Browsing by Author "Pendharkar, Sachin R."

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    The effect of CPAP therapy on kidney function in CKD patients with OSA
    (2020-01-28) Rimke, Alexander; Hanly, Patrick Joseph; Ahmed, Sofia Bano; Pendharkar, Sachin R.; Chowdhury, Tanvir Turin
    Introduction: Chronic kidney disease (CKD) is a prevalent disorder with significant consequences on patients’ health outcomes and substantial costs to the healthcare system. Obstructive sleep apnea (OSA) is present in ~40% of CKD patients and may contribute to worsening kidney function. A pilot study to investigate the effects of continuous positive airway pressure (CPAP) on kidney function in patients with CKD and OSA was performed to determine potential effects on health outcomes and feasibility of a larger study. Methods: The study was a randomized, controlled, non-blinded, parallel clinical trial in which CKD patients were screened for OSA. Although a convenience sample of 60 patients with stage 3 and 4 CKD and OSA was planned, recruitment was stopped after 57 patients due to budgetary constraints. Patients were randomized to receive usual medical treatment for CKD or usual treatment and CPAP for 12 months. Home sleep apnea tests were performed at baseline and 12 months and CPAP adherence was monitored throughout the study. Recruiting trends were recorded from July 2015 to July 2018. Estimated glomerular filtration rate (eGFR) and albumin:creatinine ratio (ACR) were recorded every three months for 12 months. Results: 57 patients were randomized from the 1665 patients eligible for the study; however, follow-up data at 12 months was obtained in 51 patients. Recruitment failure occurred primarily due to insufficient recruiters (461 patients) and refused consent (645 patients). While there were no significant differences in eGFR and ACR over 12 months between the two groups, a trend for improvement in eGFR and ACR in patients considered at low risk of progression to end-stage kidney disease occurred. Conclusions: Recruitment of CKD patients with OSA for a clinical trial was challenging, but several strategies may improve enrolment in future studies. Although primary analysis did not show treatment of OSA in patients with stage 3 and 4 CKD improved eGFR and ACR, there was a trend for CPAP to improve these outcomes in patients with a low risk of CKD progression. This pilot randomized controlled trial provides preliminary data to determine if a larger clinical trial is merited and its future design.
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    Effectiveness of a standardized electronic admission order set for acute exacerbation of chronic obstructive pulmonary disease
    (BMC Pulmonary Medicine, 2018-05-30) Pendharkar, Sachin R.; Ospina, Maria B.; Gadotti, D. A.; Hirani, Naushad; Graham, Jim Allen; Faris, Peter D.; Bhutani, Mohit; Leigh, Richard A.; Mody, Christopher H.; Strickland, Michael K.
    Background: Variation in hospital management of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may prolong length of stay, increasing the risk of hospital-acquired complications and worsening quality of life. We sought to determine whether an evidence-based computerized AECOPD admission order set could improve quality and reduce length of stay. Methods: The order set was designed by a provincial COPD working group and implemented voluntarily among three physician groups in a Canadian tertiary-care teaching hospital. The primary outcome was length of stay for patients admitted during order set implementation period, compared to the previous 12 months. Secondary outcomes included length of stay of patients admitted with and without order set after implementation, all-cause readmissions, and emergency department visits. Results: There were 556 admissions prior to and 857 admissions after order set implementation, for which the order set was used in 47%. There was no difference in overall length of stay after implementation (median 6.37 days (95% confidence interval 5.94, 6.81) pre-implementation vs. 6.02 days (95% confidence interval 5.59, 6.46) post-implementation, p = 0.26). In the post-implementation period, order set use was associated with a 1.15-day reduction in length of stay (95% confidence interval − 0.5, − 1.81, p = 0.001) compared to patients admitted without the order set. There was no difference in readmissions. Conclusions: Use of a computerized guidelines-based admission order set for COPD exacerbations reduced hospital length of stay without increasing readmissions. Interventions to increase order set use could lead to greater improvements in length of stay and quality of care. Keywords: Length of stay, Clinical decision support, Chronic obstructive pulmonary disease, Quality improvement
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    Hospitalization Costs of Canadian Cystic Fibrosis Patients
    (2020-09-29) Skolnik, Kate; Williamson, Tyler S.; Quon, Bradley S.; Pendharkar, Sachin R.; Ronksley, Paul Everett
    Introduction: Cystic fibrosis (CF) is a genetic disease that can lead to significant morbidity. As the CF population increases and treatment regimens escalate in complexity, CF care costs are expected to rise and could put tremendous strain on health care systems. Our aim was to examine the hospitalization costs of Canadian CF patients. Methods: We performed an analysis of annual CF hospital costs for the 2014 fiscal year using a public payer perspective. Secondary objectives were to examine differences in annual hospital costs for Canadian CF patients (1) by patient characteristics, (2) between provinces, and (3) over time (from 2010 to 2014). Record level data were obtained from the Canadian Institute for Health Information databases. CF patients were defined based on at least one hospital admission with an ICD-10 code of E84. Costs were estimated using a case-mix aggregate costing strategy. Results: In 2014, 953 of 2,702 (35%) Canadians with CF had 1,705 hospitalizations resulting in a total cost of $32.1 million. Mean hospital cost per patient and mean cost per hospitalization were $34,982 and $19,782, respectively. There were no differences in mean cost per hospitalization by age or sex. Mean cost per hospitalization was highest among those admitted for pneumothorax ($22,685), followed by CF pulmonary exacerbation ($21,130) and distal intestinal obstruction syndrome ($18,816). The mean cost per hospitalization was highest for Alberta ($25,229) and lowest for NB ($10,734). Between 2010 and 2014, the total cost of all hospitalizations for CF patients increased by 17% ($27.4 to $32.1 million). Conclusion: Canadian CF hospitalizations are costly; these costs vary by type of admitting diagnosis and are increasing over time. These national estimates will inform health care planning as well as future cost effectiveness analyses for CF interventions.
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    Using Operational Analysis to Improve Access to Pulmonary Function Testing
    (2016-04-07) Ip, Ada; Asamoah-Barnieh, Raymond; Bischak, Diane P.; Davidson, Warren J.; Flemons, W. Ward; Pendharkar, Sachin R.
    Background. Timely pulmonary function testing is crucial to improving diagnosis and treatment of pulmonary diseases. Perceptions of poor access at an academic pulmonary function laboratory prompted analysis of system demand and capacity to identify factors contributing to poor access. Methods. Surveys and interviews identified stakeholder perspectives on operational processes and access challenges. Retrospective data on testing demand and resource capacity was analyzed to understand utilization of testing resources. Results. Qualitative analysis demonstrated that stakeholder groups had discrepant views on access and capacity in the laboratory. Mean daily resource utilization was 0.64 (SD 0.15), with monthly average utilization consistently less than 0.75. Reserved testing slots for subspecialty clinics were poorly utilized, leaving many testing slots unfilled. When subspecialty demand exceeded number of reserved slots, there was sufficient capacity in the pulmonary function schedule to accommodate added demand. Findings were shared with stakeholders and influenced scheduling process improvements. Conclusion. This study highlights the importance of operational data to identify causes of poor access, guide system decision-making, and determine effects of improvement initiatives in a variety of healthcare settings. Importantly, simple operational analysis can help to improve efficiency of health systems with little or no added financial investment.