Kinwah Fung

• Research Methodologist at Institute for Clinical Evaluative Sciences

Purpose: To determine in Ontario-based men with a single negative transrectal ultrasound-guided prostate biopsy the long-term rates of prostate cancer-specific mortality, diagnosis, and treatment; number of repeat biopsies; and predictors of prostate cancer diagnosis and mortality. Materials and methods: This was a population-based cohort study,...

Background: Access to primary care is an important determinant of health, and data are sparse on primary care utilization for people who experience imprisonment. We aimed to describe primary care utilization for persons released from prison, and to compare utilization with the general population. Methods: We linked correctional data for all pers...

Introduction Supporting standardized approaches to common tasks is an important component of quality research using linked administrative data. Standard concept definitions and classifications are vital for ensuring accuracy and consistency in definitions between projects, and improving efficiency and quality. Other leading organizations have publi...

Background Many people experience imprisonment each year, and this population bears a disproportionate burden of morbidity and mortality. States have an obligation to provide equitable health care in prison and to attend to care on release. Our objective was to describe health care utilization in prison and post-release for persons released from pr...

Comparison of characteristics of persons released for 1 or more days in 2010 who were linked and not linked to an IKN. (DOCX)

Completed RECORD statement. (DOCX)

Flow chart for linkage of data. (DOCX)

Solid organ transplant recipients have a high risk of keratinocyte carcinoma (non‐melanoma skin cancer). Consensus‐based transplant guidelines recommend annual dermatological examination but the impact on skin cancer‐related outcomes is unclear. We conducted a population‐based, retrospective, inception cohort study using administrative health datab...

Objective: To conduct a Bayesian evidence synthesis using commonly available statistical procedures in order to estimate fracture risk for postmenopausal women undergoing hormonal therapy for breast cancer. Study design and setting: Using linked administrative data, we conducted a retrospective cohort study of women age 66 or older diagnosed wit...

Purpose: Psychiatric readmission is a common negative outcome. Predictors of readmission may differ by sex. This study aimed to derive and internally validate sex-specific models to predict 30-day psychiatric readmission. Methods: We used population-level health administrative data to identify predictors of 30-day psychiatric readmission among w...

Objective: Women with breast cancer and diabetes face worse outcomes than those with breast cancer without diabetes; however, the contribution of comorbidity to these disparities remains unclear. We evaluated the impact of diabetes on receipt of cancer treatments as well as mortality while accounting for other comorbidities. Research design and m...

Objective: The role of mental illness and addiction in acute care use for chronic medical conditions that are sensitive to ambulatory care management requires focussed attention. This study examines how mental illness or addiction affects risk for repeat hospitalization and/or emergency department use for ambulatory care-sensitive conditions (ACSC...

Background A cancer diagnosis may disrupt diabetes management, increasing the risk of preventable complications. The objective was to determine whether a cancer diagnosis in patients with diabetes is associated with an increased risk of diabetic complications. Methods This retrospective cohort study using health care data from Ontario, Canada, inc...

Objective: To understand whether high-cost users of medical care with and without comorbid mental illness or addiction differ in terms of their sociodemographic and health characteristics. Unique characteristics would warrant different considerations for interventions and service design aimed at reducing unnecessary health care utilization and ass...

Almost 40% of postpartum psychiatric hospital admissions are brief, lasting 72h or less. We aimed to identify unique subgroups of women within this group to inform better intervention. All women in Ontario, Canada with a brief postpartum psychiatric admission (≤ 72h) (2007-2012)(N = 631) were studied using latent class analysis. We identified disti...

About 1-2/1000 of postpartum women require psychiatric admission. Length of stay is variable, and little is known about short postpartum admission. From all women in Ontario, Canada, with a psychiatric admission within 1 year postpartum (2007-2012) (n = 1702), we compared women with admissions <72 h to women with longer admissions on sociodemograph...

Objective: Lithium is an essential mood disorder treatment; however, it remains unclear whether lithium increases chronic kidney disease (CKD) risk. There are few data on this in the elderly, even though older adults may be particularly susceptible to CKD. We wished to determine whether lithium is associated with increased CKD risk relative to val...

Older nursing home residents with advanced dementia have limited life expectancies. These individuals often receive intensive medical care towards the end-of-life thereby incurring burdensome interventions and antimicrobials of questionable benefit. We aimed to describe the frequency, nature, and predictors of burdensome interventions and antimicro...

Immigrant women are at high risk for postpartum mental disorders. The purpose of this study was to understand how rates of postpartum mental health contact differ among immigrant women by region of origin, time since immigration, and refugee status. We conducted a population-based cohort study of immigrant mothers in Ontario, Canada, with children...

Purpose: The objective of the present study was to use a large, population-based cohort to examine the association between metformin and breast cancer stage at diagnosis while accounting for mammography differences. Methods: We used data from Ontario administrative health databases to identify women 68 years of age or older with diabetes and inv...

Objectives: To determine the prevalence of and resident characteristics associated with the prescription of medications of questionable benefit (MQBs) near the end of life in older adults with advanced dementia in nursing homes. Design: Population-based, cross-sectional study using Resident Assessment Instrument Minimum Data Set 2.0 linked to he...

Background: The addition of oxaliplatin to adjuvant treatment regimens for colorectal cancer has been shown to improve overall survival at the expense of increased toxicity. The incidence and severity of toxicity might be greater among older patients who might also derive less benefit from oxaliplatin. We evaluated the association between adjuvant...

Mental health conditions are one of the most common reasons for postpartum emergency department (ED) visits. Characteristics of women using the ED and their mental health service use before presentation are unknown. We characterized all women in Ontario, Canada (2006–2012), who delivered a live born infant and had a psychiatric ED visit within 1 ye...

Objective: Many patients with bipolar disorder are reaching old age, but whether they are receiving evidence-based psychotropic treatment remains unclear. Our objective was to describe current psychotropic prescribing patterns in a large Canadian late-life bipolar sample. Methods: Population-based cross-sectional study of 1443 bipolar disorder p...

Importance: There is increasing interest in the effect of cardiovascular disease on cancer survivors. However, there are limited contemporary population-based data on the risk of cardiovascular death after early-stage breast cancer. Objective: To describe the incidence of cardiovascular death in a contemporary population of women with early-stag...

Women with diabetes have a higher breast cancer incidence and mortality. They are also significantly less likely to undergo screening mammography and present with more advanced stage than women without diabetes. The purpose of this study was to examine if women with diabetes are more likely to have delays in follow-up of abnormal mammograms, compar...

Importance Keratinocyte carcinoma (nonmelanoma skin cancer) accounts for substantial burden in terms of high incidence and health care costs but is excluded by most cancer registries in North America. Administrative health insurance claims databases offer an opportunity to identify these cancers using diagnosis and procedural codes submitted for re...

Objective: The objective of this study was to identify differences between men and women hospitalized for psychiatric conditions. Methods: Men and women with an inpatient psychiatric hospitalization in Ontario, Canada, between 2008 and 2013 (N=95,055) were compared on sociodemographic characteristics, health history, and clinical profiles and on...

Objective: We aimed to identify factors associated with postpartum psychiatric admission in schizophrenia. Method: In a population-based cohort study of 1433 mothers with schizophrenia in Ontario, Canada (2003-2011), we compared women with and without psychiatric admission in the 1st year postpartum on demographic, maternal medical/obstetrical,...

Objective: To quantify the burden of mental illness and addiction among high-costing users of medical services (HCUs) using population-level data from Ontario, and compare to a referent group of nonusers. Method: We conducted a population-level cohort study using health administrative data from fiscal year 2011-2012 for all Ontarians with valid...

Objective: Postpartum mental disorders are twice as common among immigrant women compared to nonimmigrant women in developed countries. Immigrant women may experience barriers to access and use of postpartum mental health services, but little is known about their service use on a population level. We described postpartum mental health service use...

Background: Almost 50% of women with schizophrenia become pregnant. Little is known about their psychiatric service use patterns during or shortly after pregnancy. Methods: Using health administrative data, we identified 1,433 women in Ontario, Canada, with schizophrenia (ICD-9, ICD-10, or DSM-IV-TR) who had a live birth delivery from January 2003...

Objectives To explore the association between the number of physicians providing care and anticholinergic drug burden in older persons newly initiated on cholinesterase inhibitor therapy for the management of dementia. DesignPopulation-based cross-sectional study. SettingCommunity and long-term care, Ontario, Canada. ParticipantsCommunity-dwelling...

295 Background: The Choosing Wisely Canada (CWC) campaign aims to start conversations about unnecessary treatments and procedures in order to improve quality of care. In particular, the CWC campaign in cancer seeks to reduce interventions that are not supported by evidence and contribute to unnecessary rising costs of cancer care. We sought to docu...

Objectives: To better understand women with a first lifetime psychiatric hospitalization in the postpartum period. Methods: We included all 1071 postpartum women in Ontario, Canada, with a psychiatric admission in the 1-year postpartum (2007-2012). We compared women with their first lifetime psychiatric admission to those with any prior psychiat...

601 Background: The addition of oxaliplatin to fluorouracil-based regimens in the adjuvant treatment of colorectal cancer (CRC) has been shown to improve overall survival at the expense of increased toxicity. Toxicity may be higher among older patients who may also derive less benefit from oxaliplatin. The incidence of toxicity in the elderly is un...

Objective: To test the hypothesis of an increased incidence of antiparkinson drug prescribing or Parkinson disease (PD) diagnostic codes after chronic lithium treatment compared with chronic valproic acid or antidepressant treatment among older adults. Methods: A retrospective cohort study using healthcare administrative databases in Ontario, Ca...

Melanoma is often managed outside hospital settings, creating the potential for underreporting to cancer registries. To our knowledge, completeness of melanoma capture in cancer registries has not been assessed using external data sources since the 1980s. We evaluated the melanoma capture rate from 1993 to 2009 in a provincial cancer registry. We i...

Bipolar disorder is associated with high rates of medical comorbidity, particularly in late life. Little is known about medical health service utilization and potential effects of bipolar pharmacotherapy. We hypothesized that lithium use would not be associated with higher rates of medical hospitalization. Population-based retrospective cohort stud...

Our aim was to create a clinically useful risk index, administered prior to discharge, for determining the probability of psychiatric readmission within 30 days of hospital discharge for general psychiatric inpatients. We used population-level sociodemographic and health administrative data to develop a predictive model for 30-day readmission among...

Objective: Lithium is an important treatment for mood disorders, but concern about its association with renal disease has contributed to its limited use, particularly in older adults. Because high-quality evidence examining renal disease in this population is lacking, this study aims to quantify the prevalence and identify clinical correlates of r...

Objective: Readmission after psychiatric hospitalization is widely used as a quality of care indicator by government funding agencies, policy-makers, and hospitals deciding on clinical priorities. Readmission rates are calculated accurately to allow these varied groups to correctly translate the knowledge into appropriate, tangible outcomes. We ai...

Study design: Retrospective economic analysis. Objectives: To determine the total direct costs of publicly funded health care utilization for the three fiscal years 2003/04 to 2005/06 (1 April 2003 to 31 March 2004 to 1 April 2005 to 31 March 2006), from the time of initial hospitalization to 1 year after initial acute discharge among individual...

Introduction Les données sur l’âge gestationnel (AG) à la naissance sont essentielles dans la recherche en santé périnatale et en santé du nourrisson, mais elles ne figurent pas toujours dans les bases de données administratives. Nous avons donc élaboré et validé un modèle de prédiction de l’AG pour les naissances simples à des fins d’études épidém...

Information on newborn gestational age (GA) is essential in research on perinatal and infant health, but it is not always available from administrative databases. We developed and validated a GA prediction model for singleton births for use in epidemiological studies. Derivation of estimated GA was calculated based on 130 328 newborn infants born i...

Cohort study. To provide recent estimates of the incidence of traumatic spinal cord injury (SCI) in adults living in Ontario. Ontario, Canada. The study included all men and women aged 18 years and older living in Ontario. The two primary data sources used for this study were the census data provided by Statistics Canada and the hospital Discharge...

Retrospective cohort design. To compare socio-demographic, impairment characteristics and utilization (physician and emergency department (ED) visits) for non-traumatic (NTSCI) and traumatic (TSCI) spinal cord injury 1 year post inpatient rehabilitation. Ontario, Canada. Inpatient stays (2003-2006) were identified from the National Rehabilitation R...

To determine the frequency of medical encounters before diagnosis of diabetes in children in Ontario, Canada; to determine risk factors for diabetic ketoacidosis (DKA). All medical encounters within 4 weeks before date of diagnosis for all new cases of diabetes in children <18 years were identified from April 1994 to March 2000 by use of administra...

Retrospective cohort study. To describe the physician utilization patterns (family physicians (FP), specialist and emergency department (ED) visits) of adults with traumatic spinal cord injury (SCI) 1 year after the initial injury. Ontario, Canada. A total of 559 individuals with a traumatic SCI were identified. Five administrative databases were l...

This is a cohort study with 1-year follow-up. The aim of this study was to examine 1-year rehospitalization rates following spinal cord injury (SCI) onset and health system factors affecting rehospitalization. All persons who had an acute care hospitalization for traumatic SCI in Ontario between 1 April 2003 and 31 March 2006 were identified accord...

The Dutch Bone Metastases Study Group developed a survival prediction model in patients with symptomatic spinal bone metastases to guide the treating physician. The objective of this study was to validate the Dutch model and compare with our previously developed survival model at the Rapid Response Radiotherapy Program (RRRP model). The following p...

Adults with diabetes are thought to have a high risk of cardiovascular disease (CVD), irrespective of their age. The main aim of this study was to find out the age at which people with diabetes develop a high risk of CVD, as defined by: an event rate equivalent to a 10-year risk of 20% or more; or an event rate equivalent to that associated with pr...

Previous studies of access to care for depression have been based on cross-sectional surveys of self-reported use of mental health service use. As the recall of use may be differentially biased by mood states, inferences about how well persons with depression are accessing services in comparison to other groups may be misleading. Accordingly, we es...

To compare recent trends in cardiovascular disease (CVD) outcomes among men and women with diabetes with those in the nondiabetic population. We conducted a retrospective cohort study using provincial health claims data to identify adults with (n = 670,602) and without (n = 9,190,721) diabetes living in Ontario, Canada, between 1 April 1992 and 31...

This study evaluated the impact of the severe acute respiratory syndrome (SARS) epidemic on access and utilization of palliative radiation therapy (RT) at a single institution using a retrospective chart review. A total of 649 patients seen between January and May 2002 and between January and May 2003 were evaluated. Treatment characteristics and w...

Estimates of the level of unmet need for mental health treatment often rely on self-reported use of mental health services. However, depressed persons may over-report their use in relation to administrative records if they are highly distressed. This study seeks to replicate and explicate the finding that persons at a high level of distress report...

The creation of fistulas or grafts before starting dialysis is recommended, but whether it reduces major adverse events is largely unknown. The objective of this study was to determine if early access creation was associated with a reduced risk of hospitalization from sepsis and mortality. Fistulas or grafts created at least 4 mo before starting he...

To develop a predictive model for survival from the time of presentation in an outpatient palliative radiotherapy clinic. Sixteen factors were analyzed prospectively in 395 patients seen in a dedicated palliative radiotherapy clinic in a large tertiary cancer center using Cox's proportional hazards regression model. Six prognostic factors had a sta...

Purpose: To develop a predictive model for survival from the time of presentation in an outpatient palliative radiotherapy clinic.Methods and Materials: Sixteen factors were analyzed prospectively in 395 patients seen in a dedicated palliative radiotherapy clinic in a large tertiary cancer center using Cox’s proportional hazards regression model.Re...

The primary objective of this report is to prospectively evaluate pain control provided by palliative radiotherapy for all irradiated patients with bone metastases by using their own assessments. A prospective database was set up for all patients referred for palliative radiotherapy for bone metastases. Patients were asked to rate their pain intens...

Clinical trials generally include motivated patients with relatively good performance status. This can result in an overestimation of the effectiveness of an intervention. Clinic follow-up protocols for outcome assessment after palliative treatments suffer from high attrition rates. In this study, the feasibility of telephone follow-up for the asse...

To determine the positive rate of the CAGE questionnaire in an outpatient palliative radiotherapy clinic and to examine the association between problem drinking, pain control, and analgesic consumption, patients referred for palliative radiotherapy were screened with the CAGE questionnaire and asked to rate their symptom distress using the modified...

We conducted a pilot study to examine patients' understanding of their illness and their expectations for palliative radiotherapy for symptomatic metastases. Participants were asked to complete a survey consisting of seven questions prior to the initial consultation. Demographic details and information on extent of disease were collected. Patients...

Palliative radiotherapy constitutes nearly 50% of the workload in radiotherapy. Surveys on the patterns of practice in radiotherapy have been published from North America and Europe. Our objective was to determine the current pattern of practice of radiation oncologists in Canada for the palliation of bone metastases. A survey was sent to 300 pract...