Influence of local provision of specialty health care service on patient access to care.
Bibliographic record
Abstract
INTRODUCTION: The impact of local provision of specialty service on patients' access to care was studied in Canada's 13 health care jurisdictions where distance may be a barrier limiting access. METHODS: A cross-sectional study of routinely collected registry data in Ontario and Nova Scotia was performed. Liver transplant was chosen as an indicator service. Transplant rate, disease severity, urgency and outcome were studied in adult recipients of first liver transplants from 1993 to 2002. Provinces that provided liver transplants were compared with those that did not; Ontario regions that provided the service were compared with those that did not; and the period of time when liver transplants were available in Nova Scotia was compared with the time when they were not. RESULTS: Use varied widely between jurisdictions but was consistently higher in provider provinces, at 10.9 per million population (pmp) compared with 8.9 pmp in nonprovider provinces (p < 0.005). Use was higher in district health councils of Ontario that provided transplantation. A larger proportion of patients in provider regions had viral or alcoholic etiologies of disease than did those from nonprovider regions, who tended to have superior survival after transplant. Service interruption in Nova Scotia did not change use rates, with transplant rates remaining above average, at 12.0 pmp. CONCLUSIONS: Differences in use between provider and nonprovider regions may reflect local service availability as well as local patterns of disease and patient referral. Expectations of patients that are established by local service availability persist after service is removed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".