Measuring the Relationship between Hospital Costs and Quality of Care: An Example of Acute Myocardial Infarction in Edmonton, Alberta, Canada

This study explores the relationship between hospital costs and quality of care for Acute Myocardial Infarction (AMI) in the Edmonton area hospitals. The importance of this relationship is realized when policy makers face decisions about cost minimization and quality maximization during times of health care budget constraints. This study uses regression modelling with increasing specifications as well as various robustness checks to ensure the accuracy of the results. The Model specifications include demographics, AMI risk adjustments, Hospital fixed effects, and year fixed effects. Semi-parametric regression removes the assumption of linearity to determine the true relationship between hospital cost and AMI quality. Higher AMI quality is associated with a 39% increase in hospital costs after adjustments and controls. The semi-parametric regression shows a fairly linear relationship between cost and AMI quality. This study suggests that Canadian policy and decision makers should take caution during budget cuts and implementing cost containment programs. The results suggest that reducing AMI budgets may have a negative effect on the quality of AMI care patients receive in Edmonton, Alberta. The linear relationship suggests that the return on the quality of AMI is consistent for each dollar invested with no economies of scale

Asthma-related productivity losses in Alberta, Canada

Nguyen X Thanh, Arto Ohinmaa, Charles YanInstitute of Health Economics, Edmonton, Alberta, CanadaObjectives: To estimate the number and cost of asthma-related productivity loss days due to absenteeism and presenteeism (at work but not fully functioning) in Alberta in 2005.Methods: Using data from the 2005 Canadian Community Health Survey, this study focused on people of working age (18–64 years), who reported having an asthma diagnosis. Total asthma-related disability days, including in-bed days and activity-restricted days, were estimated by multiplying the difference in the means of total disability days between asthmatics and nonasthmatics adjusted for sociodemographic characteristics and other health conditions by a multiple linear regression, with the number of asthmatics in the population. Number of productivity loss days was a sum between the number of in-bed days (absenteeism) and the number of activity-restricted days multiplied by a reduction in functional level (presenteeism), adjusted for five working days per week. Other data from Alberta or Canadian published literature, such as a reduction in functional level of 20%–30%, a labor participation rate of 73%, and an average wage of $158 per day in 2005, were also used for analyses.Results: The prevalence of asthma was estimated at 8.5$70 (41–99) to $84 ($49–$119) million. Of these, the presenteeism accounted for 42% to 52%.Conclusions: The results suggest that an improvement in the controlling of asthma could have a significant economic impact in Alberta and that presenteeism plays an important role in asthma-related productivity losses and therefore employers should not only pay attention to absenteeism, but also to presenteeism to minimize productivity loss.Keywords: productivity loss, absenteeism, presenteeism, asthma, Albert

Symptom Burden, Medication Detriment, and Support for the Use of the 15D Health-Related Quality of Life Instrument in a Chronic Pain Clinic Population

Chronic noncancer pain is a prevalent problem associated with poor quality of life. While symptom burden is frequently mentioned in the literature and clinical settings, this research highlights the considerable negative impact of chronic pain on the individual. The 15D, a measure of health-related quality of life (HRQOL), is a user-friendly tool with good psychometric properties. Using a modified edmonton symptom assessment scale (ESAS), we examined whether demographics, medical history, and symptom burden reports from the ESAS would be related statistically to HRQOL measured with the 15D. Symptom burden, medication detriment scores, and number of medical comorbidities were significant negative predictors of 15D scores with ESAS symptom burden being the strongest predictor. Our findings highlight the tremendous symptom burden experienced in our sample. Our data suggest that heavier prescription medication treatment for chronic pain has the potential to negatively impact HRQOL. Much remains unknown regarding how to assess and improve HRQOL in this relatively heterogeneous clinical population

Evaluation of a health promoting schools program in a school board in Nova Scotia, Canada.

A Health promoting schools (HPS) approach aims to make schools a healthy place through a holistic approach that promotes a supportive 'school ethos' and emphasizes improvements in physical, social, and emotional well-being and educational outcomes. A HPS initiative in rural Nova Scotia (Canada) provided an opportunity for a population-level natural experiment. This study investigated student well-being and health behaviours between schools with and without HPS implementation and schools with high and low school ethos scores. Student well-being, nutrition, and physical activity were examined in a cross-sectional survey of elementary students in Nova Scotia, Canada in 2014. Multiple regression was used to assess the relationship with student well-being using the Quality of Life in School (QoLS) instrument and health behaviours. The main exposure was attending one of the 10 HPS schools; secondary exposure was the school ethos score. The overall QoLS score and its subdomain scores in the adjusted models were higher in students attending HPS schools compared to those in non-HPS schools, but the differences were not statistically significant and the effect sizes were small. Students in schools that scored high on school ethos score had higher scores for the QoLS and its subdomains, but the difference was only significant for the teacher-student relationship domain. Although this study did not find significant differences between HPS and non-HPS schools, our results highlight the complexity of evaluating HPS effects in the real world. The findings suggest a potential role of a supportive school ethos for student well-being in school

Comparison of ICD code-based diagnosis of obesity with measured obesity in children and the implications for health care cost estimates

<p>Abstract</p> <p>Background</p> <p>Administrative health databases are a valuable research tool to assess health care utilization at the population level. However, their use in obesity research limited due to the lack of data on body weight. A potential workaround is to use the ICD code of obesity to identify obese individuals. The objective of the current study was to investigate the sensitivity and specificity of an ICD code-based diagnosis of obesity from administrative health data relative to the gold standard measured BMI.</p> <p>Methods</p> <p>Linkage of a population-based survey with anthropometric measures in elementary school children in 2003 with longitudinal administrative health data (physician visits and hospital discharges 1992-2006) from the Canadian province of Nova Scotia. Measured obesity was defined based on the CDC cut-offs applied to the measured BMI. An ICD code-based diagnosis obesity was defined as one or more ICD-9 (278) or ICD-10 code (E66-E68) of obesity from a physician visit or a hospital stay. Sensitivity and specificity were calculated and health care cost estimates based on measured obesity and ICD-based obesity were compared.</p> <p>Results</p> <p>The sensitivity of an ICD code-based obesity diagnosis was 7.4% using ICD codes between 2002 and 2004. Those correctly identified had a higher BMI and had higher health care utilization and costs.</p> <p>Conclusions</p> <p>An ICD diagnosis of obesity in Canadian administrative health data grossly underestimates the true prevalence of childhood obesity and overestimates the health care cost differential between obese and non-obese children.</p