The relationship between physician supply, cardiovascular health service use and cardiac disease burden in Ontario: Supply-need mismatch

Alter, David A.; Stukel, Thérèse A.; Newman, Alice

doi:10.1016/s0828-282x(08)70582-8

Cited by 23 publications

(16 citation statements)

References 33 publications

(37 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…At the 2014 fellowship directors' meeting, 16% of programs indicated that they may add 1 or more fellowship spots in the next 5 years. 2,29,30 This was demonstrated by Neuwahl et al 2 who reviewed Gini indices for primary care (0.24), general surgery (0.28), general orthopaedic surgery (0.33), ophthalmology (0.38), and neurosurgery (0.49) from 1999 to 2008 and found that they were stable over time. Despite these regional and national trends, in some areas in the US there may be a relative excess or deficiency of POS.…”

Section: Discussionmentioning

confidence: 92%

Pediatric Orthopaedic Workforce in 2014: Current Workforce and Projections for the Future

Sawyer

Jones

Copley

et al. 2017

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 92%

Pediatric Orthopaedic Workforce in 2014: Current Workforce and Projections for the Future

Sawyer

Jones

Copley

et al. 2017

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

show abstract

“…Models based on count data, for example, the numbers of deaths or hospital admissions, can also be found in the literature 813 14 19 20…”

Section: Introductionmentioning

confidence: 99%

Modelling factors in primary care quality improvement: a cross-sectional study of premature CHD mortality

et al. 2013

View full text Add to dashboard Cite

ObjectivesTo identify features of primary care quality improvement associated with improved health outcomes using premature coronary heart disease (CHD) mortality as an example, and to determine impacts of different modelling approaches.DesignCross-sectional study of mortality rates in 229 general practices.SettingGeneral practices from three East Midlands primary care trusts.ParticipantsPatients registered to the practices above between April 2006 and March 2009.Main outcome measuresNumbers of CHD deaths in those aged under 75 (premature mortality) and at all ages in each practice.ResultsPopulation characteristics and markers of quality of primary care were associated with variations in premature CHD mortality. Increasing levels of deprivation, percentages of practice populations on practice diabetes registers, white, over 65 and male were all associated with increasing levels of premature CHD mortality. Control of serum cholesterol levels in those with CHD and the percentage of patients recalling access to their preferred general practitioner were both associated with decreased levels of premature CHD mortality. Similar results were found for all-age mortality. A combined measure of quality of primary care for CHD comprising 12 quality outcomes framework indicators was associated with decreases in both all-age and premature CHD mortality. The selected models suggest that practices in less deprived areas may have up to 20% lower premature CHD mortality than those with median deprivation and that improvement in the CHD care quality from 83% (lower quartile) to 86% (median) could reduce premature CHD mortality by 3.6%. Different modelling approaches yielded qualitatively similar results.ConclusionsHigh-quality primary care, including aspects of access to and continuity of care, detection and management, appears to be associated with reducing CHD mortality. The impact on premature CHD mortality is greater than on all-age CHD mortality. Determining the most useful measures of quality of primary care needs further consideration.

show abstract

“…6 In Canada, despite a universal health care system, geographic variation in the supply of physician services is a policy concern and may contribute to regional disparities in health care outcomes. [7][8][9][10] The Cardiovascular Health in Ambulatory Care Research Team (CANHEART) "big data" initiative was established to measure and improve the cardiovascular health and quality of ambulatory cardiovascular care provided in Ontario, Canada. 11 It aims to contribute to a learning health care system by linking routinely collected information from multiple population-based data sources to form a single, comprehensive database that can RESEARCH Regional variations in ambulatory care and incidence of cardiovascular events be used to study the delivery and outcomes of clinical CVD care in the entire population over time.…”

mentioning

confidence: 99%

Regional variations in ambulatory care and incidence of cardiovascular events

Chu

Maclagan

et al. 2017

CMAJ

Self Cite

View full text Add to dashboard Cite

BACKGROUND: Variations in the prevalence of traditional cardiac risk factors only partially account for geographic variations in the incidence of cardiovascular disease. We examined the extent to which preventive ambulatory health care services contribute to geographic variations in cardiovascular event rates. METHODS:We conducted a cohort study involving 5.5 million patients aged 40 to 79 years in Ontario, Canada, with no hospital stays for cardiovascular disease as of January 2008, through linkage of multiple population-based health databases. The primary outcome was the occurrence of a major cardiovascular event (myocardial infarction, stroke or cardiovascularrelated death) over the following 5 years. We compared patient demographics, cardiac risk factors and ambulatory health care services across the province's 14 health service regions, known as Local Health Integration Networks (LHINs), and evaluated the contribution of these variables to regional variations in cardiovascular event rates.RESULTS: Cardiovascular event rates across LHINs varied from 3.2 to 5.7 events per 1000 person-years. Compared with residents of high-rate LHINs, those of lowrate health regions received physician services more often (e.g., 4.2 v. 3.5 mean annual family physician visits, p value for LHIN-level trend = 0.01) and were screened for risk factors more often. Lowrate LHINs were also more likely to achieve treatment targets for hypercholesterolemia (51.8% v. 49.6% of patients, p = 0.03) and controlled hypertension (67.4% v. 53.3%, p = 0.04). Differences in patient and health system factors accounted for 74.5% of the variation in events between LHINs, of which 15.5% was attributable to health system factors alone. INTERPRETATION:Preventive ambulatory health care services were provided more frequently in health regions with lower cardiovascular event rates. Health system interventions to improve equitable access to preventive care might improve cardiovascular outcomes.

show abstract

The relationship between physician supply, cardiovascular health service use and cardiac disease burden in Ontario: Supply-need mismatch

Cited by 23 publications

References 33 publications

Pediatric Orthopaedic Workforce in 2014: Current Workforce and Projections for the Future

Pediatric Orthopaedic Workforce in 2014: Current Workforce and Projections for the Future

Modelling factors in primary care quality improvement: a cross-sectional study of premature CHD mortality

Regional variations in ambulatory care and incidence of cardiovascular events

Contact Info

Product

Resources

About