these risks, we used a discrete-choice experiment. We conclude by considering the implications for evaluating the value of other complex health technologies that involve multiple forms of uncertainty.
Collapse
Affiliation(s)
- Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | | | - Karen V MacDonald
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - F Reed Johnson
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| |
Collapse
|
144
|
Phillips KA, Douglas MP, Trosman JR, Marshall DA. "What Goes Around Comes Around": Lessons Learned from Economic Evaluations of Personalized Medicine Applied to Digital Medicine. Value Health 2017; 20:47-53. [PMID: 28212968 PMCID: PMC5319740 DOI: 10.1016/j.jval.2016.08.736] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 08/20/2016] [Indexed: 05/03/2023]
Abstract
BACKGROUND The growth of "big data" and the emphasis on patient-centered health care have led to the increasing use of two key technologies: personalized medicine and digital medicine. For these technologies to move into mainstream health care and be reimbursed by insurers, it will be essential to have evidence that their benefits provide reasonable value relative to their costs. These technologies, however, have complex characteristics that present challenges to the assessment of their economic value. Previous studies have identified the challenges for personalized medicine and thus this work informs the more nascent topic of digital medicine. OBJECTIVES To examine the methodological challenges and future opportunities for assessing the economic value of digital medicine, using personalized medicine as a comparison. METHODS We focused specifically on digital biomarker technologies and multigene tests. We identified similarities in these technologies that can present challenges to economic evaluation: multiple results, results with different types of utilities, secondary findings, downstream impact (including on family members), and interactive effects. RESULTS Using a structured review, we found that there are few economic evaluations of digital biomarker technologies, with limited results. CONCLUSIONS We conclude that more evidence on the effectiveness of digital medicine will be needed but that the experiences with personalized medicine can inform what data will be needed and how such analyses can be conducted. Our study points out the critical need for typologies and terminology for digital medicine technologies that would enable them to be classified in ways that will facilitate research on their effectiveness and value.
Collapse
Affiliation(s)
- Kathryn A Phillips
- Department of Clinical Pharmacy, Center for Translational and Policy Research on Peronalized Medicine (TRANSPERS), University of California San Francisco, San Francisco, CA, USA; Philip R. Lee Institute for Health Policy, University of California San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
| | - Michael P Douglas
- Department of Clinical Pharmacy, Center for Translational and Policy Research on Peronalized Medicine (TRANSPERS), University of California San Francisco, San Francisco, CA, USA
| | - Julia R Trosman
- Department of Clinical Pharmacy, Center for Translational and Policy Research on Peronalized Medicine (TRANSPERS), University of California San Francisco, San Francisco, CA, USA; Center for Business Models in Healthcare, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
145
|
Barber CEH, Jewett L, Badley EM, Lacaille D, Cividino A, Ahluwalia V, Averns H, Baillie C, Ellsworth J, Pope J, Levy D, Charnock C, McGowan C, Thorne JC, Barnabe C, Zummer M, Lundon K, McDougall RS, Thomson JG, Yacyshyn EA, Mosher D, Brophy J, Ruban TN, Marshall DA. Stand Up and Be Counted: Measuring and Mapping the Rheumatology Workforce in Canada. J Rheumatol 2016; 44:248-257. [PMID: 27909087 DOI: 10.3899/jrheum.160621] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To characterize the practicing rheumatologist workforce, the Canadian Rheumatology Association (CRA) launched the Stand Up and Be Counted workforce survey in 2015. METHODS The survey was distributed electronically to 695 individuals, of whom 519 were expected to be practicing rheumatologists. Demographic and practice information were elicited. We estimated the number of full-time equivalent rheumatologists per 75,000 population from the median proportion of time devoted to clinical practice multiplied by provincial rheumatologist numbers from the Canadian Medical Association. RESULTS The response rate was 68% (355/519) of expected practicing rheumatologists (304 were in adult practice, and 51 pediatric). The median age was 50 years, and one-third planned to retire within the next 5-10 years. The majority (81%) were university-affiliated. Rheumatologists spent a median of 70% of their time in clinical practice, holding 6 half-day clinics weekly, with 10 new consultations and 45 followups seen per week. Work characteristics varied by type of rheumatologist (adult or pediatric) and by practice setting (community- or university-based). We estimated between 0 and 0.8 full-time rheumatologists per 75,000 population in each province. This represents a deficit of 1 to 77 full-time rheumatologists per province/territory to meet the CRA recommendation of 1 rheumatologist per 75,000 population, depending on the province/territory. CONCLUSION Our results highlight a current shortage of rheumatologists in Canada that may worsen in the next 10 years because one-third of the workforce plans to retire. Efforts to encourage trainees to enter rheumatology and strategies to support retention are critical to address the shortage.
Collapse
Affiliation(s)
- Claire E H Barber
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada. .,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health.
| | - Lauren Jewett
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Elizabeth M Badley
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Diane Lacaille
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Alfred Cividino
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Vandana Ahluwalia
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Henry Averns
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Cory Baillie
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Janet Ellsworth
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Janet Pope
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Deborah Levy
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Christine Charnock
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Claire McGowan
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - J Carter Thorne
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Cheryl Barnabe
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Michel Zummer
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Katie Lundon
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Robert S McDougall
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - John G Thomson
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Elaine A Yacyshyn
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Dianne Mosher
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Julie Brophy
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Thanu Nadarajah Ruban
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Deborah A Marshall
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| |
Collapse
|
146
|
Damani Z, MacKean G, Bohm E, DeMone B, Wright B, Noseworthy T, Holroyd-Leduc J, Marshall DA. The use of a policy dialogue to facilitate evidence-informed policy development for improved access to care: the case of the Winnipeg Central Intake Service (WCIS). Health Res Policy Syst 2016; 14:78. [PMID: 27756401 PMCID: PMC5070349 DOI: 10.1186/s12961-016-0149-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 09/23/2016] [Indexed: 11/19/2022] Open
Abstract
Background Policy dialogues are critical for developing responsive, effective, sustainable, evidence-informed policy. Our multidisciplinary team, including researchers, physicians and senior decision-makers, comprehensively evaluated The Winnipeg Central Intake Service, a single-entry model in Winnipeg, Manitoba, to improve patient access to hip/knee replacement surgery. We used the evaluation findings to develop five evidence-informed policy directions to help improve access to scheduled clinical services across Manitoba. Using guiding principles of public participation processes, we hosted a policy roundtable meeting to engage stakeholders and use their input to refine the policy directions. Here, we report on the use and input of a policy roundtable meeting and its role in contributing to the development of evidence-informed policy. Methods Our evidence-informed policy directions focused on formal measurement/monitoring of quality, central intake as a preferred model for service delivery, provincial scope, transparent processes/performance indicators, and patient choice of provider. We held a policy roundtable meeting and used outcomes of facilitated discussions to refine these directions. Individuals from our team and six stakeholder groups across Manitoba participated (n = 44), including patients, family physicians, orthopaedic surgeons, surgical office assistants, Winnipeg Central Intake team, and administrators/managers. We developed evaluation forms to assess the meeting process, and collected decision-maker partners’ perspectives on the value of the policy roundtable meeting and use of policy directions to improve access to scheduled clinical services after the meeting, and again 15 months later. We analyzed roundtable and evaluation data using thematic analysis to identify key themes. Results Four key findings emerged. First, participants supported all policy directions, with revisions and key implementation considerations identified. Second, participants felt the policy roundtable meeting achieved its purpose (to engage stakeholders, elicit feedback, refine policy directions). Third, our decision-maker partners’ expectations of the policy roundtable meeting were exceeded; they re-affirmed its value and described the refined policy directions as foundational to establishing the vocabulary, vision and framework for improving access to scheduled clinical services in Manitoba. Finally, our adaptation of key design elements was conducive to discussion of issues surrounding access to care. Conclusions Our policy roundtable process was an effective tool for acquiring broad input from stakeholders, refining policy directions and forming the necessary consensus starting points to move towards evidence-informed policy.
Collapse
Affiliation(s)
- Zaheed Damani
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3rd Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Gail MacKean
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3rd Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Eric Bohm
- Department of Surgery, University of Manitoba, AE101 - 820 Sherbrook Street, Winnipeg, MB, R3T 2N2, Canada
| | - Brie DeMone
- Manitoba Health, Healthy Living and Seniors, Acute, Tertiary and Specialty Care/Regional Policy and Programs, 2061- 300 Carlton Street, Winnipeg, MB, R3B 3M9, Canada
| | - Brock Wright
- Winnipeg Regional Health Authority, 4th Floor - 650 Main Street, Winnipeg, MB, R3B 1E2, Canada
| | - Tom Noseworthy
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3rd Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3rd Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3rd Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada. .,Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, 3C56, Health Research Innovation Center (HRIC) Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| |
Collapse
|
147
|
Klein AV, Hardy S, Lim R, Marshall DA. Regulatory Decision Making in Canada-Exploring New Frontiers in Patient Involvement. Value Health 2016; 19:730-733. [PMID: 27712698 DOI: 10.1016/j.jval.2016.03.1855] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/11/2016] [Accepted: 03/27/2016] [Indexed: 06/06/2023]
Abstract
Recent legislative amendments aim to enhance the transparency of the regulatory review processes about drugs, and provide public information about Health Canada's review decisions. There is also growing recognition of the value, with respect to regulatory benefit-risk assessment, of information that could be gathered from patients-the direct users of these products. Patients can provide unique insights into practical aspects of living with their disease and its treatments-as well as gaps in treatment needs. An enhanced understanding of patients' experiences and perspectives can contribute directly to better-informed decision making about these products by regulators. Health Canada is currently exploring and examining the most effective ways to collect and consider patient input in the evaluation of therapeutic products. As part of this process, Health Canada is assessing the suitability of other existing models through environmental scans, discussions with other health authorities, and pilot projects. Lessons learned from these models can inform best practices and opportunities for patient involvement when designing a model to meet Canada's needs and context. Health Canada launched a Patient Involvement Pilot Project in 2014 to simulate how input from patients, their caregivers, health care professionals, and patient groups could be collected and incorporated in the drug submission review process. This ongoing experience and continuous learning will define better how to incorporate patient input into benefit-risk assessment and regulatory decision making throughout the life cycle of therapeutic products in Canada.
Collapse
Affiliation(s)
- Agnes V Klein
- Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Stephanie Hardy
- Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Robyn Lim
- Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, O'Brien Institute for Public Health, Calgary, Alberta, Canada.
| |
Collapse
|
148
|
Hazlewood GS, Barr SG, Lopatina E, Marshall DA, Lupton TL, Fritzler MJ, Mosher DP, Steber WA, Martin L. Improving Appropriate Access to Care With Central Referral and Triage in Rheumatology. Arthritis Care Res (Hoboken) 2016; 68:1547-53. [PMID: 26815410 DOI: 10.1002/acr.22845] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/31/2015] [Accepted: 01/12/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the short-term and long-term impact of a centralized system for the intake and triage of rheumatology referrals on access to care and referral quality. METHODS An innovative central referral process, the Central Referral and Triage in Rheumatology (CReATe Rheum) program, was implemented in 2006, serving a referral base of 2 million people. Referrals are received in a central office, triaged by trained nurses, and assigned to the next available appointment on a prioritized basis. To evaluate the short-term impact, we compared wait times, duplicate referrals, and no-shows from a pre-implementation practice audit to a 2-year post-implementation evaluation (January 2007 to December 2008). Rheumatologists also assessed the quality and completeness of the referral information and accuracy of the urgency category assigned during triage. We evaluated the long-term impact by tracking referral volume, wait times, and rheumatologist manpower each year until December, 2013. RESULTS During the first 2 years, wait-time variability between rheumatologists decreased, and wait times were reduced for moderate and urgent referrals. CReATe Rheum improved the quality of referral information and eliminated duplicate referrals. The urgency of the referral was assigned correctly in 90% of referrals. Over the long term, CReATe Rheum maintained short wait times for more urgent patients despite a growing number of referrals and a stable number of rheumatologists. CONCLUSION A centralized system for the intake and triage of rheumatology referrals improved referral quality, reduced system inefficiencies, and effectively managed wait times on a prioritized basis for a large referral population.
Collapse
Affiliation(s)
- Glen S Hazlewood
- University of Calgary and Cumming School of Medicine, Calgary, Alberta, and University of Toronto, Toronto, Ontario, Canada
| | - Susan G Barr
- University of Calgary and Cumming School of Medicine, Calgary, Alberta, Canada.
| | | | - Deborah A Marshall
- University of Calgary and Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Marvin J Fritzler
- University of Calgary and Cumming School of Medicine, Calgary, Alberta, Canada
| | - Dianne P Mosher
- University of Calgary and Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Liam Martin
- University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
149
|
Barber CEH, Esdaile JM, Martin LO, Faris P, Barnabe C, Guo S, Lopatina E, Marshall DA. Gaps in Addressing Cardiovascular Risk in Rheumatoid Arthritis: Assessing Performance Using Cardiovascular Quality Indicators. J Rheumatol 2016; 43:1965-1973. [PMID: 27481908 DOI: 10.3899/jrheum.160241] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Cardiovascular disease (CVD) is a major comorbidity for patients with rheumatoid arthritis (RA). This study sought to determine the performance of 11 recently developed CVD quality indicators (QI) for RA in clinical practice. METHODS Medical charts for patients with RA (early disease or biologic-treated) followed at 1 center were retrospectively reviewed. A systematic assessment of adherence to 11 QI over a 2-year period was completed. Performance on the QI was reported as a percentage pass rate. RESULTS There were 170 charts reviewed (107 early disease and 63 biologic-treated). The most frequent CVD risk factors present at diagnosis (early disease) and biologic start (biologic-treated) included hypertension (26%), obesity (25%), smoking (21%), and dyslipidemia (15%). Performance on the CVD QI was highly variable. Areas of low performance (< 10% pass rates) included documentation of a formal CVD risk assessment, communication to the primary care physician (PCP) that patients with RA were at increased risk of CVD, body mass index documentation and counseling if overweight, communication to a PCP about an elevated blood pressure, and discussion of risks and benefits of antiinflammatories in patients at CVD risk. Rates of diabetes screening and lipid screening were 67% and 69%, respectively. The area of highest performance was observed for documentation of intent to taper corticosteroids (98%-100% for yrs 1 and 2, respectively). CONCLUSION Gaps in CVD risk management were found and highlight the need for quality improvements. Key targets for improvement include coordination of CVD care between rheumatology and primary care, and communication of increased CVD risk in RA.
Collapse
Affiliation(s)
- Claire E H Barber
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia. .,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary.
| | - John M Esdaile
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Liam O Martin
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Peter Faris
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Cheryl Barnabe
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Selynne Guo
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Elena Lopatina
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Deborah A Marshall
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| |
Collapse
|
150
|
Hazlewood GS, Bombardier C, Tomlinson G, Thorne C, Bykerk VP, Thompson A, Tin D, Marshall DA. Treatment preferences of patients with early rheumatoid arthritis: a discrete-choice experiment. Rheumatology (Oxford) 2016; 55:1959-1968. [DOI: 10.1093/rheumatology/kew280] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 06/20/2016] [Indexed: 12/27/2022] Open
|