EXAMINING HYPERTENSION RATES, SEVERITY, KNOWLEDGE, AND MODIFIABLE RISK FACTORS IN OLDER ADULTS RESIDING IN ONTARIO SUBSIDISED HOUSING

Abstract

referral to a pediatric cardiologist who then decided if a patient would receive an echocardiogram while Strategy 2 used a hypothetical situation where any physician could refer patients with heart murmurs for an echocardiogram. DESIGN: Pre-existing clinical data from a previous study consisting of 252 new, outpatient consultations to the IWK Children’s Heart Centre between August 1, 2011 and August 17, 2012 were obtained to determine what types of tests were ordered for patients with heart murmurs, in what proportions, and their final diagnoses. Costs of the different strategies were calculated using multiple hospital resources, the public physician billing manual and other publically available online resources. Descriptive statistics were used to describe observed and estimated costs and a Wilcoxon matched-pairs signed rank test assessed the significance of pair-wise differences in cost between the two approaches. RESULTS: Strategy 2, which requires performing echocardiograms on all patients, resulted in a $77.30 increase in median total costs per patient over the current Strategy 1, which required all patients to be first examined by a pediatric cardiologist before any specialized tests could be performed. The difference was significant (p<0.001). CONCLUSION: The cost of initial referral to a pediatric specialist is less costly than direct referral of patients with murmurs for echocardiography in the patient group and caregiver group studied. The percentage of echoes ordered for innocent murmurs at which the “crossover point” in cost occurs, remains to be determined. CIHR