Barriers to Office-Based Mental Health Care and Interest in E-Communication With Providers: A Survey Study.

Background: With rising availability and use of Internet and mobile technology in society, the demand and need for its integration into health care is growing. Despite great potential within mental health care and growing uptake, there is still little evidence to guide how these tools should be integrated into traditional care, and for whom.

Objective: To examine factors that might inform how e-communication should be implemented in our local outpatient mental health program, including barriers to traditional office-based care, patient preferences, and patient concerns.

An electronic documentation system improves the quality of admission notes: a randomized trial.

Objective: There are concerns that structured electronic documentation systems can limit expressivity and encourage long and unreadable notes. We assessed the impact of an electronic clinical documentation system on the quality of admission notes for patients admitted to a general medical unit.

Methods: This was a prospective randomized crossover study comparing handwritten paper notes to electronic notes on different patients by the same author, generated using a semistructured electronic admission documentation system over a 2-month period in 2014.

Appropriate prescribing in nursing homes demonstration project (APDP) study protocol: pragmatic, cluster-randomized trial and mixed methods process evaluation of an Ontario policy-maker initiative to improve appropriate prescribing of antipsychotics.

Background: Antipsychotic medications are routinely prescribed in nursing homes to address the behavioral and psychological symptoms of dementia. Unfortunately, inappropriate prescribing of antipsychotic medications is common and associated with increased morbidity, adverse drug events, and hospitalizations. Multifaceted interventions can achieve a 12-20 % reduction in antipsychotic prescribing levels in nursing homes.

Predictors and clinical outcomes of inpatient versus ambulatory management after an emergency department visit for atrial fibrillation: A population-based study.

Background: There is substantial variation in the management of atrial fibrillation (AF) in the emergency department (ED), particularly whether these patients are admitted to hospital. We sought to identify factors that predict admission and to examine the relationship between AF admission and outcomes.

Methods: We performed a retrospective cohort analysis of patients ≥20 years of age who had an index ED visit with a primary diagnosis of AF from between April 1, 2005, and March 31, 2010, in Ontario, Canada.

Appropriate use criteria: a review of need, development and applications.

The costs of healthcare in developed countries have seen a dramatic increase in tandem with the increasing utilization of diagnostic testing. As a result, Appropriate Use Criteria (AUC)-based practices have become more commonplace as a provider-driven solution to reducing unnecessary tests and procedures across various specialty societies. The AUC are meant to serve as a distinct entity from clinical guidelines to help inform clinicians of the 'appropriateness' of a diagnostic test or procedure.

Assessment of inpatient multimodal cardiac imaging appropriateness at large academic medical centers.

Background: Responding to concerns regarding the growth of cardiac testing, the American College of Cardiology Foundation (ACCF) published Appropriate Use Criteria (AUC) for various cardiac imaging modalities. Single modality cardiac imaging appropriateness has been reported but there have been no studies assessing the appropriateness of multiple imaging modalities in an inpatient environment.

Methods: A retrospective study of the appropriateness of cardiac tests ordered by the inpatient General Internal Medicine (GIM) and Cardiology services at three Canadian academic hospitals was conducted over two one-month periods.

Development of an Educational Strategy and Decision Support Tool to Enhance Appropriate Use of Stress Echocardiography at a Large Academic Medical Center: A Prospective, Pre- and Postintervention Analysis.

Background: Despite previous studies demonstrating suboptimal appropriate use of stress echocardiography (SE), few interventions have been demonstrated to improve its appropriate use. The aim of this study was to develop a novel mechanism to improve the appropriateness of SE by implementing a point-of-care decision support tool and ordering requisition coupled with an educational strategy.

Methods: A prospective pre- and postintervention analysis was conducted.

Design and methods of the Echo WISELY (Will Inappropriate Scenarios for Echocardiography Lessen SignificantlY) study: An investigator-blinded randomized controlled trial of education and feedback intervention to reduce inappropriate echocardiograms.

Background: Appropriate use criteria (AUC) for transthoracic echocardiography (TTE) were developed to address concerns regarding inappropriate use of TTE. A previous pilot study suggests that an educational and feedback intervention can reduce inappropriate TTEs ordered by physicians in training. It is unknown if this type of intervention will be effective when targeted at attending level physicians in a variety of clinical settings.

The Cardiovascular Health in Ambulatory Care Research Team (CANHEART): using big data to measure and improve cardiovascular health and healthcare services.

Background: The CArdiovascular HEalth in Ambulatory care Research Team (CANHEART) is conducting a unique, population-based observational research initiative aimed at measuring and improving cardiovascular health and the quality of ambulatory cardiovascular care provided in Ontario, Canada. A particular focus will be on identifying opportunities to improve the primary and secondary prevention of cardiovascular events in Ontario's diverse multiethnic population.

Methods And Results: A population-based cohort comprising 9.

Comparing the ambulatory care and outcomes for rural and urban patients with chronic ischemic heart disease: a population-based cohort study.

Background: Little is known about variations in the quality of ambulatory care between urban and rural communities for patients with stable ischemic heart disease. The objectives of this study were to understand the effect of rurality on variations of ambulatory processes of care and outcomes for patients with stable ischemic heart disease.

Methods And Results: A population-based cohort study was conducted, which included all Ontario patients with stable ischemic heart disease confirmed on cardiac catheterization between October 1, 2008, and September 30, 2011.

Outcomes in patients with heart failure treated in hospitals with varying admission rates: population-based cohort study.

Study Objectives: Hospital admission rates for patients with heart failure (HF) presenting for emergency department (ED) care vary, and the implications of direct discharge home from the ED are unknown. We examined whether patients treated in hospitals with low admission rates exhibit higher rates of repeat ED visits, hospital readmissions and death.

Methods: We divided EDs into low-, medium- and high-admission-rate tertiles by their standardised HF admission rate in Ontario, Canada.

Using archetypes to design services for high users of healthcare.

A subset of people with complex health and social needs account for the majority of healthcare costs in Ontario. There is broad agreement that better solutions for these patients could lead to better health outcomes and lower costs, but we have few tools to design services around their diverse needs. Predictive modelling may help determine numbers of high users, but design methods such as user archetypes may offer important ways of understanding how to meet their needs.