Digital Commons Network^™

Exploring The Quality Performance Of Ethno-Specific And Mainstream Not-For-Profit Long-Term Care Homes In Ontario, Lanei Amein

Electronic Thesis and Dissertation Repository

The purpose of this retrospective study was to determine how ethno-specific not-for-profit long-term care (LTC) homes in Ontario perform in comparison to mainstream not-for-profit LTC homes using nine RAI-MDS 2.0 quality indicators. Publicly available data from three sources: the Canadian Institute for Health Information "Your Health System: In Depth" database from the Continuing Care Reporting System, data on Ontario ethno-specific not-for-profit LTC homes from the Home and Community Care Support Services, and data on home and ownership records from the Ministry of Long-Term Care “Public Reporting” website, between 2017-2022, were retrieved and analyzed. Descriptive analysis suggests that for all quality …

Patient And Physician Factors Associated With First Diagnosis Of Non-Affective Psychotic Disorder In Primary Care, Joshua C. Wiener, Rebecca Rodrigues, Jennifer N S Reid, Suzanne Archie, Richard G Booth, Chiachen Cheng, Saadia Hameed Jan, Paul Kurdyak, Arlene G Macdougall, Lena Palaniyappan, Bridget L Ryan, Kelly K. Anderson

Epidemiology and Biostatistics Publications

Primary care physicians play a central role in pathways to care for first-episode psychosis, and their increased involvement in early detection could improve service-related outcomes. The aim of this study was to estimate the proportion of psychosis first diagnosed in primary care, and identify associated patient and physician factors. We used linked health administrative data to construct a retrospective cohort of people aged 14-35 years with a first diagnosis of non-affective psychosis in Ontario, Canada between 2005-2015. We restricted the sample to patients with help-seeking contacts for mental health reasons in primary care in the six months prior to first …

Physician Remuneration Schemes, Psychiatric Hospitalizations And Follow-Up Care: Evidence From Blended Fee-For-Service And Capitation Models., Thyna Vu, Kelly K Anderson, Rose Anne Devlin, Nibene H Somé, Sisira Sarma

Epidemiology and Biostatistics Publications

Psychiatric hospitalizations could be reduced if mental illnesses were detected and treated earlier in the primary care setting, leading to the World Health Organization recommendation that mental health services be integrated into primary care. The mental health services provided in primary care settings may vary based on how physicians are incentivized. Little is known about the link between physician remuneration and psychiatric hospitalizations. We contribute to this literature by studying the relationship between physician remuneration and psychiatric hospitalizations in Canada's most populous province, Ontario. Specifically, we study family physicians (FPs) who switched from blended fee-for-service (FFS) to blended capitation remuneration …

Population-Based Studies On Medications And Fall-Related Injury In Older Adults, Yu Ming

Electronic Thesis and Dissertation Repository

Background: Fall-related injuries in older adults result in serious consequences to individuals and health care system, especially with the increasing aging population. The purpose of this study was to (1) describe medication prescription patterns within one year prior to fall-related injuries; (2) identify medication classes prescribed within 30 days prior to the injury that were associated to fall-related injury; and (3) examine the association between fall-related injuries and continuous use or new initiation of most commonly prescribed medications.

Methods: Studies used administrative health care data in Ontario. Study 1 described the frequency of medications prescribed to older adults within one …

The Impact Of The Diabetes Management Incentive On Diabetes-Related Services: Evidence From Ontario, Canada., Thaksha Thavam, Rose Anne Devlin, Amardeep Thind, Gregory S Zaric, Sisira Sarma

Epidemiology and Biostatistics Publications

Financial incentives have been introduced in several countries to improve diabetes management. In Ontario, the most populous province in Canada, a Diabetes Management Incentive (DMI) was introduced to family physicians practicing in patient enrollment models in 2006. This paper examines the impact of the DMI on diabetes-related services provided to individuals with diabetes in Ontario. Longitudinal health administrative data were obtained for adults diagnosed with diabetes and their family physicians. The study population consisted of two groups: DMI group (patients enrolled with a family physician exposed to DMI for 3 years), and comparison group (patients affiliated with a family physician …

Adhd Symptoms And Substance Use Among Adolescents In Ontario: A Cross-Sectional Study Examining Sex Differences And Covariates, Shannon W. Wong

Electronic Thesis and Dissertation Repository

Objective: 1) Estimate the prevalence of self-reported ADHD symptoms in sample of youth (grades 9-12) in Ontario schools, by sex; and 2) Assess the relationship between ADHD symptoms and substance use (alcohol, tobacco cigarettes, cannabis, stimulants) by sex, controlling for socio-economic status, internalizing and externalizing problems.

Methods: Data from 2015 and 2017 (n = 6,923) Centre for Addiction and Mental Health Ontario Student Drug Use and Health Survey, included self-reports of ADHD symptomatology and substance use. Statistical analyses included bivariate tables and multinomial regressions.

Results: Prevalence for ADHD symptoms was 20.22%, 95% CI [18.52, 22.03] (males = 16.42%, 95% CI …

Production Of Physician Services Under Fee-For-Service And Blended Fee-For-Service: Evidence From Ontario, Canada., Nibene H Somé, Rose Anne Devlin, Nirav Mehta, Greg Zaric, Lihua Li, Salimah Shariff, Bachir Belhadji, Amardeep Thind, Amit Garg, Sisira Sarma

Epidemiology and Biostatistics Publications

We examine family physicians' responses to financial incentives for medical services in Ontario, Canada. We use administrative data covering 2003-2008, a period during which family physicians could choose between the traditional fee for service (FFS) and blended FFS known as the Family Health Group (FHG) model. Under FHG, FFS physicians are incentivized to provide comprehensive care and after-hours services. A two-stage estimation strategy teases out the impact of switching from FFS to FHG on service production. We account for the selection into FHG using a propensity score matching model, and then we use panel-data regression models to account for observed …

Healthcare Utilization Costs Of Emerging Adults With Mood And Anxiety Disorders In An Early Intervention Treatment Program Compared To A Matched Cohort, Ava A. John-Baptiste, Lihua Li, Wanrudee Isaranuwatchai, Elizabeth Osuch, Kelly K. Anderson

Epidemiology and Biostatistics Publications

AIM: The First Episode Mood and Anxiety Disorder Program (FEMAP) provides treatment to emerging adults with mood and anxiety disorders in an accessible, youth-friendly environment. We sought to investigate FEMAP's impact on the costs of care.

METHODS: We conducted a retrospective observational study of one-year health service costs using linked administrative datasets to compare emerging adults treated at FEMAP (FEMAP users) to propensity-score matched controls (non-users). Costs from the perspective of the Ontario Ministry of Health and Long-Term Care, included drug benefit claims, inpatient, physician and ambulatory care services. We used bootstrapping to perform unadjusted comparisons between FEMAP users and …

The Healthesteps™ Lifestyle Prescription Program To Improve Physical Activity And Modifiable Risk Factors For Chronic Disease: A Pragmatic Randomized Controlled Trial., Dawn P. Gill, W Blunt, N C Boa Sorte Silva, C Stiller-Moldovan, G Y Zou, R J Petrella

Family Medicine Publications

BACKGROUND: Our objective was to determine the influence of the HealtheSteps™ lifestyle prescription program on physical activity and modifiable risk factors for chronic disease in individuals at risk.

METHODS: One hundred eighteen participants were recruited from 5 sites in Southwestern Ontario, Canada and randomized to either the intervention (HealtheSteps™ program, n = 59) or a wait-list control group (n = 59). The study comprised three phases: an Active Phase (0 to 6 months) consisted of bi-monthly in-person lifestyle coaching with access to a suite of eHealth technology supports (Heathesteps app, telephone coaching and a private HealtheSteps™ social network) followed by …

Unanticipated Admissions To Paediatric Cardiac Critical Care After Cardiac Catheterisations., Erin Peebles, Michael R Miller, Lee N Benson, Tilman Humpl

Paediatrics Publications

OBJECTIVES: Cardiac catheterisation is commonly used for diagnosis and therapeutic interventions in paediatric cardiology. The inherent risk of the procedure can result in unanticipated admissions to critical care. Our goals were to provide a qualitative description of characteristics and evaluation of children admitted unexpectedly to the cardiac critical care unit (CCCU).

METHODS: A retrospective single centre review of cardiac catheterisation procedures was done between 1 January, 2003 and 30 April, 2013.

RESULTS: Of 9336 cardiac catheterisations performed, 146 (1.6%) were admitted from the catheterisation laboratory to the CCCU and met inclusion criteria. Of these 146 patients, 117 (1.3%) met criteria …

Involuntary Hospitalization Among Young People With Early Psychosis: A Population-Based Study Using Health Administrative Data., Rebecca Rodrigues, Arlene G Macdougall, Guangyong Zou, Michael Lebenbaum, Paul Kurdyak, Lihua Li, Salimah Z Shariff, Kelly K Anderson

Epidemiology and Biostatistics Publications

OBJECTIVE: Early psychosis is an important window for establishing long-term trajectories. Involuntary hospitalization during this period may impact subsequent service engagement in people with newly diagnosed psychotic disorder. However, population-based studies of involuntary hospitalization in early psychosis are lacking. We sought to estimate the proportion of people aged 16 to 35 years with early psychosis in Ontario who are hospitalized involuntarily at first admission, and to identify the associated risk factors and outcomes.

METHODS: Using linked population-based health administrative data, we identified incident cases of non-affective psychosis over a five-year period (2009-2013) and followed cases for two years to ascertain …

Family Physician Remuneration Schemes And Specialist Referrals: Quasi-Experimental Evidence From Ontario, Canada., Sisira Sarma, Nirav Mehta, Rose Anne Devlin, Koffi Ahoto Kpelitse, Lihua Li

Epidemiology and Biostatistics Publications

Understanding how family physicians respond to incentives from remuneration schemes is a central theme in the literature. One understudied aspect is referrals to specialists. Although the theoretical literature has suggested that capitation increases referrals to specialists, the empirical evidence is mixed. We push forward the empirical research on this question by studying family physicians who switched from blended fee-for-service to blended capitation in Ontario, Canada. Using several health administrative databases from 2005 to 2013, we rely on inverse probability weighting with fixed-effects regression models to account for observed and unobserved differences between the switchers and nonswitchers. Switching from blended fee-for-service …

Rural Ontario Youth And Mental Wellness, Brad Ross

Electronic Thesis and Dissertation Repository

Currently, there is a significant lack of knowledge regarding rural Ontario youth and their mental wellness. This study addresses the following research questions: 1) How do rural youth maintain mental wellness? and 2) What factors facilitate or hinder the mental wellness of rural youth from their perspective? Eight rural participants, four male and four female, aged 16-23 provided data via one on one interviews. It was found that many rural youth have adapted to utilize their rural environment, social support, and intrapersonal techniques to maintain their mental wellness. Furthermore, four main themes act as both facilitators and hindrances to their …

Higher And Lower Order Factor Analyses Of The Temperament In Middle Childhood Questionnaire., Yuliya Kotelnikova, Thomas M Olino, Daniel N Klein, Sarah V M Mackrell, Elizabeth P Hayden

Brain and Mind Institute Researchers' Publications

The Temperament in Middle Childhood Questionnaire (TMCQ) is a widely used parent-report measure of temperament. However, neither its lower nor higher order structures has been tested via a bottom-up, empirically based approach. We conducted higher and lower order exploratory factor analyses (EFAs) of the TMCQ in a large ( N = 654) sample of 9-year-olds. Item-level EFAs identified 92 items as suitable (i.e., with loadings ≥.40) for constructing lower order factors, only half of which resembled a TMCQ scale posited by the measure's authors. Higher order EFAs of the lower order factors showed that a three-factor structure (Impulsivity/Negative Affectivity, Negative …

Evaluation Of Treatment-Related Mortality Among Paediatric Cancer Deaths: A Population Based Analysis., Jason D Pole, Paul Gibson, Marie-Chantal Ethier, Tanya Lazor, Donna L Johnston, Carol Portwine, Mariana Silva, Sarah Alexander, Lillian Sung

Paediatrics Publications

BACKGROUND: Objectives were to describe the proportion of deaths due to treatment-related mortality (TRM) and to identify risk factors and probable causes of TRM among paediatric cancer deaths in a population-based cohort.

METHODS: We included children with cancer ⩽18 years diagnosed and treated in Ontario who died between January 2003 and December 2012. Deaths were identified using a provincial registry, the Pediatric Oncology Group of Ontario Networked Information System. Probable causes of TRM were described.

RESULTS: Among the 964 deaths identified, 821 were included. The median age at diagnosis was 6.6 years (range 0-18.8) and 51.8% had at least one …

Identification And Survival Outcomes Of A Cohort Of Patients With Cancer Of Unknown Primary In Ontario, Canada., Chong S Kim, Malek B Hannouf, Sisira Sarma, George B Rodrigues, Peter K Rogan, Salaheddin M Mahmud, Eric Winquist, Muriel Brackstone, Gregory S Zaric

Epidemiology and Biostatistics Publications

BACKGROUND: Cancer of unknown primary origin (CUP) is defined by the presence of pathologically identified metastatic disease without clinical or radiological evidence of a primary tumour. Our objective was to identify incident cases of CUP in Ontario, Canada, and determine the influence of histology and sites of metastases on overall survival (OS).

MATERIAL AND METHODS: We used the Ontario Cancer Registry (OCR) and the Same-Day Surgery and Discharge Abstract Database (SDS/DAD) to identify patients diagnosed with CUP in Ontario between 1 January 2000, and 31 December 2005. Patient diagnostic information, including histology and survival data, was obtained from the OCR. …

The Experiences Of Black Men Living With Hypertension In Ontario, Canada: A Critical Narrative Study, Rob Haile

Electronic Thesis and Dissertation Repository

To date, most Black hypertension literature centers on the risk factors predictive of hypertension, and the treatment of this condition within this population. The purpose of this critical narrative inquiry is to better understand how Black men make sense of their hypertension diagnosis, and how they negotiate this condition into their everyday lives. Eight individual in-depth interviews were utilized to elicit stories from four Black men living in Ontario, Canada. Additionally, a critical stance was used in this study to illuminate how racism and power dynamics embedded within social, historical, and political contexts affected participants’ experiences of living with hypertension. …

Understanding First Nations Young Adults' Health Literacy, Ebony Rempel

Electronic Thesis and Dissertation Repository

Relative to non-First Nations, Inuit, and Metis (FNIM) Canadians, FNIM people have poorer health status. A qualitative investigation of the health literacy skill and the health information (HI) needs of young FNIM adults was conducted. Eight single mothers living on-reserve were interviewed. Data analysis generated four main themes along with the subthemes of: (1) Traditional Health (TH), (i) TH Culture Excised, and (ii) Wanting to Know More about TH; (2) HI Needs of First Nations young Mothers; (3) Access to HI, (i) Asking the Doctor / Telehealth (ii) other Female Family and Friends; (4) Online Accessibility, (i) HI Online, (ii) …

Screening For Adult Adhd In Ontario: A Cross-Sectional Study Examining Sex Differences, Mental Health Correlates And Substance Use, Deanne Daigle

Electronic Thesis and Dissertation Repository

The vast majority of studies on attention-deficit/hyperactivity disorder (ADHD) are based on samples with inherent age, sex, and referral biases. Therefore, the current study used population-based data to 1) estimate the prevalence of adult ADHD (as well as previous diagnosis and medication use using an ADHD screener) and co-occurring psychiatric distress and substance use in Ontario 2) examine the sex differences in ADHD screening status and co-occurring psychiatric distress and substance use and 3) model ADHD screening status as a risk factor for psychiatric distress using the 2011 cycle of the Centre for Addiction and Mental Health Monitor. A positive …

Expanding The Basic Science Debate: The Role Of Physics Knowledge In Interpreting Clinical Findings., Mark Goldszmidt, John Paul Minda, Sarah L Devantier, Aimee L Skye, Nicole N Woods

Brain and Mind Institute Researchers' Publications

Current research suggests a role for biomedical knowledge in learning and retaining concepts related to medical diagnosis. However, learning may be influenced by other, non-biomedical knowledge. We explored this idea using an experimental design and examined the effects of causal knowledge on the learning, retention, and interpretation of medical information. Participants studied a handout about several respiratory disorders and how to interpret respiratory exam findings. The control group received the information in standard "textbook" format and the experimental group was presented with the same information as well as a causal explanation about how sound travels through lungs in both the …