Evidence map›Paper›PMID 40775317›Full record

ArticleBMC health services research2025

Evaluation of an integrated care program for thoracic surgery in Ontario, Canada: a historical cohort study.

Nicholas Bakewell, Catherine Liang, Tsoleen Ayanian, Sanjana Sundaram, Kazuhiro Yasufuku, Meghan O'Neill, Kathy Kornas, Lori Diemert, Megan Samantha Lowe, Melissa Chang and 1 more

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In one paragraph

Article in BMC health services research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Nicholas BakewellDalla Lana School of Public Health, University of Toronto, 155 College St. Health Sciences Building, 6th Floor, Toronto, ON, Canada.
Catherine LiangDalla Lana School of Public Health, University of Toronto, 155 College St. Health Sciences Building, 6th Floor, Toronto, ON, Canada.
Tsoleen AyanianUniversity Health Network, Toronto, ON, Canada.
Sanjana SundaramUniversity Health Network, Toronto, ON, Canada.
Kazuhiro YasufukuUniversity Health Network, Toronto, ON, Canada.
Meghan O'NeillDalla Lana School of Public Health, University of Toronto, 155 College St. Health Sciences Building, 6th Floor, Toronto, ON, Canada.
Kathy KornasDalla Lana School of Public Health, University of Toronto, 155 College St. Health Sciences Building, 6th Floor, Toronto, ON, Canada.
Lori DiemertDalla Lana School of Public Health, University of Toronto, 155 College St. Health Sciences Building, 6th Floor, Toronto, ON, Canada.
Megan Samantha LoweDalla Lana School of Public Health, University of Toronto, 155 College St. Health Sciences Building, 6th Floor, Toronto, ON, Canada.
Melissa ChangUniversity Health Network, Toronto, ON, Canada.
Laura C RosellaDalla Lana School of Public Health, University of Toronto, 155 College St. Health Sciences Building, 6th Floor, Toronto, ON, Canada. laura.rosella@utoronto.ca.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionIntegrated care (IC) may help to improve postoperative health outcomes among thoracic surgery patients. We conducted an outcome evaluation of an IC program implemented within the Division of Thoracic Surgery of a large hospital network in Ontario, Canada.

methodsHistorical cohort design using data on patients who underwent thoracic surgery to compare outcomes of two IC groups (Pre-COVID IC: June 2019-February 2020; COVID IC: March 2020-September 2022), to a Historical non-IC group (June 2018-February 2019). Stratified by care path (low [minimally invasive procedures], medium [other procedures], high [complex procedures]), we compared risks of readmissions and emergency department (ED) visits, and mean length of stay (LOS) and healthcare costs up to 90 days post-discharge using modified Poisson/Ordinary Least Squares, Negative Binomial and Gamma regression, respectively, adjusting for age, sex, and location of residence.

resultsIn total, 1572 patients were included (Pre-COVID IC (n = 269); COVID IC (n = 869); Historical non-IC (n = 434)), with the largest proportion enrolled in the low care path. Compared to the Historical non-IC group, both the Pre-COVID and COVID IC groups had a statistically significantly shorter mean index LOS in the low (relative mean difference (RMD): 0.74 (95% confidence interval: 0.63–0.88) [Pre-COVID]; 0.66 (0.58–0.75) [COVID]) and medium (RMD: 0.75 (0.59–0.97) [Pre-COVID]; 0.62 (0.51–0.74) [COVID]) care paths; results were similar for total LOS (including readmissions). In contrast, the Pre-COVID IC group had a statistically significantly higher mean index LOS in the high care path (RMD: 1.39 (1.02–1.89)). The Pre-COVID IC group had a statistically significantly lower risk of 90-day ED visits in the low care path (relative risk (RR): 0.59 (0.36–0.97)) and a statistically significantly lower mean index cost in the medium care path (RMD: 0.72 (0.52–0.99)). The COVID IC group had a statistically significantly lower risk of 90-day readmissions in the low care path (RR: 0.64 (0.42–0.97)).

conclusionsIC programs may reduce post-discharge ED visits, LOS and healthcare costs for thoracic surgery patients, particularly for those in a low care path. As the IC program continues, further research is needed with larger sample sizes to confirm these findings and optimize IC program delivery, especially for more complex surgical patients.

Indexed as

Delivery of Health Care, IntegratedThoracic Surgical ProceduresAgedCohort StudiesCOVID-19Emergency Room VisitsEmergency Service, HospitalFemaleHealth Care CostsHistorically Controlled StudyHumansLength of StayMaleMiddle AgedOntarioPatient ReadmissionCohort studyIntegrated carePostoperative periodThoracic surgery

Identifiers

PMID40775317
PMCPMC12333262

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.