Browsing by Author "Noseworthy, Tom"

Now showing 1 - 8 of 8
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    Costs of the Acute Respiratory Distress Syndrome
    (2023-11-29) Boucher, Paul; Clement, Fiona; Noseworthy, Tom; McBrien, Kerry
    The acute respiratory distress syndrome (ARDS) is an inflammatory condition of the lungs and is a common condition in adult intensive care units (ICU). The resources required and costs of care for patients with ARDS are substantial due to the severity of illness, resource intensity and extended lengths of stay. There are two parts to this thesis: to systematically review the costing literature in ARDS and to perform a costing study of a cohort of patients with ARDS. The systematic review searched the literature through to April 29, 2021 for articles relevant to ARDS and costs. 4633 publications were found of which 110 were included for full-text review. A total of 22 publications met inclusion criteria and were kept for the final analysis. The assessment was done independently by two reviewers and the systematic review followed PRISMA guidelines. Quality assessment was done using a modified version of the Quality of Health Economic Studies Instrument. This review helped contextualize the results of the costing study. The aim of the costing study was to calculate both hospital inpatient costs and post discharge costs for the three years that followed for patients with ARDS. Clinical factors associated with costs during both the time periods were examined. The costing study was done on a cohort of 585 patients with ARDS who were prospectively identified using a standardized screening protocol in the 4 adults ICUs in Calgary, Alberta, Canada. The post discharge costs were calculated on 364 patients who survived their initial hospital stay and had a traceable, valid Alberta postal codes at the end of the three year follow-up period.
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    Evaluation of an electronic medical record (EMR) as a transcription aid
    (2008) Zhan, Yun Zhi; Noseworthy, Tom; Edworthy, S. M.
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    Palliative care in the home: a scoping review of study quality, primary outcomes, and thematic component analysis
    (2018-03-07) Hofmeister, Mark; Memedovich, Ally; Dowsett, Laura E; Sevick, Laura; McCarron, Tamara; Spackman, Eldon; Stafinski, Tania; Menon, Devidas; Noseworthy, Tom; Clement, Fiona
    Abstract Background The aim of palliative care is to improve the quality of life of patients and families through the prevention and relief of suffering. Frequently, patients may choose to receive palliative care in the home. The objective of this paper is to summarize the quality and primary outcomes measured within the palliative care in the home literature. This will synthesize the current state of the literature and inform future work. Methods A scoping review was completed using PRISMA guidelines. PubMed, Embase, CINAHL, Web of Science, Cochrane Library, EconLit, PsycINFO, Centre for Reviews and Dissemination, Database of Abstracts of Reviews of Effects, and National Health Service Economic Evaluation Database were searched from inception to August 2016. Inclusion criteria included: 1) care was provided in the “home of the patient” as defined by the study, 2) outcomes were reported, and 3) reported original data. Thematic component analysis was completed to categorize interventions. Results Fifty-three studies formed the final data set. The literature varied extensively. Five themes were identified: accessibility of healthcare, caregiver support, individualized patient centered care, multidisciplinary care provision, and quality improvement. Primary outcomes were resource use, symptom burden, quality of life, satisfaction, caregiver distress, place of death, cost analysis, or described experiences. The majority of studies were of moderate or unclear quality. Conclusions There is robust literature of varying quality, assessing different components of palliative care in the home interventions, and measuring different outcomes. To be meaningful to patients, these interventions need to be consistently evaluated with outcomes that matter to patients. Future research could focus on reaching a consensus for outcomes to evaluate palliative care in the home interventions.
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    Physician Payment: Data Integrity and Policies for Improvement
    (2016) Cunningham, Ceara Tess; Quan, Hude; Jetté, Nathalie; Noseworthy, Tom; DeCoster, Carolyn
    Physician compensation is a key component of any health system. In Canada, various reimbursement models which exist for physicians include fee-for-service (FFS), capitation and salaries [1, 2]. There are concerns nationally that the implementation of alternative payment plans (APP) may be affecting certain processes, such as changes in billing claims submissions (i.e. decreases), potentially leading to incomplete billing data and underestimates of disease burdens and outcomes [3, 4]. Thus, four studies were conducted to examine billing patterns between traditional FFS and APP specialists and to assess existing APP policies aimed at governing issues related to physician billing. In the first study, a survey was conducted to gain consent to access medical and surgical specialist claims data in Calgary, Alberta. With a 35.0% (317/904) response rate, 317 physicians consented to data access (47.7% (71/149) of physicians on APP plans versus 38.9% (46/119) on FFS plans). The second study validated billing claims submitted by surveyed APP and FFS physicians. The proportion of submitted claims for APP and FFS physicians was over 90%. The third study looked at physician claims data to examine the impact of physician reimbursement programs on estimates of hypertension prevalence, cardiovascular disease hospitalization rate and mortality. These estimates (APP claims; 0.6%, n=3677, FFS claims; 99.4%, n=610,167) were minimally impacted if APP physicians did not submit claims. The final study surveyed and interviewed faculty of medicine department heads nationally about APP programs and government stakeholders to determine current policies regarding specialist shadow billing. Disincentive programs appear to be an efficient tool to promote APP physician billing submission. Similar studies should now be conducted in other Canadian regions to confirm the findings, to objectively explore the extent of the variability between billing submission processes nationally and to determine the impact of APP programs on disease estimates.
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    Radiofrequency Ablation for Chronic Low Back Pain: A Systematic Review of Randomized Controlled Trials
    (2014-01-01) Leggett, Laura E; Soril, Lesley JJ; Lorenzetti, Diane L; Noseworthy, Tom; Steadman, Rodney; Tiwana, Simrandeep; Clement, Fiona
    BACKGROUND: Radiofrequency ablation (RFA), a procedure using heat to interrupt pain signals in spinal nerves, is an emerging treatment option for chronic low back pain. Its clinical efficacy has not yet been established.OBJECTIVE: To determine the efficacy of RFA for chronic low back pain associated with lumbar facet joints, sacroiliac joints, discogenic low back pain and the coccyx.METHODS: A systematic review was conducted. Medline, EMBASE, PubMed, SPORTDiscus, CINAHL and the Cochrane Library were searched up to August 2013. Abstracts and full-text articles were reviewed in duplicate. Included articles were sham-controlled randomized controlled trials (RCTs), assessed the efficacy of RFA, reported at least one month of follow-up and included participants who had experienced back pain for at least three months. Data were extracted in duplicate and quality was assessed using the Cochrane Risk of Bias tool. Due to heterogeneity, as well as a lack of reported mean differences and SDs, meta-analysis was not possible using these data.RESULTS: The present systematic review retrieved 1063 abstracts. Eleven sham-controlled RCTs were included: three studies involving discogenic back pain; six studies involving lumbar facet joint pain; and two studies involving sacroiliac joint pain. No studies were identified assessing the coccyx. The evidence supports RFA as an efficacious treatment for lumbar facet joint and sacroiliac joint pain, with five of six and both of the RCTs demonstrating statistically significant pain reductions, respectively. The evidence supporting RFA for the treatment of discogenic pain is mixed.CONCLUSIONS: While the majority of the studies focusing on lumbar facet joints and sacroiliac joints suggest that RFA significantly reduces pain in short-term follow-up, the evidence base for discogenic low back pain is mixed. There is no RCT evidence for RFA for the coccyx. Future studies should examine the clinical significance of the achieved pain reduction and the long-term efficacy of RFA.
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    Wait time management strategies for total joint replacement surgery: sustainability and unintended consequences
    (2017-09-07) Pomey, Marie-Pascale; Clavel, Nathalie; Amar, Claudia; Sabogale-Olarte, Juan C; Sanmartin, Claudia; De Coster, Carolyn; Noseworthy, Tom