Improving knowledge translation of clinical practice guidelines for epilepsy.

Background: Clinical practice guidelines (CPGs) have the potential to improve quality of care. However, implementation of CPGs into the clinical care of people with epilepsy is less than optimal. This study aimed to examine barriers and facilitators to the use of CPGs for the care of people with epilepsy.

Knowledge translation of clinical practice guidelines among neurologists: A mixed-methods study.

Objectives: Clinical practice guidelines have the potential to improve care, but are often not optimally implemented. Improving guideline use in clinical practice may improve care. The objective of this study was to identify the barriers and facilitators (determinants) of guidelines use among neurologists and to propose a strategy to improve guideline implementation.

Wait time management strategies for total joint replacement surgery: sustainability and unintended consequences.

Background: In Canada, long waiting times for core specialized services have consistently been identified as a key barrier to access. Governments and organizations have responded with strategies for better access management, notably for total joint replacement (TJR) of the hip and knee. While wait time management strategies (WTMS) are promising, the factors which influence their sustainable implementation at the organizational level are understudied.

Effect of physician specialist alternative payment plans on administrative health data in Calgary: a validation study.

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.

Appropriateness for Total Joint Replacement: Perspectives of Decision-Makers.

Background: Improving access to total joint replacement (TJR) has been a priority. Without robust mechanisms to ensure appropriateness, these procedures may be overused, incurring substantial costs. In that context, decision-makers are particularly concerned with the appropriateness of TJR.

Perspectives of orthopaedic surgeons on patients' appropriateness for total joint arthroplasty: a qualitative study.

Rationale, Aims And Objectives: As total joint arthroplasty (TJA) rates rise, there is need to ensure appropriate use. Our objective was to elucidate surgeons' perspectives on appropriateness for TJA.

Methods: Semi-structured telephone interviews were conducted in a sample of orthopaedic surgeons that perform TJA in three Canadian Provinces.

Sustainability: orthopaedic surgery wait time management strategies.

Purpose: The purpose of this paper is to examine Canadian organizational and systemic factors that made it possible to keep wait times within federally established limits for at least 18 months.

Design/methodology/approach: The research design is a multiple cases study. The paper selected three cases: Case 1 - staff were able to maintain compliance with requirements for more than 18 months; Case 2 - staff were able to meet requirements for 18 months, but unable to sustain this level; Case 3 - staff were never able to meet the requirements.

Perspectives of Canadian Stakeholders on Criteria for Appropriateness for Total Joint Arthroplasty in Patients With Hip and Knee Osteoarthritis.

Objective: As rates of total joint arthroplasty (TJA) for osteoarthritis (OA) rise, there is a need to ensure appropriate use. We undertook this study to develop criteria for appropriate use of TJA.

Methods: In prior work, we used qualitative methods to separately assess OA patients' and arthroplasty surgeons' perceptions regarding appropriateness of patient candidates for TJA.

Criteria for Referring Patients With Outpatient Gastroenterological Disease for Specialist Consultation: A Review of the Literature.

Background: Demands on gastroenterology are growing, as a result of the high prevalence of digestive diseases, the impact of colon cancer screening programs and an aging population. Prioritizing referrals to gastroenterology would assist in managing wait times. Our objectives were (1) to assess whether there were consistent criteria to guide referrals from family physicians for gastroenterological outpatient consultation and (2) to determine if there were different levels of urgency or priority in referral criteria.

Wait time management strategies for scheduled care: what makes them succeed?

Objectives: To assess experts' perceptions of the contextual and local factors that promote or inhibit the implementation of waiting time management strategies (WTMS) in Canadian healthcare organizations.

Methods: We conducted 16 semi-structured interviews and one focus group with individuals involved in WTMS at the federal, provincial or organizational level.

Results: The most frequently cited local factor was physicians' participation.

Relative urgency for referral from primary care to rheumatologists: the Priority Referral Score.

Objective: Timely access to rheumatology consultation is fundamental to appropriate and effective management of patients with musculoskeletal and autoimmune diseases. Yet, for a variety of reasons, limited and delayed access is commonplace. Moreover, information exchange for referral is often inadequate or poorly communicated.

Predictors of serious complications associated with lower gastrointestinal endoscopy in a major city-wide health region.

Background: There are limited data regarding complications associated with colonoscopy and flexible sigmoidoscopy in usual clinical practice in Canada.

Objective: To determine the risk factors for lower gastrointestinal (GI) endoscopy-associated complications in usual clinical practice.

Methods: All outpatient lower GI endoscopies performed in Winnipeg (Manitoba) between April 1, 2004 and March 31, 2006, were identified from the provincial physicians' claims database.

Criteria for referring patients with renal disease for nephrology consultation: a review of the literature.

Introduction: Referrals to nephrologists comprise not only patients with chronic kidney disease but also those with other nephrological conditions. There may be confusion about when to refer a patient to a nephrologist. We conducted a literature review to identify preexisting priority-setting, triage or referral criteria developed to guide referrals from primary care to a nephrologist.

Follow-through after calling a nurse telephone advice line: a population-based study.

Background: Nurse telephone advice (NTA) lines, a major initiative in primary health care reform, provide symptom triage and health information. Compliance studies utilizing database analysis are frequently limited to a defined population, such as children or Emergency Department (ED) users.

Objectives: To explore caller characteristics associated with following NTA advice to go to the ED, see a health care professional or self-care for Calgary, Canada (population 1 million).

Colonoscopy and its complications across a Canadian regional health authority.

Background: Defining the complication rate of endoscopy performed across an entire city will capture usual as opposed to referral center data.

Objective: Our purpose was to evaluate the current practice of colonoscopy and complications associated with lower GI endoscopy in usual clinical practice.

Design: All admissions within 30 days of an outpatient lower GI endoscopy at any of the 6 adult-care Winnipeg hospitals were identified.

Mortality, cause of death and life expectancy of Chinese Canadians in Alberta.

Objective: To describe mortality, cause of death and life expectancy among Chinese (both immigrant and Canadian-born) and other Canadians in the Province of Alberta.

Methods: A Chinese surname list was applied to the Alberta Health Insurance Plan and Vital Statistics Birth registry databases to define the Chinese population, and to the Vital Statistics Death registry to determine deaths among Chinese in Alberta from 1995 to 2003. Age- and sex-specific mortality, cause of death and life expectancy were calculated.

Appropriateness of healthcare interventions: concepts and scoping of the published literature.

Objectives: This report is a scoping review of the literature with the objective of identifying definitions, conceptual models and frameworks, as well as the methods and range of perspectives, for determining appropriateness in the context of healthcare delivery.

Methods: To lay groundwork for future, intervention-specific research on appropriateness, this work was carried out as a scoping review of published literature since 1966. Two reviewers, with two screens using inclusion/exclusion criteria based on the objective, focused the research and articles chosen for review.

Priority-setting tools for rheumatology disease referrals: a review of the literature.

As part of a larger body of work to develop a rheumatology priority referral score, a literature review was conducted. The objective of the literature review was to identify preexisting priority-setting, triage, and referral tools/scales developed to guide referrals from primary care to specialist care/consultation usually provided by a rheumatologist. Using a combination of database, citation, Internet, and hand-searching, 20 papers were identified that related to referral prioritization in three areas: rheumatoid arthritis (RA; 5), musculoskeletal (MSK) diseases other than RA (3), and MSK diseases in general (12).

Comparison and validity of procedures coded With ICD-9-CM and ICD-10-CA/CCI.

Background: The use of health administrative data in health services research is facilitated by standardized classification systems, such as the International Classification of Diseases (ICD). Canada, among other countries, recently introduced the tenth version of ICD and its accompanying Canadian Classification of Interventions (CCI). It is imperative to assess errors that could occur in administrative data due to the introduction of the new coding system.

Do administrative databases accurately measure waiting times for medical care? Evidence from general surgery.

We abstracted the records of patients from general surgeons' offices in Winnipeg to compare waiting times from charts (i.e., the gold standard) with waiting times using administrative data.

Health care utilization for injury in cataract surgery patients.

Background: Although visual impairment has been associated with falls, fractures, and other injuries, the relation between cataract surgery and injuries is unclear. This study assesses whether persons waiting for cataract surgery are at increased risk of requiring health care services for an injury compared with a control group, and, if so, whether the risk changes after cataract surgery.

Methods: This is a retrospective case-control study of first-eye cataract surgery recipients in Manitoba in fiscal 1999-2000.

A systematic literature review of the evidence on benchmarks for cataract surgery waiting time.

Background: This review offered critical input to the work of Canadian federal-provincial-territorial Deputy Ministers of Health on establishing evidence-based benchmarks for waiting times (WTs) for cataract surgery. The study purpose was to synthesize the evidence regarding the relations among patient characteristics, WT, and health outcomes for patients on waiting lists for cataract surgery.

Methods: A systematic literature review was conducted using the Cochrane methodology.

The Western Canada Waiting List Project: development of a priority referral score for hip and knee arthroplasty.

Background: Recognizing the concerns about long waiting times to see some specialists in Canada, and the burden this places on both primary care and specialist clinicians, the Western Canada Waiting List (WCWL) undertook the Primary Care Project. The goal was to develop a valid, reliable, standardized prioritization tool for use by primary care providers in making referrals to specialists. WCWL is a 20-partner collaboration committed to addressing long waiting times to access scheduled health care services.