Publications by authors named "Detsky A"
Background And Aims: The expanded use of virtual care may worsen pre-existing disparities in use and delivery of end-of-life care among certain groups of people. We measured the use of virtual care in the last three months of life before and after the introduction of virtual care fee codes that funded care delivery at the start of COVID-19 on March 14, 2020, and identified changes in the characteristics of people using it.
Methods: We used linked clinical and administrative datasets to study use of virtual care in the last three months of life among 411,564 adults who died between January 25, 2018, and November 30, 2022.
Objective: To measure the association between types of serious illness and the use of different physician-delivered care models near the EOL during the COVID-19 pandemic.
Design, Setting And Participants: Population-based cohort study using health administrative datasets in Ontario, Canada, for adults aged ≥18 years in their last 90 days of life who died of cancer or terminal noncancer illness and received physician-delivered care models near the end-of-life between March 14, 2020 and January 24, 2022.
Exposure: The type of serious illness (cancer or terminal noncancer illness).
Background: People with disabilities are at elevated risk of adverse short-term outcomes following hospitalization for acute infectious illness. No prior studies have compared long-term healthcare use among this high-risk population. We compared the healthcare use of adults with disabilities in the one year following hospitalization for COVID-19 vs.
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- The study aimed to analyze the relationship between the sex of surgeons and the number of days patients spend alive and at home (DAH) after surgery.
- It found that patients treated by female surgeons had significantly more DAH compared to those treated by male surgeons over all measured time frames (30, 90, and 365 days).
- The findings suggest that higher DAH associated with female surgeons could lead to lower healthcare costs and better patient quality of life, indicating a need for further research in different healthcare settings.
Objective: We sought to examine whether the outcomes of patients who receive a surgical procedure on Friday the 13th differ from patients who receive surgery on flanking Fridays.
Background: Numerous studies have demonstrated that increased anxiety from the provider or patient around the time of surgery can lead to worse outcomes. Superstitious patients often express significant concern and anxiety when undergoing a surgical procedure on Friday the 13th.
The use of virtual care for people at the end-of-life significantly increased during the COVID-19 pandemic, but its association with acute healthcare use and location of death is unknown. The objective of this study was to measure the association between the use of virtual end-of-life care with acute healthcare use and an out-of-hospital death before vs. after the introduction of specialized fee codes that enabled broader delivery of virtual care during the COVID-19 pandemic.
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- * A study in Ontario, Canada, revealed that higher service volume physicians were more likely to provide virtual EOLC, but this association decreased during the COVID-19 pandemic.
- * Before the pandemic, physicians contributed to 36% of the variation in virtual EOLC use, which dropped significantly to 12% during the pandemic, suggesting changing dynamics in healthcare delivery.
Objective: To examine the association of anesthesiologist sex on postoperative outcomes.
Background: Differences in patient postoperative outcomes exist, depending on whether the primary surgeon is male or female, with better outcomes seen among patients treated by female surgeons. Whether the intraoperative anesthesiologist's sex is associated with differential postoperative patient outcomes is unknown.
Importance: Prior research has shown differences in postoperative outcomes for patients treated by female and male surgeons. It is important to understand, from a health system and payer perspective, whether surgical health care costs differ according to the surgeon's sex.
Objective: To examine the association between surgeon sex and health care costs among patients undergoing surgery.
Objective: To determine whether patient-surgeon gender concordance is associated with mortality of patients after surgery in the United States.
Design: Retrospective observational study.
Setting: Acute care hospitals in the US.
The Ending the HIV Epidemic (EHE) Initiative targets a subset of United States (US) priority jurisdictions hardest hit by HIV. It remains unclear which emergency departments (EDs) are the most appropriate targets for EHE-related efforts. To explore this, we used the 2001-2019 National Emergency Department Inventories (NEDI)-USA as a framework to characterize all US EDs, focusing on those in priority jurisdictions and those affiliated with a teaching hospital.
View Article and Find Full Text PDFImportance: Sex- and gender-based differences in a surgeon's medical practice and communication may be factors in patients' perioperative outcomes. Patients treated by female surgeons have improved 30-day outcomes. However, whether these outcomes persist over longer follow-up has not been assessed.
View Article and Find Full Text PDFThe Changing Medical Publishing Industry: Economics, Expansion, and Equity.
J Gen Intern Med
November 2023
Medical journal publishing has changed dramatically over the past decade. The shift from print to electronic distribution altered the industry's economic model. This was followed by open access mandates from funding organizations and the subsequent imposition of article processing charges on authors.
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- People who survive hospitalization for COVID-19 may face new health issues like cardiovascular, neurological, and mental health conditions, but it's uncertain how this risk compares to other serious illnesses.
- The objective of the study was to evaluate the risks of these new health conditions within a year of hospitalization for COVID-19, comparing it to cases of influenza and sepsis.
- Results showed that while there was a higher risk of venous thromboembolic disease after COVID-19 hospitalization compared to influenza, there were no significant increases in other health conditions when compared to both influenza and sepsis.
Article Synopsis
- The study investigates the link between diabetes and the risk of death in hospitalized COVID-19 patients, noting previous research lacked detail on disease severity and comorbidities.
- Conducted in Ontario, Canada, and Copenhagen, Denmark, the study included over 1,400 COVID-19 patients, analyzing their health conditions and diabetes status.
- Results showed that while diabetes patients had a higher in-hospital death rate, the overall impact of diabetes on mortality risk varied significantly across the two regions.
Purpose: Caring for patients with low-acuity conditions in Emergency Departments (ED) is often thought to cost more than treating those patients in other ambulatory settings. Understanding the relative cost of care between settings has critical implications for healthcare policy and system design.
Methods: We conducted a systematic review of papers comparing the cost of care for low-acuity and ambulatory care sensitive conditions in ED and other outpatient settings.
Importance: There is an urgent need for evidence to inform preoperative risk assessment for the millions of people who have had SARS-CoV-2 infection and are awaiting elective surgery, which is critical to surgical care planning and informed consent.
Objective: To assess the association of prior SARS-CoV-2 infection with death, major adverse cardiovascular events, and rehospitalization after elective major noncardiac surgery.
Design, Setting, And Participants: This population-based cohort study included adults who had received a polymerase chain reaction test for SARS-CoV-2 infection within 6 months prior to elective major noncardiac surgery in Ontario, Canada, between April 2020 and October 2021, with 30 days follow-up.
Background: There is wide variation in mortality among patients hospitalized with COVID-19. Whether this is related to patient or hospital factors is unknown.
Objective: To compare the risk of mortality for patients hospitalized with COVID-19 and to determine whether the majority of that variation was explained by differences in patient characteristics across sites.
Objective: The aim of this study was to examine the effect of surgeon-anesthesiologist sex discordance on postoperative outcomes.
Summary Background Data: Optimal surgical outcomes depend on teamwork, with surgeons and anesthesiologists forming two key components. There are sex and sex-based differences in interpersonal communication and medical practice which may contribute to patients' perioperative outcomes.
Article Synopsis
- The study explores how patients, caregivers, and society value quality of life (QOL) versus quantity of life at the end of life, highlighting a preference for QOL gains.
- A comprehensive literature search identified 51 studies with nearly 54,000 participants, revealing significant issues with the quality-adjusted life-years (QALY) measure in evaluating end-of-life preferences.
- The findings suggest that healthcare policies should prioritize interventions that enhance quality of life, as QALYs may not accurately reflect patient and caregiver values at this stage.