One Size Does Not Fit All: Diabetes Prevalence Among Immigrants of the South Asian Diaspora

Journal of Immigrant and Minority Health - The risk of diabetes is higher in South Asians compared to the general population. As a result of migration during the twentieth-century postindependence,...     

唑来磷酸联合化疗治疗非小细胞肺癌骨转移的疗效观察

目的评价唑来磷酸联合化疗治疗非小细胞肺癌骨转移的疗效及不良反应。方法将48例非小细胞癌骨转移患者随机分为治疗组和对照组,每组24例,治疗组给予唑来磷酸同步化疗治疗,对照组单用唑来磷酸。结果治疗组和对照组的止痛总有效率分别为79.2%、54.2%,治疗组效果明显优于对照组,差异有统计学意义（P〈0.05）。结论唑来磷酸联合化疗治疗非小细胞肺癌骨转移有较好疗效,值得临床推广应用。     

Repair of total anomalous pulmonary venous connection in neonates

Aim To study the results of repair of Total Anomalous Pulmonary Venous Connection (TAPVC) in neonates Materials and Methods Retrospective study of 27 neonates operated for TAPVC between January 2001 and October 2003. 27 neonates underwent TAPVC repair during the 2-year period. 21 were males and 6 were females. Results Total hospital stay ranged from 10 days to 75 days. 9 supracardiac, 13 infracardiac, 3 cardiac and 2 mixed type comprised the group. Obstruction was seen in 24 patients. All the patients had severe pulmonary artery hypertension. Vertical vein was ligated in almost all cases either at the time of surgery or during the closure of sternum. Delayed sternum was closed in all cases but 7. Of 3 deaths, one died after permanent pacemaker implantation (about 1 month after the initial surgery of repair of cardiac TAPVC), one died due to pre-operative vascular access related accident and a third died due to post-operative low cardiac output. All survivors were thriving well at last follow-up. Conclusion Repair of TAPVC in the neonatal age has been found to be rewarding with significant improvement in the well being of the child. Judicious use of pulmonary vasodilators like nitric oxide, Sildenafil and phenoxybenzamine and delayed sternal closure has improved the results in this study group. Presented at the 50^th Annual Meeting of IACTS, New Delhi, Feb., 2004.     

Intracardiac relation of extrahepatic persistent right umbilical vein

Persistent extrahepatic right umbilical vein without ductus venosus is a rare anomaly of systemic venous drainage and is reported to be associated with cardiac anomalies. We report the case of an 8-year-old boy diagnosed to have an ostium secundum atrial septal defect, in whom an abnormal vascular channel and its opening in the right atrium in close relationship to the inferior vena cava and coronary sinus opening was identified at operation. Post-operative evaluation of this vascular channel was diagnosed to be an extrahepatic persistent right umbilical vein.     

Administrative data algorithms can describe ambulatory physician utilization

OBJECTIVE: To validate algorithms using administrative data that characterize ambulatory physician care for patients with a chronic disease. DATA SOURCES: Seven-hundred and eighty-one people with diabetes were recruited mostly from community pharmacies to complete a written questionnaire about their physician utilization in 2002. These data were linked with administrative databases detailing health service utilization. STUDY DESIGN: An administrative data algorithm was defined that identified whether or not patients received specialist care, and it was tested for agreement with self-report. Other algorithms, which assigned each patient to a primary care and specialist physician, were tested for concordance with self-reported regular providers of care. PRINCIPAL FINDINGS: The algorithm to identify whether participants received specialist care had 80.4 percent agreement with questionnaire responses (kappa=0.59). Compared with self-report, administrative data had a sensitivity of 68.9 percent and specificity 88.3 percent for identifying specialist care. The best administrative data algorithm to assign each participant's regular primary care and specialist providers was concordant with self-report in 82.6 and 78.2 percent of cases, respectively. CONCLUSIONS: Administrative data algorithms can accurately match self-reported ambulatory physician utilization.     

The relationship between financial incentives and quality of diabetes care in Ontario, Canada

OBJECTIVE

We assessed the impact of a diabetes incentive code introduced for primary care physicians in Ontario, Canada, in 2002 on quality of diabetes care at the population and patient level.

RESEARCH DESIGN AND METHODS

We analyzed administrative data for 757,928 Ontarians with diabetes to examine the use of the code and receipt of three evidence-based monitoring tests from 2006 to 2008. We assessed testing rates over time and before and after billing of the incentive code.

RESULTS

One-quarter of Ontarians with diabetes had an incentive code billed by their physician. The proportion receiving the optimal number of all three monitoring tests (HbA_1c, cholesterol, and eye tests) rose gradually from 16% in 2000 to 27% in 2008. Individuals who were younger, lived in rural areas, were not enrolled in a primary care model, or had a mental illness were less likely to receive all three recommended tests. Patients with higher numbers of incentive code billings in 2006–2008 were more likely to receive recommended testing but also were more likely to have received the highest level of recommended testing prior to introduction of the incentive code. Following the same patients over time, improvement in recommended testing was no greater after billing of the first incentive code than before.

CONCLUSIONS

The diabetes incentive code led to minimal improvement in quality of diabetes care at the population and patient level. Our findings suggest that physicians who provide the highest quality care prior to incentives may be those most likely to claim incentive payments.Diabetes accounts for an increasing proportion of the global burden of disease and currently is the fifth or sixth most common cause of death in most developed countries (1). It is well established that appropriate monitoring and treatment can significantly reduce the incidence of diabetes complications and improve overall morbidity and mortality (2–6). However, numerous studies, both globally and in Canada, have shown that the quality of diabetes care, measured by adherence to recommended processes or attainment of treatment goals, consistently falls short of evidence-based guidelines (7).Over the last decade, many countries have implemented pay-for-performance programs in an effort to improve the quality of health care, but there still is limited evidence to support the effectiveness of this approach (8,9). In 2002, the government in Ontario, Canada, introduced a new fee code for primary care physicians to encourage regular, comprehensive management of diabetic patients (10). When introduced, this code could be billed a maximum of three times a year per patient at a value of $37.00 (Canadian) per visit and required maintenance of a diabetes flow sheet that tracked cholesterol, hemoglobin A_1c (HbA_1c), retinal eye examination, blood pressure, weight, and other parameters relevant to diabetes management (11). It is unclear, however, whether the new incentive code has had any impact on the quality of care provided.In this study, we aimed to investigate the quality of diabetes care, measured by receipt of three evidence-based monitoring tests, and to assess the impact of the new diabetes incentive code in Ontario on quality of care at the population and patient level. We also sought to identify patient and physician characteristics associated with higher quality care.