Colonoscopy resource availability and colonoscopy utilization in Ontario, Canada
Notice bibliographique
Résumé
ABSTRACTObjectiveEvidence of long wait times for colonoscopy and regional variations in colonoscopy utilization have raised concerns that the availability of colonoscopy resources may be insufficient to meet current needs. This study described colonoscopy resource availability in Ontario, Canada, evaluated regional variations in colonoscopy resource availability and utilization, and examined the association between colonoscopy resource availability and colonoscopy utilization. ApproachThis is a population-based cross-sectional study of colonoscopy resource availability in Ontario, Canada from 2007 to 2013 using linked administrative health databases from the Institute for Clinical Evaluative Sciences (ICES). We defined the catchment areas for colonoscopy resources using physician networks that were built upon existing patient flow patterns, with comparisons to observed colonoscopy patient travel patterns to ensure the networks reflected colonoscopy referral patterns in the province. Colonoscopy physicians were identified from physician billing data. Network-level colonoscopy availability was measured in terms of physician density, specialty, and quality, use of private colonoscopy clinics, and distance that patients travel for colonoscopy. Network-level age- and sex-standardized colonoscopy utilization rates were calculated for 2007 to 2013. Associations between colonoscopy resource availability and colonoscopy utilization were analyzed using Spearman’s rank correlation. Results The availability of colonoscopy resources in Ontario increased between 2007 and 2013. Physician density increased from 8.7 full-time equivalent (FTE) physicians per 100,000 residents in 2007 to 9.4 FTE per 100,000 residents in 2013. The proportion of colonoscopy physicians who achieved the recommended colonoscopy completion and polypectomy rates increased from 60% to 77%, and 28% to 53%, respectively. Use of private colonoscopy clinics also increased. In 2007, 21% of colonoscopies were completed in private clinics, and by 2013, that proportion increased to 30%. Across Ontario, we observed strong geographic variation in these measures of colonoscopy resource availability as well as in the utilization of colonoscopy. Colonoscopy utilization was positively correlated with physician availability (r=0.48, p=0.001), physician quality (r=0.6, p<0.0001) and use of private clinics for colonoscopy (r=0.5, p=0.001). ConclusionThe availability of colonoscopy resources improved in Ontario between 2007 and 2013. However, the geographic variation in resource availability and findings that higher colonoscopy resource availability is associated with higher colonoscopy utilization suggest that certain areas of the province may be under-resourced. These areas may be appropriate targets for efforts to improve colonoscopy capacity in Ontario.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,004 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».