Jason Sutherland

• University of British Columbia

Traumatic spinal cord injury (TSCI) is a debilitating condition that can have significant effects on physical function and overall quality of life. Mechanisms of injury can vary from major trauma to low-energy falls. There has been a recent increase in the number of elderly patients with TSCI. A retrospective analysis of population-based hospital r...

Background: Addressing suicidal behaviors (i.e., ideation or thoughts, planning, or attempt) among youth is increasingly complex and often requires a comprehensive and integrated approach to care. Integrated youth services (IYS) are a growing model of care in which youth can access a range of non-stigmatizing health and social services all delivere...

Background Delays in diagnostic and therapeutic processes are a potentially preventable cause of morbidity and mortality. Process improvement depends on accurate knowledge about as-is processes, historically collected from front-line workers and summarized in flowcharts. Such flowcharts can now be generated by process discovery algorithms supplied...

Study Design Retrospective cohort study. Objectives The impact of delayed access to operative treatment on patient reported outcomes (PROs) for lumbar degenerative conditions remains unclear. The goal of this study is to evaluate the association between wait times for elective lumbar spine surgery and post-operative PROs. Methods This study is a...

Patient-physician sex discordance (when patient sex does not match physician sex) has been associated with reduced clinical rapport and adverse outcomes including post-operative mortality and unplanned hospital readmission. It remains unknown whether patient-physician sex discordance is associated with “before medically advised” hospital discharge...

Background Research shows women experience higher mortality than men after cardiac surgery but information on sex-differences during postoperative recovery is limited. Days alive and out of hospital (DAH) combines death, readmission and length of stay, and may better quantify sex-differences during recovery. This main objective is to evaluate (i) h...

This paper examines the contentious issue of using contracted surgical facilities (CSFs) for scheduled eye surgeries within Canada's publicly funded healthcare system. Despite the debate over the use of CSFs, there is a stark lack of Canadian-focused empirical evidence to guide policy decisions. This paper uses the Organisation for Economic Co-oper...

Patient-physician communication has the potential to improve outcomes and satisfaction through the shared decision-making process (SDM). This study aims to assess the relationship between perception of SDM and demographic, clinical, and patient-reported outcomes in patients undergoing Hallux Valgus (HV) correction. A prospective analysis of 306 pat...

Aim The aim was to estimate the 10‐year cost−utility of haemorrhoidectomy surgery with preference‐based measures of health using Canadian health utility measures and costs. Methods Patients undergoing elective haemorrhoidectomies by general and colorectal surgeons in British Columbia, Vancouver, between September 2015 and November 2022, completed...

Aim Prehabilitation for colorectal cancer has focused on exercise‐based interventions that are typically designed by clinicians; however, no research has yet been patient‐oriented. The aim of this feasibility study was to test a web‐based multimodal prehabilitation intervention (known as PREP prehab) consisting of four components (physical activity...

Importance Clinical experience suggests that hospital inpatients have become more complex over time, but few studies have evaluated this impression. Objective To assess whether there has been an increase in measures of hospital inpatient complexity over a 15-year period. Design, Setting and Participants This cohort study used population-based adm...

Background Integrated youth services (IYS) are vital to addressing the needs of youth who use substances. Evidence on the characteristics of youths accessing these services and the types of services accessed have been limited. The objectives were to identify sociodemographic, self-reported health and mental health, patterns of service utilization (...

The backlog of cases on surgical wait lists is a substantial problem for surgical patients, their families, surgeons, health care systems and governments. There are several approaches governments can take to improve the health, well-being and surgical outcomes of waiting patients. First, provinces should consider patient-centred approaches to triag...

Introduction Hospital activity is often measured using diagnosis-related groups, or case mix groups, but this information does not represent important aspects of patients’ health outcomes. This study reports on case mix-based changes in health status of elective (planned) surgery patients in Vancouver, Canada. Data and methods We used a prospectiv...

Cystic fibrosis (CF) is a progressive multi-organ disease with significant morbidity placing extensive demands on the healthcare system. Little is known about those individuals with CF who continually incur high costs over multiple years. Understanding their characteristics may help inform opportunities to improve management and care, and potential...

Purpose Mental health and well-being trajectories are not expected to be homogeneous in diverse clinical populations. This exploratory study aims to identify subgroups of patients with cancer receiving radiation therapy who have different mental health and well-being trajectories, and examine which socio-demographic, physical symptoms, and clinical...

Objective To investigate patient and clinical factors that are associated with perceptions of shared decision making between hysterectomy patients and surgeons and to evaluate associations between shared decision making and postoperative health. Methods This study is based on a prospective cohort scheduled for hysterectomy for benign conditions in...

Background: This study measures patient's concordance between clinical reference pathways with survival or cost among a population-based cohort of colon cancer patients applying a continuous measure of concordance. The primary hypothesis is that a higher concordance score with the clinical pathway is significantly associated with longer survival o...

RATIONALE: Cystic fibrosis (CF) is a progressive multi-organ disease with significant morbidity placing extensive demands on the health care system. No recent estimate of CF health care costs in a Canadian context exists. OBJECTIVES: Provide up-to-date direct cost estimates of the economic burden of CF from the perspective of a Canadian health care...

Even before the recent funding announcement, the provinces had money earmarked for spending on health services, therapies and devices. Canadians expect that this money will be put to work to improve access to scheduled services and emergency care, to increase capacity of primary care to manage complex conditions and to begin the assembly of patient...

Background: In 2011, policymakers in British Columbia introduced a fee-for-service payment incentivizing Infectious Diseases physicians to supervise outpatient parenteral antimicrobial therapy (OPAT). Whether this policy increased use of OPAT remains uncertain. Methods: We conducted a retrospective cohort study using population-based administrat...

To the Editor—We thank Dr Ito for thoughtful observations about our research and we appreciate the opportunity to respond [1]. In a matched retrospective observational cohort of 1842 patients, we found that patients receiving outpatient parenteral antimicrobial therapy (OPAT) had a similar number of adverse events and lower direct healthcare costs...

Background Concerns about youth alcohol and drug use have risen since the declaration of the global COVID-19 pandemic due to the pandemic’s impact on known risk and protective factors for substance use. However, the pandemic’s immediate and long-term impact on youths’ substance use patterns has been less clear. Thus, this study sought to determine...

Purpose Many indications for hysterectomy can negatively affect patients’ quality of life. This study uses patient-reported outcomes to measure changes in self-reported health among hysterectomy patients. Method A prospective cohort of 294 hysterectomy patients completed patient-reported outcomes preoperatively and six months postoperatively in Va...

As rates of total mastectomy rise, the relationships between surgery modality with domains of health-related quality of life is not well understood. This study reports differences in depression, anxiety, pain, and health status among a cohort of women scheduled to receive total mastectomy or breast-conserving surgery. Patient-reported outcomes meas...

Objective To compare the long-term physical and mental health outcomes of matched severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) positive and negative patients controlling for seasonal effects. Study Design Retrospective cohort study. Methods This study enrolled patients presenting to emergency departments participating in the Canad...

Healthcare reform is on everyone's lips these days. persistent calls for a "difference" and "change" are becoming louder. But will these calls reach a tipping point and precipitate fundamental changes in how provinces design healthcare delivery and how they pay for it?

Organized activity participation has been linked to children’s emotional wellbeing. However, a scarcity of literature considers the role of immigrant background. This study’s primary objective was to measure the association between organized activity participation and emotional wellbeing among a population-based sample of Grade 7 children in Britis...

Recently, we have all seen myriad articles in the national newspapers announcing that provinces' healthcare systems are imploding, with authors describing systems in states of "crisis" (Laverly 2022), "visibly coming apart" (Tumilty 2022), "broken" (Urback 2022) and "a travesty" (Picard 2022). Without minimizing the hardships or frustrations that s...

Objectives Little is known about the role of emerging plant-based dietary patterns in cardiovascular disease (CVD) at the national population level. The objectives of this research were to assess the validity and reliability of newly-established plant-based dietary indices, and to evaluate their associations with CVD risk among Canadian adults. Ap...

Long-term care (LTC) is an OFT-overlooked critical component of provinces' health and social care systems. Its residents have borne a disproportionate share of the negative impact of the COVID-19 pandemic. Healthcare Policy believes that rules, regulations, policies and health system delivery factors that were associated with excess mortality and p...

Objectives Despite the growing interest in plant-based dietary patterns, no previous studies have evaluated the performance of plant-based dietary indices in a general population. The main objectives of this research were to evaluate the construct validity of plant-based dietary indices and to explore associations between adherence to these indices...

Background Postoperative bariatric management often includes high-intensity monitoring for respiratory complications since > 70% of patients have obstructive sleep apnea. Given the increasing number of bariatric surgeries, there is a need to determine safe and cost-effective processes for postoperative care.The objective of this study was to determ...

Objectives The burden and costs of abdominal surgery for chronic conditions are on the rise, but could be reduced through self-management support. However, structured support to prepare for colorectal surgery is not routinely offered to patients in Canada. This study aimed to describe experiences and explore preferences for multimodal prehabilitati...

The spring has ushered in an unexpected number of major health policy announcements compared with the last 10 years. They are led by the federal government's outlines of a national pharmacare program, an unexpected dental care program (Prime Minister of Canada Justin Trudeau 2022), plus "top-up" funding for clearing provincial surgical and imaging...

BACKGROUND Bacterial infections such as osteomyelitis and endocarditis routinely require several weeks of treatment with intravenous (IV) antimicrobials. Outpatient parenteral antimicrobial therapy (OPAT) programs allow patients to receive IV antimicrobials in an outpatient clinic or at home. The outcomes and costs of such treatments remain uncerta...

Context Socio-demographic differences, including place of residence, socio-economic status, ethnicity, and gender, have been associated with various inequities in cancer care outcomes. Objectives The aims were to distinguish subgroups of patients with different symptom patterns at the time of the initial oncology visit and determine which clinical...

Background and purpose Studies of carotid endarterectomy (CEA) require stratification by symptomatic vs asymptomatic status because of marked differences in benefits and harms. In administrative datasets, this classification has been done using hospital discharge diagnosis codes of uncertain accuracy. This study aims to develop and evaluate algorit...

Background Little is known about the role of emerging plant-based dietary patterns in cardiovascular disease (CVD) at the national population level. Objectives The objectives of this research were to assess the validity and reliability of newly-established plant-based dietary indices, and to evaluate their associations with CVD risk among Canadian...

Healthcare Policy is a vibrant and growing canada-focused health services and policy journal. As I mark my two-year anniversary as volunteer editor-in-chief of Healthcare Policy, I can say that I have had the privilege to see the scope and breadth of researchers' progress on important health system problems. From this vantage point, a number of tre...

Introduction Shared decision making between patients and clinicians is important to surgical practice and patients’ perceptions of their healthcare experiences. This study aims to measure associations between patients’ perceptions of their shared decision-making process and health-related quality of life among a cohort of patients choosing surgical...

Introduction In many countries, there are waits for elective (planned) surgery. In these settings, processes for triaging patients are applied to determine how long patients wait for their surgery. There are very few instances that evaluate the effectiveness of surgical triage processes. Methods A sample of patients from four acute care hospitals...

Is substantive transformation of healthcare delivery in canada a fool's paradise? Since this idiom refers to a state of happiness unconnected to underlying truths, it may be an apt descriptor given the many problems with the provinces' and territories' delivery of healthcare. Some of these problems cause harm, such as hospital-acquired infections,...

As I write this, positive signs regarding the pandemic are beginning to affect our daily lives. We are now able to meet with our extended families, friends and neighbours. For many people, these changes signal the end of isolation, fear and loneliness and harken a return to normal life and behaviours.

As contemporaneous data emerge from publicly funded healthcare providers, the COVID-19 pandemic provides a unique opportunity to measure their resiliency. Resiliency matters because it connotes a higher level of confidence in being able to provide needed healthcare during times of health, social or environmental stress or calamity. At the beginning...

Background Unplanned hospital readmissions are common adverse events. The LACE+ score has been used to identify patients at the highest risk of unplanned readmission or death, yet the external validity of this score remains uncertain. Methods We constructed a cohort of patients admitted to hospital between 1 October 2014 and 31 January 2017 using...

Background In 2012, the Ministry of Health in British Columbia, Canada, introduced a $75 incentive payment that could be claimed by hospital physicians each time they produced a written post-discharge care plan for a complex patient at the time of hospital discharge.Objective To examine whether physician financial payments incentivizing enhanced di...

Access to a regular primary care provider is essential to quality care. In Canada, where 15% of patients are unattached (i.e., without a regular provider), centralized waiting lists (CWLs) help attach patients to a primary care provider (family physician or nurse practitioner). Previous studies reveal mechanisms needed for CWLs to work, but focus m...

In 2020, the COVID-19 pandemic unexpectedly upended everyone's life, from sudden mass unemployment to family separations. In spite of this upheaval, health systems and services research carried on. Often, these efforts supported public health efforts to slow the spread of the virus.

Objectives: There is little published literature on the comparison of patient-reported outcomes between countries. This study aimed to assess pre- and postoperative health among samples of patients undergoing elective groin hernia repair procedures in the National Health Service (NHS), England, and groin hernia patients in Vancouver, Canada. Meth...

Objective The overarching objective of the scoping review was to examine peer reviewed and grey literature for best practices that have been developed, implemented and/or evaluated for delayed discharge involving a hospital setting. Two specific objectives were to review what the delayed discharge initiatives entailed and identify gaps in the liter...

Background: Ankle replacement and ankle arthrodesis are standard treatments for treating end-stage ankle arthritis when conservative treatment fails. Comparing patient-reported outcome scores to the instrument's minimal important difference (MID) helps physicians and researchers infer whether a meaningful change in health from the patient's perspe...

Background: Deferral of surgeries due to COVID-19 has negatively affected access to elective surgery and may have deleterious consequences for patient's health. Delays in access to elective surgery are not uniform in their impact on patients with different attributes. The objective of this study is to measure the change in patient's cost utility du...

Background Deferral of surgeries due to COVID-19 has negatively affected access to elective surgery and may have deleterious consequences for patient’s health. Delays in access to elective surgery are not uniform in their impact on patients with different attributes. The objective of this study is to measure the change in patient’s cost utility due...

Introduction The Gastrointestinal Quality of Life Index (GQLI) is used to measure domains of health and symptoms among people with gastrointestinal disorders. The objective of this study is to calculate the smallest change in the GQLI that is perceived by patients as meaningful among a sample of English-speaking adult patients undergoing elective l...

Abstract BACKGROUND: Addressing nonmedical reasons for delays in hospital discharge is important for improving the flow of patients through acute care hospital beds. Because this problem is understudied among adult surgical patients, we examined the incidence of and identified factors associated with delayed hospital discharge after major elective...

Excluding capital projects, spending on hospitals, physicians and drugs makes up more than two thirds of provincial and territorial governments' healthcare spending (CIHI 2019). One expects that health services and policy research would be aligned with where the money flows and yet, there is a misalignment. For example, research as published by Hea...

This article examines how alternate-level-of-care (ALC) days are funded through the cancer surgery funding model in Ontario and evaluates policy options to better address ALC days. The contribution of ALC days to hospital funding and the impact of removing or reallocating this funding from cancer surgery is measured. Though costs associated with AL...

This article is motivated by the need for discovering patterns of patients’ health based on their daily settings of care to aid the health policy-makers to improve the effectiveness of distributing funding for health services. The hidden process of one’s health status is assumed to be a continuous smooth function, called the health curve, ranging f...

The impact of waiting for surgery on the mental health of patients usually receives little attention. Because of the coronavirus disease 2019 (COVID-19) pandemic, the waits for elective surgery have been lengthening, potentially inducing or exacerbating mental health burdens. Provinces' health systems need to provide better support to assess not on...

In end-stage ankle arthritis, little is known about the impact of concomitant knee pathology, including the impact of ipsilateral knee pain on total ankle arthroplasty (TAA) outcomes. The aim of this study was to determine the prevalence of ipsilateral preoperative knee pain in patients undergoing TAA and analyze its impact on patient-reported func...

Each of canada's provinces and territories needs to modernize its basket of insured health services to reflect a broader conceptualization of healthcare. The narrow focus on hospital and physician services excludes multidisciplinary care models, such as those reflected by Family Health Teams in Ontario, Groupe de médecine de famille in Québec and p...

Context Many health systems have centralized waiting lists (CWLs), but there is limited evidence on CWL effectiveness and how to design and implement them. Aim To understand how CWLs’ design and implementation influence their use and effect on access to healthcare. Methods We conducted a realist review (n = 21 articles), extracting context-interv...

Aim The aim of this study is to report changes in health‐related quality of life attributable to lateral internal sphincterotomy for treatment of anal fissures. There is very little evidence regarding whether patients’ overall health‐related quality of life is detrimentally affected by the condition, nor which aspects of self‐perceived health statu...

In its conception, Healthcare Policy was a partnership between the canadian Institutes of Health Research's Institute of Health Services and Policy Research (IHSPR), the Canadian Association of Health Services and Policy Research and Longwoods Publishing. With the support of IHSPR's scientific director at the time, Dr. Morris Barer, the objective o...

Canada is one of the world's highest per capita spenders on healthcare. Yet provinces consistently boast lackluster performance on important measures of their population's health and access to healthcare (Davis et al. 2014; Doty et al. 2020). Spurred by public reporting, unease among governments about how to fix the problem and the lack of obvious...

Canada's two most populous provinces are moving toward activity-based funding (ABF) of hospitals. Although ABF may encourage greater value by improving cost-efficiency, it may decrease value in other respects. To address this trade-off, many jurisdictions have implemented value-based payment programs that modify ABF payments based on hospital perfo...

The coronavirus disease 2019 (COVID-19) pandemic has had a massive impact on waits for elective operations, with tens of thousands of scheduled surgeries being cancelled or postponed across Canada. Provincial governments will likely not only reopen elective surgical capacity when it is deemed safe, but also target new funding to address the backlog...

Background There is increasing evidence of prodromal multiple sclerosis (MS). Objective The aim of this study was to determine whether fatigue, sleep disorders, anaemia or pain form part of the MS prodrome. Methods This population-based matched cohort study used linked administrative and clinical databases in British Columbia, Canada. The odds of...

Background Incisional hernias are a frequent complication after abdominal surgeries. The aim of this study is to investigate the impact of incisional hernia repair on health related quality of life. Methods We prospectively recruited a sample of patients waiting for incisional hernia repairs in the Vancouver Coastal Health Authority, Canada. Study...

Patients, caregivers, providers, provider organizations such as hospitals and provincial government funders each have their perspectives on how and when healthcare should be delivered and have expectations for its quality, convenience and efficiency. These competing viewpoints on the value from healthcare have led many to wonder: what is the path f...

Disparities in health and healthcare plague provinces' residents. This means that different subgroups of the population have differences in health and healthcare. Examples include socio-economic status, location of residence and disability status. Disparities generate searching questions: does where you live, or who you are, affect your health or t...

Background Depression and chronic pain are debilitating disorders that co-exist with many chronic diseases. Chronic rhinosinusitis (CRS) is no exception. Nonetheless, little is known about the association between these co-related conditions and the treatment of CRS. The objective of this study is to measure outcomes following endoscopic sinus surge...

Background: There is an absence of high quality research validating instruments that measure foot and ankle related quality of life among hallux valgus (bunion) patients' perspectives. The Foot and Ankle Outcome Scale is a patient-reported outcome instrument, that when administered to patients with symptomatic hallux valgus, provides a patient-cen...

Across Canada's provinces and territories, healthcare policy discussions are often focused on the attributes of the health services delivery system that are most easily measured and monitored. The obvious examples are spending growth, number of beds and wait times. In turn, this orientation tends to induce a focus on the volume of healthcare rather...

Canada's high level of spending on healthcare and lagging performance are leading policy makers and system managers to explore the concept of value. The concept, applied to healthcare, is appearing in medical media and policy documents with increasing frequency and is being used to describe patients' outcomes vis-à-vis the costs of achieving the ou...

Background Patient-reported outcomes are becoming common for measuring patient-centric outcomes in surgery. However, there is little known about the relationship between postoperatively collected patient-reported outcomes and objective clinical outcomes. The objective of this study was to measure whether postoperative Ankle Osteoarthritis Scale (AO...

Background: There is little research investigating which aspects of health-related quality of life change following ankle arthrodesis and total ankle replacement surgery. The objective of this study was to report on statistically and clinically relevant changes in multiple dimensions of health-related quality of life among patients undergoing ankl...

Introduction: We aimed to evaluate the psychometric properties of the 26-item Expanded Prostate Cancer Index Composite (EPIC-26) for measuring the quality of life in patients treated for localized prostate cancer. The EPIC-26 is a patient-reported outcome instrument recommended for use with patients treated for localized prostate cancer. Methods:...

Background Laparoscopic cholecystectomy is a high-volume surgery that is an end-stage treatment for gallstones. There is little understanding of the surgery’s effect on the gain in patients’ health relative to its cost. The objective of this study is to measure health gain, cost and cost utility of elective laparoscopic cholecystectomy. Methods Pa...

These additional figures and tables present the detailed account of our analysis.

In this Appendix to the article, we describe steps for estimating marginal risks using inverse probability weighting on a stratified sample. We quantify mortality effects of the surgical timing alternatives by contrasting the population-average probabilities of in-hospital death that would be expected if all patients were to undergo surgery on the...

Little is known about post-acute care following hip fracture surgery. We investigated discharge destinations from surgical hospitals for nine Canadian provinces. We identified significant heterogeneity in discharge patterns across provinces suggesting different post-acute recovery pathways. Further work is required to determine the impact on patien...

Background: Patient-reported outcomes are increasingly used as measures of effectiveness of interventions. To make the tools more useful, therapeutic thresholds known as minimally important differences have been developed. The objective of this study was to calculate minimally important differences for the domains of the Foot and Ankle Outcome Sco...

Background Little is known about whether patients’ socioeconomic status influences their access to elective general surgery in Canada. The purpose of this study was to assess the association between socioeconomic status and wait times for elective general surgery. Methods Analysis of prospectively recruited participants’ data. The setting was six...

Canada has the lowest rate of attachment to primary care providers among OECD countries, which makes access and continuity of care problematic. To address this important issue, seven Canadian provinces have implemented centralized waiting lists (CWLs) for unattached patients in primary care. Introduced at different times, no two provinces' CWLs are...

Objectives: To assess (1) temporal changes (2008-2015) in nursing home (NH) length of stay (LoS) in 3 Canadian health jurisdictions (Edmonton, Calgary, Winnipeg), (2) resident admission characteristics associated with LoS, and (3) temporal changes of admission characteristics in each of the 3 jurisdictions. Design: Retrospective cohort study usi...

Background: End-stage ankle arthritis is often debilitating, associated with diminished mobility, pain, and reduced health related quality of life. Direct hospital costs of AA and TAA differ, with hospital length of stay being a major contributor. The objective of this study is to test the association between four patient-reported outcome measures...

Background: Significant ankle arthritis results in functional limitations and patient morbidity. There is a need to measure symptoms and the impact of interventions on patient’s quality of life using valid and reliable patient-reported measurement instruments. The objective of this research was to validate the Ankle Osteoarthritis Scale instrument...

Background:: Bunion correction surgery is a very common procedure to improve patients' pain and physical function attributable to a misaligned first metatarsophalangeal joint. The objective of this study was to apply a health utility framework to estimate the cost utility of bunion correction surgery. Methods:: Patients were prospectively recrui...

Background: Patients with Chronic Rhinosinusitis (CRS) can suffer from a significant decline in their quality of life. CRS patients have a high prevalence of comorbid conditions and it is important to understand the impact of these conditions on their CRS-related quality of life. This study measures the impacts of chronic pulmonary comorbidities o...