The Experts below are selected from a list of 37098 Experts worldwide ranked by ideXlab platform

David A Alter - One of the best experts on this subject based on the ideXlab platform.

  • lesson from canada s Universal Care socially disadvantaged patients use more Health services still have poorer Health
    Health Affairs, 2011
    Co-Authors: David A Alter, Alice Chong, Therese A Stukel, David Henry
    Abstract:

    Lower socioeconomic status is commonly related to worse Health. If poor access to Health Care were the only explanation, Universal access to Care should eliminate the association. We studied 14,800 patients with access to Canada’s Universal Health Care system who were initially free of cardiac disease, tracking them for at least ten years and seven months. We found that socially disadvantaged patients used Health Care services more than did their counterparts with higher incomes and education. We also found that service use by people with lower incomes and less education had little impact on their poorer Health outcomes, particularly mortality. Countries contemplating national Health insurance cannot rely on Universal Health Care to eliminate historical disparities in outcomes suffered by disadvantaged groups. Universal access can only reduce these disparities. Our findings suggest the need to introduce large-scale preventive strategies early in patients’ lives to help change unHealthy behavior.

  • relationship between cardiac rehabilitation and survival after acute cardiac hospitalization within a Universal Health Care system
    European Journal of Preventive Cardiology, 2009
    Co-Authors: David A Alter, Alice Chong
    Abstract:

    BackgroundThe magnitude and mechanisms of survival benefit associated with cardiac rehabilitation services among real-world populations within a Universal Health Care system remain unclear.MethodsT...

  • effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction
    The New England Journal of Medicine, 1999
    Co-Authors: David A Alter, Peter C Austin, C D Naylor, Jack V Tu
    Abstract:

    Background Universal Health Care systems seek to ensure access to Care on the basis of need rather than income and to improve the Health status of all citizens. We examined the performance of the Canadian Health system with respect to these goals in the province of Ontario by assessing the effects of neighborhood income on access to invasive cardiac procedures and on mortality one year after acute myocardial infarction. Methods We linked claims for payment for physicians' services, hospital-discharge abstracts, and vital-status data for all patients with acute myocardial infarction who were admitted to hospitals in Ontario between April 1994 and March 1997. Patients' income levels were imputed from the median incomes of their residential neighborhoods as determined in Canada's 1996 census. We determined rates of use and waiting times for coronary angiography and revascularization procedures after the index admission for acute myocardial infarction and determined death rates at one year. In multivariate an...

L Gostin - One of the best experts on this subject based on the ideXlab platform.

  • Health Care information and the protection of personal privacy: ethical and legal considerations.
    Annals of internal medicine, 1997
    Co-Authors: L Gostin
    Abstract:

    During the early 1990s, the U.S. government addressed the issue of providing Universal Health Care to all its citizens. Although this issue has not been completely resolved, centralization of electronic data and sharing of Health Care information among insurers and providers have been pursued. The emergence of electronic data banks in Health Care has raised another issue: each citizen's right to privacy compared with the collective benefit to society when critical data on quality assurance and scientific research are shared by an array of network users. The choices we face are difficult, and the solution may necessarily reflect a compromise that alters traditional beliefs in the right to personal privacy. However, Congress can take the initiative by enacting statutes to ensure that sensitive information contained in electronic patient records is not divulged without a patient's consent and is protected against fraudulent access and abuse.

  • Health Care information and the protection of personal privacy ethical and legal considerations
    Annals of Internal Medicine, 1997
    Co-Authors: L Gostin
    Abstract:

    During the early 1990s, the U.S. government addressed the issue of providing Universal Health Care to all its citizens. Although this issue has not been completely resolved, centralization of elect...

Jack V Tu - One of the best experts on this subject based on the ideXlab platform.

  • effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction
    The New England Journal of Medicine, 1999
    Co-Authors: David A Alter, Peter C Austin, C D Naylor, Jack V Tu
    Abstract:

    Background Universal Health Care systems seek to ensure access to Care on the basis of need rather than income and to improve the Health status of all citizens. We examined the performance of the Canadian Health system with respect to these goals in the province of Ontario by assessing the effects of neighborhood income on access to invasive cardiac procedures and on mortality one year after acute myocardial infarction. Methods We linked claims for payment for physicians' services, hospital-discharge abstracts, and vital-status data for all patients with acute myocardial infarction who were admitted to hospitals in Ontario between April 1994 and March 1997. Patients' income levels were imputed from the median incomes of their residential neighborhoods as determined in Canada's 1996 census. We determined rates of use and waiting times for coronary angiography and revascularization procedures after the index admission for acute myocardial infarction and determined death rates at one year. In multivariate an...

Jessica R Penrod - One of the best experts on this subject based on the ideXlab platform.

  • Universal Health insurance coverage does not eliminate inequities in access to cardiac procedures after acute myocardial infarction
    American Heart Journal, 2003
    Co-Authors: Louise Pilote, Patrick Bélisle, Lawrence Joseph, Jessica R Penrod
    Abstract:

    Abstract Background It remains unclear whether socioeconomic status (SES) influences access to invasive cardiac procedures after acute myocardial infarction (AMI) in a Universal Health Care system. The objective of this study was to evaluate the effect of SES on access to cardiac procedure after AMI in a Universal Health Care system. Methods This was an observational cohort study of all patients with a first AMI in the province of Quebec, Canada, between 1985 to 1995. Information on treatment was obtained from the discharge and physicians' claims databases. SES was obtained from census data by linking postal codes. SES-independent predictors of use were identified, then incorporated in hierarchical models to predict use in low, medium, and high SES areas. The main outcome measures were rates of cardiac catheterization, percutaneous coronary intervention (PCI), and coronary artery bypass graft surgery (CABG) as a function of SES. Results SES data were available for 62,364 individuals with a first AMI. Of these, 65% were men and the mean age was 64 ± 13 years. Rates of cardiac procedures rose with an increase in several SES measures. After adjustment for individual-level predictors of use of cardiac catheterization, average rent, (odds ratio per $100 difference: 1.57, 95% credible interval: 1.36 to 1.80) and proportion of renters, (odds ratio, 2.2; 95% CI: 1.21 to 3.73) in the area were independent SES predictors. Patients in low SES areas (median family income: $ 30,809 CDN) were less likely to undergo cardiac catheterization than patients in high SES areas ($92,169 CDN) (men: 33%; compared with 47%; women: 18%; compared with 47%). However, among patients with cardiac catheterization, SES was not associated with the use of revascularization procedures. For example, PCI rates for men within 90 days after AMI were 26%, compared with 25% in low and high SES areas, respectively. CABG rates were 15%, compared with 19%. Conclusions We found that in the Universal Health Care system of Canada, access to cardiac catheterization after AMI varied according to SES. Among those with cardiac catheterization, SES did not appear to influence further use of revascularization procedures.

Jonathan C Irish - One of the best experts on this subject based on the ideXlab platform.

  • volume outcome relationships for head and neck cancer surgery in a Universal Health Care system
    Laryngoscope, 2014
    Co-Authors: Antoine Eskander, Jonathan C Irish, Patti A Groome, Jeremy L Freeman, Patrick J Gullane, Ralph W Gilbert
    Abstract:

    Objectives/Hypothesis We aimed to assess whether surgeon and/or institution resection volume predicts long-term overall survival in head and neck cancer in a publicly funded HealthCare system. Study Design Population-based retrospective cohort study. Methods Head and neck cancer patients in Ontario, Canada, who underwent a resection confirmed by both hospital-level and physician-level administrative data between 1993 and 2010, comprised our cohort (N = 5,720). Physician and hospital volumes were calculated based on number of cases performed in the year prior by the physician and at an institution performing each case, respectively. A multilevel hierarchical Cox regression model was used to estimate the effect on overall survival of each 25 increase in procedure volume. Results A crude model without patient or treatment characteristics demonstrated that both surgeon volume (hazard ratio [HR]: 0.927, 95% confidence interval [CI]: 0.879-0.978, P = .006) and hospital volume (HR: 0.980, 95% CI: 0.970-0.991, P = .0003) were associated with improved overall survival. After controlling for clustering and patient/treatment covariates, hospital volume (HR: 0.976, 95% CI: 0.955-0.997, P = .02), but not physician volume (HR: 1.042, 95% CI: 0.941-1.155, P = .43), remained a statistically significant predictor of overall survival. This translates into a 2.4% decrease in the HR for every 25 additional cases performed at an institution. Conclusions Both high-volume surgeons and hospitals are predictors of better overall survival in head and neck cancer patients. However, the effect is largely explained by hospital volume. This benefit, at the institution level, could potentially be explained by important processes of Care that contribute to overall survival. Level of Evidence 4 Laryngoscope, 124:2081–2088, 2014

  • barriers to immediate breast reconstruction in the canadian Universal Health Care system
    Journal of Clinical Oncology, 2014
    Co-Authors: Toni Zhong, Refik Saskin, Kimberly A Fernandes, Rinku Sutradhar, Jennica Platt, Brett Beber, Christine B Novak, David R Mccready, Stefan O P Hofer, Jonathan C Irish
    Abstract:

    Purpose To describe the population-based rates of immediate breast reconstruction (IBR) for all women undergoing mastectomy for treatment or prophylaxis of breast cancer in the past decade, and to evaluate geographic, institutional, and patient factors that influence use in the publically funded Canadian Health Care system. Methods This population-based retrospective cohort study used administrative data that included 28,176 women who underwent mastectomy (25,141 mastectomy alone and 3,035 IBR) between April 1, 2002, and March 31, 2012, in Ontario, Canada. We evaluated factors associated with IBR by using a multivariable logistic regression model with the generalized estimating equation approach. Results The population-based, age-adjusted IBR rate increased from 5.1 procedures to 8.7 in 100,000 adult women (43.7%; P < .001), and the increase was greatest for prophylactic mastectomy or therapeutic mastectomy for in situ breast cancer (78.6%; P < .001). Women who lived in neighborhoods with higher median in...