Impact of psychiatric follow-up frequency on outcomes and waiting times.

Objectives: This study determined whether naturally occurring but significantly different outpatient follow-up frequencies are associated with clinical outcomes and service waiting times.

Study Design: Longitudinal retrospective study.

Methods: This study was conducted in an outpatient setting.

Community Treatment Order Outcomes in Quebec: A Unique Jurisdiction.

Objective: We study compulsory community treatment orders (CTOs) for patients with severe and persistent mental illness (SPMI). Focusing on a unique jurisdiction in Canada that allows for long duration CTOs with strict enforcement procedures, our objectives are to determine whether extended duration CTOs are effective and to determine whether associated hospitalization costs are reduced.

Method: A mirror image, naturalistic design was employed using patients as their own controls to enhance external validity.

The impact of specialization of hospitals on patient access to care; a queuing analysis with an application to a neurological hospital.

We study the impact of specialization on the operational efficiency of a multi-hospital system. The mixed outcomes of recently increasing hospital mergers and system re-configuration initiatives have raised the importance of studying such organizational changes from all the relevant perspectives. We consider two configuration scenarios for a multi-hospital system.

Patient-centric design of long-term care networks.

Long-term care networks may soon buckle under the weight of overwhelming demand. We present two dynamic, large-scale mixed-integer programs for long-term care network design that execute jointly strategic and tactical facility location, modular capacity acquisition, and patient-assignment decisions. The first model is an adaptive network-design model whose focus is more strategic in nature, whereas the second model focuses exclusively on the expansion of an existing long-term care network and incorporates additional tactical decisions such as patient backlogs.

Transport Mode Selection for Toxic Gases: Rail or Road?

A significant majority of hazardous materials (hazmat) shipments are moved via the highway and railroad networks, wherein the latter mode is generally preferred for long distances. Although the characteristics of highway transportation make trucks the most dominant surface transportation mode, should it be preferred for hazmat whose accidental release can cause catastrophic consequences? We answer this question by first developing a novel and comprehensive assessment methodology-which incorporates the sequence of events leading to hazmat release from the derailed railcars and the resulting consequence-to measure rail transport risk, and second making use of the proposed assessment methodology to analyze hazmat transport risk resulting from meeting the demand for chlorine and ammonia in six distinct corridors in North America. We demonstrate that rail transport will reduce risk, irrespective of the risk measure and the transport corridor, and that every attempt must be made to use railroads to transport these shipments.

Predicting the need for CT imaging in children with minor head injury using an ensemble of Naive Bayes classifiers.

Objective: Using an automatic data-driven approach, this paper develops a prediction model that achieves more balanced performance (in terms of sensitivity and specificity) than the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) rule, when predicting the need for computed tomography (CT) imaging of children after a minor head injury.

Methods And Materials: CT is widely considered an effective tool for evaluating patients with minor head trauma who have potentially suffered serious intracranial injury. However, its use poses possible harmful effects, particularly for children, due to exposure to radiation.

Improving post-stroke health outcomes: can facilitated care help?

Objectives: The objectives of this study were (1) identifying the patterns of post-stroke care, (2) determining the care-provider and patient characteristics associated with optimal management of post-stroke care and (3) estimating the potential influence of various facilitated care policies on outcomes.

Methodology: The 3946 subjects included in the study were admitted to one of Quebec's acute-care hospitals with confirmed diagnosis of stroke and subsequently discharged to their home. The records related to fee-for-service billings of this sample were obtained for the 3 months following discharge and used to define the care-provider path for each stroke survivor.

The in-hospital interval: a description of EMT time spent in the emergency department.

Objective: We conducted a time-motion study of emergency medical technician (EMT) flow in an urban, academic emergency department (ED). Our objective was to describe the activity of the EMTs during their time in the ED. Secondary objectives included the association of time of day, age, and triage code with the various time intervals.

On the significance of reducing the need for stroke patients to visit the emergency department.

We studied the care-provider paths followed by 3,946 patients in Quebec in 2001. We showed that the patients flow during the three months preceding discharge from hospital can be represented by a Markov model with memory. This model enables study of four major scenarios to improve health outcomes, workloads and cost efficiency in the overall community-based care delivery system.