Variability of waiting times for the 4 most prevalent cancer types in Ontario: a retrospective population-based analysis.
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ABSTRACT: Background
Longer waiting times in cancer care are associated with lower care quality and wait-related patient dissatisfaction. We analyzed the variability and median of waiting times from when a patient seeks care to first treatment for the 4 most prevalent cancer types in Ontario.Methods
Using retrospective health administrative data, we identified patients with a new diagnosis of prostate, breast, lung or colorectal cancer in Ontario between 2002 and 2012. Treatment interventions were categorized as chemotherapy, radiotherapy or surgery. We used regression analyses to calculate trends for the coefficient of variation, the Gini coefficient and the median waiting time for each cancer type-treatment type pair over the study period.Results
During the study period, 95 501 new cases of prostate cancer, 89 244 breast cancer cases, 82 604 lung cancer cases and 80 761 colorectal cancer cases were registered. The coefficient of variation and the Gini coefficient of waiting times decreased for all cancer type-treatment type pairs (except for the Gini coefficient for breast cancer-radiotherapy) over the study period. However, both decreasing and increasing trends in median waiting times were observed across cancer type-treatment type pairs.Interpretation
The variability of waiting time to first treatment for patients with prostate, breast, lung or colorectal cancer decreased between 2002 and 2012, which indicates improvements in equity in access to cancer care. This trend aligns with provincial efforts to improve access to and the efficiency of cancer care treatment in Ontario. The lack of consistent decreases in median waiting time highlights the need to identify improvement opportunities for cancer type-treatment type pairs with increasing median waiting times.
SUBMITTER: Rastpour A
PROVIDER: S-EPMC6117805 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveTo determine whether patients who are not admitted to hospital after attending an emergency department during shifts with long waiting times are at risk for adverse events.DesignPopulation based retrospective cohort study using health administrative databases. Setting High volume emergency departments in Ontario, Canada, fiscal years 2003-7.ParticipantsAll emergency department patients who were not admitted (seen and discharged; left without being seen).Outcome measuresRisk of adverse events (admission to hospital or death within seven days) adjusted for important characteristics of patients, shift, and hospital.Results13,934,542 patients were seen and discharged and 617,011 left without being seen. The risk of adverse events increased with the mean length of stay of similar patients in the same shift in the emergency department. For mean length of stay ≥ 6 v <1 hour the adjusted odds ratio (95% confidence interval) was 1.79 (1.24 to 2.59) for death and 1.95 (1.79 to 2.13) for admission in high acuity patients and 1.71 (1.25 to 2.35) for death and 1.66 (1.56 to 1.76) for admission in low acuity patients). Leaving without being seen was not associated with an increase in adverse events at the level of the patient or by annual rates of the hospital.ConclusionsPresenting to an emergency department during shifts with longer waiting times, reflected in longer mean length of stay, is associated with a greater risk in the short term of death and admission to hospital in patients who are well enough to leave the department. Patients who leave without being seen are not at higher risk of short term adverse events.
| S-EPMC3106148 | biostudies-literature
Project description:BACKGROUND:Cancer Waiting Time targets have been integrated into successive cancer strategies as indicators of cancer care quality in England. These targets are reported in national statistics for all cancers combined, but there is mixed evidence of their benefits and it is unclear if meeting Cancer Waiting Time targets, as currently defined and published, is associated with improved survival for individual patients, and thus if survival is a good metric for judging the utility of the targets. METHODS AND FINDINGS:We used individually-linked data from the National Cancer Waiting Times Monitoring Dataset (CWT), the cancer registry and other routinely collected datasets. The study population consisted of all adult patients diagnosed in England (2009-2013) with colorectal (164,890), lung (171,208) or ovarian (24,545) cancer, of whom 82%, 76%, and 77%, respectively, had a CWT matching record. The main outcome was one-year net survival for all matched patients by target attainment ('met/not met'). The time to each type of treatment for the 31-day and 62-day targets was estimated using multivariable analyses, adjusting for age, sex, tumour stage and deprivation. The two-week wait (TWW) from GP referral to specialist consultation and 31-day target from decision to treat to start of treatment were met for more than 95% of patients, but the 62-day target from GP referral to start of treatment was missed more often. There was little evidence of an association between meeting the TWW target and one-year net survival, but for the 31-day and 62-day targets, survival was worse for those for whom the targets were met (e.g. colorectal cancer: survival 89.1% (95%CI 88.9-89.4) for patients with 31-day target met, 96.9% (95%CI 96.1-91.7) for patients for whom it was not met). Time-to-treatment analyses showed that treatments recorded as palliative were given earlier in time, than treatments with potentially curative intent. There are possible limitations in the accuracy of the categorisation of treatment variables which do not allow for fully distinguishing, for example, between curative and palliative intent; and it is difficult in these data to assess the appropriateness of treatment by stage. These limitations in the nature of the data do not affect the survival estimates found, but do mean that it is not possible to separate those patients for whom the times between referral, decision to treat and start of treatment could actually have an impact on the clinical outcomes. This means that the use of these survival measures to evaluate the targets would be misleading. CONCLUSIONS:Based on these individually-linked data, and for the cancers we looked at, we did not find that Cancer Waiting Time targets being met translates into improved one-year survival. Patients may benefit psychologically from limited waits which encourage timely treatment, but one-year survival is not a useful measure for evaluating Trust performance with regards to Cancer Waiting Time targets, which are not currently stratified by stage or treatment type. As such, the current composition of the data means target compliance needs further evaluation before being used for the assessment of clinical outcomes.
| S-EPMC6104918 | biostudies-literature
Project description:BackgroundPsychotherapy is recommended as a first-line treatment for the management of common psychiatric disorders. The objective of this study was to evaluate the availability of publicly funded psychotherapy provided by physicians in Ontario by describing primary care physicians (PCPs) and psychiatrists whose practices focus on psychotherapy and comparing them to PCPs and psychiatrists whose practices do not.MethodsThis was a population-based retrospective cohort study. We included all PCPs and psychiatrists in Ontario who submitted at least 1 billing claim to the Ontario Health Insurance Plan between Apr. 1, 2015, and Mar. 31, 2016, and categorized them as psychotherapists if at least 50% of their outpatient billings were related to the provision of psychotherapy. We measured practice characteristics such as total number of patients and new patients, and average visit frequency for 4 physician categories: PCP nonpsychotherapists, PCP psychotherapists, psychiatrist nonpsychotherapists and psychiatrist psychotherapists. We also measured access to care for people with urgent need for mental health services.ResultsOf 12 772 PCPs, 404 (3.2%) were PCP psychotherapists; of 2150 psychiatrists, 586 (27.3%) were psychotherapists. Primary care physician nonpsychotherapists had the highest number of patients and number of new patients, followed by psychiatrist nonpsychotherapists, PCP psychotherapists and psychiatrist psychotherapists. Primary care physician nonpsychotherapists had the lowest average annual number of visits per patient, whereas both types of psychotherapists had a much greater number of visits per patient. Primary care physician and psychiatrist nonpsychotherapists saw about 25% of patients with urgent needs for mental health services, whereas PCP and psychiatrist psychotherapists saw 1%-3% of these patients.InterpretationPhysicians who provide publicly funded psychotherapy in Ontario see a small number of patients, and they see few of those with urgent need for mental health services. Our findings suggest that improving access to psychotherapy will require the development of alternative strategies.
| S-EPMC7065559 | biostudies-literature
Project description:ObjectiveTo examine the relationship between multimorbidity and mortality, and whether relationship varied by material deprivation/rural location and by age.MethodsRetrospective population-based cohort study conducted using 2013-14 data from previously created cohort of Ontario, Canada residents classified according to whether or not they had multimorbidity, defined as having 3+ of 17 chronic conditions. Adjusted rate ratios were calculated to compare mortality rates for those with and without multimorbidity, comparing rates by material deprivation/rural location, and by age group.ResultsThere were 13,581,191 people in the cohort ages 0 to 105 years; 15.2% had multimorbidity. Median length of observation was 365 days. Adjusted mortality rate ratios did not vary by material deprivation/rural location; overall adjusted mortality rate ratio was 2.41 (95% CI 2.37-2.45). Adjusted mortality rate ratios varied by age with ratios decreasing as age increased. Overall rate ratio was 14.7 (95% CI 14.48-14.91). Children (0-17 years) had highest ratio, 40.06 (95% CI 26.21-61.22). Youngest adult age group (18-24 years) had rate ratio of 9.96 (95% CI 7.18-13.84); oldest age group (80+ years) had rate ratio of 1.97 (95% CI 1.94-2.04).ConclusionCompared to people without multimorbidity, multimorbidity conferred higher risk of death in this study at all age groups. Risk was greater in early and middle adulthood than in older ages. Results reinforce the fact multimorbidity is not just a problem of aging, and multimorbidity leads not only to poorer health and higher health care utilization, but also to a higher risk of death at a younger age.
| S-EPMC7457707 | biostudies-literature
Project description:Endoscopic ultrasonography is a safe and accurate modality for evaluating and managing hepatobiliary and gastrointestinal conditions (malignant and nonmalignant); its use is increasing. The aim of this study was to describe regional trends in the use of endoscopic ultrasonography in Ontario.We conducted a population-based retrospective cohort study using health administrative databases. We identified all patients who underwent an endoscopic ultrasound procedure in Ontario from 2003 to 2011 using physician billing data. Patient, physician and institution characteristics were examined. The primary outcome was use of endoscopic ultrasonography.We identified 9076 endoscopic ultrasound procedures performed in 8001 patients (3858 women [48.2%]; median patient age at first procedure 59 years). A total of 3066 procedures (33.8%) involved fine-needle aspiration. Use of endoscopic ultrasonography increased 17-fold over the study period. In 2011, people living in the health region with the highest rate of use of endoscopic ultrasonography were more than 4 times more likely to undergo the procedure than people living in the health region with the lowest rate of use (standardized rate 61.6 v. 12.9 per 100?000). About 7 in 10 endoscopic ultrasound procedures were performed in an academic institution or regional cancer centre. All 17 endoscopists performing endoscopic ultrasonography during the study period practised in urban areas.Although the use of endoscopic ultrasonography increased over time in Ontario, there were marked regional differences in use. Provincial needs- and evidence-based initiatives may be needed to narrow the regional gaps in provision of endoscopic ultrasound services in the province.
| S-EPMC5498178 | biostudies-other
Project description:ObjectivesImmigrants are thought to be healthier than their native-born counterparts, but less is known about the health of refugees or forced migrants. Previous studies often equate refugee status with immigration status or country of birth (COB) and none have compared refugee to non-refugee immigrants from the same COB. Herein, we examined whether: (1) a refugee mother experiences greater odds of adverse maternal and perinatal health outcomes compared with a similar non-refugee mother from the same COB and (2) refugee and non-refugee immigrants differ from Canadian-born mothers for maternal and perinatal outcomes.DesignThis is a retrospective population-based database study. We implemented two cohort designs: (1) 1:1 matching of refugees to non-refugee immigrants on COB, year and age at arrival (±5 years) and (2) an unmatched design using all data.Setting and participantsRefugee immigrant mothers (n=34 233), non-refugee immigrant mothers (n=243 439) and Canadian-born mothers (n=615 394) eligible for universal healthcare insurance who had a hospital birth in Ontario, Canada, between 2002 and 2014.Primary outcomesNumerous adverse maternal and perinatal health outcomes.ResultsRefugees differed from non-refugee immigrants most notably for HIV, with respective rates of 0.39% and 0.20% and an adjusted OR (AOR) of 1.82 (95% CI 1.19 to 2.79). Other elevated outcomes included caesarean section (AOR 1.04, 95% CI 1.00 to 1.08) and moderate preterm birth (AOR 1.08, 95% CI 0.99 to 1.17). For the majority of outcomes, refugee and non-refugee immigrants experienced similar AORs when compared with Canadian-born mothers.ConclusionsRefugee status was associated with a few adverse maternal and perinatal health outcomes, but the associations were not strong except for HIV. The definition of refugee status used herein may not sensitively identify refugees at highest risk. Future research would benefit from further refining refugee status based on migration experiences.
| S-EPMC5898303 | biostudies-literature
Project description:BackgroundCancer survival is known to be associated with socioeconomic status. The income gap between the richer and poorer segments of the population has widened over the last 20 years in Canada. The purpose of this study was to investigate temporal trends in disparities in cancer-specific survival related to socioeconomic status in Ontario.MethodsThere were 920 334 cancer cases between 1993 and 2009 in the Ontario Cancer Registry. We linked median household income from the Canadian census to the registry. We calculated 5-year cancer-specific survival rates for all cancers combined and for specific cancer sites by socioeconomic status quintile and year of diagnosis, and modelled time to death using Cox regression.ResultsBetween 1993 and 2009, for all cancers combined, the hazard of death decreased by 3.1% (hazard ratio [HR] 0.969 [95% confidence interval (CI) 0.967-0.971]) per year in the richest quintile and by 1.2% (HR 0.988 [95% CI 0.987-0.990]) per year in the poorest quintile. The corresponding values for breast cancer were 4.3% (HR 0.957 [95% CI 0.951-0.964]) and 2.0% (HR 0.980 [95% CI 0.975-0.986]); for lung cancer, 1.4% (HR 0.986 [95% CI 0.982-0.990]) and 0.3% (HR 0.997 [95% CI 0.995-1.000]); for colorectal cancer, 3.7% (HR 0.963 [95% CI 0.958-0.968]) and 1.8% (HR 0.982 [95% CI 0.978-0.985]); and for head and neck cancer, 3.1% (HR 0.969 [95% CI 0.958-0.979]) and 1.0% (HR 0.990 [95% CI 0.983-0.996]).InterpretationBetween 1993 and 2009, cancer-specific survival in Ontario improved more among patients from affluent communities than among those from poorer communities. This phenomenon cannot be explained by increased disparity in income.
| S-EPMC5621958 | biostudies-literature
Project description:This paper aims to analyse the variation in the delivery of diagnostic imaging services in order to suggest possible solutions for the reduction of waiting times, increase the quality of services and reduce financial costs. This study provides a logic model to manage waiting times in a regional context. Waiting times measured per day were compared on the basis of the variability in the use rates of CT and MRI examinations in Tuscany for the population, as well as on the basis of the capacity offered with respect to the number of radiologists available. The analysis was performed at the local health authority level to support the decision-making process of local managers. Diagnostic imaging services, in particular the CT and MRI examinations. The study involved all the 12 local health authorities that provide services for 3.7 million inhabitants of the Italian Tuscany Region. the study uses regional administrative data on outpatients and survey data on inpatient diagnostic examinations in order to measure productivity. The study uses the volumes per 1000 inhabitants, the days of waiting times and the number of examinations per radiologist. Variability was measured using the traditional SD measures. A significant variation in areas considered homogeneous in terms of age, gender or mortality may indicate that the use of radiological services is not optimal and underuse or overuse occurs and that there is room for improvement in the service organisation. Considering that there is a high level of variability among district use rates and waiting times, this study provides managers with a specific tool to find the cause of the problem, identify a possible solution, assess the financial impact and initiate the eventual reduction of waste.
| S-EPMC3533122 | biostudies-literature
Project description:This audit was conducted to measure waiting times for systemic cancer therapy across the United Kingdom. All patients, aged 16 years or older, commencing their first course of systemic therapy between 13 November and 19 November 2006 were eligible for inclusion. Data on 936 patients from 81 hospital sources were collected. Systemic therapy is largely given in compliance with national waiting time targets. In terms of the Joint Council for Clinical Oncology (JCCO) targets, 84% of patients commence treatment within 21 days and 98% of patients complied with the Department of Health target that treatment should follow within 31 days of the decision being agreed with the patient. Only 76% complied with the Department of Health 62-day target from GP referral to first definitive treatment. However, the date of urgent referral by the GP was not submitted for most patients in our survey, leaving a sample of only 84 out of 936 patients (9% of total) suitable for this analysis. There was only a 3- to 5-day difference between the waiting times for systemic therapy for patients categorised as urgent compared with routine. Locally agreed definitions had little impact on patients' priority for treatment. This audit has established a baseline measurement of waiting times for systemic therapy across the United Kingdom. The continuing introduction of novel therapies is likely to have a significant effect on the service and we recommend that service managers model the likely impact on resource requirements. In addition, urgent treatment should be clearly defined as that required within 24 h (maximum 48 h) to avoid the risk of clinical deterioration, particularly in patients with acute leukaemia, lymphoma or germ cell tumour.
| S-EPMC2528160 | biostudies-other
Project description:IntroductionEvidence suggests that many risk factors for cancer are overrepresented in people who experience incarceration, and data on cancer epidemiology are limited for this population. We aimed to describe cancer prevalence, incidence and mortality in adults admitted to provincial custody in Ontario, Canada in 2000.MethodsWe linked data on 48,166 adults admitted to provincial custody in Ontario in 2000 with Ontario Cancer Registry data to 2012. We calculated cancer prevalence in the 10 years prior to admission to custody in 2000, incidence between 2000 and 2012 and mortality between 2000 and 2011. Standardized for age, we calculated incidence and mortality ratios by sex compared to the general population of Ontario.ResultsThe 10-year cancer prevalence was 0.4% in men and 0.6% in women at admission to provincial custody in 2000. Between 2000 and 2012, 2.6% of men and 2.8% of women were diagnosed with new cancer. The standardized incidence ratio for cancer was 1.0 (95% CI 0.9-1.0) for men and 0.9 (95% CI 0.7-1.0) for women compared to the general population, and was significantly increased for cervical, head and neck, liver and lung cancers. The standardized mortality ratio was 1.6 (95% CI 1.4-1.7) in men and 1.4 (95% CI 1.0-1.9) in women, and was significantly increased for head and neck, liver, and lung cancers.ConclusionsThere is an excess burden of cancer in people who experience incarceration. Cancer prevention should include people who experience incarceration, and the period of incarceration may offer an opportunity for intervention.
| S-EPMC5321272 | biostudies-literature