PubMed Health⌕ Search

Biomedical subjects

Arto Ohinmaa

Publications and source records attributed to Arto Ohinmaa.

18 recordsLinked to original sources
PubMed2007

Predictive validity of a computerized emergency triage tool.

BACKGROUND: Emergency department (ED) triage prioritizes patients on the basis of the urgency of need for care. eTRIAGE is a Web-based triage decision support tool that is based on the Canadian Triage and Acuity Scale (CTAS), a five level triage system (CTAS 1 = resuscitation, CTAS 5 = nonurgent). OBJECTIVES: To examine the validity of eTRIAGE on the basis of resource utilization and cost as measures of acuity. METHODS: Scores on the CTAS, specialist consultations, computed-tomography use, ED length of stay, ED disposition, and estimated ED and hospital costs (if the patient was subsequently admitted to hospital) were collected for each patient over a six month period. These data were queried from a database that captures all regional ED visits. Correlations between CTAS score and each outcome were measured by using logistic regression models (categorical variables), univariate analysis of variance (continuous variables), and the Kruskal-Wallis analysis of variance (costs). A multivariate regression model that used cost as the outcome was used to identify interaction between the variables presented. RESULTS: Over the six month study, 29,524 patients were triaged by using eTRIAGE. When compared with CTAS level 3, the odds ratios for consultation, CT scan, and admission were significantly higher in CTAS 1 and 2 and were significantly lower in CTAS 4 and 5 (p < 0.001). When compared with CTAS levels 2-5 combined, the odds ratio for death in CTAS 1 was 664.18 (p < 0.001). The length of stay also demonstrated significant correlation with CTAS score (p < 0.001). Costs to the ED and hospital also correlated significantly with increasing acuity (median costs for CTAS levels in Canadian dollars: CTAS 1 = 2,690 dollars, CTAS 2 = 433 dollars, CTAS 3 = 288 dollars, CTAS 4 = 164 dollars, CTAS 5 = 139 dollars, and p < 0.001). Significant interactions between the data collected were found in a multivariate regression model, although CTAS score remained highly associated with costs. CONCLUSIONS: Acuity measured by eTRIAGE demonstrates excellent predictive validity for resource utilization and ED and hospital costs. Future research should focus on specific presenting complaints and targeted resources to more accurately assess eTRIAGE validity.

Adult↗
PubMed2006

Reliability of computerized emergency triage.

OBJECTIVES: Emergency department (ED) triage prioritizes patients based on urgency of care. This study compared agreement between two blinded, independent users of a Web-based triage tool (eTRIAGE) and examined the effects of ED crowding on triage reliability. METHODS: Consecutive patients presenting to a large, urban, tertiary care ED were assessed by the duty triage nurse and an independent study nurse, both using eTRIAGE. Triage score distribution and agreement are reported. The study nurse collected data on ED activity, and agreement during different levels of ED crowding is reported. Two methods of interrater agreement were used: the linear-weighted kappa and quadratic-weighted kappa. RESULTS: A total of 575 patients were assessed over nine weeks, and complete data were available for 569 patients (99.0%). Agreement between the two nurses was moderate if using linear kappa (weighted kappa = 0.52; 95% confidence interval = 0.46 to 0.57) and good if using quadratic kappa (weighted kappa = 0.66; 95% confidence interval = 0.60 to 0.71). ED overcrowding data were available for 353 patients (62.0%). Agreement did not significantly differ with respect to periods of ambulance diversion, number of admitted inpatients occupying stretchers, number of patients in the waiting room, number of patients registered in two hours, or nurse perception of busyness. CONCLUSIONS: This study demonstrated different agreement depending on the method used to calculate interrater reliability. Using the standard methods, it found good agreement between two independent users of a computerized triage tool. The level of agreement was not affected by various measures of ED crowding.

Adult↗
PubMed2006

Utility of surgery for ruptured abdominal aortic aneurysm.

Our aim was to assess the utility of surgery for ruptured abdominal aortic aneurysm (RAAA) using the number of quality-adjusted life years (QALYs) in a retrospective study with cross-sectional quality-of-life (QoL) evaluation. During a 7-year period up to 2002, 242 of 269 (90%) patients with RAAA underwent surgery. Survivors were sent the EQ-5D self-administered questionnaire to assess their long-term outcome. EQ-5D single index values were calculated for each survivor and combined with age- and sex-adjusted Finnish life tables to obtain QALY estimates. Total hospital mortality (90-day) and operative mortality (30-day) were 140 of 269 (52.0%) and 106 of 242 (43.8%), respectively. Of the 129 surviving patients, 111 were available for QoL evaluation. The response rate was 85%. The mean (range) number of QALYs after RAAA was 4.1 (0-30.9) for all and 8.5 (0.2-30.9) for hospital survivors. Young age and low Glasgow Aneurysm Score were associated with a high number of QALYs irrespective of the statistical method used for analysis. Successful repair of RAAA was able to lend considerable benefit as measured by QALYs.

Adult↗
PubMed2006

What lessons can be learned from telemedicine programmes in other countries?

Reviews of telemedicine literature have shown that about half of the published studies come from the USA. This suggests that there is a large potentially useful stock of research outside the USA that could be used to guide telemedicine decision-making in the USA. In the present study, a request was sent to eight international experts in telemedicine asking about successful telemedicine programmes that have been assessed and could potentially be implemented in the US health-care system. We also conducted a focused review of a few key publications in the field to identify examples of successful telemedicine programmes. The review found that in some specific areas, such as teleradiology, telemental health, telegeriatric applications, e-referrals and discharge letters, and integration of health-care organizations with telemedicine networks, applications successfully implemented in international settings would be suitable for implementation in the USA. If telemedicine programmes from other countries are disseminated to the USA, differences in health-care systems, and technological infrastructure will probably affect their chances of success.

Delivery of Health Care↗
PubMed2006

A population-based analysis of health behaviours, chronic diseases and associated costs.

Health behaviours influence the future incidence of certain common chronic diseases and thus have an impact on health status and utilization of health care services and costs. We analyzed person-level data of the Albertan adult population from the Canadian Community Health Survey, Cycle 1.1 (2000) to determine health care costs associated with specific health behaviours (smoking, sub-optimal diet, physical inactivity) and chronic disease states (heart disease, diabetes, COPD). We found that 74.7 percent of the population exhibited one or more risk behaviours, while 10.5 percent had one or more of the chronic diseases of interest. Greater health care utilization and costs were noted in groups exhibiting risk behaviour and chronic disease states. Approximately 31 percent of health care costs in Alberta were attributable to people having one or more of the three chronic diseases. Our findings of higher health care costs incurred by those exhibiting unhealthy behaviour prior to development of disease, as well as by those with multiple co-existent diseases, are important indicators to guide future prevention and treatment strategies of chronic illness.

Adult↗
PubMed2005

The direct public-sector costs for mental health in Alberta.

The purpose of the study was to estimate the direct 2002 fiscal year costs for mental health, services in Alberta. Data were collected on mental health publicly funded services and costs. Mental health services cost $573 million annually, amounting to about 8.4% of all provincial health services. The greatest share of costs was for regional inpatient services and physician services (both at 22%). The more direct method used in this study shows higher estimates of mental health costs than previous studies.

Alberta↗
PubMed2005

Providing systematic guidance in pharmacoeconomic guidelines for analysing costs.

BACKGROUND: Despite the considerable amount of work that has gone into the standardisation of costs, a recent survey indicated that there is still a wide variation in methods used in costing studies in the published literature. Part of the answer to the lack of standardisation may lie in pharmacoeconomic guidelines themselves. OBJECTIVE: The purpose of this paper is to categorise the current recommendations for the analysis of costs within an economic evaluation, and to use these categories to assess variations in guidelines. DESIGN: Based on identified costing methodology, we developed a detailed categorisation. We then surveyed existing guidelines to determine similarities and differences in the guidelines. RESULTS: Our framework had five categories: general design items; resource identification and classification; resource measurement; resource valuation; and overall reporting. We noted differences in perspective, some of which were due to methodological uncertainty and differences in the purposes of the studies covered by the guidelines. There was very little guidance in how to put the basic cost measure into operation. In addition, the preferred concept for resource utilisation was that of resource use under actual (rather than experimental) conditions, and there was very little guidance as to how to achieve this measure. CONCLUSION: There are still large variations, as well as gaps, in guidelines in the costing area. This is due, in part, to wide-ranging objectives for studies, methodological uncertainty and a neglect of the fundamentals of costing. We recommend that the contents of the basic measure of 'average cost' should be explained in more detail, with recurring, capital and allocated overhead costs being reported separately. A target capacity level (e.g. 80%) should be reported, even if in a sensitivity analysis. More guidance should be provided regarding the translation of utilisation under experimental care to that under routine care. For resource valuation, adjustments to the 'average cost' measure should be made explicit. There should be more guidance on how to project system-wide costs from the costs of one hospital. The manner in which overall results are reported should be addressed, including the identification of how costs should be categorised.

Costs and Cost Analysis↗
PubMed2004

A health production function for persons with back problems: results from the Canadian Community Health Survey of 2000.

STUDY DESIGN: A retrospective, population-based analysis. OBJECTIVES: To analyze the relation between health outcomes and resources used by persons with back problems in an everyday setting. SUMMARY OF BACKGROUND DATA: The Canadian Community Health Survey (2000) contains self-reported variables on change in health status, use of health resources, and socioeconomic characteristics of a population sample. METHODS: We use a health production function approach, in which we explore the association between change in health status and a series of utilization variables for persons with a single diagnosis of back pain using a regression equation. The independent variables include use of family physicians, chiropractors, physiotherapists, and exercise. RESULTS: Change in health status was negatively and significantly associated with family practice, chiropractic, and physiotherapy visits and positively associated with physical activity. The magnitudes of the results were small. CONCLUSIONS: Our results indicate that exercise is an important factor in back problems, while persons who seek formal care do not improve.

Adult↗
PubMed2004

Study quality and evidence of benefit in recent assessments of telemedicine.

We carried out a systematic review of recent telemedicine assessments to identify scientifically credible studies that included comparison with a non-telemedicine alternative and that reported administrative changes, patient outcomes or the results of an economic assessment. From 605 publications identified in the literature search, 44 papers met the selection criteria and were included in the review. Four other publications were identified through references cited in one of the retrieved papers and from a separate project to give a total of 48 papers for consideration, which referred to 42 telemedicine programmes and 46 studies. Some kind of economic analysis was included in 25 (52%) of the papers. In considering the studies, we used a quality appraisal approach that took account of both study design and study performance. For those studies that included an economic analysis, a further quality-scoring approach was applied to indicate how well the economic aspects had been addressed. Twenty-four of the studies were judged to be of high or good quality and 11 of fair to good quality but with some limitations. Seven studies were regarded as having limited validity and a further four as being unacceptable for decision makers. New evidence on the efficacy and effectiveness of telemedicine was given by studies on geriatric care, intensive care and some of those on home care. For a number of other applications, reports of clinical or economic benefits essentially confirmed previous findings. Although further useful clinical and economic outcomes data have been obtained for some telemedicine applications, good-quality studies are still scarce.

Costs and Cost Analysis↗
PubMed2004

Published evidence on the success of telecardiology: a mixed record.

We carried out a systematic review of the literature on telecardiology assessment from 1992 to September 2003. We selected articles reporting clinical, economic or administrative outcomes. Quality of evidence was assessed using an approach that considered both study design and study performance. Forty-four studies met the selection criteria. Studies of home care applications, particularly management of congestive heart failure, were of highest quality, giving a high degree of confidence in their findings. Studies on paediatric and non-emergency adult hospital applications were of poorer quality; they were mostly reports of case series and gave relatively little detail. Economic analysis was limited to cost studies and in most cases was judged to be of poor to fair quality. While telecardiology has been widely applied, there is still limited good-quality evidence of its benefits to health-care. Success in establishing the feasibility of telecardiology applications is offset by a failure to obtain convincing data on their influence on health outcomes and on their cost-effectiveness.

Cardiology↗
PubMed2003

A single European currency for EQ-5D health states. Results from a six-country study.

The EQ-5D questionnaire is a widely used generic instrument for describing and valuing health that was developed by the EuroQol Group. A primary objective of the EuroQol Group is the investigation of values for health states in the general population in different countries. As part of the EuroQol enterprise 11 population surveys were carried out in six Western European countries (Finland, Germany, The Netherlands, Spain, Sweden and the UK) to value health states as defined by the EQ-5D using a standardised visual analogue scale (EQ-5D VAS). This contribution reports how a European set of general population preference weights was derived from the data collected in the 11 valuation studies. The scores from this set of preference weights can be applied to generate a VAS-based weighted health status index for all the potential 243 EQ-5D health states for use in multi-national studies. To estimate the preference weights a multi-level regression analysis was performed on 82,910 valuations of 44 EQ-5D health states elicited from 6,870 respondents. Stable and plausible solutions were found for the model parameters. The R(2) value was 75%. The analysis showed that the major source of variance, apart from 'random error', was variance between individuals (28.3% of the total residual variance). These results suggest that VAS values for EQ-5D health states in six Western European countries can be described by a common model.

Journal Article↗
PubMed2003

Videoconferencing for orthopaedic outpatients: one-year follow-up.

We studied whether consultations via videoconferencing and traditional outpatient clinic visits differ in terms of the implementation of the patient management plan during a one-year follow-up. First-admission and follow-up orthopaedic patients were randomly allocated to an outpatient visit at the surgical department of Oulu University Hospital or to videoconferencing at a health centre in Pyhäjärvi. In a prospective one-year study, there were 145 consecutive orthopaedic patients who met the inclusion criteria: 84 referred for their first visit to a specialist and 61 of them for follow-up. There were 66 males (46%) in the study population. Over half the patients had some form of regenerative arthritis: 15% had hip arthritis, 33% knee arthritis and 4% other arthritis. There were no differences in the implementation of the management plan between the two groups. The study showed that videoconferencing is a valid alternative to outpatient clinic visits for orthopaedic specialist consultations.

Ambulatory Care↗
PubMed2002

Endovenous obliteration versus conventional stripping operation in the treatment of primary varicose veins: a randomized controlled trial with comparison of the costs.

OBJECTIVE: The aim of this randomized study was to compare a new method of endovenous saphenous vein obliteration (Closure System, VNUS Medical Technologies, Inc, Sunnyvale, Calif) with the conventional stripping operation in terms of short-term recovery and costs. METHODS: Twenty-eight selected patients for operative treatment of primary greater saphenous vein tributary varicose veins were randomly assigned to endovenous obliteration (n = 15) or stripping operation (n = 13). Postoperative pain was daily assessed during the 1st week and on the 14th postoperative day. The length of sick leave was determined. The RAND-36 health survey was used to assess the patient health-related quality of life. The patient conditions were controlled 7 to 8 weeks after surgery, and patients underwent examination with duplex ultrasonography. The comparison of costs included both direct medical costs and costs resulting from lost of productivity of the patients. Costs that were similar in the study groups were not considered in the analysis. RESULTS: All operations were successful, and the complication rates were similar in the two groups. Postoperative average pain was significantly less severe in the endovenous obliteration group as compared with the stripping group (at rest: 0.7, standard deviation [SD] 0.5, versus 1.7, SD 1.3, P =.017; on standing: 1.3, SD 0.7, versus 2.6, SD 1.9, P =.026; on walking: 1.8, SD 0.8, versus 3.0, SD 1.8, P =.036; with t test). The sick leaves were significantly shorter in the endovenous obliteration group (6.5 days, SD 3.3 days, versus 15.6 days, SD 6.0 days; 95% CI, 5.4 to 12.9; P <.001, with t test). Physical function was also restored faster in the endovenous obliteration group. The estimated annual investment costs of the closure operation were US $3360. The other direct medical costs of the Closure operation were about $850, and those of the conventional treatment were $360. With inclusion of the value of the lost working days, the Closure treatment was cost-saving for society, and when 40% of the patients are retired (or 60% of the productivity loss was included), the Closure procedure became cost-saving at a level of 43 operations per year. CONCLUSION: Endovenous obliteration may offer advantages over the conventional stripping operation in terms of reduced postoperative pain, shorter sick leaves, and faster return to normal activities, and it appears to be cost-saving for society, especially among employed patients. Because the procedure is also associated with shorter convalescence, this new method may potentially replace conventional varicose vein surgery.

Adult↗
PubMed2002

A cost-minimization analysis of orthopaedic consultations using videoconferencing in comparison with conventional consulting.

We compared the costs of conventional outpatient visits to the surgical department of the University Hospital of Oulu with those of videoconferencing between the primary care centre in Pyhäjärvi and the University Hospital (separated by 160 km). The cost data were obtained from a randomized controlled trial that included 145 first-admission and follow-up orthopaedic patients. In the telemedicine group the annual fixed costs were 6074 in the hospital and 3910 in the primary care centre. The additional variable costs were 2 in the hospital and 19 in primary care. At a workload of 100 patients, the total cost, including travel and indirect costs, was 87.8 per patient in the telemedicine group and 114.0 per patient in the conventional group (i.e. a total cost saving from the use of teleconsultation of 2620). A cost-minimization analysis showed that telemedicine was less costly for society than conventional care at a workload of more than 80 patients per year. If the distance to specialist care were reduced from 160 km to 80 km, the break-even point increased to about 200 patients per year. Wider utilization of the videoconferencing equipment for other purposes, or the use of less expensive videoconferencing equipment, would make services cost saving even at relatively short distances. The study showed that orthopaedic outpatient telecare can be cost minimizing.

Costs and Cost Analysis↗
PubMed2002

Systematic review of evidence for the benefits of telemedicine.

A systematic review of telemedicine assessments based on searches of electronic databases between 1966 and December 2000 identified 66 scientifically credible studies that included comparison with a non-telemedicine alternative and that reported administrative changes, patient outcomes, or results of economic assessment. Thirty-seven of the studies (56%) suggested that telemedicine had advantages over the alternative approach, 24 (36%) also drew attention to some negative aspects or were unclear whether telemedicine had advantages and five (8%) found that the alternative approach had advantages over telemedicine. The most convincing evidence on the efficacy and effectiveness of telemedicine was given by some of the studies on teleradiology (especially neurosurgical applications), telemental health, transmission of echocardiographic images, teledermatology, home telecare and on some medical consultations. However, even in these applications, most of the available literature referred only to pilot projects and to short-term outcomes. Few papers considered the long-term or routine use of telemedicine. For several applications, including teleradiology, savings and sometimes clinical benefit were obtained through avoidance of travel and associated delays. Studies of home care and monitoring applications showed convincing evidence of benefit, while those on teledermatology indicated that there were cost disadvantages to health-care providers, although not to patients. Forty-four of the studies (67%) appeared to have potential to influence future decisions on the telemedicine application under consideration. However, a number of these had methodological limitations. Although useful clinical and economic outcomes data have been obtained for some telemedicine applications, good-quality studies are still scarce and the generalizability of most assessment findings is rather limited.

Cost-Benefit Analysis↗
PubMedDate not supplied

Public investment in providing information for chronic disease prevention for adults in Alberta.

BACKGROUND: The World Health Organization in 2000 cited specific chronic diseases (chronic obstructive pulmonary disease, heart disease, diabetes and certain cancers) as major and preventable health hazards. There have subsequently been calls for increased investment in prevention activities. Currently there is no information on the economic magnitude of these promotion activities. In this study, we present an estimate of the investment in Alberta, by public organization, for chronic disease prevention activities which provide information that promotes behaviour changes in adults at risk. METHODS: We surveyed board members of the Alberta Healthy Living Network (AHLN) to obtain economic data and information on activities related to chronic disease (primary) prevention. We also asked for further contacts on programs in other agencies. We continued the ("snowball") process until no new agencies were identified. Agencies provided the information on a survey form. RESULTS: In 2003 in Alberta, the cost of publicly provided information to change risk behaviours related to chronic diseases for persons over 20 was dollars 24.9 million. This investment was diffused over a large number of bodies. Anti-smoking programs used the largest proportion of the money. The total cost per person at risk was about dollars 15. Regional Health Authorities spend about 1/10th of 1% of their budget on these activities. DISCUSSION: There are difficulties in collecting and organizing society-level data on chronic disease prevention. Nevertheless, all indications are that the amount of resources devoted in this area is small, and much smaller than has been suggested.

Adult↗