Mohammad Agha

Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada

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Publications (6)10.98 Total impact

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    ABSTRACT: BACKGROUND: Families of children with cancer are confronted with a broad range of direct costs (out-of-pocket expenses), but the nature of these costs is poorly understood. This study aimed to disaggregate and describe these costs. PROCEDURE: A prospective, mixed method, cost-of-illness design was utilized. Starting in the fourth week following their child's diagnosis, parents recorded resources consumed, and costs incurred for 1 week per month for 3 consecutive months. Any additional costs not captured in this typical 1 week period were added for the remainder of the month. Parents also discussed their costs in an audio-taped interview at the end of the 3 months. Descriptive statistics and qualitative content analyses were performed to disaggregate and describe families' costs. RESULTS: In total, 99 families reported utilizing 16 cost categories and 74 cost items. Nearly three quarters of these costs were attributed to travel (56%) and food (18%). Costly items included acquisition of a car ($CAD35,000), relocation of a family ($CAD6,000), and purchase of a wheelchair ($CAD6,800). Parents described facing significant out-of-pocket expenses to ensure that their children had access to cancer treatment, to cope with the clinical treatment side effects of treatment, and to maintain the family household. CONCLUSION: Families of children with cancer experience a wide range of costs. Our understanding of the nature of their costs and resource use may formulate the basis for future cost assessments and provide insight into practice and policy changes aimed at lessening the economic impact of this burden. Pediatr Blood Cancer © 2012 Wiley Periodicals, Inc.
    Pediatric Blood & Cancer 09/2012; · 2.35 Impact Factor
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    ABSTRACT: BACKGROUND:: Cancer in children may place considerable economic burden on more than individual family members. The costs incurred to families' support networks (FSNs) have not been previously studied. OBJECTIVES:: The study objectives were to (a) identify and determine independent predictors of the direct and time costs incurred by the FSN and (b) explore the impact of these cancer-related costs on the FSN. METHODS:: A prospective mixed-methods study was conducted. Representing the FSN, parents recorded the resources consumed and costs incurred during 1 week per month for 3 consecutive months, beginning 1 month following their child's diagnosis. Descriptive statistics, multiple regression modeling, and descriptive qualitative analytical methods were used to analyze the data. RESULTS:: In total, 28 fathers and 71 mothers participated. The median total direct and time costs for the 3 months were Can$154 and $2776, respectively, per FSN. The largest component of direct and time costs was travel and foregone leisure. Direct and time costs were greatest among those parents who identified a support network at baseline. Parents relied on their FSN to "hold the fort," which entailed providing financial support, assuming household chores, maintaining the siblings' routines, and providing cancer-related care. CONCLUSIONS:: Families' support networks are confronted with a wide range of direct and time costs, the largest being travel and foregone leisure. IMPLICATIONS FOR PRACTICE:: Families' support networks play an important role in mitigating the effects of families' costs. Careful screening of families without an FSN is needed.
    Cancer nursing 05/2012; · 1.88 Impact Factor
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    ABSTRACT: Emergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions. Issues regarding increased wait times for services and crowding illustrate the need to investigate which factors are associated with increased frequency of emergency department utilization. The evidence from this study can help inform policy makers on the appropriate mix of supply and demand targeted health care policies necessary to ensure that patients receive appropriate health care delivery in an efficient and cost-effective manner. The purpose of this report is to assess those factors resulting in increased demand for emergency department services in Ontario. We assess how utilization rates vary according to the severity of patient presentation in the emergency department. We are specifically interested in the impact that access to primary care physicians has on the demand for emergency department services. Additionally, we wish to investigate these trends using a series of novel regression models for count outcomes which have yet to be employed in the domain of emergency medical research. Data regarding the frequency of emergency department visits for the respondents of Canadian Community Health Survey (CCHS) during our study interval (2003-2005) are obtained from the National Ambulatory Care Reporting System (NACRS). Patients' emergency department utilizations were linked with information from the Canadian Community Health Survey (CCHS) which provides individual level medical, socio-demographic, psychological and behavioral information for investigating predictors of increased emergency department utilization. Six different multiple regression models for count data were fitted to assess the influence of predictors on demand for emergency department services, including: Poisson, Negative Binomial, Zero-Inflated Poisson, Zero-Inflated Negative Binomial, Hurdle Poisson, and Hurdle Negative Binomial. Comparison of competing models was assessed by the Vuong test statistic. The CCHS cycle 2.1 respondents were a roughly equal mix of males (50.4%) and females (49.6%). The majority (86.2%) were young-middle aged adults between the ages of 20-64, living in predominantly urban environments (85.9%), with mid-high household incomes (92.2%) and well-educated, receiving at least a high-school diploma (84.1%). Many participants reported no chronic disease (51.9%), fell into a small number (0-5) of ambulatory diagnostic groups (62.3%), and perceived their health status as good/excellent (88.1%); however, were projected to have high Resource Utilization Band levels of health resource utilization (68.2%). These factors were largely stable for CCHS cycle 3.1 respondents. Factors influencing demand for emergency department services varied according to the severity of triage scores at initial presentation. For example, although a non-significant predictor of the odds of emergency department utilization in high severity cases, access to a primary care physician was a statistically significant predictor of the likelihood of emergency department utilization (OR: 0.69; 95% CI OR: 0.63-0.75) and the rate of emergency department utilization (RR: 0.57; 95% CI RR: 0.50-0.66) in low severity cases. Using a theoretically appropriate hurdle negative binomial regression model this unique study illustrates that access to a primary care physician is an important predictor of both the odds and rate of emergency department utilization in Ontario. Restructuring primary care services, with aims of increasing access to undersupplied populations may result in decreased emergency department utilization rates by approximately 43% for low severity triage level cases.
    BMC Emergency Medicine 08/2011; 11:13.
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    ABSTRACT: A diagnosis of cancer in childhood places a considerable economic burden on families, although costs are not well described. The objectives of this study were to identify and determine independent predictors of the direct and time costs incurred by such families. A prospective, cost-of-illness study was conducted in families of children newly diagnosed with cancer. Parents recorded the resources consumed and costs incurred during 1 week per month for three consecutive months beginning the fourth week following diagnosis and listed any additional costs incurred since then. Descriptive and multiple regression analyses were performed to describe families' costs (expressed in 2007 Canadian dollars) and to determine direct and time cost predictors. In total, 28 fathers and 71 mothers participated. The median total direct and time costs in 3 months were $CAD3503 and $CAD23 130, respectively, per family. The largest component of direct costs was travel and of time costs was time allocated previously for unpaid activities. There were no statistically significant predictors of direct costs. Six per cent of the variance for time costs was explained by language spoken at home. Families of children with cancer are confronted with a wide range of direct and time costs, the largest being travel and time allocated previously for unpaid activities. Copyright © 2011 John Wiley & Sons, Ltd.
    Psycho-Oncology 07/2011; 21(10):1113-23. · 3.51 Impact Factor
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    ABSTRACT: The objective of this study was to evaluate an administrative data-based risk adjustment method for predicting physician utilization and the contribution of survey-derived indicators of health status. The results of this study will support the use of administrative data for planning, reimbursement, and assessing equity of physician utilization. The Ontario portion of the 2000-2001 Canadian Community Health Survey was linked with administrative physician claims data from 2002-2003 and 2003-2004. Explanatory models of family physician (FP) and specialist physician (SP) utilization were run using demographic information and The Johns Hopkins University Adjusted Clinical Groups (ACG) Case-mix System. Survey-based measures of health status were then added to the models. The coefficient of determination, R, indicated the models' explanatory power. The study sample consisted of 25,558 individuals aged 20 to 79 years representing approximately 7.8 million people. Over the 2 years of study period, 82.5% of the study population had a FP visit with a median of 6 visits and 53.2% had a SP visit with a median of 1 visit. The R values based on administrative data alone were 33% and 21% for the frequency of FP and SP visits and 16% and 35% for having one or more visit to an FPs and SPs, respectively. The addition of the survey-based measures to the administrative data-based models produced less than a 2% increase in explanatory power for any outcome. Administrative data-based measures of morbidity burden are valid and useful indicators of future physician utilization. The survey-derived measures used in this study did not contribute significantly to models on the basis of administrative data-based measures. These findings support the future use of administrative data-based data and Adjusted Clinical Groups for planning, reimbursement, and research.
    Medical care 11/2009; 48(2):175-82. · 3.24 Impact Factor
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    ABSTRACT: In Ontario, psychiatric care is fully covered by provincial health insurance without co-payments or deductibles. The provincial fee schedule supports a "gatekeeper" system for psychiatric care by paying psychiatrists more for consultations with patients who have a physician referral. In this context, we sought to explore socio-economic differences in patterns of mental health service delivery. We employed a retrospective cohort design using administrative and census data from 1995 to 2004. Subjects were 1,448,820 adults in Toronto with no physician mental healthcare in the previous three years. We determined time-dependent differences by sex and neighbourhood education quintile for the time to first mental health visit, time to the first mental health visit with a family physician or general practitioner (FP/GP), referral time from the FP/GP to a psychiatrist and the time to the first mental health visit with a psychiatrist. Relative to the lowest neighbourhood education group, individuals in the highest neighbourhood education groups were less likely, and took longer, to have a first visit to a FP/GP, but once seen were more likely, and took less time, to be referred to a psychiatrist. The highest education group was more than twice as likely to see a psychiatrist without a FP/GP referral and took less time to do so than the lowest education group. CONCLUSIONS/DISCUSSION: THE PATTERNS OF CARE WE FOUND SUGGEST THREE MAJOR CONCLUSIONS: (1) that a significant portion of psychiatric service users in our setting bypass the gatekeeper function of the FP/GP; (2) that social inequities are particularly marked when the gatekeeper role of the FP/GP is bypassed; and (3) that even within the gatekeeper system there is evidence of inequity in referral patterns and referral times. New models of mental healthcare delivery or adjustment of the current model may be needed to redress these disparities.
    Healthcare policy = Politiques de sante 05/2009; 4(4):e133-50.

Publication Stats

32 Citations
10.98 Total Impact Points


  • 2011–2012
    • Pediatric Oncology Group of Ontario
      Toronto, Ontario, Canada
    • Columbia University
      • School of Nursing
      New York City, NY, United States
    • Institute for Clinical Evaluative Sciences
      Toronto, Ontario, Canada