Manuel DG, Rosella LCA, Tuna M, Bennett C. June 2010
Estimating a population’s baseline risk of disease is a cornerstone of modern health planning. This report estimates Canadians’ future risk of developing diabetes based, for the first time, on current levels of obesity and other risk factors in the population. New cases of diabetes are estimated by provinces, socioeconomic status, body weight and age groups, as well as across 121 Canadian health regions. The potential effect of different provincial prevention strategies is also examined.
Hall R, O'Callaghan C, Bayley M, Meyer S, Khan F, Liu Y, Linkewich B, Lumsden J, Willems D. April 2010
This report provides a comprehensive look at the variation in stroke care and patient outcomes by stroke care sectors, including Emergency Department, Acute Inpatient, Inpatient Rehabilitation and Home Care Services. The results are based on a study of close to 60,000 Ontario stroke patients between 2003/04 and 2007/08. Information about acute inpatient care and outcomes for paediatric stroke patients is also presented. [2.92 MB PDF]
Schull M, Hatcher C, Guttmann A, Leaver C, Vermeulen M, Rowe B, Anderson G, Zwarenstein M. March 2010
There is much concern about access to, and quality of, emergency department (ED) care in Canada, where every year more than 12 million ED visits are made. However, there is no common agreement as to what constitutes appropriate measures of quality of care in the ED. The evaluation of ED care in Canada is hampered by the absence of a common agreement on what constitutes appropriate measures of quality of ED care. This report presents a prioritized set of evidence-based quality of care indicators for EDs which was developed through a nationally representative and scientifically rigorous process. [1.3 MB PDF]
Gomes T, Juurlink DN, Shah BR, Paterson JM, Mamdani MM. December 2009
Self-monitoring of blood glucose levels in patients with diabetes, using blood glucose test strips (BGTS), is an important part of disease management, and one that has significant associated costs. This report describes BGTS patterns of use and costs among older Ontarians with diabetes. Costs for BGTS use are projected for the next five years and the impact of potential cost-saving scenarios, relating to reduced test frequency, are presented. [938 KB PDF]
Manuel DG, Creatore MI, Rosella LC, Henry DA. November 2009
This report benchmarks Ontario against the leading Canadian and international jurisdictions which have achieved the best overall health and health behaviours in their populations and examines how such jurisdictions have achieved their leading status. [1.33 MB PDF]
Kapral M, Hall R, Silver F, Richards J, Robertson A, Fang J. February 2009 (Revised)
This report presents data obtained from the Registry of the Canadian Stroke Network (RCSN) Ontario Stroke Audit for fiscal year 2004/05, with comparisons to the previous audit performed for fiscal year 2002/03.
The audit was conducted to evaluate the characteristics, management and outcomes of stroke patients in Ontario. These data were compared according to the Ontario Stroke System (OSS) region, by institutional designation within the Stroke Strategy (Regional Stroke Centre, District Stroke Centre, non-designated hospital), and by Local Health Integration Network (LHIN) of patient residence. [6.05 MB PDF]
The current electronic version of the report (posted April 7, 2009) is correct.
Glazier R, Moineddin R, Agha M, Zagorski B, Hall R, Manuel D, Sibley L, Kopp A. July 2008
Primary care plays a pivotal role in health care systems as the first point of access to care. According to recent surveys, nearly one in ten (nine percent) of Ontarians reported not having a regular medical doctor, and many more people said they had problems accessing primary care.
This report examines specific health system impacts related to Ontarians with chronic health conditions who did not have a primary care physician at the time they were surveyed.[1.53 MB PDF]
The outcomes of patients receiving CABG surgery at each of the 11 cardiac surgery centres in Ontariowere examined for 2005/06 and 2006/07. CABG surgery mortality rates have continued to decline despite the proportion of high-risk CABG surgery patients remaining relatively stable. In-hospital mortality rates in Ontario were among the lowest in North America (1.13% during the fiscal period 2005/06–2006/07). This is likely due to ongoing advances in perioperative CABG care. [646 KB PDF]
Iron K, Zagorski B, Sykora K, Manuel D. March 2008
Good quality health care data provide a critical foundation for health services planning, policy development and system performance evaluation. This report assesses information in the Registered Persons' Database—a population-based register maintained by the Ontario Ministry of Health and Long-Term Care to manage publicly funded health care services covered under the Ontario Health Insurance Plan (OHIP).[565 KB PDF]
The administration of universal health care in Canada produces a wide variety of health information that is routinely collected and covers large segments of the population. However, there is a need for more robust and better quality health data.
This report describes a quality assessment model to evaluate administrative data from the perspective of the data user, who is required to accurately analyze and interpret health data for service planning, decision support, performance measurement and research.[739 KB PDF]
In the fall of 2004, Canada’s First Ministers announced plans to implement a national wait time strategy (WTS). As a result, there has been a clear increase in the rate of WTS procedures. However, at the same time, there have also been anecdotal reports of decreased numbers of, and increased waits for, non-priority services. This report assesses the impact of the Ontario WTS upon various procedures both within and beyond the WTS priority areas. Trends in physician billings from 1992 to 2006 were analyzed for a range of surgical procedures—including orthopedic, ophthalmology and other high volume surgeries—to determine whether the announcement of the WTS had any effect on the rates of these procedures. [924 KB PDF]
You J, Alter D, Iron K, Slaughter P, Kopp A, Przybysz R, Thiruchelvam D, Devore L, Laupacis A. April 2007 (Revised)
Modern diagnostic testing services offer the potential for significant health benefits, and technological advances have been accompanied by a rapid proliferation of these services. Yet, it remains unclear as to whether the marked increases in utilization are sustainable, consistent with increased medical need, or a wise allocation of limited resources.
This report provides a description of the delivery of 31 different diagnostic services—focusing on diagnostic imaging—in Ontariofrom 1996/97 to 2005/06. Specifically, trends in testing over time, demographic trends, geographic variation, and patterns of repeat testing are presented. The delivery of diagnostic services—including utilization, cost and appropriateness—in several jurisdictions is also reviewed in order to highlight overall policy options for Ontario.[920 KB PDF]
Jeyanathan T, Dhalla I, Culyer T, Levinson W, Laupacis A, Martin DK, Sullivan T, Evans BK. November 2006
The Ontariolegislature recently passed Bill 102, the Transparent Drug System for Patients Act, which mandates the establishment of a Citizens’ Council. The intent of the Council is to help guide drug policy in Ontario. This report describes the theoretical and practical issues related to establishing a Citizens’ Council, present approaches used in other jurisdictions, and recommends preferred options for the Citizens’ Council proposed in the Act.[696 KB PDF]
To T, Gershon A, Tassoudji M, Guan J, Wang C, Estrabillo E, Cicutto L. September 2006
Asthma places not only a large burden on the individual, but also on society, and contributes significantly to health care costs. Yet relatively little detail about the burden of asthma on individuals and society has been studied in Canada, in general, and in Ontariospecifically.This report takes a comprehensive look at asthma in Ontarians under age 40, between 1994/95 and 2001/02, by asking the following questions:
Who has asthma?
What is the risk of an individual developing asthma?
What health care resources are being used by people with asthma?
How much does asthma cost the health care system?
What is the geographical variation of asthma in Ontario?[4,942 KB PDF]
Kapral M, Lindsay P, Silver F, Richards J, Robertson A, Shi S, Fang J. June 2006
This report presents information obtained from the Registry of the Canadian Stroke Network (RCSN) Ontario Stroke Audit for fiscal year 2002/03, which was prior to the full implementation of the Ontario Stroke Strategy and therefore provides baseline data for ongoing strategy evaluation. The audit was performed to evaluate the characteristics, management and outcomes of stroke patients in the province, with comparisons by Ontario Stroke Strategy region, by institutional designation within the Stroke Strategy (Regional Stroke Centre, District Stroke Centre, non-designated hospital), by hospital peer group (Regional Stroke Centre, academic hospital, large community hospital, small community hospital), and by Local Health Integration Network (LHIN) region.
Juurlink D, Preyra C, Croxford R, Chong A, Austin P, Tu J, Laupacis A. June 2006
High quality administrative data are essential to policy makers and health services researchers.By their nature, however, administrative data are imperfect and can be improved. Much of the research conducted at ICES relies heavily on the Canadian Institute for Health Information (CIHI) Discharge Abstract Database (DAD), which contains detailed clinical, demographic, and administrative data for hospital admissions and day surgeries throughout Canada. Recently, concern has surfaced about the accuracy of data recorded in the DAD. This report details the findings of a validation study of the CIHI DAD conducted by ICES.[615 KB PDF]
There is growing concern that the scope, level of detail and quality of health data in Ontarioare insufficient for ongoing health system evaluation, particularly at the local level. This report demonstrates how the current organization, availability and quality of health data affect our ability to evaluate different aspects of our health care system. Several generic "real world" scenarios are provided to demonstrate how the current provincial system for producing and sharing health care data is, and isn't, working.[1,143 KB PDF]
Tepper J, Schultz S, Rothwell D, Chan B. January 2006
Ontario’s extensive rural and northern regions face significant and unique challenges in the recruitment and retention of physicians. The goal of this report is to provide an understanding of these communities, and the general practitioners/family physicians and specialists who work there.
The report explores the characteristics of the different rural and northern communities; government initiatives and policies to address rural and northern physician issues; location of training, demographic profile and overall numbers of these physicians in relation to the population they serve; and, frequency of physician turnover. The report also offers several new approaches to the study of Health Human Resources (HHR) and rural issues, which can help to guide HHR policy development and resource allocation.[1,978 KB PDF]
Coburn N, Przybysz R, Law C, Barbera L, Hodgson D, Sharir S, Laupacis A. December 2005
Reducing wait times for Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) scans are a government priority and are of great concern to the public. Access to these diagnostic services is of particular concern to cancer patients.
This report examines the use of CT and MRI resources by cancer patients in Ontario, relative to the general provincial population, during the period 1993 to 2002. Specifically, ICES researchers determined the rate of utilization of CT and MRI scans for cancer patients by body site and by Local Health Integration Network (LHIN), and for the five most common types of cancer. [1,490 KB PDF]
Kapral M, Silver F, Richards J, et al. September 2005
The Registry of the Canadian Stroke Network (RCSN) was established in 2001 and is intended to be part of a comprehensive stroke surveillance system that may be used to monitor and evaluate approaches to stroke care delivery, inform policymakers and formulate recommendations for best practice in stroke management.
This report summarizes the management structure and research methodology of the RCSN, and provides some basic analyses of the characteristics, care and outcomes of stroke patients seen at participating institutions. [2,446 KB PDF]
Tu J, Donovan L, Lee D, Ko D, Austin P, Wang J, Newman A. September 2005
Eighty-five Ontario acute care hospital corporations (103 hospitals) are participating in the EFFECT (Enhanced Feedback for Effective Cardiac Treatment) study.The study’s second report, Quality of Cardiac Care in Ontario Group B Delayed Feedback Hospitals, describes the performance of the 41 Ontario hospital corporations randomized to receive delayed feedback.
The purpose of the EFFECT study is to:
Set national benchmarks for cardiac care;
Produce cardiac report cards that measure performance;
Provide hospitals with the information needed to minimize the gap between current practice and ideal care; and,
Test the utility of report cards as a catalyst for change.
The face of family medicine has changed substantially with a decreasing physician supply, an aging workforce, and less comprehensive care. These trends are significant because primary care practitioners are critical to accessing the health system, as they serve as a first line of contact for patients and a venue for accessing specialized services.
This report examines trends affecting the sustainability of Ontario's primary care workforce, and recommends increased vigilance in reviewing and monitoring the impact of established policies governing physician supply and models of care, as well as evolving social trends. [2,686 KB PDF]
Many clinical and policy questions related to outcomes and costs have arisen following the recent introduction of a group of nonsteroidal anti-inflammatory drugs (NSAIDs), selective cyclooxygenase (COX-2) inhibitors, to drug formularies.
The purpose of this report is to:
Examine clinically relevant outcomes associated with COX-2 inhibitors relative to nonselective NSAIDS among an elderly population;
Examine changes in population costs to the health care system and clinical outcome rates following the introduction of the COX-2 inhibitors onto the Ontario Drug Benefit formulary; and
Examine basic adherence rates associated with COX-2 inhibitors and nonselective NSAIDS among an elderly population.[564 KB PDF]
Anderson GM, Bassett K and the BC-Ontario Pharmacosurveillance for Decision-Making Collaborative. June 2005
Provincial drug plan managers seek real world evidence regarding the safety and effectiveness of drugs and drug coverage policies. University-based researchers with access to routinely gathered health administrative data can help to meet these information needs. In this collaborative report, Ontario- and British Columbia-based researchers describe an effort to:
Work with formulary decision-makers in the two provinces to identify pharmacosurveillance information needs;
Develop and refine techniques for producing such evidence; and,
Assess its impact upon formulary decision-making. [446 KB PDF]
Neurosurgical resourceshave been stretched to capacity, and, in some circumstances, beyond. Ontario could soon face a severe shortage of neurosurgeons and related specialists unless important changes are made immediately.
The report describes:
Types of services and providers;
Current and future demand/supply of services;
Emerging treatments; and,
Current technology.
This report provides workable recommendations to mitigate system-level medical staffing and technology issues affecting access to neurosurgery, complex spinal surgery, and interventional neuroradiology. [4,344 KB PDF]
Quality health care data is essential to plan and improve the quality, efficiency and equity of health care services. In other jurisdictions, substantial investments in health care data have transformed the performance and efficiency of health care delivery, for example, the U.S. Department of Veterans’ Affairs.
This report provides a description of the usefulness and limitations of existing provincial data for services provided within Ontario’s publicly funded health care system health. Chief concerns addressed include: comprehensiveness, completeness, accuracy, timeliness, linkability, anonymity and consistency over time. In particular, the report describes uses of available data and outlines the improvements required to meet the Ontario health care system’s growing information needs.
Dick P, Kavanagh L, Spalding K, McKeever P. January 2005
Children represent a small, though important, segment of the population, and consume a wide spectrum of health care services. This report provides a descriptive bird’s-eye view of how ambulatory treatment services are distributed, coordinated and utilized in Ontario. Services examined include medical and nursing, rehabilitation and developmental, and mental health. Specifically this included well child, newborn and minor assessments, general assessments, and consultations for three classes of physicians [generalists, pediatric specialists, and “other” (otolaryngology, ophthalmology, optometry, psychiatry and chiropractic)].
Comprehensive research that included meetings with stakeholders, surveys of health service delivery organizations, focus groups, and administrative data analysis, illuminates the need for a blueprint for a cohesive delivery strategy for children’s services.
Diagnosis and management of cardiovascular disease relies heavily on non-invasive cardiac testing (NICT). While NICT helps shape clinical decisions, the vast majority of tests are done on a discretionary basis. Utilization rates in Ontario, and elsewhere, have risen exponentially over the last decade.
Together, six NICTs accounted for nearly a quarter of a billion dollars in direct annual health expenditures in Ontario. This report focuses on utilization of the six most prevalent NICT tests, namely: electrocardiography; stress testing or graded exercise treadmill testing; echocardiography; holter monitoring or ambulatory electrocardiography; myocardial perfusion imaging; and, wall motion studies, including radionuclide angiography.[1,458 KB PDF]
Public health has a mandate to promote and protect health and prevent disease in the population. Recent events such as the Walkerton tainted water crisis, SARS, and West Nile Virus have reinforced the critical role of public health and the importance of performance assessment and accountability.
This report illustrates the principles involved in developing a balanced scorecard to facilitate improvements in service quality and effectiveness, and to support strategic and operational planning. [1,221 KB PDF]
To T, Dell S, Dick P, Cicutto L, Harris J, Tassoudji M, Duong-Hua M. May 2004
Asthma is the most common chronic childhood illness in North America. Although prevalence estimates derived from cross-sectional survey data are useful, they are less informative than estimates calculated from population-based longitudinal surveillance.
This report presents Canada's first longitudinal surveillance program implemented to examine the burden of asthma on Ontario's children and on the provincial health care system. [1,418 KB PDF]
Woodward G, Stukel T, Schull M, Gunraj N, Laupacis A. May 2004
In late February 2003, a Canadian resident returned from Hong Kong with what later became known as Severe Acute Respiratory Syndrome (SARS). The spread of this disease within the Greater Toronto Area (GTA) during the next few months would directly impact hundreds of Ontario residents. As of August 2003, there had been 438 probable and suspect cases in Canada, including 44 deaths, the majority in the GTA.
This study examines how the health system and public response to the SARS outbreak affected utilization of non-SARS related health services.
Iron K, Jaakkimainen L, Rothwell D, Li P, Laupacis A. April 2004
Low back pain (LBP) will be experienced by more than 70 percent of people throughout the developed world at some point in their lifetime.
This report examines use of radiology for LBP in Ontario, reviews Ontario-specific and international guidelines for clinical management of LBP, and explores temporal and geographic trends of lumbar spine X-rays, spinal CT, and MRI across the province.
Laupacis A, Paszat L, Hodgson D, Benk V. April 2004
Introduced in 2001, the ICES reportHealth Technology Assessment of PETpresented an extensive review of relevant literature from 1975 to 2000 to determine the potential use of PET scanning in diagnosing certain types of cancer and other diseases.
Between February 2003 and April 2004, this report was regularly updated with a review of the most recent literature on the clinical applications of PET among six commonly occurring categories of cancer: carcinoma of the lung, colorectal carcinoma, squamous carcinoma of the head and neck, carcinoma of the breast, malignant lymphoma, and malignant melanoma.
Tu J, Donovan L, Lee D, Ko D, Austin P, Wang J, Newman A. January 2004
Cardiovascular disease is the leading cause of death in Canada, claiming over 78,000 lives each year. While there have been significant improvements in treatments and therapies, the uptake of these advances into practice has been slow.
The purpose of the EFFECT study is to:
Set national benchmarks for cardiac care;
Produce cardiac report cards that measure performance;
Provide hospitals with the information needed to minimize the gap between current practice and ideal care;
Test the utility of report cards as a catalyst for change.
Paterson M, Bassett K, Mamdani M, Wright J, Naglie G, Laupacis A, Anderson G. November 2003
Concern over the cost and appropriate use of new drugs has led provinces to look at various policies for drug coverage under provincial drug plans. While some drugs are covered as a general benefit, and will be routinely paid for, others are covered only when information is provided to demonstrate use in specific clinical situations.
This study examined the use of two new classes of drugs – cyclo-oxygenase-2 (COX-2) inhibitors and atypical neuroleptics – prescribed to persons aged 65 years and older under different drug coverage policies in Ontario and BC. [1,173 KB PDF]
Timely access to MRI (magnetic resonance imaging) is of concern to patients, health care providers and governments. Long and growing wait times have recently been reported by various health organizations, however, despite the focus on health system accountability, comprehensive and timely information about access to, and use of, MRI in Ontario is not available.
This report examines MRI utilization in the province and evaluates appropriateness of use and wait times using available data. A series of recommendations are provided that would help to ensure that the necessary information is collected to support informed decision-making regarding MRI services in Ontario.
Bondy S, Slaughter P, Przybysz R, Benk V. December 2002
In recent years, waiting times for radiation therapy in Ontario have increased markedly causing growing concern for cancer patients, health care providers and government. Monitoring and reducing wait times is an important goal, yet, adequate data has not been available to determine if efforts to expand treatment capacity and shorten waiting times are working (e.g. out of region/province treatment and extended hours of care).
Commissioned by the Ministry of Health and Long-term Care, this report examines existing data to: determine the extent of the problem; make evidence-based recommendations on target timelines for delivery of radiation therapy; and establish requirements to implement a waiting times reporting system. [1,776 KB PDF]
Mamdani M, Paterson M, Laupacis A, Handa K, Jacka R. June 2002
Large academic health sciences centres are typically viewed as innovators in health care delivery and are often the first to utilize cutting edge diagnostic and therapeutic modalities. With the advent of several new and expensive drugs, there is concern that hospitals will not be able to afford these drugs or that such medications will be provided at the expense of other important hospital services.
Commissioned by the Ontario Council of Teaching Hospitals (OCOTH), this report identifies options for how hospitals, in particular, and the health care system, in general, might optimize the funding and use of expensive new medicines. [4,396 KB PDF]
Prostate cancer screening in asymptomatic men remains an area of significant controversy, with the potential benefits and harms continuing to be debated among health professionals and the public after more than a decade of use.
This report reviews the current evidence regarding the effectiveness of screening for prostate cancer in asymptomatic men, using a blood test called prostate-specific antigen (PSA).
Blackstien-Hirsch P, Golligh J, Hawker G, Kreder H, Mahomed N, Williams J. August 2000
Total hip and knee replacements are the definitive treatments for reducing pain and disability caused by arthritic disease or injury of the lower limbs. Over the fiscal years 1993/94 to 1998/99, the number of total hip replacements in Ontario increased by 22%, from 6,000 to 8,000 procedures, while total knee replacements increased by 54%, from 6,000 to 9,200 procedures.
This report provides recommendations for a system to supply information on waiting lists, severity ratings, wait times and patient outcomes following primary total hip and knee replacements. It also gives health care providers the tools to prioritize patients with respect to clinical condition, pain and degree of disability, and manage waiting lists. [364 KB PDF]
McKillop I, Pink G, Porter J, Schraa E. August 2000
This investigative report presents the findings from two studies that examine issues related to data quality in the classification and reporting of financial and operational activity data by Ontario hospitals. It focuses on hospitals' use of the prescribed reporting framework of the Ontario Hospital Reporting System (OHRS) during its first five years.
The study is intended to stimulate discussion among researchers, policymakers and hospital administrators regarding steps that could be taken to minimize the number of unexpected or unusual balances found in the year-end submissions by hospitals, which will ultimately improve the quality of the data used to support decision-making. [415 KB PDF]
Statistical and financial data are used extensively for decision-making at all levels of health care systems in many jurisdictions. The purpose of this report is to evaluate the quality of hospital-specific statistical and financial data for hip and knee replacement surgeries that have been organized and reported in accordance with the Ontario Hospital Reporting System (OHRS) Guidelines.
Specifically, this report examines the completeness, consistency and reasonableness of orthopedic surgery-related administrative data over a three-year period. Discharge abstract data from the Canadian Institute for Health Information (CIHI) was compared with procedure-specific statistical and financial data from hospital accounting systems according to Ontario Hospital Reporting System (OHRS) guidelines. [160 KB PDF]
As the mental health care system shifts from an institutional to community-based model of care, a lack of focus on the second largest sector of care delivery has become evident. This report analyzes the evolving role of fee-for-service physicians, particularly of family physicians and psychiatrists, in the provision of mental health care.
The report compares data on mental health care from 1992/93 and 1997/98 and looks at regional spending patterns, extent and nature of ‘shadow’ care, recipients of mental health care by general practitioner, psychiatrist or both, frequent users and types of services received, and changes over time. [447 KB PDF]
Szick S, Angus D, Nichol G, Harrison M, Page J, Moher D. June 1999
Almost four decades ago, Canada and the United States had very similar health care systems. Now, the Canadian system is primarily publicly funded, and in contrast, the American system is predominantly privately funded. The question of whether the health outcomes of patients are equivalent in both systems was investigated in this report by a systematic review of 18 relevant studies on the subject.
Since Canada’s current health care environment consists of resource constraints, restructuring of health services and an aging population, this project focused on potential implications for future health care programming and policy at the individual and population levels. [171 KB PDF]
Slaughter P, Pinfold P, Flintoft V, Gort E, Thiel E, Blackstien-Hirsch P, Axcell T, Paterson M, Cameron C, Estabrooks C, Mercer S, Goel V, Williams J. May 1999
ICES conducts health services research using a diverse range of quantitative and qualitative methods. This report features advice and information for conducting various types of focus groups, such as interviews with lay public, stakeholder panel discussions and facilitated multi-physician discussions. Useful ‘how to’ content includes sample consent forms, checklists, budgets, and descriptions of deliverables.
Stroke is a complex and devastating disease, requiring a multidisciplinary and integrated approach to care. This report provides an inventory of stroke care programs at acute, rehabilitation and complex continuing care hospitals in Ontario.
In particular, the report examines hospital resources and programs for stroke patients, access to rehabilitation resources and imaging technology, readiness of hospitals to administer thrombolytic therapy, and regional referral patterns. The results demonstrate wide variations in access to various types of stroke diagnostic services and treatments in Ontario and indicate the need to develop a more coordinated stroke care delivery program.
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