1,721,034 research outputs found
How a biosimilar switching policy impacted healthcare resource utilization and cost in British Columbia
No full textThe uptake of biosimilars has been slower than hoped in many jurisdictions across the globe. A concern has been raised that switch from originator to biosimilar would be associated with increased health care resource utilization (HCRU) such as increased physician visits and hospitalizations. However, the signals for these concerns have been based on small samples and potentially biased methods. In this study, administrative data were analyzed from British Columbia (BC), Canada where in the past 5 years, policies have led to patients with inflammatory bowel disease (IBD), inflammatory joint disease (IJD), and inflammatory skin disease (ISD) being switched from an originator to a biosimilar to maintain insurance coverage.
A literature review was conducted using Embase, Medline, and Web of Science to update existing systematic reviews. HCRU and cost from current literature were summarized. An empirical analysis was undertaken using population-based, administrative databases (Population Data BC) from 2015 to 2021 including individuals with IBD, IJD and ISD based on ICD-9 and -10 codes. The cohort included those using originator TNF-α blockers (adalimumab, etanercept, or infliximab) before the mandatory switch policy. Descriptive analysis of HCRU components (physician visits, hospital days, emergency visits, and other medications) was conducted. An interrupted time series was used to assess the pre- and post-switch trend by treatment and cohort on total HCRU related costs.
The literature review showed no pattern in increase HCRU and cost following a switch policy. The analysis on BC population included 6326, 6205, and 2474 patients in the IBD, IJD, and ISD cohorts, respectively. Based on descriptive statistics and interrupted time series analysis, no important changes in physician visits, hospital admission, or emergency visits following the policy occurred for all three cohorts. Overall, no important changes in HCRU costs due to the switch were observed, but a historical trend in decreasing hospitalizations in IBD cohort was identified.
This study suggests concerns about biosimilar switch policies creating increases in other HCRU is unfounded in IBD, IJD, and ISD patients. Policy makers in other jurisdictions can feel reassured that mandatory biosimilar switching polices should not lead to increases in the cost of other healthcare resources.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat
Evaluating the incremental value of patient-reported outcome measures in predicting unplanned hospital readmission or mortality
No full textBackground: Hospital readmissions significantly impact patient outcomes and healthcare costs globally. While prediction models are widely used to identify patients at high risk of readmissions, their discriminative ability often falls short of achieving adequate accuracy. Integrating patient-reported outcome measures (PROMs) may enhance these models by considering patient perspectives on their own health conditions.
Objective: To investigate the contribution of PROMs to the performance of prediction models for hospital readmissions by (1) systematically reviewing the literature on readmission prediction models, (2) assessing the incremental value of incorporating PROMs on the performance of risk prediction models, and (3) exploring extra predictive value of PROMs across various clinical and geographic subgroups.
Methods: A systematic review of readmission risk prediction models that included PROMs was conducted through searching electronic databases. A retrospective population-based cohort study was performed using data from the British Columbia Acute Inpatient Survey linked to administrative healthcare databases. The study cohort comprised patients discharged from acute care facilities between September 2016 and March 2017 who had completed PROMs. Subgroups were stratified by the presence of ambulatory care sensitive conditions and distance from major hospitals relative to patients’ residences. Prediction models were constructed using both statistical methods and machine learning techniques. Model performance was compared with and without PROMs data for the overall cohort and subgroups.
Results: The systematic review highlighted the potential of PROMs in predicting hospital readmission, although the effectiveness varied depending on how PROMs data were collected and used in the prediction models. The analysis included 9,148 patients discharged from BC’s acute care hospitals, with PROMs completed between 26- and 60-days following discharge. While global summary of PROMs were influential predictors, the inclusion of PROM data led to only modest improvement in model performance. Subgroup analyses indicated the need for adjusting risk thresholds to accommodate specific clinical and demographic characteristics.
Conclusion: Incorporating PROMs into prediction models for unplanned hospital readmission or death within one year modestly enhanced model performance. However, the marginal gains in predictive accuracy must be balanced against the benefits to patients and the costs associated with collecting these data.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat
Improving referrals to rheumatologists for patients with inflammatory arthritis
No full textBackground: There are two broad types of arthritis, and patient care differs by type. Those with inflammatory arthritis (IA) should be treated by a rheumatologist within 12 weeks of symptom onset, while those with non-IA, can benefit from multi-disciplinary care and lifestyle modifications. No standard referral tools are used to help primary care physicians (PCP) direct people with joint pain to the appropriate healthcare provider. Many patients wait needlessly, sometimes in the wrong queue, increasing their chances of disability.
Objectives: First, to understand recent trends in patient referrals to rheumatologists in British Columbia (BC). Second, to identify and test the accuracy of a patient-completed questionnaire to classify and prioritize patients with IA for referral from primary care to rheumatologists and seek the perspectives of patients and rheumatologists for implementation considerations.
Methods: Using administrative databases from Population Data BC, current rheumatology referrals trends were examined. A scoping review was performed to identify validated questionnaire(s) to evaluate in a BC clinical study: The Patient Self-Administered Inflammatory Arthritis Detection (SAID) study. A multi- and mixed methods approach was used to gain user perspectives of barriers and opportunities to implement a questionnaire in the referral pathway.
Results: Rheumatology referral trends in BC showed long wait times for patients with IA and a high proportion of referral of patients with non-IA. Access improved between 2010-2020 but remained long, particularly for females and people living outside of metropolitan areas. The scoping review identified 53 studies of referral tools. Two tools were selected for The Patient SAID Study; the Early Inflammatory Arthritis Questionnaire (EIAQ) and the Case Finding Axial Spondyloarthritis (CaFaSpa) questionnaire. The reported EIAQ performance was not replicated, but a new, preliminary scoring algorithm, that added a back pain question, had promising performance (AUC=0.740, 95%CI 0.632-0.849) suggesting that EIAQ questions were informative. Patients and rheumatologists supported the use of the questionnaire for referrals and provided recommendations for clinical implementation.
Conclusions: There is a need to improve the rheumatology referral process in BC and this thesis tested a patient-completed questionnaire that may support that. The findings suggest the potential value of the questionnaire to streamline referrals and access to care.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Patient-oriented research to support decision-making in pregnancy hypertension
No full textBackground: Pregnancy hypertension is a common, potentially fatal condition. New guidance recommends ‘tight’ control of pregnancy hypertension over ‘less-tight’ control. However, guidance also suggests that treatment recommendations consider patient preferences. This dissertation aims to understand how to support patients and providers to make preference-congruent and informed decisions about pregnancy hypertension management.
Methods: First, a mixed-methods study, including a best-worst scaling task, of patient preferences for pregnancy hypertension management was conducted. Next, a systematic review built upon ancillary findings by assessing emotion in patient decision aids (PtDAs) for decisions during pregnancy. Using results from the preferences study, the subsequent study re-analyzed the Control of Hypertension in Pregnancy Study (CHIPS) trial using a patient-oriented composite endpoint. A PtDA was developed and assessed for quality and effectiveness. Lastly, a preliminary study explored emotion-regulation in patient decision-making.
Results: The mixed-methods preference study (n=210) found that individuals prioritised seven outcomes when choosing how to manage pregnancy hypertension. Latent class analysis identified three preference profiles (a profile comprises participants with similar preferences). Each profile placed different importance on each outcome: 1) ‘equal prioritisers’ valued the outcomes equally; 2) ‘early delivery avoiders’ prioritised avoiding delivery before 34 weeks; and 3) ‘medication minimisers’ prioritised avoiding medication. A systematic review of 39 PtDAs found that most did not address emotion. Reanalysis of the CHIPS trial using a weighted patient-oriented composite endpoint found that while both strategies yielded equal outcomes for equal prioritisers; ‘tight’ control produced better outcomes for early delivery avoiders; and ‘less-tight’ control produced better outcomes for medication minimisers. A prototype PtDA that incorporated these profiles was assessed (n=99) as very acceptable and clear, and significantly improved knowledge. The preliminary emotion study (n=107) found that individuals’ beliefs about their own ability to regulate emotions may limit the benefit of a PtDA.
Conclusions: Patient preferences for management of pregnancy hypertension can be broadly described by three profiles. ‘Tight control’ is well-suited to only two of these profiles, emphasizing the importance of shared decision-making in reaching treatment decisions. A PtDA for pregnancy hypertension may help patients make more informed decisions. Future work should explore how to include emotion in PtDAs.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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