1
|
McNeill K, Vaillancourt S, Choe S, Yang I, Sonnadara R. "I don't know if I can keep doing this": a qualitative investigation of surgeon burnout and opportunities for organization-level improvement. Front Public Health 2024; 12:1379280. [PMID: 38799682 PMCID: PMC11116672 DOI: 10.3389/fpubh.2024.1379280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Burnout is a pressing issue within surgical environments, bearing considerable consequences for both patients and surgeons alike. Given its prevalence and the unique contextual factors within academic surgical departments, it is critical that efforts are dedicated to understanding this issue. Moreover, active involvement of surgeons in these investigations is critical to ensure viability and uptake of potential strategies in their local setting. Thus, the purpose of this study was to explore surgeons' experiences with burnout and identify strategies to mitigate its drivers at the level of the organization. Methods A qualitative case study was conducted by recruiting surgeons for participation in a cross-sectional survey and semi-structured interviews. Data collected were analyzed using reflexive thematic analysis, which was informed by the Areas of Worklife Model. Results Overall, 28 unique surgeons participated in this study; 11 surgeons participated in interviews and 22 provided responses through the survey. Significant contributors to burnout identified included difficulties providing adequate care to patients due to limited resources and time available in academic medical centers and the moral injury associated with these challenges. The inequitable remuneration associated with education, administration, and leadership roles as a result of the Fee-For-Service model, as well as issues of gender inequity and the individualistic culture prevalent in surgical specialties were also described as contributing factors. Participants suggested increasing engagement between hospital leadership and staff to ensure surgeons are able to access resources to care for their patients, reforming payment plans and workplace polities to address issues of inequity, and improving workplace social dynamics as strategies for addressing burnout. Discussion The high prevalence and negative sequalae of burnout in surgery necessitates the formation of targeted interventions to address this issue. A collaborative approach to developing interventions to improve burnout among surgeons may lead to feasible and sustainable solutions.
Collapse
Affiliation(s)
- Kestrel McNeill
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada
| | - Sierra Vaillancourt
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada
- Department of Biology, McMaster University, Hamilton, ON, Canada
| | - Stella Choe
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada
| | - Ilun Yang
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Ranil Sonnadara
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Vector Institute for Artificial Intelligence, Toronto, ON, Canada
| |
Collapse
|
2
|
Karaceper MD, Khangura SD, Wilson K, Coyle D, Brownell M, Davies C, Dodds L, Feigenbaum A, Fell DB, Grosse SD, Guttmann A, Hawken S, Hayeems RZ, Kronick JB, Laberge AM, Little J, Mhanni A, Mitchell JJ, Nakhla M, Potter M, Prasad C, Rockman-Greenberg C, Sparkes R, Stockler S, Ueda K, Vallance H, Wilson BJ, Chakraborty P, Potter BK. Health services use among children diagnosed with medium-chain acyl-CoA dehydrogenase deficiency through newborn screening: a cohort study in Ontario, Canada. Orphanet J Rare Dis 2019; 14:70. [PMID: 30902101 PMCID: PMC6431026 DOI: 10.1186/s13023-019-1001-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 01/10/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND We describe early health services utilization for children diagnosed with medium-chain acyl-CoA dehydrogenase (MCAD) deficiency through newborn screening in Ontario, Canada, relative to a screen negative comparison cohort. METHODS Eligible children were identified via newborn screening between April 1, 2006 and March 31, 2010. Age-stratified rates of physician encounters, emergency department (ED) visits and inpatient hospitalizations to March 31, 2012 were compared using incidence rate ratios (IRR) and incidence rate differences (IRD). We used negative binomial regression to adjust IRRs for sex, gestational age, birth weight, socioeconomic status and rural/urban residence. RESULTS Throughout the first few years of life, children with MCAD deficiency (n = 40) experienced statistically significantly higher rates of physician encounters, ED visits, and hospital stays compared with the screen negative cohort. The highest rates of ED visits and hospitalizations in the MCAD deficiency cohort occurred from 6 months to 2 years of age (ED use: 2.1-2.5 visits per child per year; hospitalization: 0.5-0.6 visits per child per year), after which rates gradually declined. CONCLUSIONS This study confirms that young children with MCAD deficiency use health services more frequently than the general population throughout the first few years of life. Rates of service use in this population gradually diminish after 24 months of age.
Collapse
Affiliation(s)
- Maria D Karaceper
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Cr, Ottawa, ON, K1G 5Z3, Canada
| | - Sara D Khangura
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Cr, Ottawa, ON, K1G 5Z3, Canada
| | - Kumanan Wilson
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Cr, Ottawa, ON, K1G 5Z3, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.,Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Cr, Ottawa, ON, K1G 5Z3, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Christine Davies
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Linda Dodds
- Departments of Obstetrics & Gynecology and Pediatrics, Dalhousie University, Halifax, Canada
| | - Annette Feigenbaum
- Department of Pediatrics, Division of Clinical & Metabolic Genetics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Deshayne B Fell
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Cr, Ottawa, ON, K1G 5Z3, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.,ICES, Toronto and Ottawa, Canada
| | - Scott D Grosse
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, USA
| | - Astrid Guttmann
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.,ICES, Toronto and Ottawa, Canada.,Department of Pediatrics, Division of Paediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Steven Hawken
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Cr, Ottawa, ON, K1G 5Z3, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.,ICES, Toronto and Ottawa, Canada
| | - Robin Z Hayeems
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Jonathan B Kronick
- Department of Pediatrics, Division of Clinical & Metabolic Genetics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Anne-Marie Laberge
- Medical Genetics, CHU Sainte-Justine and Department of Pediatrics, Université de Montréal, Montreal, Canada
| | - Julian Little
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Cr, Ottawa, ON, K1G 5Z3, Canada
| | - Aizeddin Mhanni
- Department of Paediatrics and Child Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John J Mitchell
- Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Meranda Nakhla
- Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Murray Potter
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada.,Clinical Genetics Program, McMaster University Medical Centre, Hamilton Health Sciences, Hamilton, Canada
| | - Chitra Prasad
- London Health Sciences Centre, Western University, London, Canada
| | - Cheryl Rockman-Greenberg
- Department of Paediatrics and Child Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Rebecca Sparkes
- Department of Paediatrics, Section of Clinical Genetics, Alberta Children's Hospital, Calgary, Canada
| | - Sylvia Stockler
- Children's & Women's Health Centre of British Columbia, Vancouver, Canada.,Biochemical Genetics Laboratory, Children's & Women's Health Centre of British Columbia, Vancouver, Canada
| | - Keiko Ueda
- Children's & Women's Health Centre of British Columbia, Vancouver, Canada
| | - Hilary Vallance
- Biochemical Genetics Laboratory, Children's & Women's Health Centre of British Columbia, Vancouver, Canada.,Department of Pathology, University of British Columbia, Vancouver, Canada
| | - Brenda J Wilson
- Division of Community Health and Humanities, Memorial University of Newfoundland, St. John's, Canada
| | - Pranesh Chakraborty
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Cr, Ottawa, ON, K1G 5Z3, Canada. .,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada. .,ICES, Toronto and Ottawa, Canada.
| | | |
Collapse
|
3
|
Karaceper MD, Chakraborty P, Coyle D, Wilson K, Kronick JB, Hawken S, Davies C, Brownell M, Dodds L, Feigenbaum A, Fell DB, Grosse SD, Guttmann A, Laberge AM, Mhanni A, Miller FA, Mitchell JJ, Nakhla M, Prasad C, Rockman-Greenberg C, Sparkes R, Wilson BJ, Potter BK. The health system impact of false positive newborn screening results for medium-chain acyl-CoA dehydrogenase deficiency: a cohort study. Orphanet J Rare Dis 2016; 11:12. [PMID: 26841949 PMCID: PMC4741015 DOI: 10.1186/s13023-016-0391-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/19/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is no consensus in the literature regarding the impact of false positive newborn screening results on early health care utilization patterns. We evaluated the impact of false positive newborn screening results for medium-chain acyl-CoA dehydrogenase deficiency (MCADD) in a cohort of Ontario infants. METHODS The cohort included all children who received newborn screening in Ontario between April 1, 2006 and March 31, 2010. Newborn screening and diagnostic confirmation results were linked to province-wide health care administrative datasets covering physician visits, emergency department visits, and inpatient hospitalizations, to determine health service utilization from April 1, 2006 through March 31, 2012. Incidence rate ratios (IRRs) were used to compare those with false positive results for MCADD to those with negative newborn screening results, stratified by age at service use. RESULTS We identified 43 infants with a false positive newborn screening result for MCADD during the study period. These infants experienced significantly higher rates of physician visits (IRR: 1.42) and hospitalizations (IRR: 2.32) in the first year of life relative to a screen negative cohort in adjusted analyses. Differences in health services use were not observed after the first year of life. CONCLUSIONS The higher use of some health services among false positive infants during the first year of life may be explained by a psychosocial impact of false positive results on parental perceptions of infant health, and/or by differences in underlying health status. Understanding the impact of false positive newborn screening results can help to inform newborn screening programs in designing support and education for families. This is particularly important as additional disorders are added to expanded screening panels, yielding important clinical benefits for affected children but also a higher frequency of false positive findings.
Collapse
Affiliation(s)
- Maria D Karaceper
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8 M5, Canada.
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
| | - Doug Coyle
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8 M5, Canada.
| | - Kumanan Wilson
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. .,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Jonathan B Kronick
- Department of Pediatrics, Division of Clinical & Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Steven Hawken
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Christine Davies
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
| | - Marni Brownell
- Manitoba Centre for Health Policy, Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Linda Dodds
- Departments of Obstetrics & Gynecology and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Annette Feigenbaum
- Department of Pediatrics, Division of Clinical & Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Deshayne B Fell
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada.
| | - Scott D Grosse
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia, USA.
| | - Astrid Guttmann
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. .,Department of Pediatrics, Division of Paediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Anne-Marie Laberge
- Medical Genetics, CHU Sainte-Justine and Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada.
| | - Aizeddin Mhanni
- Department of Paediatrics and Child Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - John J Mitchell
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
| | - Meranda Nakhla
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
| | - Chitra Prasad
- Genetics, Metabolism and Pediatrics, London Health Sciences Centre, Western University, London, Ontario, Canada.
| | - Cheryl Rockman-Greenberg
- Department of Paediatrics and Child Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Rebecca Sparkes
- Department of Paediatrics, Section of Clinical Genetics, Alberta Children's Hospital, Calgary, Alberta, Canada.
| | - Brenda J Wilson
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8 M5, Canada.
| | - Beth K Potter
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8 M5, Canada.
| | | |
Collapse
|
4
|
Cunningham CT, Jetté N, Li B, Dhanoa RR, Hemmelgarn B, Noseworthy T, Beck CA, Dixon E, Samuel S, Ghali WA, DeCoster C, Quan H. Effect of physician specialist alternative payment plans on administrative health data in Calgary: a validation study. CMAJ Open 2015; 3:E406-12. [PMID: 27051661 PMCID: PMC4816270 DOI: 10.9778/cmajo.20140116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There are concerns that alternate payment plans for physicians may be associated with erosion of data quality, given that physicians are paid regardless of whether claims are submitted. Our objective was to determine the proportion of claims submitted by physician specialists using fee-for-service and alternative payment plans, and to identify and compare the validity of information coded in physician billing claims submitted by these specialists in Calgary. METHODS We conducted a survey of physician specialists to determine their plan status and obtained consent to use physicians' claims data from 4 acute care hospitals in Calgary. Inpatient and emergency department services were identified from the Discharge Abstract Database for Alberta (Canadian Institute for Health Information) and the Alberta Ambulatory Care Classification System database. We linked services to claims by Alberta physicians from 2002 to 2009 by using unique patient and physician identifiers. After identifying the proportion of claims submitted, we reviewed inpatient charts to determine the completeness of submissions as defined by positive predictive value. RESULTS Of 182 physicians who responded to the survey, 94 (51.6%) used fee-for-service plans exclusively and 51 (28.0%) used alternative payment plans exclusively. Overall completeness of physician submissions for claims was 91.8% for physicians using fee-for-service plans and 90.0% for physicians using alternative payment plans. Submission rate varied by medical specialty (surgery: 92.4% for fee for service v. 88.6% for alternative payment; internal medicine: 94.1% v. 91.3%; neurology: 95.1% v. 91.0%; and pediatrics: 95.1% v. 89.3%). Among claims submitted, the physician accuracies for billing of medical conditions were 87.8% for fee-for-service and 85.0% for alternative payment. INTERPRETATION Overall submission rates and accuracy in recording diagnoses by physicians who used both plans were high. These findings show that the implementation of alternative payment plan programs in Alberta may not have an impact on the quality of physician claims data.
Collapse
Affiliation(s)
- Ceara Tess Cunningham
- Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta
| | - Nathalie Jetté
- Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta
| | - Bing Li
- Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta
| | - Ravneet Robyn Dhanoa
- Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta
| | - Brenda Hemmelgarn
- Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta
| | - Tom Noseworthy
- Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta
| | - Cynthia A Beck
- Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta
| | - Elijah Dixon
- Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta
| | - Susan Samuel
- Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta
| | - William A Ghali
- Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta
| | - Carolyn DeCoster
- Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta
| | - Hude Quan
- Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta
| |
Collapse
|
5
|
Cunningham CT, Cai P, Topps D, Svenson LW, Jetté N, Quan H. Mining rich health data from Canadian physician claims: features and face validity. BMC Res Notes 2014; 7:682. [PMID: 25270407 PMCID: PMC4193126 DOI: 10.1186/1756-0500-7-682] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 09/26/2014] [Indexed: 11/30/2022] Open
Abstract
Background Physician claims data are one of the largest sources of coded health information unique to Canada. There is skepticism from data users about the quality of this data. This study investigated features of diagnostic codes used in the Alberta physician claims database. Methods Alberta physician claims from January 1 to March 31, 2011 are analyzed. Claims contain coded diagnoses using the International Classification of Diseases, 9th revision (ICD-9), procedures, physician specialty and service-fee type. Descriptive statistics examined the diversity and frequency of unique ICD-9 diagnostic codes used and the level of code extension (e.g. 3- or 4-digit coding). Results A total of 7,441,005 claims by 6,601 physicians were analyzed. The average number of claims per physician was 1,079, with ranges between 1,330 for family medicine, 690 for internal medicine, 722 for surgery, 516 for pediatrics and 409 for neurology. Family physicians used an average of 121 diagnostic codes, internal medicine physicians 32, surgery 36, pediatrics 46 and neurology 27. Overall, 43.5% of claims had a more detailed diagnosis (ICD code with >3 digits). Physicians on a fee-for-service plan submitted 1,184 claims and used 88 unique diagnosis codes on average compared to 438 claims and 44 unique diagnosis codes from physicians on an alternative payment plan (APP). Conclusions Face validity of diagnosis coded in physician claims is substantially high and the features of diagnosis codes seem to reasonably reflect the clinical specialty. Physicians submit a diverse array of ICD 9 diagnostic codes and nearly half of the ICD-9 diagnostic codes examined were more detailed than required (i.e. ICD code with >3 digits). Finally, guidelines and policies should be explored to assess the submission of shadow billings for physicians on APPs.
Collapse
Affiliation(s)
| | | | | | | | | | - Hude Quan
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr, NW, Calgary, Alberta T2N 4Z6, Canada.
| |
Collapse
|
6
|
Liddy C, Singh J, Kelly R, Dahrouge S, Taljaard M, Younger J. What is the impact of primary care model type on specialist referral rates? A cross-sectional study. BMC FAMILY PRACTICE 2014; 15:22. [PMID: 24490703 PMCID: PMC3933232 DOI: 10.1186/1471-2296-15-22] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 01/29/2014] [Indexed: 12/15/2022]
Abstract
Background Several new primary care models have been implemented in Ontario, Canada over the past two decades. These practice models differ in team structure, physician remuneration, and group size. Few studies have examined the impact of these models on specialist referrals. We compared specialist referral rates amongst three primary care models: 1) Enhanced Fee-for-service, 2) Capitation- Non-Interdisciplinary (CAP-NI), 3) Capitation – Interdisciplinary (CAP-I). Methods We conducted a cross-sectional study using health administrative data from primary care practices in Ontario from April 1st, 2008 to March 31st, 2010. The analysis included all family physicians providing comprehensive care in one of the three models, had at least 100 patients, and did not have a prolonged absence (eight consecutive weeks). The primary outcome was referral rate (# of referrals to all medical specialties/1000 patients/year). A multivariable clustered Poisson regression analysis was used to compare referral rates between models while adjusting for provider (sex, years since graduation, foreign trained, time in current model) and patient (age, sex, income, rurality, health status) characteristics. Results Fee-for-service had a significantly lower adjusted referral rate (676, 95% CI: 666-687) than the CAP-NI (719, 95% confidence interval (CI): 705-734) and CAP-I (694, 95% CI: 681-707) models and the interdisciplinary CAP-I group had a 3.5% lower referral rate than the CAP-NI group (RR = 0.965, 95% CI: 0.943-0.987, p = 0.002). Female and Canadian-trained physicians referred more often, while female, older, sicker and urban patients were more likely to be referred. Conclusions Primary care model is significantly associated with referral rate. On a study population level, these differences equate to 111,059 and 37,391 fewer referrals by fee-for-service versus CAP-NI and CAP-I, respectively – a difference of $22.3 million in initial referral appointment costs. Whether a lower rate of referral is more appropriate or not is not known and requires further investigation. Physician remuneration and team structure likely account for the differences; however, further investigation is also required to better understand whether other organizational factors associated with primary care model also impact referral.
Collapse
Affiliation(s)
- Clare Liddy
- C,T, Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St, Room 369Y, Ottawa, Ontario K1N 5C8, Canada.
| | | | | | | | | | | |
Collapse
|
7
|
Jaakkimainen RL, Shultz SE, Tu K. Effects of implementing electronic medical records on primary care billings and payments: a before-after study. CMAJ Open 2013; 1:E120-6. [PMID: 25077111 PMCID: PMC3985899 DOI: 10.9778/cmajo.20120039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Several barriers to the adoption of electronic medical records (EMRs) by family physicians have been discussed, including the costs of implementation, impact on work flow and loss of productivity. We examined billings and payments received before and after implementation of EMRs among primary care physicians in the province of Ontario. We also examined billings and payments before and after switching from a fee-for-service to a capitation payment model, because EMR implementation coincided with primary care reform in the province. METHODS We used information from the Electronic Medical Record Administrative Data Linked Database (EMRALD) to conduct a retrospective before-after study. The EMRALD database includes EMR data extracted from 183 community-based family physicians in Ontario. We included EMRALD physicians who were eligible to bill the Ontario Health Insurance Plan at least 18 months before and after the date they started using EMRs and had completed a full 18-month period before Mar. 31, 2011, when the study stopped. The main outcome measures were physicians' monthly billings and payments for office visits and total annual payments received from all government sources. Two index dates were examined: the date physicians started using EMRs and were in a stable payment model (n = 64) and the date physicians switched from a fee-for-service to a capitation payment model (n = 42). RESULTS Monthly billings and payments for office visits did not decrease after the implementation of EMRs. The overall weighted mean annual payment from all government sources increased by 27.7% after the start of EMRs among EMRALD physicians; an increase was also observed among all other primary care physicians in Ontario, but it was not as great (14.4%). There was a decline in monthly billings and payments for office visits after physicians changed payment models, but an increase in their overall annual government payments. INTERPRETATION Implementation of EMRs by primary care physicians did not result in decreased billings or government payments for office visits. Further economic analyses are needed to measure the effects of EMR implementation on productivity and the costs of implementing an EMR system, including the costs of nonclinical work by physicians and their staff.
Collapse
Affiliation(s)
- R Liisa Jaakkimainen
- Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Department of Family and Community Medicine, University of Toronto, Toronto, Ont. ; Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Susan E Shultz
- Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - Karen Tu
- Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Department of Family and Community Medicine, University of Toronto, Toronto, Ont. ; Department of Family and Community Medicine, Toronto Western Hospital, University Health Network, Toronto, Ont
| |
Collapse
|
8
|
Greene J. An examination of pay-for-performance in general practice in Australia. Health Serv Res 2013; 48:1415-32. [PMID: 23350933 DOI: 10.1111/1475-6773.12033] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study examines the impact of Australia's pay-for-performance (P4P) program for general practitioners (GPs). The voluntary program pays GPs A$40 and A$100 in addition to fee-for-service payment for providing patients recommended diabetes and asthma treatment over a year, and A$35 for screening women for cervical cancer who have not been screened in 4 years. DESIGN Three approaches were used to triangulate the program's impact: (1) analysis of trends in national claims for incentivized services pre- and postprogram implementation; (2) fixed effects panel regression models examining the impact of GPs' P4P program participation on provision of incentivized services; and (3) in-depth interviews to explore GPs' perceptions of their own response to the program. RESULTS There was a short-term increase in diabetes testing and cervical cancer screens after program implementation. The increase, however, was for all GPs. Neither signing onto the program nor claiming incentive payments was associated with increased diabetes testing or cervical cancer screening. GPs reported that the incentive did not influence their behavior, largely due to the modest payment and the complexity of tracking patients and claiming payment. IMPLICATIONS Monitoring and evaluating P4P programs is essential, as programs may not spark the envisioned impact on quality improvement.
Collapse
Affiliation(s)
- Jessica Greene
- George Washington University School of Nursing, Washington, DC 20036, USA.
| |
Collapse
|
9
|
Chen A, Bushmeneva K, Zagorski B, Colantonio A, Parsons D, Wodchis WP. Direct cost associated with acquired brain injury in Ontario. BMC Neurol 2012; 12:76. [PMID: 22901094 PMCID: PMC3518141 DOI: 10.1186/1471-2377-12-76] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 07/26/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acquired Brain Injury (ABI) from traumatic and non traumatic causes is a leading cause of disability worldwide yet there is limited research summarizing the health system economic burden associated with ABI. The objective of this study was to determine the direct cost of publicly funded health care services from the initial hospitalization to three years post-injury for individuals with traumatic (TBI) and non-traumatic brain injury (nTBI) in Ontario Canada. METHODS A population-based cohort of patients discharged from acute hospital with an ABI code in any diagnosis position in 2004 through 2007 in Ontario was identified from administrative data. Publicly funded health care utilization was obtained from several Ontario administrative healthcare databases. Patients were stratified according to traumatic and non-traumatic causes of brain injury and whether or not they were discharged to an inpatient rehabilitation center. Health system costs were calculated across a continuum of institutional and community settings for up to three years after initial discharge. The continuum of settings included acute care emergency departments inpatient rehabilitation (IR) complex continuing care home care services and physician visits. All costs were calculated retrospectively assuming the government payer's perspective. RESULTS Direct medical costs in an ABI population are substantial with mean cost in the first year post-injury per TBI and nTBI patient being $32132 and $38018 respectively. Among both TBI and nTBI patients those discharged to IR had significantly higher treatment costs than those not discharged to IR across all institutional and community settings. This tendency remained during the entire three-year follow-up period. Annual medical costs of patients hospitalized with a brain injury in Ontario in the first follow-up year were approximately $120.7 million for TBI and $368.7 million for nTBI. Acute care cost accounted for 46-65% of the total treatment cost in the first year overwhelming all other cost components. CONCLUSIONS The main finding of this study is that direct medical costs in ABI population are substantial and vary considerably by the injury cause. Although most expenses occur in the first follow-up year ABI patients continue to use variety of medical services in the second and third year with emphasis shifting over time from acute care and inpatient rehabilitation towards homecare physician services and long-term institutional care. More research is needed to capture economic costs for ABI patients not admitted to acute care.
Collapse
Affiliation(s)
- Amy Chen
- Toronto Rehabilitation Institute, Toronto, ON, Canada
| | | | | | | | | | | |
Collapse
|
10
|
Brown JB, French R, McCulloch A, Clendinning E. Primary health care models: medical students’ knowledge and perceptions. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2012; 58:e166-e171. [PMID: 22518904 PMCID: PMC3303670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To explore the knowledge and perceptions of fourth-year medical students regarding the new models of primary health care (PHC) and to ascertain whether that knowledge influenced their decisions to pursue careers in family medicine. DESIGN Qualitative study using semistructured interviews. SETTING The Schulich School of Medicine and Dentistry at The University of Western Ontario in London. Participants Fourth-year medical students graduating in 2009 who indicated family medicine as a possible career choice on their Canadian Residency Matching Service applications. METHODS Eleven semistructured interviews were conducted between January and April of 2009. Data were analyzed using an iterative and interpretive approach. The analysis strategy of immersion and crystallization assisted in synthesizing the data to provide a comprehensive view of key themes and overarching concepts. MAIN FINDINGS Four key themes were identified: the level of students’ knowledge regarding PHC models varied; the knowledge was generally obtained from practical experiences rather than classroom learning; students could identify both advantages and disadvantages of working within the new PHC models; and although students regarded the new PHC models positively, these models did not influence their decisions to pursue careers in family medicine. CONCLUSION Knowledge of the new PHC models varies among fourth-year students, indicating a need for improved education strategies in the years before clinical training. Being able to identify advantages and disadvantages of the PHC models was not enough to influence participants’ choice of specialty. Educators and health care policy makers need to determine the best methods to promote and facilitate knowledge transfer about these PHC models.
Collapse
Affiliation(s)
- Judith Belle Brown
- Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, King’s University College.
| | | | | | | |
Collapse
|
11
|
Liddy C, Singh J, Hogg W, Dahrouge S, Taljaard M. Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study. BMC FAMILY PRACTICE 2011; 12:114. [PMID: 22008366 PMCID: PMC3215648 DOI: 10.1186/1471-2296-12-114] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 10/18/2011] [Indexed: 01/24/2023]
Abstract
Background Primary care providers play an important role in preventing and managing cardiovascular disease. This study compared the quality of preventive cardiovascular care delivery amongst different primary care models. Methods This is a secondary analysis of a larger randomized control trial, known as the Improved Delivery of Cardiovascular Care (IDOCC) through Outreach Facilitation. Using baseline data collected through IDOCC, we conducted a cross-sectional study of 82 primary care practices from three delivery models in Eastern Ontario, Canada: 43 fee-for-service, 27 blended-capitation and 12 community health centres with salary-based physicians. Medical chart audits from 4,808 patients with or at high risk of developing cardiovascular disease were used to examine each practice's adherence to ten evidence-based processes of care for diabetes, chronic kidney disease, dyslipidemia, hypertension, weight management, and smoking cessation care. Generalized estimating equation models adjusting for age, sex, rurality, number of cardiovascular-related comorbidities, and year of data collection were used to compare guideline adherence amongst the three models. Results The percentage of patients with diabetes that received two hemoglobin A1c tests during the study year was significantly higher in community health centres (69%) than in fee-for-service (45%) practices (Adjusted Odds Ratio (AOR) = 2.4 [95% CI 1.4-4.2], p = 0.001). Blended capitation practices had a significantly higher percentage of patients who had their waistlines monitored than in fee-for-service practices (19% vs. 5%, AOR = 3.7 [1.8-7.8], p = 0.0006), and who were recommended a smoking cessation drug when compared to community health centres (33% vs. 16%, AOR = 2.4 [1.3-4.6], p = 0.007). Overall, quality of diabetes care was higher in community health centres, while smoking cessation care and weight management was higher in the blended-capitation models. Fee-for-service practices had the greatest gaps in care, most noticeably in diabetes care and weight management. Conclusions This study adds to the evidence suggesting that primary care delivery model impacts quality of care. These findings support current Ontario reforms to move away from the traditional fee-for-service practice. Trial Registration ClinicalTrials.gov: NCT00574808
Collapse
Affiliation(s)
- Clare Liddy
- CT Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, Ottawa, Ontario, K1N 5C8, Canada.
| | | | | | | | | |
Collapse
|
12
|
Abstract
BACKGROUND Federal, provincial, and municipal organizations in Canada have recently begun to promote an equity agenda for their health systems, but much of the necessary data by which to identify those with social disadvantage are not currently collected. METHODS We conducted a national survey of 1005 Canadian adults to assess the perceived importance of, and concern about, the collection of personal sociodemographic information by hospitals. We also examined public preference for practical approaches to the future collection of such information. RESULTS In this sample of Canadian adults, nearly half did not believe it was important for hospitals to collect individual-level sociodemographic data. The majority had concerns that the collection of these data could negatively affect their or others' care; this was especially true among visible minorities and those who have experienced discrimination. There was substantial variation across participant subgroups in their comfort with the collection of various types of information, but greater discomfort in general for current household income, sexual orientation, and education background. There was consistent discomfort reported from older participants. Participants in general were most comfortable providing this type of information to their family physician. INTERPRETATION The importance of collecting patient-level equity-relevant data is not widely appreciated in Canada, and our survey has shown that concern about how these data could be misused are high, especially among certain subgroups. Qualitative research to further explore and understand these concerns, patient education about data usage and privacy issues, and using the family doctor's office as a linked electronic data collection point, will likely be important as we move toward high-quality equity measurement.
Collapse
|