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Research

Regional differences in use of endoscopic ultrasonography in Ontario: a population-based retrospective cohort study

Paul D. James, Mae Hegagi, Lilia Antonova, Jill Tinmouth, Steven J. Heitman, Carmine Simone, Elaine Yeung and Elaine Yong
June 09, 2017 5 (2) E437-E443; DOI: https://doi.org/10.9778/cmajo.20160153
Paul D. James
Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont.
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Mae Hegagi
Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont.
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Lilia Antonova
Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont.
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Jill Tinmouth
Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont.
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Steven J. Heitman
Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont.
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Carmine Simone
Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont.
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Elaine Yeung
Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont.
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Elaine Yong
Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont.
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    Figure 1

    Age- and sex-standardized rates of use of endoscopic ultrasonography in the 14 Local Health Integration Networks in Ontario, 2011.

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    Figure 2

    Age-standardized rates of use of endoscopic ultrasonography in Ontario by sex, 2003-2011.

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    Figure 3

    Age- and sex-standardized rates of use of endoscopic ultrasonography in the 2 Local Health Integration Networks with the highest, lowest and median rates of use in Ontario, 2003-2011.

Tables

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    Table 1: Patient characteristics at the time of the index endoscopic ultrasound procedure in Ontario, 2003-2011
    CharacteristicNo. (%) of patients*
    n = 8001
    Median age (IQR), yr59 (51-67)
    Female sex3858 (48.2)
    Urban residence7057 (88.2)
    Income quintile
        1 (lowest)1539 (19.2)
        21533 (19.2)
        31531 (19.1)
        41656 (20.7)
        5 (highest)1707 (21.3)
        Unknown35 (0.4)
    No. of morbidity groups†
        0-51924 (24.0)
        6-104733 (59.2)
        > 101344 (16.8)

    Note: IQR = interquartile range.

    *Except where noted otherwise.

    †Johns Hopkins Adjusted Clinical Groups case-mix system.

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      Table 2: Institution and endoscopist characteristics in Ontario, 2011
      CharacteristicNo. (%)
      Institution (n = 8001 patients)
      Academic centre3193 (39.9)
      Regional cancer centre2401 (30.0)
      Other/missing data2407 (30.1)
      Endoscopist* (n = 17)
      Practising specialty
          Gastroenterology12 (70)
          Thoracic surgery3 (18)
          Other†2 (12)
      Health region practice location‡
          Toronto Central6 (35)
          Central West2 (12)
          Champlain2 (12)
          South East2 (12)
          South West2 (12)
          Mississauga Halton1 (6)
          Central East1 (6)
          Hamilton Niagara1 (6)

      *Active endoscopists during 2011 only.

      †One endoscopist's main specialty was listed as "unknown," and 1 endoscopist's main specialty was listed as "general surgery."

      ‡None of the endoscopists practised in the following health regions: North West, North East, Waterloo Wellington, Hamilton Niagara, Erie St. Clair, North Simcoe Muskoka or Central.

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      1 Apr 2017
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      Regional differences in use of endoscopic ultrasonography in Ontario: a population-based retrospective cohort study
      Paul D. James, Mae Hegagi, Lilia Antonova, Jill Tinmouth, Steven J. Heitman, Carmine Simone, Elaine Yeung, Elaine Yong
      Apr 2017, 5 (2) E437-E443; DOI: 10.9778/cmajo.20160153

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      Regional differences in use of endoscopic ultrasonography in Ontario: a population-based retrospective cohort study
      Paul D. James, Mae Hegagi, Lilia Antonova, Jill Tinmouth, Steven J. Heitman, Carmine Simone, Elaine Yeung, Elaine Yong
      Apr 2017, 5 (2) E437-E443; DOI: 10.9778/cmajo.20160153
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