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154. Why do family physicians fail to detect renal impairment?

Author

Hogg, William, Rowan, Margo S., Lemelin, Jacques, Swedko, Peter J., Magner, Peter O., Clark, Heather D., and Akbari, Ayub

Subjects
Adult, Aged, 80 and over, Male, Ontario, Research, Decision Making, Physicians, Family, Health Care Surveys, Humans, Education, Medical, Continuing, Female, Renal Insufficiency, Diagnostic Errors, Practice Patterns, Physicians', Medical History Taking, Aged
Abstract

To investigate why many patients with renal impairment (30.7%) were not recognized by their family physicians despite an earlier educational intervention on detecting renal impairment; and to determine whether certain factors related to physicians, patients, or the intervention itself were associated with whether renal impairment was detected.Qualitative approach using grounded theory.A Health Service Organization in Ottawa, Ont.A purposeful sample of six family physicians.In semistructured interviews, participants were asked to describe the workup ordered and their decision-making processes for patients in whom they had recently detected renal impairment. They were also asked to evaluate the six components of an educational intervention designed to help them to detect renal impairment. Finally, one patient's chart was reviewed (a chart containing a laboratory report noting an abnormal result for kidney function and having no indication that renal impairment had been recognized) to identify reasons for lack of detection.Most physicians did not investigate every patient with renal impairment (glomerular filtration rate of78 mL/min) in the same way because they took individual patient factors into consideration. Reasons for not detecting renal impairment were "managed differently" or "missed," with the former being the most common. The educational intervention physicians remembered most often was chart rounds, and these were viewed as helpful. "Missed" cases were more often deliberately managed differently than unintentionally not detected.Physicians used various approaches to detect and manage renal impairment despite interventions that recommended a consistent procedure.

Published
2006

163. Développement d'un questionnaire mesurant la perception du patient atteint de maladies chroniques de l'habilitation par le médecin de famille

Author

Bravo, Gina, Hogg, William, Hudon, Catherine, St-Cyr Tribble, Denise, Bravo, Gina, Hogg, William, Hudon, Catherine, and St-Cyr Tribble, Denise

Abstract

Contexte: Les maladies chroniques constituent un fardeau important et impliquent une adaptation souvent majeure à la gestion de la maladie au quotidien. Les professionnels de la santé, dont le médecin de famille, peuvent aider la personne à acquérir davantage de pouvoir sur sa santé (habilitation). Bien qu'il soit utile de mesurer la perception du patient de l'habilitation par le médecin de famille à l'aide d'un questionnaire valide, les questionnaires existants présentent des lacunes importantes. But et objectifs: Cette étude visait le développement d'un questionnaire auto-administré pour mesurer la perception du patient atteint de maladies chroniques de l'habilitation par son médecin de famille. Les objectifs suivants étaient poursuivis: 1) Approfondir la conceptualisation de l'habilitation en médecine de famille en validant le cadre conceptuel proposé auprès de patients atteints de maladies chroniques et préciser l'importance relative des dimensions; 2) Opérationnaliser les dimensions en proposant des indicateurs de ces dimensions (bassin d'items); 3) Vérifier la validité de contenu du questionnaire. Méthodes: Un dispositif de recherche mixte de type séquentiel exploratoire a été retenu. Le volet qualitatif descriptif (objectifs 1 et 2) comportait des entrevues en profondeur auprès de 30 patients âgés de 35 à 75 ans atteints d'au moins une maladie chronique, ayant le même médecin de famille depuis au moins un an et recrutés selon un échantillonnage à variabilité maximale. Les enregistrements étaient transcrits et analysés à l'aide d'une codification mixte selon Miles et Huberman (2003a). Le volet quantitatif (méthode Del phi électronique, objectif 3) comportait trois tours auprès de 15 experts canadiens en médecine de famille aptes à lire le français. Les experts cotaient les items proposés selon une échelle allant de ( 1) inapproprié à (9) très approprié et pouvaient suggérer des reformulations et des ajouts. Les items cotés de sept à neuf par tous les experts é, Rationale: Chronic diseases represent an important health burden that often involves major adaptations to manage the disease on a daily basis. Health professionals, such as the family physician, can help a person acquire more power over his or her health (enablement). While it would be useful to measure patient perception of enablement by the family doctor with a valid questionnaire, existing tools present important gaps. Aim and objectives: This study aimed at developing a self-administered questionnaire to measure the perception of patients with chronic diseases of enablement by their family physician. The objectives were: 1) To deepen the conceptualization of enablement by validating the proposed conceptual framework with patients presenting with chronic diseases and to specify the relative importance of its dimensions; 2) To operationalise the dimensions by proposing indicators of these dimensions (pool of items); 3) To verify the content validity of the questionnaire. Methods: An exploratory sequential mixed-method research design was chosen. The descriptive qualitative study (objectives 1 and 2) used in-depth interviews with 30 patients aged 35 to 75 presenting with at least one chronic disease, having the same family doctor for at least one year and recruited through maximum variation sampling. Taped interviews were transcribed and analyzed using Miles and Huberman's mixed coding method (2003a). A three-round e-Delphi study (objective 3) involved 15 Canadian experts in family medicine, able to read in French. The experts scored the items proposed on a 9-point scale (1 = Inappropriate to 9 = Very appropriate) and could suggest rewording and additions. Items scored 7-9 by the experts were considered consensual and were not presented in the following round. Items that were not consensual after the third round were decided upon by the team of researchers. Results: The partnership (the trusting relationship and decisions to be taken) that develops over t

Published
2011

171. Practice facilitation for improving cardiovascular care: secondary evaluation of a stepped wedge cluster randomized controlled trial using population-based administrative data.

Author

Armstrong, Catherine Deri, Taljaard, Monica, William Hogg, Mark, Amy E., Liddy, Clare, Deri Armstrong, Catherine, and Hogg, William

Subjects
CARDIOVASCULAR diseases, HOSPITAL care, PRIMARY care, CLUSTER randomized controlled trials, MEDICAL quality control, HOSPITAL care quality, CARDIOVASCULAR disease diagnosis, CARDIOVASCULAR disease treatment, QUALITY assurance standards, CLINICAL medicine, COMPARATIVE studies, DATABASES, EXPERIMENTAL design, HEALTH care teams, INTEGRATED health care delivery, RESEARCH methodology, EVALUATION of medical care, MEDICAL care research, MEDICAL cooperation, MEDICAL protocols, GENERAL practitioners, PRIMARY health care, REGRESSION analysis, RESEARCH, TIME, LOGISTIC regression analysis, EVALUATION research, KEY performance indicators (Management), RANDOMIZED controlled trials, TREATMENT effectiveness, ODDS ratio
Abstract

Background: Practice facilitation (PF), a multifaceted approach in which facilitators (external health care professionals) help family physicians to improve their adoption of best practices, has been highly successful. Improved Delivery of Cardiovascular Care (IDOCC) was an innovative PF trial designed to improve evidence-based care for people who have, or are at risk of, cardiovascular disease (CVD). The intervention was found to be ineffective as assessed by a patient-level composite score based on chart reviews from a subsample of patients (N = 5292). Here, we used population-based administrative data to examine IDOCC's effect on CVD-related hospitalizations.Methods: IDOCC used a pragmatic, stepped wedge cluster randomized controlled design involving primary care providers recruited across Eastern Ontario, Canada. IDOCC's effect on CVD-related hospitalizations was assessed in the 2 years of active intervention and post-intervention years. Marginal and mixed-effects regression analyses were used to account for the study design and to control for patient, physician, and practice characteristics. Secondary and subgroup analyses investigated robustness.Results: Our sample included 262,996 patient/year observations representing 54,085 unique patients who had, or were at risk of, CVD, from 70 practices. There was a strong decreasing secular trend in CVD-related hospitalizations but no statistically significant effect of IDOCC. Relative to patients in the control condition, patients in the intervention condition were estimated to have 4 % lower odds of CVD-related hospitalizations (adjOR = 0.96, 99 % CI 0.83 to 1.11). The nonsignificant result persisted across robustness analyses.Conclusions: Clinical outcomes from administrative databases were examined to form a more complete picture of the (in)effectiveness of a large-scale quality improvement intervention. IDOCC did not have a significant effect on CVD hospitalizations, suggesting that the results from the primary composite adherence score analysis were neither due to choice of outcome nor relatively short follow-up period.Trial Registration: ClinicalTrials.gov NCT00574808 , registered on 14 December 2007. [ABSTRACT FROM AUTHOR]

Published
2016
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172. A scoping review to explore the suitability of interactive voice response to conduct automated performance measurement of the patient’s experience in primary care.

Author

Falconi, Michael, Johnston, Sharon, and Hogg, William

Abstract

IntroductionPractice-based performance measurement is fundamental for improvement and accountability in primary care. Traditional performance measurement of the patient’s experience is often too costly and cumbersome for most practices.Objective/MethodsThis scoping review explores the literature on the use of interactive voice response (IVR) telephone surveys to identify lessons for its use for collecting data on patient-reported outcome measures at the primary care practice level.ResultsThe literature suggests IVR could potentially increase the capacity to reach more representative patient samples and those traditionally most difficult to engage. There is potential for long-term cost effectiveness and significant decrease of the burden on practices involved in collecting patient survey data. Challenges such as low response rates, mode effects, high initial set-up costs and maintenance fees, are also reported and require careful attention.ConclusionThis review suggests IVR may be a feasible alternative to traditional patient data collection methods, which should be further explored. [ABSTRACT FROM PUBLISHER]

Published
2016
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173. Primary Care Physician Panel Size and Quality of Care: A Population-Based Study in Ontario, Canada.

Author

Dahrouge, Simone, Hogg, William, Younger, Jaime, Muggah, Elizabeth, Russell, Grant, and Glazier, Richard H.

Subjects
*PRIMARY care, *GROUP medical practice, *PHYSICIAN-patient relations, *MEDICAL record access control, *MEDICAL care, *MEDICAL care standards, *CHRONIC diseases, *CLINICAL medicine, *CONTINUUM of care, *DATABASES, *HEALTH services accessibility, *PATIENTS, *PRIMARY health care, *DISEASE management, *KEY performance indicators (Management), *CROSS-sectional method, *FEE for service (Medical fees), *EARLY detection of cancer
Abstract

Purpose: The purpose of this study was to determine the relationship between the number of patients under a primary care physician's care (panel size) and primary care quality indicators.Methods: We conducted a cross-sectional, population-based study of fee-for-service and capitated interprofessional and non-interprofessional primary health care practices in Ontario, Canada between April 2008 and March 2010, encompassing 4,195 physicians with panel sizes ≥1,200 serving 8.3 million patients. Data was extracted from multiple linked, health-related administrative databases and covered 16 quality indicators spanning 5 dimensions of care: access, continuity, comprehensiveness, and evidence-based indicators of cancer screening and chronic disease management.Results: The likelihood of being up-to-date on cervical, colorectal, and breast cancer screening showed relative decreases of 7.9% (P <.001), 5.9% (P = .01), and 4.6% (P <.001), respectively, with increasing panel size (from 1,200 to 3,900). Eight chronic care indicators (4 medication-based and 4 screening-based) showed no significant association with panel size. The likelihood of individuals with a new diagnosis of congestive heart failure having an echocardiogram, however, increased by a relative 8.1% (P <.001) with higher panel size. Increasing panel size was also associated with a 10.8% relative increase in hospitalization rates for ambulatory-care-sensitive conditions (P = .04) and a 10.8% decrease in non-urgent emergency department visits (P = .004). Continuity was highest with medium panel sizes (P <.001), and comprehensiveness had a small decrease (P = .03) with increasing panel size.Conclusions: Increasing panel size was associated with small decreases in cancer screening, continuity, and comprehensiveness, but showed no consistent relationships with chronic disease management or access indicators. We found no panel size threshold above which quality of care suffered. [ABSTRACT FROM AUTHOR]

Published
2016
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174. STATISTICAL EXTRAPOLATION IN COMPLEX LITIGATION: SCIENCE OR GUESSWORK?

Author

SULLIVAN, LAURA, HOGG, WILLIAM, and BROWN, DIANA

Subjects
EXTRAPOLATION, APPROXIMATION theory, CRIMINAL law, FEDERAL courts, HEALTH care fraud laws, OVERPAYMENT
Abstract

The article provides author's views regarding complex litigation which involves statistical extrapolation as statistical sampling may be used to draw scientifically supported conclusions from data in civil and criminal cases. Federal courts have repeatedly held that the government may use statistical sampling methods when calculating claims overpayments or actual damages in health care fraud and abuse cases.

Published
2016

175. How family physicians are funded in Canada

Author

Martin, Carmel M. and Hogg, William E.

Subjects
Family medicine -- Evaluation, Physicians (General practice) -- Evaluation, Medical fees -- Evaluation, Health
Abstract

The remuneration model for Family Health Networks (FHN), preferred by the Ontario Ministry of Health was based on virtual patient populations and is paid on a fee-for-service model using different funding arrangements in different setting. The Primary Health Care Transition Fund policy aimed to shift physicians to a blended capitation model with an aim to improve access to case, quality and cost effectiveness.

Published
2004

176. Order please: The mere existence of the resolution represents a victory for the grassroots, say WILLIAM HOGG and MARC BELANGER

Author

Hogg, William and Belanger, Marc

Subjects
Quebec -- Political aspects, Political planning -- Analysis -- Political aspects, General interest, News, opinion and commentary, Liberal Party (Canada) -- Political activity -- Political aspects
Abstract

Byline: WILLIAM HOGG and MARC BELANGER Since the adoption of the 'Quebec nation' resolution by the Quebec wing of the Liberal Party of Canada, much has been misinterpreted. As co-sponsors [...]

Published
2006

178. William Hogg oral history interview

Author

Misenhimer, Richard; Hobbs, Marilyn, Hogg, William, Misenhimer, Richard; Hobbs, Marilyn, and Hogg, William

Abstract

The National Museum of the Pacific War presents an oral interview with William Hogg. Born in Louisiana 1 March 1926, Hogg joined the US Army Air Forces in 1944. After basic training at Amarillo, Texas he was selected for gunnery school and tells of training at various locations. Upon completion of gunnery training, he was assigned as a tail gunner on a B-24 bomber. He recalls that at 20 years of age the pilot and co-pilot were the oldest of the 10 crew members. Hogg boarded HMS Queen Elizabeth and sailed to Glasgow, Scotland, where he took a train to Norwich, England. There his crew was assigned to the 93rd Bomb Group. He flew no combat missions during the three months he was in England. Returning to the United States, he was discharged 2 May 1946.

Published
2004

183. Improved delivery of cardiovascular care (IDOCC) through outreach facilitation: study protocol and implementation details of a cluster randomized controlled trial in primary care

Author

Liddy, Clare, primary, Hogg, William, additional, Russell, Grant, additional, Wells, George, additional, Armstrong, Catherine Deri, additional, Akbari, Ayub, additional, Dahrouge, Simone, additional, Taljaard, Monica, additional, Mayo-Bruinsma, Liesha, additional, Singh, Jatinderpreet, additional, and Cornett, Alex, additional

Published
2011
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184. Impact of integrating a physical activity counsellor into the primary health care team: physical activity and health outcomes of the Physical Activity Counselling randomized controlled trial

Author

Fortier, Michelle S., primary, Hogg, William, additional, O’Sullivan, Tracey L., additional, Blanchard, Christopher, additional, Sigal, Ronald J., additional, Reid, Robert D., additional, Boulay, Pierre, additional, Doucet, Éric, additional, Bisson, Étienne, additional, Beaulac, Julie, additional, and Culver, Diane, additional

Published
2011
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195. Cardiovascular Health Awareness Program (CHAP): A community cluster-randomised trial among elderly Canadians

Author

Kaczorowski, Janusz, primary, Chambers, Larry W., additional, Karwalajtys, Tina, additional, Dolovich, Lisa, additional, Farrell, Barbara, additional, McDonough, Beatrice, additional, Sebaldt, Rolf, additional, Levitt, Cheryl, additional, Hogg, William, additional, Thabane, Lehana, additional, Tu, Karen, additional, Goeree, Ron, additional, Paterson, J. Michael, additional, Shubair, Mamdouh, additional, Gierman, Tracy, additional, Sullivan, Shannon, additional, and Carter, Megan, additional

Published
2008
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