Lynn Lethbridge

Towards using administrative databases to measure population-based indicators of quality of end-of-life care : testing the methodology

This study is concerned with methods to measure population-based indicators of quality end-of-life care. Using a retrospective cohort approach, we assessed the feasibility, validity and reliability of using administrative databases to measure quality indicators of end-of-life care in two Canadian provinces. The study sample consisted of all females who died of breast cancer between 1 January 1998 and 31 December 2002, in Nova Scotia or Ontario, Canada. From an initial list of 19 quality indicators selected from the literature, seven were determined to be fully measurable in both provinces. An additional seven indicators in one province and three in the other province were partially measurable. Tests comparing administrative and chart data show a high level of agreement with inter-rater reliability, confirming consistency in the chart abstraction process. Using administrative data is an efficient, population-based method to monitor quality of care which can compliment other methods, such as qualitative and purposefully collected clinical data.

Poverty and the extent of child obesity in Canada, Norway and the United States

The goal of this paper is to compare the extent of child obesity in Canada, Norway and the United States. As child poverty is an important correlate of child obesity, we wish to examine the potential role of international differences in child poverty in explaining international differences in the extent of child obesity. We use three representative microdata surveys containing parental reports of child height and weight collected in the mid‐1990s in Canada, Norway and the US. We calculate both the prevalence and proportional severity of child obesity for 6–11‐year‐old children in each country, and represent the ‘extent’ of obesity diagrammatically. Differences in patterns of child poverty are similarly depicted. Obesity extent is also compared for poor and non‐poor children in Canada and the US. Finally, child obesity in the three countries is compared using only non‐poor children where we find that the extent of child obesity is much lower in Norway than in Canada or the US. The pattern apparent for obesity is remarkably similar to that found for child poverty. In Canada and especially in the US, we find a much greater extent of obesity for poor than non‐poor children. However, when we compare only non‐poor children in the three countries, although the magnitude of difference is smaller, it remains clear that Norwegian children are much less likely to be obese. Policy and research directed towards reducing the extent of child obesity in both Canada and the US should pay particular attention to issues of child poverty.

Cost-utility of the 21-gene recurrence score assay in node-negative and node-positive breast cancer

The 21-gene recurrence score (Oncotype DX®: RS) appears to augment clinico-pathologic prognostication and is predictive of adjuvant chemotherapy benefit in node-negative (N−) and node-positive (N+), endocrine-sensitive breast cancer. RS is a costly assay that is associated with good ‘value for money’ in N− disease, while economic evaluations in N+ disease based on most recent data have not been conducted. We examined the cost-utility (CU) of a RS-guided adjuvant strategy, compared to current practice without RS in N− and N+, endocrine-sensitive, breast cancer from a Canadian health care system perspective. A generic state-transition model was developed to compute cumulative costs and quality-adjusted life years (QALYs) over a 25-year horizon. Patient outcomes with and without chemotherapy in RS-untested cohorts and in those with low, intermediate and high RS were examined based on the reported prognostic and predictive impact of RS in N− and N+ disease. Chemotherapy utilization (current vs. RS-guided), unit costs and utilities were derived from a Nova Scotia Canadian population-based cohort, local unit costs and the literature. Costs and outcomes were discounted at 3% annually, and costs were reported in 2011 Canadian dollars (

Measuring Obesity in Young Children

). Probabilistic and one-way sensitivity analyses were conducted for key model parameters. Compared to a non-RS-guided strategy, RS-guided adjuvant therapy was associated with

Planning for what? Challenging the assumptions of health human resources planning

2,585 and

Co-morbidities of persons dying of Parkinson's disease

864 incremental costs, 0.27 and 0.06 QALY gains, and resultant CUs of

In and out of the labour market: long‐term income consequences of child‐related interruptions to women's paid work

9,591 and

Taking Its Toll: The Influence of Paid and Unpaid Work on Women's Well-Being

14,844 per QALY gained for N− and N+ disease, respectively. CU estimates were robust to key model parameters, and were most sensitive to chemo utilization proportions. RS-guided adjuvant therapy appears to be a cost-effective strategy in both N− and N+, endocrine-sensitive breast cancer with resultant CU ratios well below commonly quoted thresholds.

Long-run consequences of parental paid work hours for child overweight status in Canada

Child obesity is currently an important policy problem in Canada. Making the best evidence-based policy choices in response requires having the best possible evidence. Yet, we point out how easy it can be to make serious mistakes when measuring child obesity, particularly for young children. We demonstrate that parental reports of child height and weight very likely overestimate obesity prevalence for very young children. Given the importance of child obesity as a policy issue, our main conclusion is that it is critical for national surveys in Canada to provide interviewers with appropriate equipment and ask them to weigh and measure children very accurately. While this would certainly increase survey costs, the costs to society of making less than the best policy choices are likely to be even higher.

Children with disabilities and chronic conditions and longer-term parental health

OBJECTIVES Health human resource planning has traditionally been based on simple models of demographic changes applied to observed levels of service utilization or provider supply. No consideration has been given to the implications of changing levels of need within populations over time. Recently, needs based resource planning models have been suggested that incorporate changes in needs for care explicitly as a determinant of health care needs. METHODS In this paper, population indicators of morbidity, mortality and self-assessed health are analyzed to determine if health care needs have changed across birth cohorts in Canada from 1994 to 2005 among older age groups. Multivariate regression analysis was used to estimate the age pattern of health by birth year with interaction terms included to examine whether the association of age with health was conditional on the birth year. RESULTS Results indicate that while the probability of mortality, mobility problems and pain rises with age, the rate of change is greater for those born earlier. The probability of self-assessed poor health increases with age but the rate of change with age is constant across birth years. CONCLUSIONS Even in the short time period covered, our analysis shows that health care needs by age are changing over time in Canada.