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Biomedical subjects

Hude Quan

Publications and source records attributed to Hude Quan.

44 records · Page 3Linked to original sources
PubMed2002

Health service costs for patients on the waiting list.

OBJECTIVE: To find out if the cost of health services was artificially increased because of a delay in surgery due to a lack of resources. DESIGN: A retrospective cohort study. SETTING: Three urban hospitals in Calgary, Alta. PATIENTS: The study cohort comprised 4441 patients (1 index procedure for each patient). INTERVENTIONS: Cholecystectomy, discectomy, hysterectomy, total knee and total hip replacements. OUTCOME MEASURES: The costs for physician claims, use of home care and pharmaceutical prescriptions 1 year before and after the selected procedures, using 1997/98 administrative records and waiting times maintained by Alberta Health and Wellness and Calgary Regional Health Authority. RESULTS: The median wait for joint surgery (88 d for knee replacements and 65 d for hip replacements) was longer than for the other selected procedures (29 d for cholecystectomies, 21 d for discectomies and 42 d for hysterectomies). Total per patient physician claim costs decreased after surgery (cholecystectomy--30%, discectomy--24%, hip replacement--6%, hysterectomy--23% and knee replacement--4%). Seeing the procedure specialist more than once preoperatively was associated with a greater decrease in postoperative physician claim costs. Longer waits were not associated with more physician claim costs or Blue Cross prescriptions claim costs for seniors (> or = 65 yr) in the year before or after surgery nor were they associated with more physician claim costs during the actual wait compared with a matched postoperative time period. CONCLUSIONS: No evidence was found to suggest that waiting for 1 of 5 common surgical procedures is correlated with greater health service expenditures pre- or postoperatively. In this study, wait time is not a proxy for health service use nor do health service costs decrease markedly after surgery.

Alberta↗
PubMed2002

Patient profiles at a centralized, urban, diabetes education centre.

BACKGROUND: Little is known about the characteristics of patients attending diabetes education centres (DECs). To address this knowledge gap, we examined the clinical characteristics of patients referred to a centralized urban DEC. METHODS: Using a clinically detailed patient registry, we studied the profiles of 1459 patients seen in an urban DEC, and compared patients referred to the DEC by family physicians (FPs) to those referred by other physicians (usually specialists), and patients referred to the DEC for the first time to those who had been referred a number of times (multiply-referred patients). RESULTS: Among patients with a known source of referral, 73% were referred by their FP and 27% by a physician other than the FP. Eighty-seven percent of patients were being referred for the first time, and 13% had previous referrals. Blood glucose control at the time of referral was poorer for non-FP referrals and for multiply-referred patients. Patients in the former subgroup were more likely taking insulin when referred (38% v. 12%, p < 0.000), to have type 1 diabetes (19% v. 8%, p < 0.000) and to be referred for insulin initiation (12% v. 2%, p < 0.000) than were FP referrals. Meanwhile, multiply-referred patients were younger (51.9 v. 56.1 yr, p < 0.000) and were more likely to be female (59% v. 46%, p = 0.001) than were patients referred only once. INTERPRETATION: Source of referral (FP v. non-FP) and presence or absence of previous referrals define unique DEC patient subgroups. Attention to the relative size and service needs of these subgroups is relevant to the planning of diabetes services.

Aged↗
PubMedDate not supplied

Utilization of a preoperative assessment clinic in a tertiary care centre.

OBJECTIVE: To describe the utilization of a preoperative assessment clinic (PAC) by various surgical divisions, and the types of consultations sought by those divisions. DESIGN: Cross-sectional descriptive study of PAC utilization. SETTING: A large university-affiliated tertiary care centre. PATIENTS: All patients who underwent surgical procedures by selected surgical divisions between July 1, 1996, and Mar. 31, 1998. MEASUREMENTS: The number of patients referred to the centre's PAC, utilization by surgical division, and the types of consultation obtained (general internal medicine, anesthesia, cardiology, intensive care). Adjusted rates of consultations were determined by logistic regression, controlling for age, sex, comorbidity and major versus minor procedure. RESULTS: Of 9603 surgical cases, 5725 (60%) were referred to the PAC. The adjusted rates of PAC utilization ranged from a low of 46% for cardiovascular and thoracic surgery to a high of 72% for general surgery. The adjusted rates of general internal medicine consultations ranged from 5% for oral surgery to 33% for otolaryngology. For anesthesia consultations, the rates ranged from 6% for orthopedics to 39% for general surgery. Increasing age (odds ratio [OR] = 1.14 for 10-year age increments), female sex (OR = 1.23), major surgery (OR = 1.94) and a number of comorbidity variables were significant predictors of PAC referral on multivariable analysis. CONCLUSIONS: PAC utilization varies across surgical divisions and in the types of consultation sought, even when controlling for age, sex, comorbidity and type of procedure. The potential exists for standardized PAC referral guidelines to reduce these variations.

Alberta↗
PubMedDate not supplied

A home study-based spirituality education program decreases emotional distress and increases quality of life--a randomized, controlled trial.

CONTEXT: Although epidemiological studies have reported protective effects of religion and spirituality on mental health, it is unknown whether spirituality can be used as an intervention to improve psychological well-being. OBJECTIVE: To evaluate the efficacy of a home study-based spirituality program on mood disturbance in emotionally distressed patients. DESIGN, SETTING, AND PARTICIPANTS: A non-blinded, randomized, wait list-controlled trial of 165 individuals with mood disturbance [score of >40 on the Profile of Mood States (POMS)] were recruited from primary care clinics in a Canadian city between August 2000 and March 2001. INTERVENTIONS: Participants were randomized to a spirituality group (an 8-week audiotaped spirituality home-study program), a mindfulness meditation-based stress reduction group (attendance at facilitated classes for 8 weeks), or a wait-list control group (no intervention for 12 weeks). MAIN OUTCOME MEASURES: Primary outcomes were mood disturbance, measured using POMS, and quality of life, measured using the SF-36, a short-form health survey with 36 questions. The POMS and the SF-36 were completed at baseline, at 8 weeks, and at 12 weeks. RESULTS: At the end of the 8-week intervention period, the mean POMS score improvement was -43.1 (-45.7%) for the spirituality group, -22.6 (-26.3%) for the meditation group, and -10.3 (11.3%) for the control group (P<.001 for spirituality vs control group; P=.034 for spirituality vs meditation group). Mean improvement in the SF-36 mental component summary score was 14.4 (48.6%) for the spirituality group, 7.1 (22.3%) for the meditation group, and 4.7 (16.1%) for the control group (P<.001 for spirituality vs control group; P=.029 for spirituality vs meditation group). At 12 weeks, POMS and SF-36 scores remained significantly different from baseline for the spirituality group.

Adult↗