PRISM :: Browsing by Author "Hemmelgarn, Brenda"

Browsing by Author "Hemmelgarn, Brenda"

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Open Access
Acute Kidney Injury and Renal and Cardiovascular Outcomes after Coronary Angiography in Alberta, Canada
(2010) James, Matthew Thomas; Hemmelgarn, Brenda; Tonelli, Marcello
Open Access
An outcome evaluation of the diabetes education component of the Living Well Program
(2013-03-15) Weaver, Robert; Hemmelgarn, Brenda; James, Matthew
The main objectives of this thesis were to determine the associations between participation in Diabetes Essentials (DE), and change in HbA1c and the rate of hospitalizations/ED visits for diabetes-specific ambulatory care sensitive conditions (ACSC). We linked attendance data for DE with administrative and laboratory data for Alberta, and conducted a retrospective cohort study, with the exposure being attendance at DE in the first six months after diagnosis. The study population was adults residing in the Calgary area with recently diagnosed diabetes. We conducted regression analysis using the full cohort and within a propensity-matched sample. All analytical approaches found participation in DE was associated with a significantly greater reduction in HbA1c of approximately 0.3% at follow-up. No significant association was found with the rate of hospitalizations/ED visits for diabetes-specific ACSC. Health care programs should consider interventions such as DE to help individuals with newly diagnosed diabetes improve glycemic control.
Open Access
Assessing the Impact of Financial Barriers on Care and Outcomes for Patients with Cardiovascular-Related Chronic Diseases
(2017) Campbell, David John Thomas; Manns, Braden; King-Shier, Kathryn; Hemmelgarn, Brenda; Sanmartin, Claudia
Patients with cardiovascular-related chronic diseases, such as coronary artery disease and diabetes may face numerous barriers to accessing the complex care that they require. Even in Canada, which has a universal healthcare system, some patients may face financial barriers to accessing important goods and services. Our objective was to enhance the understanding of financial barriers and their impact on clinical outcomes. This thesis is comprised of four reports of three independent studies that form an overarching sequential mixed methods program of research. The first study was a population-weighted survey of Western Canadians with cardiovascular-related chronic conditions in which we found that 1 in 10 respondents perceived having financial barriers to accessing goods and services required for their chronic disease. Those who reported having a financial barrier self-reported being 70% more likely to require hospital or emergency department care than those who did not perceive having financial barriers. In the second study, we built on this by linking data for patients self-reporting financial barriers within a series of national health surveys to outcomes available within administrative data sources. Those who perceived having a financial barrier to any aspect of their care had a hospitalization rate and mortality rate that was 36% and 24% higher, respectively, than those who denied having financial barriers. In the third study, we explored patients’ experiences with financial barriers using grounded theory methodology. We developed a conceptual framework for understanding how financial barriers impact patients’ lives. We outlined protective, predisposing, and modifying factors that ultimately determine how resilient an individual can be in the face of financial barriers. Finally, we undertook a qualitative descriptive analysis to describe the aspects of care to which patients most commonly experience financial barriers. These include: non-insured goods and services, items required to support self-management and incidental expenses associated with insured services. Many Canadians with chronic diseases face financial barriers to care, which are associated with adverse health outcomes. Interventions to address the prevalence and impact of financial barriers are possible but have never been tested in rigorous trials. Such studies would inform important policy reform at all levels of government.
Open Access
Association between Severity of Obstructive Sleep Apnea and Health Care Utilization
(2008) Ronksley, Paul Everett; Hemmelgarn, Brenda; Tsai, Willis
Open Access
Association between Severity of Obstructive Sleep Apnea and Health Care Utilization
(2008) Ronksley, Paul Everett; Hemmelgarn, Brenda; Tsai, Willis
Open Access
Authors’ opinions on publication in relation to annual performance assessment
(BioMed Central, 2010-03-09) Walker, Robin L.; Sykes, Lindsay; Hemmelgarn, Brenda; Quan, Hude
Open Access
Care and Outcomes for Older Adults with Advanced Chronic Kidney Disease
(2017) Helen, Tam-Tham; Hemmelgarn, Brenda; Fruetel, Karen; King-Shier, Kathryn; Quinn, Robert; Thomas, Chandra
The prevalence of older adults with advanced chronic kidney disease (CKD) is increasing globally, although optimal treatment remains uncertain. We examined in this thesis survival outcomes for older adults with kidney failure treated and not treated with dialysis. We also sought to identify barriers and facilitators to optimal conservative (non-dialysis) care for older adults with kidney failure managed by primary care physicians. We conducted three studies: a population-based retrospective cohort study using administrative and laboratory data to compare survival outcomes between dialysis and non-dialysis treatment; a qualitative descriptive study to explore primary care physician experiences when providing conservative care to older adults with kidney failure; and a cross-sectional population-based survey study within Alberta, Canada, to quantify results from the previous qualitative study. These last two studies formed a sequential exploratory mixed methods program of work to identify barriers and facilitators to community-based conservative care. We found that compared to non-dialysis care, dialysis was associated with a reduced risk of all-cause mortality but only within the first three years following onset of kidney failure. Conservative care for older adults is commonly provided by primary care physicians; however, they face substantial barriers to optimal care. Primary care physicians also expressed a need for resources including telephone access to nephrology or conservative care expertise, better access to conservative care clinics, and improved ability to appropriately co-manage patients with nephrologists. Research in conservative care has previously focused on patients with advanced CKD referred to nephrology. However, conservative care and outcomes among older adults not referred to nephrology is largely unknown. This thesis examined clinical care and outcomes through a wider perspective. To foster clinical impact we worked closely from conceptualization to dissemination stages with key stakeholders in Alberta including the Southern Alberta Conservative Management Program, the Conservative Kidney Management Pathway Steering Committee, the Kidney Health Strategic Clinical Network, and the Alberta College of Family Physicians. Our findings contributed to development of a conservative kidney management clinical care pathway and province-wide telephone access for primary care physicians to directly contact nephrologists and conservative care specialists.
Open Access
Chronic kidney disease among First Nations people in Alberta: prevalence, health services utilization and access to quality care
(2006) Gao, Song; Manns, Braden; Hemmelgarn, Brenda
Open Access
Co-designing person-centred quality indicator implementation for primary care in Alberta: a consensus study
(2022-11-08) Manalili, Kimberly; Scott, Catherine M.; Hemmelgarn, Brenda; O’Beirne, Maeve; Bailey, Allan L.; Haener, Michel K.; Banerjee, Cyrene; Peters, Sue P.; Chiodo, Mirella; Aghajafari, Fariba; Santana, Maria J.
Abstract Background We aimed to contribute to developing practical guidance for implementing person-centred quality indicators (PC-QIs) for primary care in Alberta, Canada. As a first step in this process, we conducted stakeholder-guided prioritization of PC-QIs and implementation strategies. Stakeholder engagement is necessary to ensure PC-QI implementation is adapted to the context and local needs. Methods We used an adapted nominal group technique (NGT) consensus process. Panelists were presented with 26 PC-QIs, and implementation strategies. Both PC-QIs and strategies were identified from our extensive previous engagement of patients, caregivers, healthcare providers, and quality improvement leaders. The NGT objectives were to: 1. Prioritize PC-QIs and implementation strategies; and 2. Facilitate the participation of diverse primary care stakeholders in Alberta, including patients, healthcare providers, and quality improvement staff. Panelists participated in three rounds of activities. In the first, panelists individually ranked and commented on the PC-QIs and strategies. The summarized results were discussed in the second-round face-to-face group meeting. For the last round, panelists provided their final individual rankings, informed by the group discussion. Finally, we conducted an evaluation of the consensus process from the panelists’ perspectives. Results Eleven primary care providers, patient partners, and quality improvement staff from across Alberta participated. The panelists prioritized the following PC-QIs: ‘Patient and caregiver involvement in decisions about their care and treatment’; ‘Trusting relationship with healthcare provider’; ‘Health information technology to support person-centred care’; ‘Co-designing care in partnership with communities’; and ‘Overall experience’. Implementation strategies prioritized included: ‘Develop partnerships’; ‘Obtain quality improvement resources’; ‘Needs assessment (stakeholders are engaged about their needs/priorities for person-centred measurement)’; ‘Align measurement efforts’; and ‘Engage champions’. Our evaluation suggests that panelists felt that the process was valuable for planning the implementation and obtaining feedback, that their input was valued, and that most would continue to collaborate with other stakeholders to implement the PC-QIs. Conclusions Our study demonstrates the value of co-design and participatory approaches for engaging stakeholders in adapting PC-QI implementation for the primary care context in Alberta, Canada. Collaboration with stakeholders can promote buy-in for ongoing engagement and ensure implementation will lead to meaningful improvements that matter to patients and providers.
Open Access
Data enhancement for co-morbidity measurement among patients referred for sleep diagnostic testing: an observational study
(BioMed Central, 2009-07-15) Ronksley, Paul E; Tsai, Willis H; Quan, Hude; Faris, Peter; Hemmelgarn, Brenda
Open Access
Development of a Clinical Risk Prediction Tool for Early Mortality After Dialysis Initiation Among Older Adults
(2015-11-12) Wick, James; Hemmelgarn, Brenda; Turin, Tanvir Chowdhury
Background: Early mortality after dialysis initiation is common among older adults. Information on an individual’s risk of death may influence the decision to initiate dialysis. Objective: To develop a clinical risk prediction tool for mortality within six and twelve months of dialysis initiation, for older adults. Methods: Eligible individuals were adults age ≥65 who initiated chronic dialysis between May 1, 2003 and March 31, 2012. Measures of demographics, laboratory values, health-usage and comorbidity were potential predictors of early mortality. We used logistic regression to predict mortality, and created a point score system. Results: The six- and twelve-month tools included age, glomerular filtration rate, atrial fibrillation, lymphoma, chronic heart failure, prior hospitalization and metastatic cancer. Cirrhosis and late referral to nephrologist were also in the twelve-month score. Model discrimination was 0.72 for each outcome. Conclusion: These tools may aide decision making for older adults considering dialysis.
Open Access
Documentation of preventive screening interventions by general practitioners: a retrospective chart audit
(BioMed Central, 2010-03-09) Ngwakongnwi, Emmanuel; Hemmelgarn, Brenda; Quan, Hude
Open Access
Enhancing Person-Centred Practice in Primary Care: Co-designing Strategies to Implement Quality Indicators Informed by the Patient Perspective
(2022-03) Manalili, Kimberly; Santana, Maria Jose; Scott, Catherine; O'Beirne, Maeve; Hemmelgarn, Brenda
Person-Centred Care (PCC) promotes engagement with patients and caregivers to improve patient experiences and outcomes. Person-Centred Quality Indicators (PC-QIs) are quality improvement (QI) tools that support healthcare providers and organizations to identify gaps in the delivery of PCC and improve the quality of care for patients. Little is known about how to implement PC-QIs effectively so that they are adopted and used to create meaningful change in practice. We aimed to address these knowledge gaps by applying a person-centred and implementation science lens to QI and collaborate with stakeholders to inform the future implementation of PC-QIs for primary care in Alberta, Canada. The first study of this thesis was a systematic review and meta-analysis on the effectiveness of person-centred QI strategies on the management of hypertension in primary care. Our findings suggest that consistent features of person-centered QI interventions that were effective for improving hypertension outcomes included tailored communication with patients, use of health information technology, and multidisciplinary collaboration. The second and third studies of this thesis were mixed methods studies focussed on co-designing the implementation of the PC-QIs for future use in primary care in Alberta. In study two, our findings from an organizational readiness survey and interviews conducted with participants representing both Canadian system-level and Alberta clinical primary care perspectives shed light on key factors that may influence implementation. These factors included: the organization or clinics’ interest and motivation to implement the PC-QIs, resources and capacity to collect and use data for improvements, and the organizational climate for implementation of the PC-QIs, related to PCC and QI. In the third study, we conducted a consensus process with primary care stakeholders to prioritize the PC-QIs for implementation and implementation strategies that were identified, which emerged from our second study. Consensus panelists prioritized PC-QIs related to: patient and caregiver involvement in decisions about care, having a trusting relationship with the healthcare provider, health information technology to support PCC, co-designing care in partnership with communities, and overall experience. The strategies prioritized included: developing partnerships among stakeholder groups, obtaining QI resources, conducting a needs assessment, aligning measurement efforts provincially, and engaging champions.
Open Access
Enhancing Self-management Support for Adults with Chronic Kidney Disease: A Person-centered, Theory-informed Approach
(2019-11) Donald, Maoliosa; Hemmelgarn, Brenda; Beanlands, Heather J.; Ronksley, Paul Everett; Straus, Sharon E.
Strategies to support patients to self-manage their chronic kidney disease (CKD) have been identified as one of the top 10 kidney research priorities internationally. Recognizing that this research priority is key to delivering person-centered care, this thesis examines enhancing adult CKD self-management support using patient-centered and theoretical approaches. We conducted three sequential studies: a scoping review to identify and describe self-management interventions for adult patients with CKD; a descriptive qualitative study to identify the needs of adults with CKD and their caregivers based on their experiences with managing CKD; and a one-day consensus workshop using personas to determine the preferences for content and features for a CKD patient self-management electronic health (eHealth) tool. We found a lack of patient engagement and application of behaviour change theories in the development of CKD self-management interventions. In addition, we identified the needs of patients and their caregivers regarding areas of knowledge, information sharing, and relevant supports for self-management in early stages of CKD. Patients, caregivers, health care professionals, and policy makers provided detailed subject matter for CKD topic areas, as well as preferred features to consider for a novel approach to supporting CKD self-management. This thesis work is pragmatic, as well as innovative in nature. To our knowledge, this is the first multi-phase study to meaningfully engage patients with CKD and caregivers as patient partners. Their involvement went beyond the role of consultation, where they actively participated in informing all phases of the research. To enhance CKD self-management support, our work offers evidence to inform the co-development of a tailored self-management support intervention for adults with CKD and their informal caregivers in Canada.
Open Access
Enhancing the uptake of systematic reviews of effects: what is the best format for health care managers and policy-makers? A mixed-methods study
(2018-06-22) Marquez, Christine; Johnson, Alekhya M; Jassemi, Sabrina; Park, Jamie; Moore, Julia E; Blaine, Caroline; Bourdon, Gertrude; Chignell, Mark; Ellen, Moriah E; Fortin, Jacques; Graham, Ian D; Hayes, Anne; Hamid, Jemila; Hemmelgarn, Brenda; Hillmer, Michael; Holmes, Bev; Holroyd-Leduc, Jayna; Hubert, Linda; Hutton, Brian; Kastner, Monika; Lavis, John N; Michell, Karen; Moher, David; Ouimet, Mathieu; Perrier, Laure; Proctor, Andrea; Noseworthy, Thomas; Schuckel, Victoria; Stayberg, Sharlene; Tonelli, Marcello; Tricco, Andrea C; Straus, Sharon E
Abstract Background Systematic reviews are infrequently used by health care managers (HCMs) and policy-makers (PMs) in decision-making. HCMs and PMs co-developed and tested novel systematic review of effects formats to increase their use. Methods A three-phased approach was used to evaluate the determinants to uptake of systematic reviews of effects and the usability of an innovative and a traditional systematic review of effects format. In phase 1, survey and interviews were conducted with HCMs and PMs in four Canadian provinces to determine perceptions of a traditional systematic review format. In phase 2, systematic review format prototypes were created by HCMs and PMs via Conceptboard©. In phase 3, prototypes underwent usability testing by HCMs and PMs. Results Two hundred two participants (80 HCMs, 122 PMs) completed the phase 1 survey. Respondents reported that inadequate format (Mdn = 4; IQR = 4; range = 1–7) and content (Mdn = 4; IQR = 3; range = 1–7) influenced their use of systematic reviews. Most respondents (76%; n = 136/180) reported they would be more likely to use systematic reviews if the format was modified. Findings from 11 interviews (5 HCMs, 6 PMs) revealed that participants preferred systematic reviews of effects that were easy to access and read and provided more information on intervention effectiveness and less information on review methodology. The mean System Usability Scale (SUS) score was 55.7 (standard deviation [SD] 17.2) for the traditional format; a SUS score < 68 is below average usability. In phase 2, 14 HCMs and 20 PMs co-created prototypes, one for HCMs and one for PMs. HCMs preferred a traditional information order (i.e., methods, study flow diagram, forest plots) whereas PMs preferred an alternative order (i.e., background and key messages on one page; methods and limitations on another). In phase 3, the prototypes underwent usability testing with 5 HCMs and 7 PMs, 11 out of 12 participants co-created the prototypes (mean SUS score 86 [SD 9.3]). Conclusions HCMs and PMs co-created prototypes for systematic review of effects formats based on their needs. The prototypes will be compared to a traditional format in a randomized trial.
Open Access
Health care costs associated with hospital acquired complications in patients with chronic kidney disease
(2017-12-28) Bohlouli, Babak; Jackson, Terri; Tonelli, Marcello; Hemmelgarn, Brenda; Klarenbach, Scott
Abstract Background Patients with CKD are at increased risk of potentially preventable hospital acquired complications (HACs). Understanding the economic consequences of preventable HACs, may define the scope and investment of initiatives aimed at prevention. Methods Adult patients hospitalized from April, 2003 to March, 2008 in Alberta, Canada comprised the study cohort. Healthcare costs were determined and categorized into ‘index hospitalization’ including hospital cost and in-hospital physician claims, and ‘post discharge’ including ambulatory care cost, physician claims, and readmission costs from discharge to 90 days. Multivariable regression was used to estimate the incremental healthcare costs associated with potentially preventable HACs. Results In fully adjusted models, the median incremental index hospitalization cost was CAN-$6169 (95% CI; 6003–6336) in CKD patients with ≥1 potentially preventable HACs, compared with those without. Post-discharge incremental costs were 1471(95% CI; 844–2099) in those patients with CKD who developed potentially preventable HACs within 90 days after discharge compared with patients without potentially preventable HACs. Additionally, the incremental costs associated with ≥1 potentially preventable HACs within 90 days from admission in patients with CKD were $7522 (95% CI; 7219–7824). A graded relation of the incremental costs was noted with the increasing number of complications. In patients without CKD but with ≥1 preventable HACs incremental costs within 90 days from hospital admission was $6688 (95% CI: 6612–6723). Conclusions Potentially preventable HACs are associated with substantial increases in healthcare costs in people with CKD. Investment in implementing targeted strategies to reduce HACs may have a significant benefit for patient and health system outcomes.
Open Access
Identifying Chronic Kidney Disease in the Community: The See Kidney Disease Targeted Screening Program
(2015-09-30) Galbraith, Lauren; Hemmelgarn, Brenda; Ronksley, Paul
Background: Guidelines recommend early identification of chronic kidney disease (CKD), with targeted screening as a potential method. Methods: The See Kidney Disease (SeeKD) targeted screening program screened 5,194 participants for CKD across Canada. Participant characteristics and clinical measures, including point-of-care creatinine testing for at-risk participants to determine unrecognized CKD (estimated glomerular filtration rate < 60 mL/min/1.73m2), were obtained. Individual counselling sessions were provided to participants as a behaviour change intervention. Results: The majority of participants (88.9%) had at least one risk factor for CKD, amongst whom the prevalence of unrecognized CKD was 18.8%. The majority of respondents to the post-screening survey (89.8%) self-reported a health behaviour change 2-4 weeks after their individual counselling session. Conclusion: The SeeKD program was able to identify a high prevalence of unrecognized CKD. Individual counselling may be an important component in facilitating health behaviour change among participants at risk of CKD.
Open Access
Living kidney donation: Increasing utilization and assessing costs
(2010) Barnieh, Lianne Josephine; Hemmelgarn, Brenda
Open Access
Measuring Accessibility to Primary Health Care Across the Urban-rural Continuum in the Province of Alberta
(2016) Barrett, Olesya; Bertazzon, Stefania; Miller, Byron; Hemmelgarn, Brenda; Patel, Alka; Yiannakoulias, Nikolaos
The proper estimation of accessibility is necessary to understand the issue of the urban-rural divide in access health care. The main concern with the previously developed accessibility measures is that the urban-rural continuum is treated as a dichotomous variable, while many degrees of rurality exist. While many studies attempted to include a distance decay function to address local travel patterns, it is usually arbitrary and may not exactly reflect the reality. This project is an attempt to improve the current methodology and make it more suitable for provincial settings that include various degrees of rurality. The past records of health care utilization are analyzed and distance decay coefficients are extracted for each type of urban and rural area. These coefficients are used to enhance a commonly used two-step floating catchment area (2SFCA) method to estimate accessibility scores. In addition, health needs and mobility measures are added to the model. The result of this enhanced methodology is compared to other methods where distance decay is used. The proposed method consistently shows better and more accurate results. The alternative methods often underestimate accessibility, especially in remote areas. The distance decay function derived from actual utilization data also allows use of this approach for large areas such as a Canadian province.
Open Access
Measuring agreement of administrative data with chart data using prevalence unadjusted and adjusted kappa
(BioMed Central, 2009) Chen, Guanmin; Faris, Peter; Hemmelgarn, Brenda; Walker, Robin L; Quan, Hude