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A Malter

Publications and source records attributed to A Malter.

6 recordsLinked to original sources
PubMed1998

Trends in hospital use for mechanical neck and back problems in Ontario and the United States: discretionary care in different health care systems.

OBJECTIVE: To describe and compare trends in hospital admission rates for mechanical neck and back problems between 1982 and 1992 in Ontario and the United States. DESIGN: A descriptive analysis of hospital admissions, with data for Ontario extracted from the Canadian Institute for Health Information database and data for the US extracted from the National Hospital Discharge Survey. SETTING: All acute care hospitals in Ontario and a probability sample of acute care hospitals in the US. PATIENTS: Adults aged 20 years or more who were admitted to an acute care hospital for mechanical neck or back problems in 1982, 1987 or 1992. Mechanical neck and back problems were defined using an algorithm developed by the study team. OUTCOME MEASURE: Hospital admission rate per 100,000 adults. RESULTS: Between 1982 and 1992 the hospital admission rate for medically treated cases decreased by 52% in Ontario and by 75% in the US. Over the same period the admission rate for surgically treated cases increased by 14% and by 35% respectively. By 1992 the admission rate for medically treated cases in the US was 23% higher than that in Ontario, whereas the rate for surgically treated cases was 164% higher. CONCLUSIONS: The hospital-based medical or surgical treatment of mechanical neck and back problems provides an example of discretionary care. The higher admission rates for surgery in the US may reflect a larger supply of surgical specialists and imaging units. Further work is needed to confirm these findings for other types of discretionary care and to compare the appropriateness of care and clinical outcomes for discretionary care in these 2 jurisdictions.

Adult↗
PubMed1998

Hospitalizations for back and neck problems: a comparison between the Province of Ontario and Washington State.

OBJECTIVE: To examine back and neck hospitalizations in the Province of Ontario and Washington State. Because of their different organization and financing, there has been considerable interest in comparing healthcare systems in Canada and the United States. Features of healthcare systems might be expected to result in greater variations in care for elective than urgent conditions. DATA SOURCE: Automated hospital discharge databases. STUDY DESIGN: Previously developed algorithms were used to identify surgical and nonsurgical hospitalizations for back and neck problems in the administrative databases. We compared overall rates of hospitalization and lengths of hospital stay in Ontario and Washington as well as small area variations within the province and state. PRINCIPAL FINDINGS: Surgical back and neck hospitalizations were three times as common in Washington, but medical hospitalizations were twice as common in Ontario. Provincial lengths of stay were longer for both surgical and nonsurgical hospitalizations. Admission rates varied substantially and significantly among small areas in both Washington and Ontario. Variations in hospital length of stay were greater in Ontario, particularly for nonsurgical back and neck hospitalizations. CONCLUSION: The two jurisdictions had very different patterns of hospital utilization for one of the most common health problems seen by physicians. Our results suggest that the global controls on hospital budgets and access to technology in Ontario were associated with lower rates of surgery, higher rates of hospital-based medical care, and longer lengths of stay. They also indicate that the utilization review process in Washington was associated with lower small area variation rates for medical back care.

Adult↗
PubMed1996

Consensus summary of the diagnosis and treatment of lumbar disc herniation.

Clinicians must not simply decide that a patient with symptoms and a positive diagnostic test has a reason for a specific treatment, and likewise clinicians must not decide that a patient with symptoms and a negative test does not have a clinically important problem. We must also consider the sensitivity, specificity and predictive value of the diagnostic test and the individual characteristics of the patient. Treatment outcome depends on many factors. Point of service decisions vs population based decisions are obviously different. Each patient presents to the treating practitioner on a given day, at a given time, and it is this picture upon which a plan of care is formulated.

Humans↗