Health Care System In Ontario Research Articles

Who Do We Serve? Role Conflict in Ontario Midwifery

The integration of midwifery into the Ontario health care system has posed challenges to the role of the midwife. The pressure to maintain hospital privileges and the fear of litigation can place midwives in opposition to their role of advocate and support for childbearning women. Additionally, collaborative maternity care models may also create conflicting demands on midwives. Midwives can experience these challenges as role conflict which can have a detrimental effect on midwifery care and lead to work stress and attrition in the profession. Open dialogue, further research, education, consumer involvement and improved interdisciplinary communication are among the strategies that could be used to better understand and address role conflict amongst midwives.

Orthopedic surgeons' transition into full-time practice over the last 20 years: an analysis using Ministry of Health billing data.

Underemployment is a reality for many new graduates, who accept locum or part-time work as an alternative to unemployment because of lack of opportunities. We sought to analyze orthopedic surgeons' Ontario Health Insurance Program (OHIP) billing data over a 20-year period as a proxy of practice patterns and hypothesized that billing in the first 6 years of practice would be affected by underemployment and locum. We analyzed the annual average billing totals of orthopedic surgeons, broken down by year of graduation, year of billings, and number of surgeons billing in that year. We analyzed public census data of the Ontario population size as a proxy of orthopedic demand. A 2019 cross-sectional analysis showed that around 15 surgeons per graduating year were billing in Ontario from the 1995 to 2016 cohorts, while 2017 and 2018 saw an increase to 30 and 36 actively billing surgeons, respectively. The number returned to more historical numbers in 2019, with 20 actively billing surgeons. For those surgeons billing in Ontario, billing trends have been roughly stable, with average billings increasing each year for the first 6 years in practice (p < 0.001). Year of graduation did not have an effect on the first 6 years of billings (p > 0.5). Billings were stable after 6 years in practice (p > 0.09). The Ontario health care system has not expanded to support more orthopedic surgeons despite the aging and growing population; despite our growing population, the number of surgeons being trained and retained has not matched this growth. Further research needs to be done to guide optimal health human resource decision-making.

Gendered ecologies: Explaining interprofessional and gender inequalities in Ontario midwifery

Abstract Although midwifery has been a self-regulating profession in Ontario, Canada for over 30 years, practitioners continue to face barriers and inequalities due to the intersection of professional and gender dynamics. To understand these dynamics better we develop a gendered ecologies approach, refining ecological theories of professions by drawing on research on gender and professions. We then apply this approach when analysing qualitative in-depth interviews with a sample of Ontario midwives about their work. We argue that a gendered ecological approach—by underscoring that gender and professional inequalities are reproduced at the micro, meso, and macro levels by gendered actors contesting (gendered) spaces as they pursue a variety of interests—illuminates midwives’ struggles on the job and their continued subordination within the Ontario healthcare system.

Integrated Care: A Person-Centered and Population Health Strategy for the COVID-19 Pandemic Recovery and Beyond.

The COVID-19 pandemic has mandated a re-imagination of how healthcare is administered and delivered, with a view towards focusing on person-centred care and advancing population health while increasing capacity, access and equity in the healthcare system. These goals can be achieved through healthcare integration. In 2019, the University Health Network (UHN), a consortium of four quaternary care hospitals in Ontario, Canada, established the first stage of a pilot program to increase healthcare integration at the institutional level and vertically with other primary, secondary and tertiary institutions in the Ontario healthcare system. Implementation of the program was accelerated during the COVID-19 pandemic and demonstrated how healthcare integration improves person-centred care and population health; therefore serving as the foundation for a health system response for the COVID-19 pandemic recovery and beyond.

Comparison of the Efficacy in Clinical Trials Versus Effectiveness in the Real-World of Treatments for Multiple Myeloma: A Population-Based Cohort Study

Introduction: Improvements in outcomes of patients with multiple myeloma (MM) depend on the use of regimens approved based on results from large phase III randomized controlled trials (RCTs) demonstrating their efficacy. However, many real-world (RW) patients would not have met the stringent RCTs inclusion criteria. Therefore, the effectiveness of these drugs in the RW setting is unknown. Understanding this efficacy-effectiveness gap is important to contextualize the expected outcomes in the current RW setting. Therefore, we conducted a retrospective population-based study to compare the efficacy versus effectiveness of registration RCTs with RW patients using standard of care (SoC) MM regimens for the primary outcomes of 1) progression free survival [PFS]; 2) overall survival [OS] and 3) serious adverse events (AEs). Methods: RW data was obtained from the Institute for Clinical Evaluative Sciences, an administrative database capturing all health records in the publicly funded health care system in Ontario, Canada. Adult patients treated between Jan 2007 to Dec 2020 with SoC regimens were included. Only regimens with corresponding registrational phase III RCTs which led to the public reimbursement in Ontario were included (lenalidomide/dex [Rd] and bortezomib/Rd [VRd] for newly diagnosed transplant ineligible patients, and relapsed MM (RRMM) regimens included carfilzomib/Rd [KRd], carfilzomib/dex [Kd], daratumumab/Rd [DRd], daratumumab/bortezomib/dex [DVd], pomalidomide/dex [Pd]). In the RW cohort, PFS was defined as the time from initiation of index regimen to death, initiation of subsequent MM treatment, or last follow-up, and patients remaining on the index regimen as last follow up were censored. Kaplan-Meier curves from pivotal phase 3 RCTs were manually digitized to provide individual patient-level estimates of PFS and OS. Meta-analyses were performed to compare the gap of PFS and OS outcomes of RW versus RCT patients, and effect estimates were summarized using hazard ratios (HR). The frequency of serious AE data was abstracted from published RCTs. Given that serious AEs in RCTs would have resulted in hospitalization, hospital admission during treatment with the index regimen was used as a surrogate for serious AEs in the RW cohort. Differences in RW and RCT safety outcomes were reported descriptively. Results &amp; Discussion: A total of 3951 RW MM patients, treated with 7 standard of care MM regimens, were included. Baseline characteristics of patients in the RW and RCT cohorts are shown in table 1. Overall, patients in the RW cohort were older than in the RCTs. For relapsed regimens, there was a longer time between MM diagnosis and start of the regimen in the real-world versus RCT. With regards to the efficacy-effectiveness gap, MM patients treated in routine practise in the RW had a worse PFS despite overestimated of RW PFS compared to highly selected RCT patients for 6 of the 7 MM regimens evaluated, with a pooled HR of 1.44 (95% CI 1.34-1.54) in the meta-analysis (Figure 1A). Similarly, RW patients had a worse OS compared to RCT patients treated with 6 of the 7 regimens, with a pooled HR of 1.75 (95% ci 1.63-1.88) in the meta-analysis (Figure 1B). RRMM patients in the RW had higher rates of prior lenalidomide exposure compared to RCT patients. The only regimen which showed a trend towards performing better in the RW as compared to RCTs was Pd. The reason for this is likely multifactorial but perhaps patients included in the MM-003 RCT may have had more refractory MM (given the higher prior immunomodulatory drug exposure and longer time from diagnosis to treatment among Pd RCT patient) compared to RW patients in this study. With regards to safety, the percentage of patients with inpatient hospitalization during treatment in the real-world cohort and reported serious AEs in RCT were comparable (VRD 57% vs not reported [NR]; Rd 64% vs NR; Kd 57% vs 59%; KRd 53% vs 60%; DVd 36% vs NR; DRd 46% vs 49%; Pd 59% vs 61%). Conclusion: This is one the largest population-level studies highlighting the significant efficacy-effectiveness gap between registrational RCTs and RW usage of these regimens, with RW patients experiencing 44% worse PFS and 75% worse OS compared to RCT patients. Our data emphasize the importance of ongoing evaluation of RW data to contextualize effectiveness and toxicity of selected regimens in the clinic, and better inform both clinicians and patients for shared treatment decision making.

Estimating Cumulative Health Care Costs of Childhood and Adolescence Autism Spectrum Disorder in Ontario, Canada: A Population-Based Incident Cohort Study.

Few studies have estimated cumulative health care costs post-diagnosis for individuals with autism spectrum disorder (ASD). Using an incidence-based approach, the objective of this analysis was to estimate cumulative costs of ASD to the Ontario health care system of children and adolescents. Using administrative health records from Ontario, Canada's most populous province, a retrospective, population-based, incident cohort study of children and adolescents aged 0-19 years old diagnosed with ASD was undertaken to estimate cumulative health care costs of ASD to the health care system from 2010 to 2019. Cumulative health care costs in 2021 Canadian dollars (CAD) from diagnosis to death or end of observation period were estimated using a consistent estimator based on the inverse probability weighting technique. Cumulative health care costs (and respective 95% confidence intervals [CI]) were estimated for 1, 5 and 10years post-diagnosis by sex, age group and health service. In 2010, there were 2867 diagnosed cases of ASD; in 2019, the number of incident cases had risen to 6072. The first year (i.e., 1-year) post-diagnosis cost of ASD was $4710.18 CAD (95% CI 4560.28-4860.08); just under a third of costs were for physician services. Total cumulative 5- and 10-year discounted costs were $16,025.95 CAD (15,371.64-16,680.26) and $32,635.76 CAD (28,906.94-36,364.58), respectively. Mean costs were higher for females and older age groups. These results suggest that costs of ASD are high in the year of diagnosis and then increase at a steady rate thereafter. This information will help with future resource planning within the health care sector to ensure individuals with ASD are supported once their diagnosis is established.

Access to Surgery for Endometrial Cancer Patients During the COVID-19 Pandemic in Ontario, Canada: A Population-Based Study

ObjectivesTo assess the impact of the COVID-19 pandemic on endometrial cancer stage and surgical treatment in Ontario, Canada. MethodsThis descriptive study identified cases from January 1, 2017 to December 31, 2021 from endometrial cancer hysterectomy specimens in the Ontario Health–Cancer Care Ontario, ePath system. Endometrial biopsy records from January 1, 2016 to December 31, 2021 were matched to surgical specimens by provincial health card number. Time to surgery and surgical stage were compared before (2017–2019) and during (2020–2021) the COVID-19 pandemic. ResultsThere were 10 446 women treated with hysterectomy for endometrial cancer in Ontario from 2017–2021. In April and May 2020, corresponding with the provincial state of emergency, there was a 56% relative reduction in endometrial biopsies. Despite this 2-month reduction in endometrial biopsy volume, there was no change in surgical volume for endometrial cancer treatment. The median time from endometrial biopsy to surgery was 56 days (IQR 40, 80) during the pandemic (2020–2021) compared to 58 days (IQR 43, 82) prior to the pandemic (2017–2019) (P < 0.001). There was no upstaging of endometrial cancer during the COVID-19 pandemic. ConclusionsThe Ontario healthcare system continued to prioritize service delivery to endometrial cancer patients during the COVID-19 pandemic, despite the increase in virtual care and decrease in operating room time. There were no significant surgical delays or upstaging of endometrial cancer.

Commentary: Minding the Gap - Why Wage Parity Is Crucial for the Care of Older Canadians.

Zagrodney and colleagues (2023) have highlighted the pay differences that exist between those working in the home and community care (HCC) sector and other healthcare sectors. The authors argue that achieving wage parity could significantly mitigate the current HCC human resource crisis, support the overall sustainability of Ontario's healthcare system and improve patient outcomes. We build on their argument by highlighting issues that have contributed to wage disparities within healthcare systems and discuss how addressing them can create more equitable systems for both those receiving and those providing care. We further note how other healthcare systems that have wage parity have demonstrated that it is not a "nice to have" but an essential element of establishing a sustainable health human resources strategy. Finally, the new 10-year bilateral healthcare funding agreements that the federal, provincial and territorial governments are currently announcing will not only provide significant new funding but also an opportunity to decisively address the long-standing issue of wage parity in Canada, once and for all.

Frameworks, guidelines, and tools to develop a learning health system for Indigenous health: An environmental scan for Canada.

First Nations, Inuit, and Métis (FNIM) peoples experience systemic health disparities within Ontario's healthcare system. Learning health systems (LHS) is a rapidly growing interdisciplinary area with the potential to address these inequitable health outcomes through a comprehensive health system that draws on science, informatics, incentives, and culture for ongoing innovation and improvement. However, global literature is in its infancy with grounding theories and principles still emerging. In addition, there is inadequate information on LHS within Ontario's health care context. We conducted an environmental scan between January and April 2021 and again in June 2022 to identify existing frameworks, guidelines, and tools for designing, developing, implementing, and evaluating an LHS. We found 37 relevant sources. This paper maps the literature and identifies gaps in knowledge based on five key pillars: (a) data and evidence-driven, (b) patient-centeredness, (c) system-supported, (d) cultural competencies enabled, and (e) the learning health system. We provide recommendations for implementation accordingly. The literature on LHS provides a starting point to address the health disparities of FNIM peoples within the healthcare system but Indigenous community partnerships in LHS development and operation will be key to success.

Physician ratings of physician assistant competencies and their experiences and satisfaction working with physician assistants: Results from the supervising physician survey in Ontario, Canada.

Physician Assistants (PAs) are a relatively new addition to the Ontario healthcare system. To understand the impact of the PA role, this study investigated supervising physician satisfaction and perception of PA roles, interprofessional team integration, pandemic supports, and barriers and enablers to PA employment. A web-based survey was conducted of 118 physician supervisors of Ontario PA education program alumni. PAs were employed in a variety of community and hospital settings. In addition to patient care, PAs were involved teaching (65.6%), quality improvement (52.7%), and mentorship (40.0%). Overall, 92.9% of physicians indicated they were satisfied with their PAs. Important barriers to hiring PAs included maintaining PA salaries, billing limitations, and PA shortages. PAs have established themselves as valuable and competent members of healthcare teams. By continuing to explore the enablers and barriers to PA employment from the physician perspective, health leaders can continue to optimize and support role integration.

349 Translation of novel multidisciplinary health technologies in the Ontario healthcare system: A case study of pharmacogenomic testing

OBJECTIVES/GOALS: There is a need for high-quality and efficient translation of health technologies in the Ontario healthcare system. The goal of this project is to understand the decision-making processes of government expert groups developing recommendations for the system-level implementation of pharmacogenomic testing. METHODS/STUDY POPULATION: This prospective observational case study includes the Ontario Health Pharmacogenomics (PGx) Working Group focused on developing recommendations for a PGx testing implementation strategy in the province. Ontario Health is the government agency that oversees provincial healthcare planning and service delivery. Using qualitative ethnographic methods, we will observe and document the working group’s activities over a 10-month period. Data collection involves meeting recordings, correspondences, researcher field notes, decision-making processes, and group characteristics. Using descriptive statistics and inductive qualitative analyses, the data will be examined to build theory and frameworks for knowledge translation. RESULTS/ANTICIPATED RESULTS: The results will be presented through a case report, process maps, decision milestones, visualizations, and procedural recommendations for future expert groups. This study will contribute to the body of foundational knowledge about translational sciences and support the National Center for Advancing Translational Sciences’guiding principles. To enhance translational processes and train the future translational workforce, this research can be used for educational initiatives. In addition, the observed processes will inform a theory about how expert recommendations are developed in public healthcare systems. DISCUSSION/SIGNIFICANCE: This research addresses a current gap in understanding around translational processes, government decision-making, and the development of recommendations for the adoption, implementation, and dissemination of the novel health technologies transforming public healthcare in Canada.

Is 911 The Answer? A Retrospective Review of Emergency Medical Services Use by Home Care Providers.

With the Ontario healthcare system under strain the use of resources-particularly emergency medical services (EMS) is an increasing focus. Recent work has identified long-term care facilities as high users of EMS despite access to health-related support outside of the hospital. However, such insights are not available for home care. A retrospective review of administrative records of EMS calls drawn from over 6 million visits by home care providers found relatively low call rates: 8.4 calls per 100 000 personal support visits, 4.1 calls per 100 000 for rehabilitation providers, and 0.9 calls per 100 000 for nurses. The majority (85%) of calls resulted in transport to the hospital; the notable exception was fall-related events, and of these falls, a third (32%) were treated at home. Classification of reported physical symptoms suggests opportunities for leveraging in-home clinical specialists to avoid hospital transport where possible and preserve EMS capacity to respond to the most urgent and severe events.

Expectations of the Ontario Healthcare System following the Implementation of Ontario Health Teams

With the arrival of Ontario Health Teams (OHTs), healthcare providers, clinicians and patients seek to witness the efficacy of an integrated care model. OHTs are built on the concept of healthcare integration, coordinated care, shared fiscal and clinical accountabilities between multiple healthcare service providers, as well as bridging the gaps between the clinical, social and health promotional aspects of care delivery. This meta-narrative review seeks to examine, compare and determine the efficacy of the integrated care model using cross-sectional studies from around the world to see how integrated care effects health related outcomes. The efficacy of the model will be determined by evaluating the abilities of other integrated care models to reduce healthcare expenditures, improve coordination of care between healthcare service providers, bolster patient satisfaction and health outcomes, minimise emergency and life-threatening cases, lower emergency hospital admission rates as well as provide a comprehensive set of healthcare services including biomedical, mental and social supports. For future applications, this study could be used as a guideline to highlight areas of improvement in integrated care models, as well as to evaluate benefits of existing models and determine best approaches forward.

Changes in healthcare costs and survival in the era of immunotherapy and targeted systemic therapy for melanoma.

ObjectivesMelanoma treatment has evolved over the past decade with the adoption of adjuvant and palliative immunotherapies and targeted therapies and changes in use of sentinel node biopsy. The impact on real-world healthcare costs and outcomes is uncertain. Here we examine changes in healthcare costs and survival using administrative data.&#x0D; ApproachUsing data from the universal healthcare system in Ontario, Canada, we examine a propensity-matched, retrospective cohort of patients aged 20+ years with Stage I-IV invasive cutaneous melanoma from 2018-2019 compared with those from 2007-2012. The primary outcomes were public payer’s mean healthcare per-person costs, and overall survival (OS). Costs were estimated with an established case-mix and claim-based costing algorithm for Ontario, in which person-level costs are allocated for the various healthcare utilizations over time. Standardized mean differences were used to compare costs, and the log-rank test and Cox regression were used to compare survival among stage-stratified, propensity-score matched cohorts.&#x0D; ResultsWe identified 1,138 patients with melanoma from 2018-2019 and 7,654 from 2007-2012. After stage stratification and propensity-matching (N=1,101 per cohort), sentinel lymph node biopsy (62.3% vs. 43.4%) and systemic therapy use (27.3% vs. 12.5%) were more frequent in 2018-2019 compared to 2007-2012. 2018-2019 patients had greater mean healthcare (including systemic therapy) costs compared to 2007-2012 with Stage II ($27,835 vs. $21,179), III ($90,508 vs. $46,242) and IV disease ($118,398 vs. $46,500). There was a seven-to-twelve-fold increase in mean systemic therapy costs for treated patients with Stage III ($68,207 vs. $9,832) and IV disease ($80,905 vs. $6,883). OS was greater in 2018-2019 versus 2007-2012 (2-year OS: 87.8% [95% Confidence Interval {CI}: 85.8-89.6%] vs. 83.7% [95% CI: 81.3-85.7%]; Hazard Ratio {HR}: 0.72 [95% CI: 0.59-0.89]; p&lt;0.05).&#x0D; ConclusionThese real-world data highlight trade-offs with adoption of new effective systemic therapies for melanoma, with a greater economic burden to the healthcare system but an associated improvement in survival. Such evolving paradigm changes may prompt dynamic evaluations of healthcare resources and policies to ensure cancer care is sustainable.

Racial variations of adverse perinatal outcomes: A population-based retrospective cohort study in Ontario, Canada.

IntroductionRacial differences in adverse maternal and birth outcomes have been studied in other countries, however, there are few studies specific to the Canadian population. In this study, we sought to examine the inequities in adverse perinatal outcomes between Black and White pregnant people in Ontario, Canada.MethodsWe conducted a population-based retrospective cohort study that included all Black and White pregnant people who attended prenatal screening and had a singleton birth in any Ontario hospital (April 1st, 2012-March 31st, 2019). Poisson regression with robust error variance models were used to estimate the adjusted relative risks of adverse perinatal outcomes for Black people compared with White people while adjusting for covariates.ResultsAmong 412,120 eligible pregnant people, 10.1% were Black people and 89.9% were White people. Black people were at an increased risk of gestational diabetes mellitus, preeclampsia, placental abruption, preterm birth (<37, <34, <32 weeks), spontaneous preterm birth, all caesarean sections, emergency caesarean section, low birth weight (<2500g, <1500g), small-for-gestational-age (<10th percentile, <3rd percentile) neonates, 5-minute Apgar score <4 and <7, neonatal intensive care unit admission, and hyperbilirubinemia requiring treatment but had lower risks of elective caesarean section, assisted vaginal delivery, episiotomy, 3rd and 4th degree perineal tears, macrosomia, large-for-gestational-age neonates, and arterial cord pH≤7.1, as compared with White people. No difference in risks of gestational hypertension and placenta previa were observed between Black and White people.ConclusionThere are differences in several adverse perinatal outcomes between Black and White people within the Ontario health care system. Findings might have potential clinical and health policy implications, although more studies are needed to further understand the mechanisms.

Prevalence and predictors for being unscreened for diabetic retinopathy: a population-based study over a decade

ObjectifDéterminer les facteurs de prédiction d'une absence de dépistage de la rétinopathie diabétique (RD) au sein d'une population de patients diabétiques dans un pays industrialisé. NatureÉtude populationnelle transversale, répétée et rétrospective. ParticipantsTous les patients présentant un diabète (de type 1 et de type 2) âgés de ≥ 20 ans et figurant dans le système de soins de santé universel de l'Ontario ont été recensés pendant 2 périodes (2011–2013 et 2017–2019). MéthodesLe test de Mantel–Haenszel a servi à calculer la comparaison du risque relatif (RR) dans les sous-catégories stratifiées en fonction des 2 périodes transversales. RésultatsAu total, 1 145 645 sujets diabétiques ont été recensés pendant la période 2011–2013 et 1 346 578, pendant la période 2017–2019. La proportion de patients qui n'ont subi aucun dépistage de la RD a diminué très légèrement pour passer de 35 % (n = 405 967) en 2011–2013 à 34 % (n = 455 027) en 2017–2019 de l'ensemble des sujets diabétiques (RR = 0,967; intervalle de confiance [IC] à 95 %: 0,964–0,9693; p < 0,0001). Les jeunes adultes (20–39 ans) constituaient la plus grande proportion de patients qui n'ont bénéficié d'aucun dépistage (62 % et 58 % en 2011–2013 et en 2017–2019, respectivement). Qui plus est, les sujets qui appartenaient à un quintile de revenus plus faibles (RR = 1,039; IC à 95% : 1,036–1,044; p < 0,0001), qui étaient des immigrants récents (RR = 1,286; IC à 95 % : 1,280–1,293; p < 0,0001), qui vivaient en milieu urbain (RR = 1,149; IC à 95 % : 1,145–1,154; p < 0,0001), qui avaient des antécédents de troubles de la santé mentale (RR = 1,117; IC à 95 % : 1,112–1,122; p < 0,0001) ou qui n'avaient pas accès à un médecin de soins primaires (RR = 1,656; IC à 95 % : 1,644–1,668; p < 0,0001) couraient un risque plus élevé d’échapper au dépistage. ConclusionsSelon notre étude populationnelle qui s'est étalée sur une décennie, 33 % des patients diabétiques ne font l'objet d'aucun dépistage de la RD. Les principaux facteurs de prédiction d'une absence de dépistage sont le jeune âge, le revenu faible, l'immigration, la résidence dans une grande ville, les troubles de la santé mentale et l'absence d'accès à un médecin de soins primaires.

Barriers and reliability of patient experience evaluation in Ontario: perspectives of healthcare providers, managers, and policymakers

PurposePatient experience (PE) evaluation can identify critical issues in healthcare quality. Various methods are used for PE evaluation in the healthcare system in Ontario; however, evidence suggests that PE evaluation is not systematically performed and has not received substantial buy-in from healthcare providers. This study explores the perspectives of healthcare providers, managers and policymakers in Ontario on PE evaluation methods, barriers, utility and reliability.Design/methodology/approachThe study used a qualitative descriptive design. Twenty-one semistructured interviews were conducted with healthcare providers, managers and policymakers in Ontario between April 2018 and May 2019. The authors used thematic analysis to analyze the data. The Consolidated Criteria for Reporting Qualitative Research quality criteria were used.FindingsBarriers to PE evaluation include evaluation cost and the time and effort required to collect and analyze the data. Several factors affect the reliability of the evaluation, resulting in an unrealistically high level of patient satisfaction. These include the inclusivity of evaluation, the subjective nature of patient feedback, patients' concerns about health service continuity and the anonymity of evaluation. Participants were skeptical about the meaningfulness of evaluation because it may only yield general information that cannot be acted upon by healthcare providers, managers and policymakers for quality improvement.Originality/valueThis paper reveals that many healthcare providers, managers and policymakers do not see a tangible value in PE evaluation, regardless of Ontario's patient-centeredness and “patient first” rhetoric. An improvement in evaluation methods and a cultural change in the healthcare system regarding the value of PE are required to foster a better appreciation of the benefits of PE evaluation.

Prevalence and health care costs of mitochondrial disease in Ontario, Canada: A population-based cohort study.

BackgroundMitochondrial disease prevalence has been estimated at 1 in 4000 in the United States, and 1 in 5000 worldwide. Prevalence in Canada has not been established, though multi-linked health administrative data resources present a unique opportunity to establish robust population-based estimates in a single-payer health system. This study used administrative data for the Ontario, Canada population between April 1988 and March 2019 to measure mitochondrial disease prevalence and describe patient characteristics and health care costs.Results3069 unique individuals were hospitalized with mitochondrial disease in Ontario and eligible for the study cohort, representing a period prevalence of 2.51 per 10,000 or 1 in 3989. First hospitalization was most common between ages 0–9 or 50–69. The mitochondrial disease population experiences a high need for health care and incurred high costs (mean = CAD$24,023 in 12 months before first hospitalization) within the single-payer Ontario health care system.ConclusionsThis study provides needed insight into mitochondrial disease in Canada, and demonstrates the high health burden on patients. The methodology used can be adapted across jurisdictions with similar routine collection of health data, such as in other Canadian provinces. Future work should seek to validate this approach via record linkage of existing disease cohorts in Ontario, and identify specific comorbidities with mitochondrial disease that may contribute to high health resource utilization.

A critical analysis of the social media policies in Ontario's healthcare system

PurposeSocial media has made a revolutionary change in the relationship between the customers and business or service providers by enabling customers to publish and share feedback and views about product or service quality. This revolutionary change has not been echoed in some healthcare systems. This study analyses the social media policies of healthcare regulatory authorities in Ontario and explores how these policies encourage or discourage healthcare professionals' use of social media for collecting patient stories and understanding patient experience.Design/methodology/approachThe study used qualitative content analysis to analyse the policy documents, focusing on the manifest themes in these documents. It used convenient sampling to select 12 organizations, including regulating and licensing bodies and health service delivery organizations in Ontario. The authors collected 24 documents from these organizations, including policies, practice standards and social media learning materials.FindingsIn Ontario's healthcare system, social media is perceived as a source of risks to the healthcare professions and professionals. Healthcare regulators emphasize that the codes of conduct and professional standards extend to social media. The study found no systematic recognition of patient stories on social media as a source of information on healthcare quality that can be useful for healthcare professionals.Originality/valueThe study identifies potential unintended consequences of social media policies in the healthcare system and calls for policy and cultural changes to enable the development of safe social media platforms that can facilitate interaction between healthcare providers and patients, when necessary, without the fear of legal consequences or privacy breaches.

Is Symptom Burden Associated with Health Care Utilization: A Longitudinal Population-Based Cohort Study of Transplant Ineligible Patients with Newly Diagnosed Multiple Myeloma

IntroductionTransplant ineligible patients with newly-diagnosed multiple myeloma (TI NDMM) have high rates of health care utilization [emergency department visits and/or unplanned hospitalization (ED/hosp)] due to a combination of co-morbidities/frailty, disease manifestations and toxicities of anti-MM treatment. Understanding and optimizing unplanned health care utilization represents an important step in delivering person-centred care in MM.Patient reported outcomes (PROs) may represent one opportunity for predicting health care utilization. Databases within Ontario, Canada represent a unique opportunity to evaluate this association due to the implementation of a standardized population-wide PRO tool (the Edmonton Symptoms Assessment System [ESAS]). ESAS scores have been completed by patients during all outpatient cancer clinic visits since 2007. The ESAS is a validated and reliable tool that assesses the severity of nine common symptoms: well-being, pain, tiredness, anxiety, depression, drowsiness, lack of appetite, nausea and shortness of breath. Patients score these on a rating scale from 0 (no symptom) to 10 (worse possible symptom).The objective of our study was to evaluate the association between PROs (ESAS score) and the subsequent 14-day risk of ED/hosp among TI NDMM patients in the first year following diagnosis.MethodsWe conducted a retrospective population-based study using administrative data from ICES (previously known as the Institute of Clinical Evaluative Sciences), which maintains databases of health records for all patients in the publicly funded health care system in Ontario, Canada. All patients with NDMM identified using the ICD-O-3 code 9732 (MM), who received treatment without transplant in the first year between Jan 2007-Dec 2018 were included. Patients with no documented ESAS score within one year following diagnosis were excluded. The main outcome of interest was the occurrence of at least one ED/hosp within 14 days of an ESAS assessment in the first year following diagnosis. The main exposure variable was ESAS score (individual score for each of the nine symptoms and total score of all the nine symptoms [t-ESAS]) at each index date. A logistic regression model was used to assess the association of ESAS score and subsequent 14-day ED/hosp. A generalized estimating equations approach was used to account for patient level clustering, arising from multiple ESAS assessments taken on the same patient (over the first year after diagnosis).ResultsThere were 2876 TI NDMM patients identified completing a total of 17,353 ESAS assessments. Baseline characteristics of the cohort are shown in Table 1. Tiredness, poor well-being and pain were the three most common severe symptoms present in 19.6%, 12.4% and 12.2% of the assessments, respectively. With regards to health care utilization, there were a total of 1755 ED/hosp visits in 1172/2876 (40.8%) TI NDMM patients within one year following diagnosis in our cohort.The proportion of patients with ED/hosp within 14 days of the ESAS assessment are outlined in Figure 1. There was an incremental increase in ED/hosp with increasing ESAS scores (higher score indicative of worse symptoms) for each individual symptom. A similar trend was noted for those with increasing t-ESAS scores with a 14-day ED/hosp event rate of 31.3% for those with a maximum score of 90 compared with 5.5% for those with a score of 0.Univariable and multivariate odds for ED/hosp are presented in Table 2. All nine symptom scores and t-ESAS were associated with an increased risk of ED/hosp visits. After controlling for confounders, individual symptoms (pain, tiredness, lack of appetite, shortness of breath and impaired well-being) and t-ESAS remained positively associated with ED/hosp. Conversely, self-reported depression was associated with decreased risk of ED/hosp (odds ratio 0.96 per unit increase, 95% Cl 0.93-0.99, p=0.01).ConclusionOur findings represent the largest study to date demonstrating that a PRO measure of symptom burden is associated with health care utilization in TI NDMM. Even after controlling for baseline factors, ED/hosp remained positively associated with higher ESAS symptom scores. The results of this study may help clinicians identify patients at high risk for ED/hosp. Further studies are required to understand whether targeted intervention aimed at reducing this symptom burden may help decrease ED/hosp usage. [Display omitted] DisclosuresMian: BMS: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Research Funding. Pond: Takeda: Membership on an entity's Board of Directors or advisory committees; Astra-Zeneca, Merck, Profound Medical: Consultancy; Roche Canada: Current holder of individual stocks in a privately-held company. D'Souza: Sanofi, Takeda, Teneobio, CAELUM, Prothena: Research Funding; Janssen, Prothena: Consultancy; Imbrium, Pfizer, BMS: Membership on an entity's Board of Directors or advisory committees. Wildes: Carevive: Consultancy; Seattle Genetics: Consultancy; Sanofi: Consultancy; Janssen: Consultancy.