ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne1993
Variations in surgical rates in Quebec: does access to teaching hospitals make a difference?
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 1993. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
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- Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis.Paediatrics & child health · 2017Article
- Appropriateness for Total Joint Replacement: Perspectives of Decision-Makers.Healthcare policy = Politiques de sante · 2016Article
- Current practices of laparoscopic inguinal hernia repair: a population-based analysis.Hernia : the journal of hernias and abdominal wall surgery · 2015Article
- Does good science make good medicine? Incorporating evidence into practice is complicated by the fact that clinical practice is as much art as science.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 1997Review
- Distribution of physicians in Ontario. Where are there too few or too many family physicians and general practitioners?Canadian family physician Medecin de famille canadien · 1997Article
- Defining basic services and de-insuring the rest: the wrong diagnosis and the wrong prescription.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 1995Article
- Variations in hysterectomy rates in Ontario: does the indication matter?CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 1994Article
- Revascularization after acute myocardial infarction: impact of hospital teaching status and on-site invasive facilities.Journal of general internal medicine · 1994Article
- Regionalized delivery and variable utilization of coronary artery bypass grafting in Ontario from 1981 to 1991.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 1994Article
Corrections and comments
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Authors and funding
1 author.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo document the geographic variations in the rates of 10 common surgical procedures in Quebec and to examine the relation between surgical rates and level of access to teaching hospitals.
designPopulation-based rates standardized for age and sex were calculated from 1985-88 data from MED-ECHO (the provincial hospital discharge database) for each of the 32 community health districts (départements de santé communautaire [DSCs]) in Quebec. Variation across DSCs was analysed with the use of the ratio of the highest to the lowest rate, the coefficient of variation and the systematic component of variation. On the basis of an urbanization index designed by Statistics Canada, DSCs were classified as having a low, medium, high or very high level of access to teaching hospitals. PATIENTS: All Quebec residents except those whose DSC of residence could not be traced (accounting for no more than 1.7% of patients for any study procedure) and aboriginal people from northern Quebec. SURGICAL PROCEDURES STUDIED: Appendectomy, cesarean section, cholecystectomy, coronary artery bypass grafting (CABG), hysterectomy, inguinal hernia repair, prostatectomy, tonsillectomy with or without adenoidectomy, total hip replacement and varicose vein stripping.
resultsThere was considerable systematic variation in the surgical rates for all 10 procedures. Cesarean section, the rates of which varied the least, still exhibited almost a twofold variation between the highest and lowest rates. The rates of tonsillectomy varied the most, by a factor of more than five. With a few exceptions there was relatively little relation between the rates of the procedures within the DSCs. The rates of appendectomy, cholecystectomy, hysterectomy and tonsillectomy tended to be lower in the DSCs containing teaching hospitals, whereas the reverse was true for CABG. For the other procedures the relation between the rates and the level of access to teaching hospitals was nonsignificant.
conclusionsThe overall consistency of the observed variations with those of previous studies invites a closer look at the practice patterns and the scientific basis of the clinical decisions associated with procedures showing high variations in rates. The lack of a systematic relation between the surgical rates and the level of access to teaching hospitals challenges the belief that remote regions are underserved with respect to the procedures studied.
Indexed as
Identifiers
8485676PMC1485540What OpenQuestion holds
Registered trials
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