1,721,085 research outputs found
Effect of Continuity of Care on the Risk of Developing Multimorbidity in Ontario, Canada between 2001 - 2015: A Retrospective Cohort Study
Full text linkIdentifying modifiable, population-based factors for the prevention of multimorbidity is necessary to protect the health of patients and avoid unnecessary healthcare system costs. This study explored whether relationship continuity of care delays the onset of chronic conditions in patients from Ontario, Canada. Health administrative databases were used to assemble the cohort (N= 166,665) that was followed retrospectively between 2001 - 2015. A cause-specific hazards regression modelling approach was used to estimate the effect of continuity treated as a time-dependent exposure on the risk of developing multimorbidity and subsequent conditions adjusted for age, sex, place of residence, patient enrolment, income, and the number of physician visits. Estimates revealed that the risk of developing a second, third, and fourth condition was 8%, 10%, and 11% lower for patients with high versus low continuity, respectively. Therefore, efforts should be made to reduce the burden of multimorbidity by focusing on continuity of care.M.Sc
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe 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
Person-centred Care Coordination in Ontario: A Multimethod Evaluation of Implementation and Impact
Full text linkAs the number of persons living with complex health and social care needs increases, healthcare systems are faced with the challenge of providing high quality care to these individuals. One approach utilized by many healthcare systems to achieve high quality care for persons living with complex health and social care needs is person-centred care coordination). A gap still exists in our knowledge on how to implement person-centred care coordination in ways that meet individual and family expectations and needs. In addition, more is to be learned about the care experiences of persons receiving person-centred care coordination and their family caregivers.The aim of this dissertation was to fill these gaps by evaluating Health Links by conducting three interconnected studies. In the first study of this dissertation, an implementation evaluation approach was utilized to assess the extent to which the implementation plans of person-centredness, and engagement were operationalized within Health Links. In the second and third studies an impact evaluation approach was employed to assess the care experiences of persons living with complex health and social care needs and their family caregivers after being enrolled in Health Links. In order to assess the care experiences comprehensively, multimethods were used. A patient experience survey was used in the second study and in-depth interviews with enrollees and their caregivers in the third study.
The first study concluded that operationalization of implementation plans in network structures like Health Links was faced by numerous challenges. The second study found that the intended components of the Health Links approach (care plan and care coordinator) positively impacted the experience of the enrollees. However, issues with implementation of these components led to a negative care experience. The third study showed that despite being enrolled in an initiative that aimed at delivering person-centred care coordination, persons living with complex health and social care needs and their family caregivers were still shouldering the main burden of care coordination.
The findings of the three studies can guide policy makers, planners, implementers, and evaluators on how to better plan, deliver and evaluate person-centred care coordination (integrated patient care) interventions.Ph.D
Variations on the Author
Full text link“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
Accumulating Multimorbidity: the Role of Depression, Socioeconomic Status, and Other Factors
Full text linkMultimorbidity is a significant challenge facing patients, clinicians, and the healthcare system. This study examines whether depression and socioeconomic status are associated with incident physical illness and multimorbidity, after controlling for potential sociodemographic, behavioural, and clinical confounders.
This is a longitudinal retrospective cohort study. Cohorts were derived by linking adult respondents to three population health surveys to health administrative databases in Ontario and were followed for ten years. Cox proportional hazards regression was used to examine the rate at which participants developed illnesses, and Poisson regression was used to examine the number of conditions developed after ten years.
In this study, depression increased the risk of accumulating multimorbidity, in terms of both time to development of conditions and number of conditions accumulated after ten years. Higher household incomes were protective against developing a second and subsequent physical illness, but not the first incident illness in a disease-free cohort.M.Sc
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe 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
The quality of care among older adults with diabetes comorbid with other chronic conditions
No full textThe management of people with multiple chronic conditions requires understanding the extent to which concurrent chronic conditions contribute and interact to affect the patientâ s health status, as well as assessing the risk and benefits of various strategies for the treatment of complex needs in patients. A single condition focus in both clinical care and research remains and limits the assessment of care for people with multiple chronic conditions.
The overall aim of this project was to evaluate the quality of overall care for older adults with selected disease combinations in ambulatory care settings. The first study aimed to identify a set of evidence-based and valid quality indicators for evaluating ambulatory care for older adults with selected chronic conditions, including diabetes, hypertension, chronic ischemic heart disease, major depression and osteoarthritis. The second study aimed to critically appraise the identified quality indicators and select a set of indicators for evaluating the quality of care for older adults with diabetes with comorbid concordant and discordant chronic conditions. The third study aimed to examine the difference in the quality of care between patients with 2 vs. 1 selected concordant vs. discordant comorbid conditions, and to examine associations of quality of care and hospitalizations among older adults with selected disease combinations.
The study findings suggest that older adults with diabetes are at risk of suboptimal care with additional selected comorbid conditions, especially those with discordant comorbid conditions. The study findings also support the importance of continuity of care for older diabetes patients with comorbid chronic conditions. The study findings suggest that the likelihood of hospitalizations increases with the number of prescribed drugs among older adults with comorbidities.
There is a need for a holistic approach in education and clinical care of older adults with diabetes taking into account concomitant conditions that affect patientâ s health status. Future research is needed for measuring the quality of care in the larger diabetes population and reporting by different stratifications, including age, sex, primary care models to see if there are any patterns in certain groups and target the interventions towards improving practices for specific sub groups.Ph.D
Determining the Relationship between Quality and Staffing Characteristics in Ontario Long-term Care Homes
Full text linkResearch exploring the relationship between nurse staffing characteristics and quality in Long-Term Care (LTC) settings is needed to inform how staffing relates to quality. The present thesis addresses this research gap using a systematic review and two Ontario-based empirical studies exploring the relationship between LTC quality of care outcomes and nursing and personal care (NPC) staffing characteristics in LTC. The systematic review was conducted using OVID databases (Medline, CINAHL and Ageline) and several Cochrane databases to retrieve studies published between 2008 and 2017, and using the STROBE checklist to evaluate study quality and risk of bias. 31 studies were included in the systematic review. Findings align with previous literature reviews, with mixed results but mainly positive findings for registered nurses (RNs) and personal care (PC) providers (e.g., nursing assistants), and a mix of both positive and negative findings for registered practical nurses (RPNs). The two empirical cross-sectional studies examined the entire population of Ontario LTC residents in 2012 and used risk-adjusted multi-level multivariate regression to relate staffing characteristics to resident outcomes. In the empirical studies, four resident-level NPC-sensitive quality indicators from the Ontario Resident Assessment Instrument Minimum Data Set (prevalence of pain and incidence of falls, worsening continence and pressure ulcers) were regressed on four home-level NPC staffing characteristics (staffing level, skill mix, skills and competencies as well as roles and responsibilities). The studies also tested whether the observed relationships between staffing and outcomes varied according to the profit status of the LTC operator. Both empirical studies found similar mixed results, and few significant relationships in the full sample of residents. However, subgroup analyses, comparing residents with lower disablement, revealed RN staffing levels were generally associated with better outcomes, while RPNs had both protective and worsening effects on different indicators. Profit status had an inconsistent influence on relationships. Although many effects were substantial and supported hypotheses, many more were not significant or did not support hypotheses. Other factors influencing resident outcomes should be considered to develop new theory on what drives the differences in risk-adjusted quality measures. Longitudinal studies with more nuanced measurement of staff characteristics will also be useful.Ph.D
Accumulating Multimorbidity: the Role of Depression, Socioeconomic Status, and Other Factors
No full textMultimorbidity is a significant challenge facing patients, clinicians, and the healthcare system. This study examines whether depression and socioeconomic status are associated with incident physical illness and multimorbidity, after controlling for potential sociodemographic, behavioural, and clinical confounders.
This is a longitudinal retrospective cohort study. Cohorts were derived by linking adult respondents to three population health surveys to health administrative databases in Ontario and were followed for ten years. Cox proportional hazards regression was used to examine the rate at which participants developed illnesses, and Poisson regression was used to examine the number of conditions developed after ten years.
In this study, depression increased the risk of accumulating multimorbidity, in terms of both time to development of conditions and number of conditions accumulated after ten years. Higher household incomes were protective against developing a second and subsequent physical illness, but not the first incident illness in a disease-free cohort.M.Sc
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