CJEM Articles: Antoinette Colacone
Displaying 1-3 of 3 results
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July
2010
12
4
Antoinette Colacone, Bernard Unger, Eddy Lang, Eli Segal, Eric Grafstein, Jean François Boivin, Marc Afilalo, Michael Bullard, Michael Schull, Nathalie Soucy, Xiaoqing Xue
Objective: Managers of emergency departments (EDs), governments and researchers would benefit from reliable data sets that characterize use of EDs. Although Canadian ED lists for chief complaints and triage acuity exist, no such list exists for diagnosis classification. This study was aimed at developing a standardized Canadian Emergency Department Diagnosis Shortlist (CED-DxS), as a subset of the full International Classification of Diseases, 10th revision, with Canadian Enhancement (ICD-10-CA).
Methods: Emergency physicians from across Canada participated in the revision of the ICD-10-CA through 2 rounds of the modified Delphi method. We randomly assigned chapters from the ICD-10-CA (approximately 3000 diagnoses) to reviewers, who rated the importance of including each diagnosis in the EDspecific diagnosis list. If 80% or more of the reviewers agreed on the importance of a diagnosis, it was retained for the final revision. The retained diagnoses were further aggregated and adjusted, thus creating the CED-DxS.
Results: Of the 83 reviewers, 76% were emergency medicine (EM)–trained physicians with an average of 12 years of experience in EM, and 92% were affiliated with a university teaching hospital. The modified Delphi process and further adjustments resulted in the creation of the CED-DxS, containing 837 items. The chapter with the largest number of retained diagnoses was injury and poisoning (n = 292), followed by gastrointestinal (n = 59), musculoskeletal (n = 55) and infectious disease (n = 42). Chapters with the lowest number retained were neoplasm (n = 18) and pregnancy (n = 12).
Conclusion: We report the creation of the uniform CED-DxS, tailored for Canadian EDs. The addition of ED diagnoses to existing standardized parameters for the ED will contribute to homogeneity of data across the country.
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March
2007
9
2
Alain Vandal, Antoinette Colacone, Bernard Unger, Eddy Lang, Jean-François Boivin, Marc Afilalo, Nathalie Soucy, Ruth Léger, Xiaoqing Xue
Objective: It has been suggested that continuity of care is hampered because of the lack of communication between emergency departments (EDs) and primary care providers. A web-based, standardized communication system (SCS) that enables family physicians (FPs) to visualize information regarding their patients' ED visits was developed. This paper aims to evaluate the impact of this SCS on continuity of care.
Methods: We conducted an open, 4-period crossover, cluster-randomized controlled trial of 23 FP practices. During the intervention phase, FPs received detailed reports via SCS, while in the control phase they received mailed copies of the ED notes. Continuity of care was evaluated with a web questionnaire completed by FPs 21 days after the ED visit. The primary measures of continuity of care were knowledge of ED visit (quality and quantity), patient management and follow-up rate.
Results: We analyzed a total of 2022 ED visits (1048 intervention and 974 control). The intervention group received information regarding the ED visit more often (odds ratio [OR] 3.14, 95% confidence interval [CI] 2.6-3.79), found the information more useful (OR 5.1, 95% CI 3.49-7.46), possessed a better knowledge of the ED visit (OR 6.28, 95% CI 5.12-7.71), felt they could better manage patients (OR 2.46, 95% CI 2.02-2.99) and initiated actions more often following receipt of information (OR 1.62, 95% CI 1.36-1.93). However, there was no significant difference in the follow-up rate at FPs offices (OR 1.25, 95% CI 0.97-1.61).
Conclusion: The use of SCS between an ED and FPs led to significant improvements in continuity of care by increasing the usefulness of transferred information and by improving FPs' perceived patient knowledge and patient management.
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November
2005
7
6
Antoinette Colacone, Eddy Lang, Eleena Pearson, Marc Afilalo, Nadia Farooki
Objectives: To determine the proportion of patients vaccinated with pneumococcal (PVAX) and influenza (IVAX) vaccines under an emergency department (ED) vaccination program, that would not otherwise have been vaccinated by other primary care resources.
Methods: This prospective cohort study was performed in a tertiary care academic centre. A questionnaire was administered to all consenting ED patients who met screening eligibility criteria to receive either IVAX or PVAX. Eligible unvaccinated patients who did not plan on receiving vaccination elsewhere were offered one or both of the vaccines and, if agreeable, were immunized in the ED.
Results: During the 4-week study period, 754 patients (36% of all presenting ED patients) were eligible for vaccination with one or both vaccines. Of these 525 (70%) consented to participate in the study and completed a questionnaire. Of the 525 participants, 289 (55% of IVAX eligible patients; 95% confidence interval [CI], 51%–59%) were unvaccinated against influenza that year and did not plan on being vaccinated elsewhere and 277 (60% of PVAX eligible patients; 95% CI, 56%–64%) were unvaccinated against pneumococcus and did not plan on being vaccinated elsewhere. IVAX was administered to 187 patients (65% penetration; 95% CI, 59%–70%), and PVAX was administered to 165 patients (60% penetration; 95% CI, 54%–65%). Overall vaccine penetration was 46% (95% CI, 42%–50%) in the study participants and 32% (95% CI, 29%–35%) for the entire ED screened and eligible group. Reasons for vaccination refusal included concerns about benefit, side effects, and the desire to discuss vaccination with their primary care physician.
Conclusions: An ED-based program can result in the vaccination of a significant proportion of patients eligible for IVAX and/or PVAX who would otherwise likely go unprotected.
