Informing family physician payment reform in Canada: protocol for a cross-provincial, multimethod study.

Background: Amid growing concerns about primary care accessibility and the need to support longitudinal, community-based models of care, Canadian provinces have implemented major reforms to how family physicians are paid. These models share objectives of making longitudinal, community-based family practice more attractive and, to some degree, addressing long-standing disparities in pay between family medicine and other specialties. These new remuneration models require robust evaluation to guide improvements, future investments and planning.

Paid family leave and reduced acute respiratory infections in young infants: Does everyone benefit equally?

Background And Objectives: To examine whether the effect of a paid family leave program on acute care encounters for respiratory tract infections (RTI) among young infants differed by subgroups.

Methods: We examined 52943 hospitalizations and emergency department visits between Oct 2015 and Feb 2020 among infants aged ≤8 weeks in New York, which introduced paid family leave in January 2018, and four New England control states (Massachusetts, New Hampshire, Vermont, Maine). We conducted a controlled time series analysis that compared observed counts in New York during the putative respiratory virus season (Oct-Mar) in each population subgroup to those predicted in the absence of the policy.

Antenatal Corticosteroid Administration and Childhood Respiratory Morbidity: A Regression Discontinuity Study.

Objective: To determine if routine administration of antenatal corticosteroids affects the risk of infant lower respiratory tract infection and/or childhood asthma.

Design: Linked population-based cohort analysed using a regression discontinuity design, which better controls for confounding than standard observational studies.

Setting: British Columbia, Canada.

Real-world comparative effectiveness and safety of Pertuzumab in patients with HER2+ metastatic breast cancer: A pan-Canadian population-based cohort study.

We assessed the comparative effectiveness and safety of pertuzumab plus trastuzumab and chemotherapy versus trastuzumab and chemotherapy for patients with HER2+ metastatic breast cancer (mBC) in Canada. We conducted a population-based retrospective study of patients receiving first-line treatment for mBC across eight Canadian provinces. Patients receiving trastuzumab and chemotherapy were historical comparators, and patients receiving pertuzumab plus trastuzumab and chemotherapy were the treatment group.

The effect of enrolment policies on patient affiliation to a family physician: A quasi-experimental evaluation in Canada.

Affiliation, defined as having a usual source of care, revealed by patterns of repeated interactions between the patient and a clinician over time, can influence patients' care experience, continuity of care and health outcomes. Many jurisdictions implement primary care enrolment policies, with the motivation to increase affiliation and thereby improve downstream patient outcomes. However, there is little evidence on the impacts of these policies on patient-physician affiliation.

Reporting a regular medical doctor index: A new measure of patient-physician affiliation for health administrative data.

Having a regular medical doctor is associated with better process of care and health outcomes. The goal of this study was to harness the richness in health administrative data to create a measure which accurately predicted whether patients self-identified as having a regular medical doctor. The Canadian Community Health Survey (2007-2012) was linked with health administrative data (HAD) (2002-2012) from Quebec, Canada's second largest province.

Probabilistic bias analysis for exposure misclassification of household income by neighbourhood in a cohort of individuals with colorectal cancer.

Introduction: Despite poor agreement, neighbourhood income is used as a proxy for household income, due to a lack of data availability. We quantified misclassification between household and neighbourhood income and demonstrate quantitative bias analysis (QBA) in scenarios where only neighbourhood income is available in assessing income inequalities on colorectal cancer mortality.

Methods: This was a retrospective study of adults with colorectal cancer diagnosed 2006-14 from Statistics Canada's Canadian Census Health and Environment Cohort.

Development of a Canadian Guidance for reporting real-world evidence for regulatory and health-technology assessment (HTA) decision-making.

Background And Objective: Real-world evidence (RWE) can complement and fill knowledge gaps from randomized controlled trials to assist in health-technology assessment (HTA) for regulatory decision-making. However, the generation of RWE is an intricate process with many sequential decision points, and different methods and approaches may impact the quality and reliability of evidence. Standardization and transparency in reporting these decisions is imperative to appraise RWE and incorporate it into HTA decision-making.

Paid Family Leave and Prevention of Acute Respiratory Infections in Young Infants.

Importance: Acute respiratory tract infections are the leading cause of emergency department visits and hospitalizations in US children, with highest risks in the first 2 months after birth. Out-of-home childcare settings increase the spread of respiratory tract infections. The study team hypothesized that access to state-paid family leave could reduce acute care encounters (hospital admissions or emergency department visits) for respiratory tract infections in young infants by reducing out-of-home childcare transmissions.

Income differences in time to colon cancer diagnosis.

Introduction: People with low income have worse outcomes throughout the cancer care continuum; however, little is known about income and the diagnostic interval. We described diagnostic pathways by neighborhood income and investigated the association between income and the diagnostic interval.

Methods: This was a retrospective cohort study of colon cancer patients diagnosed 2007-2019 in Ontario using routinely collected data.

Human resource implications of expanding latent tuberculosis patient care activities.

Introduction: The World Health Organization (WHO) declared increasing services for latent tuberculosis infection (LTBI) a priority to eliminate tuberculosis (TB) by 2035. Yet, there is little information about thehuman resource needs required to implement LTBI treatment scale-up. Our study aimed to estimate the change in healthcare workers (HCW) time spent on different patient care activities, following an intervention to strengthen LTBI services.

Antenatal corticosteroids and newborn respiratory outcomes in twins: A regression discontinuity study.

Objective: To estimate the effect of antenatal corticosteroids on newborn respiratory morbidity in twins.

Design: Regression discontinuity applied to population-based birth registry data.

Setting: British Columbia, Canada, 2008-2018.

The impact of team-based primary care on medication-related outcomes in older adults: A comparative analysis of two Canadian provinces.

Objective: To evaluate if access to team-based primary care is related to medication management outcomes for older adults.

Methods: We completed two retrospective cohort studies using administrative health data for older adults (66+) in Ontario (n = 428,852) and Québec (n = 310,198) who were rostered with a family physician (FP) between the 2001/02 and 2017/18 fiscal years. We generated matched comparison groups of older adults rostered to an FP practicing in a team-based model, and older adults rostered to an FP in a non-team model.

Cost modelling incorporating procalcitonin for the risk stratification of febrile infants ≤60 days old.

Objectives: Procalcitonin testing is recommended to discriminate febrile young infants at risk of serious bacterial infections (SBI). However, this test is not available in many clinical settings, limited largely by cost. This study sought to evaluate contemporary real-world costs associated with the usual care of febrile young infants, and estimate impact on clinical trajectory and costs when incorporating procalcitonin testing.

Inequalities in survival and care across social determinants of health in a cohort of advanced lung cancer patients in Quebec (Canada): A high-resolution population-level analysis.

Background: Advanced lung cancer patients exposed to breakthrough therapies like EGFR tyrosine kinase inhibitors (EGFR-TKI) may experience social inequalities in survival, partly from differences in care. This study examined survival by neighborhood-level socioeconomic and sociodemographic status, and geographical location of advanced lung cancer patients who received gefitinib, an EGFR-TKI, as first-line palliative treatment. Differences in the use and delay of EGFR-TKI treatment were also examined.

Agreement between individual and neighborhood income measures in patients with colorectal cancer in Canada.

Introduction: With increasing interest in income-related differences in cancer outcomes, accurate measurement of income is imperative. Misclassification of income can result in wrong conclusions as to the presence of income inequalities. We determined misclassification between individual- and neighborhood-level income and their association with overall survival among colorectal cancer (CRC) patients.

Team-based primary care reforms and older adults: a descriptive assessment of sociodemographic trends and prescribing endpoints in two Canadian provinces.

Background: Team-based primary care reforms aim to improve care coordination by involving multiple interdisciplinary health professionals in patient care. Team-based primary care may support improved medication management for older adults with polypharmacy and multiple points of contact with the healthcare system. However, little is known about this association.

Advanced Lung Cancer Patients' Use of EGFR Tyrosine Kinase Inhibitors and Overall Survival: Real-World Evidence from Quebec, Canada.

EGFR tyrosine kinase inhibitors (EGFR-TKIs) are breakthrough palliative treatments for advanced lung cancer patients with tumors harboring mutations in the EGFR gene. Using healthcare administrative data, three cohorts were created to describe the use of three EGFR-TKIs that are publicly funded in Quebec for specific indications (i.e.

Health care services use, stillbirth, and neonatal and infant survival following implementation of the Maternal Health Voucher Scheme in Bangladesh: A difference-in-differences analysis of Bangladesh Demographic and Health Survey data, 2000 to 2016.

Background: Starting in 2006 to 2007, the Government of Bangladesh implemented the Maternal Health Voucher Scheme (MHVS). This program provides pregnant women with vouchers that can be exchanged for health services from eligible public and private sector providers. In this study, we examined whether access to the MHVS was associated with maternal health services utilization, stillbirth, and neonatal and infant mortality.

Mapping Canadian Data Assets to Generate Real-World Evidence: Lessons Learned from Canadian Real-World Evidence for Value of Cancer Drugs (CanREValue) Collaboration's RWE Data Working Group.

Canadian provinces routinely collect patient-level data for administrative purposes. These real-world data (RWD) can be used to generate real-world evidence (RWE) to inform clinical care and healthcare policy. The CanREValue Collaboration is developing a framework for the use of RWE in cancer drug funding decisions.

Antenatal corticosteroid administration and attention-deficit/hyperactivity disorder in childhood: a regression discontinuity study.

Background: Antenatal corticosteroids reduce respiratory morbidity in preterm infants, but their use during late preterm gestation (34-36 weeks) is limited because their safety for longer-term child neurodevelopment is unclear. We sought to determine if fetuses with higher probability of exposure to antenatal corticosteroids had increased rates of prescriptions for attention-deficit/hyperactivity disorder (ADHD) medication in childhood, using a quasiexperimental design that better controls for confounding than existing observational studies.

Methods: We identified 16 358 children whose birthing parents were admitted for delivery between 31 + 0 (31 weeks, 0 days) and 36 + 6 weeks' gestation in 2000-2013, using a perinatal data registry from British Columbia, Canada, and linked their records with population-based child ADHD medication data (2000-2018).

Patient characteristics associated with enrolment under voluntary programs implemented within fee-for-service systems in British Columbia and Quebec: a cross-sectional study.

Background: There is a paucity of information on patient characteristics associated with enrolment under voluntary programs (e.g. incentive payments) implemented within fee-for-service systems.

The effects of early pregnancy loss on health outcomes and health care utilization and costs.

Objective: To evaluate the effects of early pregnancy loss on subsequent health care use and costs.

Data Sources: Linked administrative health databases from Manitoba, Canada.

Study Design: This was a population-based cohort study.

Evaluating Montréal's harm reduction interventions for people who inject drugs: protocol for observational study and cost-effectiveness analysis.

Introduction: The main harm reduction interventions for people who inject drugs (PWID) are supervised injection facilities, needle and syringe programmes and opioid agonist treatment. Current evidence supporting their implementation and operation underestimates their usefulness by excluding skin, soft tissue and vascular infections (SSTVIs) and anoxic/toxicity-related brain injury from cost-effectiveness analyses (CEA). Our goal is to conduct a comprehensive CEA of harm reduction interventions in a setting with a large, dispersed, heterogeneous population of PWID, and include prevention of SSTVIs and anoxic/toxicity-related brain injury as measures of benefit in addition to HIV, hepatitis C and overdose morbidity and mortalities averted.

Avoidable Hospitalizations in Persons with Dementia: a Population-Wide Descriptive Study (2000-2015).

Background: Whether avoidable hospitalizations in community-dwelling persons with dementia have decreased during primary care reforms is unknown.

Methods: We described the prevalence and trends in avoidable hospitalizations in population-based repeated yearly cohorts of 192,144 community-dwelling persons with incident dementia (Quebec, 2000-2015) in the context of a province-wide primary care reform, using the provincial health administrative database.

Results: Trends in both types of Ambulatory Care Sensitive Condition (ACSC) hospitalization (general and older population) and 30-day readmission rates remained constant with average rates per 100 person-years: 20.