Study design to determine the effects of widespread restrictions on hospital utilization to control an outbreak of SARS in Toronto, Canada

Figures & data

Table 1. Patterns of healthcare utilization by type of utilization.

Healthcare sector	Specific types of utilization
Physician visits	Total physician visits, total primary care visits, total specialist visits (cardiologists, internists)
Emergency department visits	Total emergency department visits (overall and by triage level)
Hospital admissions	Total hospital admissions (overall, medical, surgical [elective, urgent])
Prescription drugs	Total evidence-based prescriptions filled for population 65+ years (antihyperglycemics, antihypertensives, inhalers)
Acute care inter-hospital ambulance transfers	Total inter-hospital transfers (acute care to acute care hospital, emergency department to acute care hospital)

Table 2. Health outcomes in acute conditions requiring hospitalization.

Acute conditions	Specific outcomes	Population of interest
Acute conditions where physician consensus exists regarding diagnosis and need for hospitalization	Total hospital admissions for AMI, hip fracture Total hospital admissions for births All-cause readmissions Mortality (30 day, 6 month) Readmissions for recurrent AMI	Adult population age 18+ years Adult female population age 15–44 years Cohort-specific hospitalized patients Cohort-specific hospitalized patients Patients hospitalized with AMI
Acute conditions where substantial patient/physician discretion exists in diagnosis or management or that require complex coordination of multiple health system resources	Total hospital admissions for pulmonary embolus, intracranial hemorrhage, gastrointestinal bleeds, cancer of trachea, bronchus, lung All-cause readmissions Mortality (30 day, 6 month)	Adult population age 18+ years Cohort-specific hospitalized patients Cohort-specific hospitalized patients

AMI: Acute myocardial infacrtion.

Table 3. Primary and ambulatory care health outcomes.

Healthcare service	Specific type of service/outcome	Populations of interest
Recommended preventive care	Total well-baby checks, total immunizations	Children less than 2 years old Children less than 6 years old
Essential drug prescriptions	Total antihypertensive pills dispensed, total oral hypoglycemic pills dispensed, total inhalers dispensed	Noninstitutionalized population 65+ years
Ambulatory care sensitive conditions	Hospital admissions	Population-based and cohort-specific outcomes for diabetes, severe chronic obstructive pulmonary disease, severe congestive heart failure, pediatric asthma

Table 4. Power analyses.

Parameter	Congestive heart failure	COPD	Diabetes	Pediatric asthma	Acute conditions (AMI, hip fracture)	Acute conditions (pulmonary embolism, intracranial hemorrhage, gastrointestinal bleed, respiratory cancer)
N Toronto*	5590	995	140,000	2400	20,970	6990
	Hospitalization rates				6-month mortality rates
Rate pre-restrictions	0.43	0.51	0.01	0.10	0.17	0.40
Min RR^‡	1.05	1.1	1.1	1.2	1.05	1.05

*N represents total Greater Toronto Area ambulatory care sensitive conditions cohort size on 4/1/01; and total number of acute condition admissions over 3 years.

^‡Minimum detectable relative risk.

AMI: Acute myocardial infarction; COPD: Chronic obstructive pulmonary disease.