Publications by authors named "Stukel T"

Article Synopsis
  • Income-based disparities in hip fracture treatment and outcomes were examined across six high-income countries, revealing that lower-income individuals generally faced worse health outcomes.
  • The study indicated that low-income populations had higher incidence rates of hip fractures and worse 1-year mortality compared to their high-income counterparts, with the most pronounced difference in Israel.
  • Overall, high-income patients experienced shorter hospital stays, lower readmission rates, and quicker surgery times, highlighting the significant impact of income on healthcare quality and access for older adults with hip fractures.
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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).

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Importance: Patients with a non-English language preference served within English-dominant health care settings are at increased risk of adverse events that may be associated with communication barriers and inequitable access to care.

Objective: To investigate the association of non-English language preference with surgical wait time and postoperative outcomes in older patients undergoing hip fracture repair.

Design, Setting, And Participants: This population-based, retrospective cohort study was conducted using linked databases to measure surgical wait time and postoperative outcomes among older adults (aged ≥66 years) in Ontario, Canada, who underwent hip fracture surgery between January 1, 2017, and December 31, 2022.

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Background: Immigration inadmissibility on medical grounds is common among high-income countries. In Canada, the Immigrant and Refugee Protection Act (IRPA) became law in 2002. With humanitarian protection as a priority, IRPA removed medical inadmissibility based on exceeding a cost threshold for the projected use of health and social services for resettled refugees.

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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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Article Synopsis
  • Differences exist between what patients and clinicians view as important endpoints, influenced by personal preferences and values.
  • A scoping review was conducted to identify effective methods for eliciting patient preferences related to invasive procedures, aiming to guide future research and clinical practices.
  • The review included 394 articles on patient preferences, highlighting a variety of elicitation methods; quantitative methods dominated, while qualitative approaches provided deeper insights into patient views.
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Background It is not known how disability, homelessness, or neighborhood marginalization influence risk-adjusted hospital performance measurement in a universal health care system. Methods We evaluated the effect of including these equity-related factors in risk-adjustment models for in-hospital mortality, and 7- and 30-day readmission in 28 hospitals in Ontario, Canada. We compared risk-adjustment with commonly-used clinical factors to models that also included homelessness, disability, and neighborhood indices of marginalization.

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Background: Across Canada, Child Protection Services (CPS) disrupt Indigenous families by apprehending their children at alarmingly high rates. The harms borne by children in out-of-home care (OoHC) have been extensively documented. We examined the impact of OoHC on Manitoba children's health and legal system outcomes to provide rigorous evidence on how discretionary decision-making by CPS agencies can affect these outcomes.

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Objective: With increased utilization of virtual care in mental health, examining its appropriateness in various clinical scenarios is warranted. This study aimed to compare the risk of adverse psychiatric outcomes following virtual versus in-person mental health follow-up care after a psychiatric emergency department (ED) visit.

Methods: Using population-based health administrative data in Ontario (2021), we identified 28,232 adults discharged from a psychiatric ED visit who had a follow-up mental health visit within 14 days postdischarge.

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Article Synopsis
  • A study was conducted to evaluate a machine learning-based early warning system aimed at improving patient outcomes in a general internal medicine (GIM) unit at a hospital, focusing on its effect on non-palliative in-hospital deaths.
  • The research compared patient data from before and after the system's implementation, looking at admissions from Nov. 2016 to Jun. 2022, using various statistical methods to analyze the results.
  • Findings showed that the intervention period had a significant reduction in non-palliative deaths in the GIM unit, with a lower risk of mortality for high-risk patients receiving alerts, while no such improvements were observed in other medical units.
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Background: Public funding of cataract surgery provided in private, for-profit surgical centres increased to help mitigate surgical backlogs during the COVID-19 pandemic in Ontario, Canada. We sought to compare the socioeconomic status of patients who underwent cataract surgery in not-for-profit public hospitals with those who underwent this surgery in private for-profit surgical centres and to evaluate whether differences in access by socioeconomic status decreased after the infusion of public funding for private, for-profit centres.

Methods: We conducted a population-based study of all cataract operations in Ontario, Canada, between January 2017 and March 2022.

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Background: Associations between procedure volumes and outcomes can inform minimum volume standards and the regionalization of health services. Robot-assisted surgery continues to expand globally; however, data are limited regarding which hospitals should be using the technology.

Study Design: Using administrative health data for all residents of Ontario, Canada, this retrospective cohort study included adult patients who underwent a robot-assisted radical prostatectomy (RARP), total robotic hysterectomy (TRH), robot-assisted partial nephrectomy (RAPN), or robotic portal lobectomy using 4 arms (RPL-4) between January 2010 and September 2021.

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Background: Early post-discharge assessments for newborns are recommended. Virtual care has become more prevalent during the pandemic, providing an opportunity to better understand its impact on the quality of post-discharge newborn care. The objective of this study was to understand whether primary care visit modality (in-person vs.

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Article Synopsis
  • The study examines changes in respiratory syncytial virus (RSV) hospitalizations in children under 5 years old in Ontario, Canada, before and after the COVID-19 pandemic.
  • It compares RSV hospital and ICU admission rates during the 2021-2022 and 2022-2023 seasons to pre-pandemic years, finding a significant increase in hospitalizations in 2022-2023.
  • The study highlights that the proportion of children admitted to ICU increased from pre-pandemic levels, with notable demographic factors being taken into account, affecting RSV outcomes.
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Background: Immigrants in high-income countries experienced inequities in COVID-19 severe outcomes. We examined hospitalization and death throughout the pandemic, and change during the vaccine era, in Ontario, Canada.

Methods: We conducted a population-based study using linked immigration and health data, following two cohorts for 20 months from January 1, 2020 (pre-vaccine) and September 1, 2021 (vaccine era).

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Importance: Emergency department (ED) use postpartum is a common and often-preventable event. Unlike traditional obstetrics models, the Ontario midwifery model offers early care postpartum.

Objective: To assess whether postpartum ED use differs between women who received perinatal care in midwifery-model care vs in traditional obstetrics-model care.

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Background: Clinical practice guidelines recommend early serum electrolyte monitoring when starting antidepressants in older adults due to the increased risk of hyponatremia. It is unclear whether this monitoring improves outcomes.

Methods: Population-based, retrospective cohort study of Ontario adults aged ≥66 years who initiated therapy with a selective serotonin reuptake inhibitor (SSRI) or selective norepinephrine reuptake inhibitor (SNRI) between April 1, 2013, and January 31, 2020.

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Article Synopsis
  • - The study examines how the long-term relationship between family physicians and older patients affects follow-up care after starting antidepressants, as side effects can occur quickly while benefits take longer to be felt.
  • - Researchers analyzed data from Ontario, focusing on patients aged 66 and older who received their first antidepressant prescription between 2016 and 2019, using regression analysis to explore the relationship between continuity of care and 30-day follow-up.
  • - Results showed a slight positive link between relational continuity and follow-up care, especially in non-major urban and rural areas, though the evidence for improved management of antidepressants remains weak overall.
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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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Article Synopsis
  • * 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.
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Purpose: The incidence of childhood-onset inflammatory bowel disease (IBD) is rising. We described variation in health services utilization and need for surgery among children with IBD between six and 60 months following IBD diagnosis across Canadian pediatric centers and evaluated the associations between care provided at diagnosis at each center and the variation in these outcomes.

Patients And Methods: Using population-based deterministically-linked health administrative data from four Canadian provinces (Alberta, Manitoba, Nova Scotia, Ontario) we identified children diagnosed with IBD <16 years of age using validated algorithms.

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Background: Patterns of health services utilization among children with inflammatory bowel disease (IBD) are important to understand as the number of children with IBD continues to increase. We compared health services utilization and surgery among children diagnosed <10 years of age (Paris classification: A1a) and between 10 and <16 years of age (A1b).

Methods: Incident cases of IBD diagnosed <16 years of age were identified using validated algorithms from deterministically linked health administrative data in 5 Canadian provinces (Alberta, Manitoba, Nova Scotia, Ontario, Quebec) to conduct a retrospective cohort study.

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