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The Evidence Speaks (January 2017)

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We’re proud to introduce our Evidence Speaks series, a recurring feature highlighting the latest in CHÉOS research. This series features summaries of select publications as well as in-depth features on the latest work from our investigators.

In the early days of CHÉOS, the Centre had a series known as “The Evidence Speaks,” a monograph series to keep media and the research community up-to-date with CHÉOS’ current research results in the health outcomes field.

Blair AH, Pearce ME, Katamba A, Malamba SS, Muyinda H, Schechter MT, Spittal PM. The Alcohol Use Disorders Identification Test (AUDIT): Exploring the factor structure and cutoff thresholds in a representative post-conflict population in Northern Uganda. Alcohol Alcohol. Epub ahead of print 2016 Dec 20.

Uganda has one of the highest per-capita alcohol consumption levels in sub-Saharan Africa. Northern Uganda, a region marred by recent civil war, has high rates of post-traumatic stress, depression, and HIV, all three of which can be exacerbated by excessive alcohol use. CHÉOS Scientists Drs. Martin Schechter and Patricia Spittal led a team of researchers to identify an appropriate tool to accurately assess problematic alcohol consumption and its implications in Northern Uganda. The team used the Alcohol Use Disorders Identification Test (AUDIT), a 10-question scale that identifies and categorizes disordered drinking, its behavioural, mental, and physical impacts, and the resulting social harms. The study found that the AUDIT was appropriate for use in this unique, post-conflict setting and recommended the use of a low threshold to increase sensitivity of the test. The team also found that the rates of alcohol consumption in Northern Uganda were significantly lower than the rest of the country—meaning that this region could benefit from proactive intervention to disrupt this destructive national trend.

Sutherland JM, Liu G, Crump RT, Law M. Paying for volume: British Columbia’s experiment with funding hospitals based on activity. Health Policy. 2016;120(11):1322–8.

In 2010, the Government of British Columbia changed how it funded its larger hospitals. Instead of paying hospitals using blocks of funding for all services delivered, called global funding, the province diverted a portion of funding, giving hospitals a fixed amount on a per-case basis based on a particular diagnosis (activity-based funding or ABF). The province introduced the ABF program to counteract the known shortcomings of global funding programs, including incentivizing lower volumes and decreased treatment efficiency. CHÉOS Scientist Dr. Jason Sutherland headed a team of researchers that sought to identify the impacts of B.C.’s health care reform. The group found that the ABF program increased inpatient surgical volume, decreased volume and increased length of stay for inpatient medical care, and did not affect quality of care. The results of the ABF program were clearly mixed and were small compared to similar programs in other countries. The researchers identified several potentially problematic components of the program, concluding that small, short-term reforms are unlikely to quickly change hospitals’ behaviours.

Bansback N, Bell M, Spooner L, Pompeo A, Han PKJ, Harrison M. Communicating uncertainty in benefits and harms: A review of patient decision support interventions. The Patient. 2016 Nov 30 epub ahead of print.

CHÉOS Scientists Drs. Nick Bansback and Mark Harrison recently authored a paper that looked at how patient decision support interventions (PDSIs) describe uncertainty in potential treatment benefits and harms. PDSI are tools that help patients and their families participate in health care choices and promote shared, informed decisions. The research team broke down uncertainty into two types: first-order uncertainty, often expressed as probability or risk of future outcomes, and second-order uncertainty, which is uncertainty about risk estimates, commonly represented as risk ranges or confidence intervals. Almost 9000 uncertainty statements from 460 PDSIs were reviewed. The majority (76 per cent) of first-order uncertainty was communicated qualitatively (“this medicine may cause side effects”) as opposed to quantitatively (“3 of every 10 will have this side effect”). Almost half (47 per cent) of PDSIs reviewed did not provide any second-order uncertainty. The researchers concluded that a more deliberate approach is needed to communicate uncertainty with these tools and further study is needed to better identify knowledge gaps.

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