Sonia Vanderby

Modelling the Future of the Canadian Cardiac Surgery Workforce Using System Dynamics

Due to the high costs and lengthy lead times involved with training health human resources such as physicians and surgeons, combined with the serious burden borne by the general population when health care provider shortages occur, advance planning of resource requirements is critical. This is particularly true in light of current demographic trends and Canada’s ageing population, which will potentially increase demand for health care providers in the future while also leading to the retirement of many of the providers currently practicing. The purpose of this research was to develop a model simulating the workforce within a single specialty at a national level, which includes students training to enter the profession, providing a tool that would help to inform future resource planning. We present the details of this model, developed using system dynamics modelling, and demonstrate it using the example of cardiac surgeons in Canada.

Modelling the complete continuum of care using system dynamics: the case of osteoarthritis in Alberta

Estimating how many patients will require care, the nature of the care they require, and when and where they will require it, is critical when planning resources for a sustainable health-care system. Resource planning must consider how quickly patients move among stages of care, the various different pathways they may take and the resources required at each stage. This research presents a preliminary long-term, population-driven system dynamics simulation developed to support resource planning and policy development relating to osteoarthritis care. The simulation models osteoarthritis patients as they transition through the continuum of care from disease onset through end-stage care, and provides insight into the size and characteristics of the patient population, their resource requirements and associated health-care costs. Although the model presented is specific to the osteoarthritis care system in the Province of Alberta, Canada, similar methods could be applied to develop simulations relating to other chronic conditions.

Estimating the Burden of Osteoarthritis to Plan for the Future

With aging and obesity trends, the incidence and prevalence of osteoarthritis (OA) is expected to rise in Canada, increasing the demand for health resources. Resource planning to meet this increasing need requires estimates of the anticipated number of OA patients. Using administrative data from Alberta, we estimated OA incidence and prevalence rates and examined their sensitivity to alternative case definitions.

Finding the Truth in Medical Imaging: Painting the Picture of Appropriateness for Magnetic Resonance Imaging in Canada

Background Questions about the appropriateness of medical imaging exams, particularly related to magnetic resonance exams, have arisen in recent years. However, the prevalence of inappropriate imaging in Canada is unclear as inappropriate exam proportion estimates are often based on studies from other countries. Hence, we sought to compare and summarize Canadian studies related to magnetic resonance imaging appropriateness. Methods We completed a systematic literature search identifying studies related to magnetic resonance appropriateness in Canada published between 2003 and 2013. Two researchers independently searched and evaluated the literature available. Articles that studied or discussed magnetic resonance appropriateness in Canada were selected based on titles, abstracts, and, where necessary, full article review. Articles relating solely to other modalities or countries were excluded, as were imaging appropriateness guidelines and reviews. Results Fourteen articles were included: 8 quantitative studies and 6 editorials/commentaries. The quantitative studies reported inappropriate proportions of magnetic resonance exams ranging from 2%-28.5%. Our review also revealed substantial variations among study methods and analyses. Common topics identified among editorials/commentaries included reasons for obtaining imaging in general and for selecting a specific modality, consequences of inappropriate imaging, factors contributing to demand, and suggested means of mitigating inappropriate medical imaging use. Conclusions The available studies do not support the common claim that 30% of medical imaging exams in Canada are inappropriate. The actual proportion of inappropriate magnetic resonance exams has not yet been established conclusively in Canada. Further research, particularly on a widespread national scale, is needed to guide healthcare policies.

Variations in Magnetic Resonance Imaging Provision and Processes Among Canadian Academic Centres

Purpose Increasing demand has led to questions regarding the appropriateness of advanced imaging exams, particularly for magnetic resonance imaging (MRI). The study aimed to explore variability in MRI service provision and request variation within Canadian academic medical imaging departments, particularly factors potentially affecting appropriate MRI service provision. Methods All Canadian academic centres with medical imaging residency programs were invited to participate. Participation involved completing an institution-level survey and submitting exam requests for all MRI exams completed in a common 24-hour period. The surveys and request forms were analysed and contrasted. Results The 13 participating institutions reported scanner operating hours per week ranging from 101-672; large urban centres typically had higher hours. A total of 42% of sites housed multiple scanners, and 28% housed a 3-T scanner. Most accept requests from all general practitioners and specialists. Only 1 institution has a solely electronic request submission process. Requisitions are focused on patient safety, including contrast considerations, metallic foreign bodies, and implants. Request prioritization scales vary substantially across institutions. Few use referral guidelines to evaluate request appropriateness. Conclusions Our analysis showed great variation among facility-level factors such as hours of operation, request forms, and prioritization scales among institutions and facilities. Opportunities exist to create standardized processes and improve request forms to focus more on specific information required for appropriateness, increase consistency in patient care, and promote demand balancing, minimizing unnecessary exams and therefore reducing wait times.

A Day in the Life of MRI: The Variety and Appropriateness of Exams Being Performed in Canada

Purpose This study aimed to determine the volumes and types of magnetic resonance imaging exams being performed across Canada, common indications for the exams, and exam appropriateness using multiple evaluation tools. Methods Thirteen academic medical institutions across Canada participated. Data were obtained relating to a single common day, October 1, 2014. Patient demographics, type by anatomic region and indication for imaging were analysed. Each exam was assessed for appropriateness via the Canadian Association of Radiologists Referral Guidelines and the American College of Radiology Appropriateness Criteria. The Alberta and Saskatchewan spine screening forms and the Alberta knee screening form were also used where applicable. The proportion of exams that were unscorable, appropriate, and inappropriate was determined. Exam-level results were compared between the 2 main evaluation tools. Results Data were obtained for 1087 relevant exams. There were 591 women and 460 men. 36 requisitions did not indicate the patients sex. Brain exams were the most common, comprising 32.5% of the sample. Cancer was the most common indication. Overall, 87.0%–87.4% of the MR exams performed were appropriate; 6.6%–12.6% were inappropriate, based on the 2 main evaluation tools. Results differed by anatomic region; spine exams had the highest proportion, with nearly one-third of exams deemed inappropriate. Conclusion Variations by anatomic region indicate that focused exam request evaluation or screening methods could substantially reduce inappropriate imaging.