Fiona Clement

Fiona Clement
The University of Calgary | HBI · Department of Community Health Sciences

About

134
Publications
46,711
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4,811
Citations
Citations since 2017
44 Research Items
2768 Citations
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20172018201920202021202220230100200300400500

Publications

Publications (134)
Article
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Background Inappropriate and wasteful use of health care resources is a common problem, constituting 10–34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging—in which the diagnostic test confers little to no clinical b...
Article
Background Health technology reassessment (HTR) is a process to manage existing health technologies to ensure ongoing optimal use. A model to guide HTR was developed; however, there is limited practical experience. This paper addresses this knowledge gap through the completion of a multi-phase HTR of red blood cell (RBC) transfusion practices in th...
Article
Background: To develop a knowledge translation (KT) tool that will provide guidance to stakeholders actively planning or considering implementation of a health technology reassessment (HTR) initiative. Methods: The KT tool is an international and collaborative endeavour between HTR researchers in Canada, Australia, and the United Kingdom. Evidence...
Article
Introduction Health technology reassessment (HTR) is a structured evidence-based assessment of an existing technology in comparison to its alternatives. The process results in the following four outputs: (i) increased use; (ii) decreased use; (iii) no change; or (iv) de-adoption. However, implementing these outputs remains a challenge. Knowledge tr...
Article
Full-text available
Objective Health technology reassessment (HTR) is a field focused on managing a technology throughout its life cycle for optimal use. The process results in one of four possible recommendations: increase use, decrease use, no change or complete withdrawal of the technology. However, implementation of these recommendations has been challenging. This...
Article
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Background Health Technology Reassessment (HTR) is a process that systematically assesses technologies that are currently used in the health care system. The process results in four outputs: increase use or decrease use, no change, or de-adoption of a technology. Implementation of these outputs remains a challenge. The Knowledge Translation (KT) fi...
Article
Background Diabetic retinopathy is a common microvascular complication that leads to vision loss. Despite national and international organizations developing guidelines for diabetic retinopathy screening, patients with diabetes remain unscreened. Purpose To understand facilitators and barriers influencing diabetic retinopathy screening attendance...
Preprint
Full-text available
Background: Health Technology Reassessment (HTR) is a process that systematically assesses technologies that are currently used in the health care system. The process results in four outputs: increase use or decrease use, no change, or de-adoption of a technology. Implementation of these outputs remains a challenge. The Knowledge Translation (KT) f...
Article
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Background: Many decisions regarding health resource utilization flow through the patient-clinician interaction. Thus, it represents a place where de-implementation interventions may have considerable effect on reducing the use of clinical interventions that lack efficacy, have risks that outweigh benefits, or are not cost-effective (i.e., low-val...
Article
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Background: Low-value care initiatives are rapidly growing; however, it is not clear how members of the public should be involved. The objective of this scoping review was to systematically examine the literature describing public involvement in initatives to reduce low-value care. Methods: Evidence sources included MEDLINE, EMBASE, and CINAHL d...
Article
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Background: Application of knowledge translation (KT) theories, models, and frameworks (TMFs) is one method for successfully incorporating evidence into clinical care. However, there are multiple KT TMFs and little guidance on which to select. This study sought to identify and describe available full-spectrum KT TMFs to subsequently guide users....
Article
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Background: Red blood cell (RBC) transfusions are common procedures performed in the intensive care unit (ICU). However, conservative transfusion approaches have been recommended to avoid RBC transfusions that are not clinically necessary and to achieve optimal patient outcomes. The objective of this study was to examine the utilization and costs...
Article
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Background & Aims: Inflammatory bowel diseases (IBDs) exist worldwide, with high prevalence in North America. IBD is complex and costly, and its increasing prevalence places a greater stress on health care systems. We aimed to determine the past current, and future prevalences of IBD in Canada. Methods: We performed a retrospective cohort study usi...
Article
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Background: Despite recommendations for restrictive approaches to red blood cell transfusion in the intensive care unit (ICU), variation from best practices persists. The aim of this study was to explore potential facilitators of and barriers to practising a restrictive red blood cell transfusion strategy among intensive care physicians using the...
Article
RATIONALE: Tobacco use is the leading cause of preventable death in Canada and worldwide. Funding smoking cessation pharmacotherapy increases the likelihood of smoking cessation pharmacotherapy use, making a quit attempt, and the probability of abstinence from smoking. OBJECTIVES: The aim of our study was to model the cost-effectiveness of a health...
Article
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IntroductionThe prevalence of diagnosed hypertension in Canada is projected to increase despite the incidence rate decreasing. Previous work around the world has utilized survey data to provide estimates of prevalence and incidence. Administrative data is population-level, and may provide more reliable estimates of provincial prevalence and inciden...
Article
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Background: Active management of existing health technologies (e.g., devices, diagnostic, and/or medical procedures) to ensure the delivery of high value care is increasingly recognized around the world. A number of initiatives have raised awareness of technologies that may be overused, mis-used, or potentially harmful by compiling them into lists...
Article
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Background: Formal mentorship plays a key career development role in medicine. Traditional mentorship consists of dyadic relationships between mentors and their mentees. However, research favours utilization of mentorship networks involving individuals at multiple levels.Objective: This study aimed to rigorously evaluate a formalized mentorship net...
Article
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Introduction: Clinical decision support (CDS) has been implemented in many clinical settings in order to improve decision-making. Their potential to improve diagnostic accuracy and reduce unnecessary testing is well documented; however, their effectiveness in impacting physician practice in real world implementations has been limited by poor physic...
Article
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Objective To assess the impact of behaviour modification interventions to promote restrictive red blood cell (RBC) transfusion practices. Design Systematic review and meta-analysis. Setting, participants, interventions Seven electronic databases were searched to January 2018. Published randomised controlled trials (RCTs) or non-randomised studies...
Article
Objectives: Health technology reassessment (HTR) is a policy process to manage health technologies throughout their lifecycle and ensure their ongoing optimal use. However, within an ever-evolving field, HTR is only one of many concepts associated with the optimization of health technologies. There is limited understanding of how other concepts an...
Article
Background: As populations age, more elderly patients will undergo surgery. Frailty and complications are considered to increase in-hospital cost in older adults, but little is known on costs following discharge, particularly those borne by the patient. We examined risk factors for increased cost and the type of costs accrued following discharge i...
Article
Background: Chronic constipation (CC) has a significant impact on patients' quality of life and imposes an economic burden on individuals and the healthcare system. Treatment options include dietary changes, lifestyle modifications, fibre supplements, stool softeners, and laxatives. Objective: We undertook this systematic review to comprehensive...
Article
Background: Recreational marijuana has been legalized in 11 jurisdictions; Canada will legalize marijuana by July 2018. With this changing landscape, there is a need to understand the public health risks associated with marijuana to support patient-care provider conversations, harm-reduction measures and evidence-informed policy. The objective of...
Article
Objective: Kaplan-Meier survival analysis may overestimate cumulative incidence in competing risks (CR) settings. The clinical significance of this overestimation has been questioned and CR methods are infrequently used. This meta-analysis compares the Kaplan-Meier method to the cumulative incidence function (CIF), a CR method. Study design and s...
Article
Purpose The purpose of the study was to establish the efficacy and safety of breast intensity-modulated radiation therapy (IMRT) compared with non-IMRT standard wedge radiation therapy (RT) for the treatment of adjuvant breast cancer. Methods A systematic review and meta-analysis were completed using STATA and a random effects model. A total of 1,...
Article
Of background data: In the general population, it has been estimated that 1.5% of people have ≥1 Tarlov cysts, with about 13% of those being symptomatic. Despite a range of options for treatment, there is debate about when, and how to optimally treat individuals with Tarlov cysts among clinicians, and among policy decision makers. Objective: To...
Article
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Objectives To describe marijuana use by Canadians and their perceptions of risk and harm. Design A cross-sectional, structured, online and telephone survey. Participants A nationally representative sample of Canadians. Methods This survey used random probability sampling and targeted respondents based on age, sex, region and their expected respo...
Article
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Background and purpose: Rapid endovascular therapy (EVT) is an emerging treatment option for acute ischemic stroke. Several economic evaluations have been published examining the cost-effectiveness of EVT, and many international bodies are currently making adoption decisions. The objective of this study was to establish the cost-effectiveness of E...
Article
Health technology reassessment (HTR) is an emerging evidence-based policy approach that addresses sub-optimal utilization of health technologies at the systems-level. Internationally, there are few documented accounts of HTR processes and little is known of its potential impact(s). The objective of this study is to explore and describe the initial...
Article
Background: Induction treatment of mild-to-moderate Crohn's disease is controversial. Purpose: To compare the induction of remission between different doses of mesalamine, sulfasalazine, corticosteroids, and budesonide for active Crohn's disease. Data sources: We identified randomized controlled trials from existing Cochrane reviews and an upd...
Article
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Background and Aims . The lived experience of HCV has not been well documented in the literature. The aim of this systematic review was to understand the experiences of living with Hepatitis C Virus (HCV). Methods . Five databases were searched from inception until January 19, 2015. Studies were included if they focused on adults diagnosed with HCV...
Article
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Background Healthcare providers, managers and policy-makers in many jurisdictions are focused on a common goal: optimizing value and quality of care provided to their citizens within a resource envelope. Health technology reassessment is a structured, evidence-based assessment of the clinical, social, ethical and economic effects of a technology cu...
Article
Background: Induction treatment of mild-to-moderate Crohn's disease is controversial. Purpose: To compare the induction of remission between different doses of mesalamine, sulfasalazine, corticosteroids, and budesonide for active Crohn's disease. Data sources: We identified randomized controlled trials from existing Cochrane reviews and an upd...
Article
Full-text available
Importance: At the turn of the 21st century, studies evaluating the change in incidence of appendicitis over time have reported inconsistent findings. Objectives: We compared the differences in the incidence of appendicitis derived from a pathology registry versus an administrative database in order to validate coding in administrative databases...
Data
Age and sex standardized incidence of appendicitis with annual percent change (APC). (DOCX)
Data
Comparative analysis in incidence and temporal trends between cohorts of appendicitis patients derived from a pathology-proven registry and an administrative healthcare database stratified by male and female. (DOCX)
Article
La réévaluation des technologies de la santé (RTS), ce domaine émergent des services de santé et des recherches stratégiques, favorise la prise en charge optimale des technologies pendant toute leur vie utile. La RTS, qui est une évaluation structurée et fondée sur des données probantes des effets cliniques, économiques, sociaux et éthiques des tec...
Article
Health Technology Reassessment (HTR) is an emerging area of health services and policy research that supports optimal management of technologies throughout their lifecycle. As a structured, evidence-based assessment of the clinical, economic, social, and ethical impacts of existing technologies, HTR is a means of achieving optimal use, managed exit...
Article
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Objectives With the developments of near-cures for hepatitis C virus (HCV), who to screen has become a high-priority policy issue in many western countries. Cost-effectiveness of screening programmes should be one consideration when developing policy. The objective of this work is to synthesise the cost-effectiveness of HCV screening programmes. S...
Data
Appendix S1. Members of the AKDN and APPROACH Investigators.
Article
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Background Although patients with kidney disease have potential to benefit from revascularization, they are also at higher risk of complications, which may affect quality of life. Methods and Results We studied a cohort of 8198 adults who underwent coronary angiography in Alberta, between 2004 and 2008, and completed health‐related quality‐of‐life...
Article
Acute upper gastrointestinal bleeding is a potentially life-threatening medical emergency that frequently requires red blood cell (RBC) transfusions. However, the optimal hemoglobin thresholds for transfusion is controversial. The objective of this study was to establish the most efficacious transfusion threshold. Methods: A systematic review of th...
Article
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A variety of methods may be used to obtain costing data. Although administrative data are most commonly used, the data available in these datasets are often limited. An alternative method of obtaining costing is through self-reported questionnaires. Currently, there are no systematic reviews that summarize self-reported resource utilization instrum...
Article
Objectives: The objectives of this study were to synthesize and compare population characteristics associated with frequent emergency department (ED) use within and across healthcare systems. Methods: A systematic review of literature published between 1950 and 2015 was conducted. Healthcare systems of included studies were categorized using the...
Article
Background: Between 30% and 60% of individuals with major depressive disorder will have treatment-resistant depression (TRD): depression that does not subside with pharmaceutical treatment. Repetitive transcranial magnetic stimulation (rTMS) is an emerging treatment for TRD.
Article
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It is estimated that seniors (≥65 years old) account for >50 % of acute inpatient hospital days and are presenting for surgical evaluation of acute illness in increasing numbers. Unfortunately, conventional acute care models rarely take into account needs of the elderly population. The failure to consider these special needs have resulted in poor o...
Article
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Accurately documenting the current and future costs of hypertension is required to fully understand the potential economic impact of currently available and future interventions to prevent and treat hypertension. The objective of this work was to calculate the healthcare costs attributable to hypertension in Canada and to project these costs to 202...
Article
To assess the cost utility of a center-based outpatient cardiac rehabilitation program compared with no program within patient subgroups on the basis of age, sex, and clinical presentation (acute coronary syndrome [ACS] or non-ACS). We performed a cost-utility analysis from a health system payer perspective to compare cardiac rehabilitation with no...
Article
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Hospitalization costs for ulcerative colitis (UC) following the introduction of infliximab have not been evaluated. OBJECTIVE: To study predictors of costs for UC patients who were hospitalized for a flare or colectomy. METHODS: Population-based surveillance identified adults (≥18 years of age) admitted to hospital for UC flare or colectomy between...
Article
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Pharmaceutical expenditure has increased rapidly across many Organisation for Economic Cooperation and Development (OECD) countries over the past three decades. This growth is an increasing concern for governments and other third-party payers seeking to provide equitable and comprehensive healthcare within sustainable budgets. In order to create he...
Article
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Although Kaplan-Meier survival analysis is commonly used to estimate the cumulative incidence of revision after joint arthroplasty, it theoretically overestimates the risk of revision in the presence of competing risks (such as death). Because the magnitude of overestimation is not well documented, the potential associated impact on clinical and po...
Article
Objectives: Patients with Crohn's disease (CD) who smoke are at a higher risk of flaring and requiring surgery. Cost-effectiveness studies of funding smoking cessation programs are lacking. Thus, we performed a cost-utility analysis of funding smoking cessation programs for CD. Methods: A cost-utility analysis was performed comparing five smokin...
Article
In the short time since its April 2012 launch by the American Board of Internal Medicine Foundation, the Choosing Wisely campaign has affected more than 60 US specialty societies. Now the campaign is becoming an international phenomenon, as evidenced by Selby et al¹ and Gupta and Detsky² in this issue. These publications should be considered in the...
Article
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To determine the effectiveness of built environment interventions in managing behavioural and psychological symptoms of dementia (BPSD) among residents in long-term care settings. Systematic review of literature published from 1995-2013. Studies were included if they: were randomized controlled trials, quasi-experimental trials, or comparative coho...
Article
Background: The cost-effectiveness of annual colonoscopy for detection of colorectal neoplasia among patients with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC) is uncertain. The aim of this study was to determine whether annual colonoscopy among patients with IBD-PSC is cost-effective compared with less frequent interv...
Article
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Radiofrequency ablation (RFA), a procedure using heat to interrupt pain signals in spinal nerves, is an emerging treatment option for chronic low back pain. Its clinical efficacy has not yet been established. OBJECTIVE: To determine the efficacy of RFA for chronic low back pain associated with lumbar facet joints, sacroiliac joints, discogenic low...
Article
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Background Access to primary care physicians (PCP) improves health outcomes among patients with hypertension. The study objective is to compare PCP use among patients with incident hypertension with and without comorbidities. Methods Newly diagnosed hypertensives between April 1, 1998 and March 31, 2009 were identified using Alberta administrative...
Article
Objectives: Value-based insurance design (V-BID) is an insurance cost-sharing model in which patients pay less for medications deemed to be of higher value. Our objective was to determine the association between V-BID and medication adherence, clinical outcomes, healthcare utilization, and spending in patients with or at risk for cardiovascular ch...
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Objectives: The objective of this study was to explore the degree to which databases other than MEDLINE contribute studies relevant for inclusion in rapid health technology assessments (HTA). Methods: We determined the extent to which the clinical, economic, and social studies included in twenty-one full and four rapid HTAs published by three Ca...
Article
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Prescription drugs are used in people with hypertension, diabetes, and cardiovascular disease to manage their illness. Patient cost sharing strategies such as copayments and deductibles are often employed to lower expenditures for prescription drug insurance plans, but the impact on health outcomes in these patients is unclear. To determine the ass...