Sten Ardal

Publications (7)3.23 Total impact

• Article: Understanding the Unattached Population in Ontario: Evidence from the Primary Care Access Survey (PCAS).

  Carley Hay, Michael Pacey, Namrata Bains, Sten Ardal
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  ABSTRACT: To measure primary care access on an ongoing basis, the Ontario Ministry of Health and Long-Term Care implemented the Primary Care Access Survey (PCAS) in 2006. The PCAS, a cross-sectional telephone survey, samples approximately 8,400 Ontario adults each year. It collects information on access to a family doctor, use of services, health status and socio-demographics. Analysis of the 2007-2008 PCAS (n=16,560) shows that 7.1% of Ontario's adults were without a family doctor (i.e., unattached). The attached and unattached populations differed on socio-demographic and health characteristics. Emergency department use was similar between the two groups, but walk-in clinic use was higher among the unattached. The unattached were less likely to have used care for immediate issues but accessed care in a more timely fashion than the attached. This initial exploration of the PCAS provides a better understanding of some of the differences between the attached and unattached populations in Ontario.
  Healthcare policy = Politiques de sante 11/2010; 6(2):33-47.
• Article: Making health system performance measurement useful to policy makers: aligning strategies, measurement and local health system accountability in ontario.

  Jeremy Veillard, Tai Huynh, Sten Ardal, Sowmya Kadandale, Niek S Klazinga, Adalsteinn D Brown
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  ABSTRACT: This study examined the experience of the Ontario Ministry of Health and Long-Term Care in enhancing its stewardship and performance management role by developing a health system strategy map and a strategy-based scorecard through a process of policy reviews and expert consultations, and linking them to accountability agreements. An evaluation of the implementation and of the effects of the policy intervention has been carried out through direct policy observation over three years, document analysis, interviews with decision-makers and systematic discussion of findings with other authors and external reviewers. Cascading strategies at health and local health system levels were identified, and a core set of health system and local health system performance indicators was selected and incorporated into accountability agreements with the Local Health Integration Networks. despite the persistence of such challenges as measurement limitations and lack of systematic linkage to decision-making processes, these activities helped to strengthen substantially the ministry's performance management function.
  Healthcare policy = Politiques de sante 02/2010; 5(3):49-65.
• Article: Hospital standardized mortality ratio: the way forward in Ontario.

  John McKinley, Debbie Gibson, Sten Ardal
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  ABSTRACT: Variations in quality of care persist despite an increased understanding of optimal practice and an improved ability to monitor outcomes. The reporting of hospital standardized mortality ratios (HSMRs) is an important step in highlighting the need to improve quality; but, as with most measures, the HSMR is not without flaws. Intense debate in the United Kingdom and the United States, and now here in Canada, has focused too much on the shortcomings of this measure and not enough on the issue at hand. The Ontario Ministry of Health and Long-Term Care--assuming our commitment to steward the healthcare system--embraces the themes of transparency and accountability as key tools in focusing attention on system performance and quality. The analysis of HSMRs in Ontario has indicated limitations to its interpretation, similar to those observed in the Winnipeg Regional Health Authority. The HSMR may not be a specific measure of adverse events, but this does not negate its usefulness in tracking the impact of quality improvement initiatives over time; it may be considered a valuable tool among a suite of indicators. In light of this, there is an opportunity to develop better statistics, including better data and measurement frameworks, and to educate the public to facilitate accurate interpretation, which will drive improvements in practice, quality and patients' experiences.
  HealthcarePapers 02/2008; 8(4):43-9; discussion 69-75.
• Article: Variation in emergency department visits for conditions that may be treated in alternative primary care settings.

  Chris A Altmayer, Sten Ardal, Graham L Woodward, Michael J Schull
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  ABSTRACT: The purpose of this report is to examine Ontario's geographic variation in emergency department (ED) visits for conditions that may be treated in alternative primary care settings. We studied all visits to Ontario EDs in 2002/03 and calculated county-specific age-standardized rates. Overall in Ontario, there were 3174 ED visits per 100,000 population aged 1-74 for conditions that could be treated in alternate primary care settings, but rates varied widely across counties. They were higher in rural counties with rates up to 7-fold higher than the provincial average. Urban counties had lower rates, some were less than one-third of the provincial average. Further research is needed to determine the relationship between ED utilization and primary care capacity.
  CJEM: Canadian journal of emergency medical care = JCMU: journal canadien de soins medicaux d'urgence 08/2005; 7(4):252-6. · 1.18 Impact Factor
• Article: Defining needs-based urban health planning areas is feasible and desirable: a population-based approach in Toronto, Ontario.

  Richard H Glazier, Mandana Vahabi, Cynthia Damba, Dianne Patychuk, Sten Ardal, Ian Johnson, Graham Woodward, Donald P DeBoer, Adalsteinn Brown, Harvey Low, Claire McConnell, Lynne Lawrie, Scott Dudgeon
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  ABSTRACT: Reporting health data for large urban areas presents numerous challenges. In the case of Toronto, Ontario, amalgamation in 1998 merged six census subdivisions into one mega-city, resulting in the disappearance of standard reporting units. A population-based approach was used to define new health planning areas. Census tracts were used as building blocks and combined according to residential income homogeneity, respecting natural and man-made boundaries, forward sortation areas and the City of Toronto's community neighbourhoods whenever possible. Correlations and maps were used to establish area boundaries. The city was divided into 5 major planning areas which were further subdivided creating 15 minor areas. Both major and minor areas showed significant differences in population characteristics, health status and health service utilization. This commentary demonstrates the feasibility and describes the outcomes of one method for establishing planning and reporting areas in large urban centres. Next steps include the further generation of health data for these areas, comparisons with other Canadian urban areas, and application of these methods to recently announced Ontario Local Health Integration Networks. These areas can be used for planning and evaluating health service delivery, comparison with other Canadian urban areas and ongoing monitoring of and advocacy for equity in health.
  Canadian journal of public health. Revue canadienne de santé publique 96(5):380-4. · 1.02 Impact Factor
• Source

  Available from: cpha.ca

  Article: Under-reporting of live births in Ontario: 1991-1997.

  Graham L Woodward, Monica K Bienefeld, Sten Ardal
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  ABSTRACT: To examine unregistered births in Ontario and consider related factors, including adoption of administrative fees for birth registration. Documents from both the parents and the attending physician are required for births to be entered into Ontario's live birth database. Our study used data from the Ontario Registrar General to look at the prevalence and characteristics of unregistered births, and a survey of municipal clerks to identify municipalities charging fees for parental documentation. The percentage of births going unrecorded increased threefold from 1991 to 1997. The odds of an unregistered birth were higher for teenage mothers, low birthweight babies, and mothers residing in a municipality that charged birth registration fees. The introduction of registration fees by some municipalities appears to account for an increase in unregistered births. It is recommended that the Ontario Registrar General work to remove financial and administrative barriers that compromise birth statistics.
  Canadian journal of public health. Revue canadienne de santé publique 94(6):463-7. · 1.02 Impact Factor
• Source

  Available from: cpha.ca

  Article: Defining needs-based urban health planning areas is feasible and desirable: A population-based approach in Toronto, Ontario. Commentary

  Richard H Glazier, Donald P Deboer, Mmath, Mandana Vahabi, Adalsteinn Brown, Dphil, Cynthia Damba, Mhsc, Harvey Low, Ba, Dianne Patychuk, Claire Mcconnell, Sten Ardal, Ma, Lynne Lawrie, Ian Johnson, Msc, Scott Dudgeon, Graham Woodward
  [show abstract] [hide abstract]
  ABSTRACT: Reporting health data for large urban areas presents numerous challenges. In the case of Toronto, Ontario, amalgamation in 1998 merged six census subdivisions into one mega-city, resulting in the disappearance of standard reporting units. A population-based approach was used to define new health planning areas. Census tracts were used as building blocks and combined according to residential income homogeneity, respecting natural and man-made boundaries, forward sortation areas and the City of Toronto's community neighbourhoods whenever possible. Correlations and maps were used to establish area boundaries. The city was divided into 5 major planning areas which were further subdivided creating 15 minor areas. Both major and minor areas showed significant differences in population characteristics, health status and health service utilization. This commentary demonstrates the feasibility and describes the outcomes of one method for establishing planning and reporting areas in large urban centres. Next steps include the further generation of health data for these areas, comparisons with other Canadian urban areas, and application of these methods to recently announced Ontario Local Health Integration Networks. These areas can be used for planning and evaluating health service delivery, comparison with other Canadian urban areas and ongoing monitoring of and advocacy for equity in health.