Referring and Specialist Physician Gender and Specialist Billing.

Importance: While a gender pay gap in medicine has been well documented, relatively little research has addressed mechanisms that mediate gender differences in referral income for specialists.

Objective: To examine gender-based disparities in medical and surgical specialist referrals in Ontario, Canada.

Design, Setting, And Participants: This cross-sectional study included referrals for specialist care ascertained from Ontario Health Insurance Plan physician billings for fiscal year 2018 to 2019.

Association between virtual primary care and emergency department use during the first year of the COVID-19 pandemic in Ontario, Canada.

Background: Uptake of virtual care increased substantially during the first year of the COVID-19 pandemic. The aim of this study was to evaluate whether a shift from in-person to virtual visits by primary care physicians was associated with increased use of emergency departments among their enrolled patients.

Methods: We conducted an observational study of monthly virtual visits and emergency department visits from Apr.

COVID-19 and the duration of operating room procedures in Ontario: a population-based retrospective study.

Background: Studies have estimated that a large backlog of procedures was generated by emergency measures implemented in Ontario, Canada, at the onset of the COVID-19 pandemic, when nonessential and scheduled procedures were postponed. Understanding the impact of the COVID-19 pandemic on the time needed to perform a procedure may help to determine the resources needed to tackle the substantial backlog caused by the deferral of cases. The purpose of this study was to examine the duration of operating room (OR) procedures before and after the onset of the COVID-19 pandemic to inform planning around changes in required resources.

Impact of the COVID-19 pandemic upon self-reported physician burnout in Ontario, Canada: evidence from a repeated cross-sectional survey.

Objectives: To estimate the impact of the SARS-CoV-2 (COVID-19) pandemic on levels of burnout among physicians in Ontario, Canada, and to understand physician perceptions of the contributors and solutions to burnout.

Design: Repeated cross-sectional survey.

Setting: Active and retired physicians, residents and medical students in Canada's largest province were invited to participate in an online survey via an email newsletter.

Health-care utilization and costs in adults with systemic lupus erythematosus in the United Kingdom: a real-world observational retrospective cohort analysis.

Objective: The aim was to describe direct health-care costs for adults with SLE in the UK over time and by disease severity and encounter type.

Methods: Patients aged ≥18 years with SLE were identified using the linked Clinical Practice Research Datalink-Hospital Episode Statistics database from January 2005 to December 2017. Patients were classified as having mild, moderate or severe disease using an adapted claims-based algorithm based on prescriptions and co-morbid conditions.

Disease severity, flares and treatment patterns in adults with systemic lupus erythematosus in the UK: a real-world observational retrospective cohort analysis.

Objectives: The aim was to characterize disease severity, clinical manifestations, treatment patterns and flares in a longitudinal cohort of adults with SLE in the UK.

Methods: Adults with SLE were identified in the Clinical Practice Research Datalink-Hospital Episode Statistics database (1 January 2005-31 December 2017). Patients were required to have ≥12 months of data before and after the index date (earliest SLE diagnosis date available).

Disparities in Physician Compensation by Gender in Ontario, Canada.

Importance: Men and women should earn equal pay for equal work. An examination of the magnitude of pay disparities could inform strategies for remediation.

Objective: To examine gender-based differences in pay within a large, comprehensive physician population practicing within a variety of payment systems.

Adoption of a laboratory EMR system and inappropriate laboratory testing in Ontario: a cross-sectional observational study.

Background: Electronic medical record (EMR) systems have the potential to facilitate appropriate laboratory testing. We examined three common medical tests in primary care-hemoglobin A1c (HbA1c), lipid, and thyroid stimulating hormone (TSH)- to assess whether adoption of a laboratory EMR system in Ontario had an impact on the rate of inappropriate testing among primary care physicians.

Methods: We used FY2016-17 population-level laboratory data to estimate the association between adoption of a laboratory EMR system and the rate of inappropriate testing.

Trends in prevalence of chronic disease and multimorbidity in Ontario, Canada.

Background: New case-mix tools from the Canadian Institute for Health Information offer a novel way of exploring the prevalence of chronic disease and multimorbidity using diagnostic data. We took a comprehensive approach to determine whether the prevalence of chronic disease and multimorbidity has been rising in Ontario, Canada.

Methods: In this observational study, we applied case-mix methodology to a population-based cohort.

Effect of Strict and Soft Policy Interventions on Laboratory Diagnostic Testing in Ontario, Canada: A Bayesian Structural Time Series Analysis.

Applications of behavioral economics targeted at optimizing laboratory utilization among physicians have been implemented in Ontario through different types of nonfinancial interventions. Strict policy interventions restrict Ontario Health Insurance Plan (OHIP) payment for tests to patients with specific conditions or limit ordering to particular physician specialties, while soft policy interventions involve modifications to the laboratory requisition form. This study evaluates the effectiveness of these interventions in terms of changing physician ordering behavior for eight tests that were subject to a strict or soft policy intervention during the study period.

Use of the Population Grouping Methodology of the Canadian Institute for Health Information to predict high-cost health system users in Ontario.

Background: Prior research has consistently shown that the heaviest users account for a disproportionate share of health care costs. As such, predicting high-cost users may be a precondition for cost containment. We evaluated the ability of a new health risk predictive modelling tool, which was developed by the Canadian Institute for Health Information (CIHI), to identify future high-cost cases.

Persistent postoperative pain and healthcare costs associated with instrumented and non-instrumented spinal surgery: a case-control study.

Purpose: To compare rates of persistent postoperative pain (PPP) after lumbar spine surgery-commonly known as Failed Back Surgery Syndrome-and healthcare costs for instrumented lumbar spinal fusion versus decompression/discectomy.

Methods: The UK population-based healthcare data from the Hospital Episode Statistics (HES) database from NHS Digital and the Clinical Practice Research Datalink (CPRD) were queried to identify patients with PPP following lumbar spinal surgery. Rates of PPP were calculated by type of surgery (instrumented and non-instrumented).

Using Diagnoses to Estimate Health Care Cost Risk in Canada.

Objective: Until recently, the options for summarizing Canadian patient complexity were limited to health risk predictive modeling tools developed outside of Canada. This study aims to validate a new model created by the Canadian Institute for Health Information (CIHI) for Canada's health care environment.

Research Design: This was a cohort study.

Costs of gastrointestinal bleeding events in atrial fibrillation: a UK Clinical Practice Research Datalink study.

To estimate the healthcare costs attributable to gastrointestinal (GI) bleeds in nonvalvular atrial fibrillation (NVAF) patients. A difference-in-differences approach was used in which NVAF patients suffering a (GI) bleed were propensity score matched to those not suffering a GI bleed, and the difference in healthcare costs in the year prior to the GI bleed and the subsequent 3 years was compared between the two groups. The mean cost attributable to GI bleeds was £3989 (p < 0.

Reoperation following lumbar spinal surgery: costs and outcomes in a UK population cohort study using the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES).

Purpose: To assess the likelihood of persistent postoperative pain (PPP) following reoperation after lumbar surgery and to estimate associated healthcare costs.

Methods: This is a retrospective cohort study using two linked UK databases: Hospital Episode Statistics and UK Clinical Practice Research Datalink. Costs and outcomes associated with reoperation were evaluated over a 2-year postoperative period using multivariate logistic regression for cases who underwent reoperation and controls who did not, based on demographics, index surgery type, smoking status, and pre-index comorbidities using propensity score matching.

Short- and long-term cost and utilization of health care resources in Parkinson's disease in the UK.

Background: There is currently no robust long-term data on costs of treating patients with Parkinson's disease. The objective of this study was to report levels of health care utilization and associated costs in the 10 years after diagnosis among PD patients in the United Kingdom.

Methods: We undertook a retrospective population-based cohort study using linked data from the UK Clinical Practice Research Datalink and Hospital Episode Statistics databases.

The economic burden of cancer care in Canada: a population-based cost study.

Background: Resource and cost issues are a growing concern in health care. Thus, it is important to have an accurate estimate of the economic burden of care. Previous work has estimated the economic burden of cancer care for Canada; however, there is some concern this estimate is too low.

The incidence and healthcare costs of persistent postoperative pain following lumbar spine surgery in the UK: a cohort study using the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES).

Objective: To characterise incidence and healthcare costs associated with persistent postoperative pain (PPP) following lumbar surgery.

Design: Retrospective, population-based cohort study.

Setting: Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases.

Relationship between initial therapy and blood pressure control for high-risk hypertension patients in the UK: a retrospective cohort study from the THIN general practice database.

Objective: To examine the UK practice patterns in treating newly diagnosed hypertension and to determine whether subgroups of high-risk patients are more or less likely to follow particular therapeutic protocols and to reach blood pressure goals.

Design: Retrospective cohort study.

Setting: This study examined adults in The Health Improvement Network (THIN) UK general practice medical records database who were initiated on medication for hypertension.

Cost-effectiveness of helicopter versus ground emergency medical services for trauma scene transport in the United States.

Study Objective: We determine the minimum mortality reduction that helicopter emergency medical services (EMS) should provide relative to ground EMS for the scene transport of trauma victims to offset higher costs, inherent transport risks, and inevitable overtriage of patients with minor injury.

Methods: We developed a decision-analytic model to compare the costs and outcomes of helicopter versus ground EMS transport to a trauma center from a societal perspective during a patient's lifetime. We determined the mortality reduction needed to make helicopter transport cost less than $100,000 and $50,000 per quality-adjusted life-year gained compared with ground EMS.

Neuromodulation for neurodegenerative conditions.

Pharmacological therapy has had limited success in the treatment of most major neurological diseases. This has motivated the development of a number of novel surgical approaches designed to ameliorate drug-induced side effects or pharmacoresistant symptoms. Deep brain stimulation (DBS) has been quite successful in controlling both the cardinal motor manifestation of Parkinson's disease and the side effects of prolonged levodopa therapy.

Utilization and costs of health care after geriatric traumatic brain injury.

Despite the growing number of older adults experiencing traumatic brain injury (TBI), little information exists regarding their utilization and cost of health care services. Identifying patterns in the type of care received and determining their costs is an important first step toward understanding the return on investment and potential areas for improvement. We performed a health care utilization and cost analysis using the National Study on the Costs and Outcomes of Trauma (NSCOT) dataset.

Disparities in routine breast cancer screening for Medicaid managed care members with a work-limiting disability.

Objective: Examine disparities in routine mammography for women who qualify for Medicaid, because of a work-limiting disability.

Methods: Individual-level data were obtained for women enrolled in Massachusetts Medicaid Managed Care plans who met the 2007 Healthcare Effectiveness Data and Information Set (HEDIS) criteria for the breast cancer screening measure (n=35,171). Disability status was determined from Medicaid eligibility records.

Predictors of prenatal and postpartum care adequacy in a medicaid managed care population.

Purpose: To examine factors affecting prenatal and postpartum care for an insured, but vulnerable, population.

Methods: Individual-level data on three measures of care adequacy were obtained for Massachusetts Medicaid Managed Care women who met the National Committee on Quality Assurance's Healthcare Effectiveness Data and Information Set denominator criteria for the prenatal and postpartum care measures in 2007 (n = 1,882). We modeled individual compliance with each measure separately as a binomial logistic function with individual and neighborhood characteristics, provider type, and health plan as explanatory variables.

The value of trauma center care.

Background: The cost of trauma center care is high, raising questions about the value of a regionalized approach to trauma care. To address these concerns, we estimate 1-year and lifetime treatment costs and measure the cost-effectiveness of treatment at a Level I trauma center (TC) compared with a nontrauma center hospital (NTC).

Methods: Estimates of cost-effectiveness were derived using data on 5,043 major trauma patients enrolled in the National Study on Costs and Outcomes of Trauma, a prospective cohort study of severely injured adult patients cared for in 69 hospitals in 14 states.