Eric Latimer | McGill University (original) (raw)

Papers by Eric Latimer

PubMed, 1995

The practice expense component of the Medicare fee schedule (MFS), which is currently based on hi... more The practice expense component of the Medicare fee schedule (MFS), which is currently based on historical charges and rewards physician procedures at the expense of cognitive services, is due to be changed by January 1, 1998. The Physician Payment Review Commission (PPRC) and others have proposed microcosting direct costs and allocating all indirect costs on a common basis, such as physician time or work plus direct costs. Without altering the treatment of direct costs, the service-class approach disaggregates indirect costs into six practice function costs. The practice function costs are then allocated to classes of services using cost-accounting and statistical methods. This approach would make the practice expense component more resource-based than other proposed alternatives.

PubMed, Oct 1, 1996

Objectives: In response to rising demand and increased costs for home care services for frail eld... more Objectives: In response to rising demand and increased costs for home care services for frail elderly and disabled Medicaid clients, New York City implemented cluster care, a shared-aide model of home care. Our objective: to evaluate the effects of cluster care on home care hours and costs, client functioning, depressive symptoms, and satisfaction. Data sources: Client interviews, conducted prior to implementation and again 16 months later; Medicaid claims records; home attendant payroll files; and vendor agency records. Study design: The study employed a pretest/posttest design, comparing 229 clients at the first seven demonstration sites to 175 clients at four comparison sites before and after cluster care implementation. Regression methods were used to analyze pre and post-intervention data. Principal findings: Cluster care reduced costs by about 10 percent. Most savings occurred among the more vulnerable clients (those with five or more ADL/IADL limitations). Clients at cluster care sites who started out with fewer than five limitations appeared to decline somewhat more slowly than similarly impaired clients at comparison sites, while those with more than five ADL/IADLs tended to decline more rapidly. This difference was small-less than one limitation per year. Cluster care is associated with a significant decline in satisfaction but appears unrelated to depressive symptoms. Conclusions: Cluster care appears benign for home care clients with fewer limitations. For the more vulnerable, we recommend experimentation with low-cost interventions that might augment service and improve outcomes without reverting to traditional one-on-one care.

The Canadian Journal of Psychiatry, Mar 21, 2022

BackgroundCompared to treatment as usual (TAU), early psychosis intervention programs (EPI) have ... more BackgroundCompared to treatment as usual (TAU), early psychosis intervention programs (EPI) have been shown to reduce mortality, hospitalizations and days of assisted living while improving employment status.AimsThe study aim was to conduct a cost-benefit analysis (CBA) and a cost-effectiveness analysis (CEA) to compare EPI and TAU in Canada.MethodsA decision-analytic model was used to estimate the 5-year costs and benefits of treating patients with a first episode of psychosis with EPI or TAU. EPI benefits were derived from randomized controlled trials (RCTs) and Canadian administrative data. The cost of EPI was based on a published survey of 52 EPI centers in Canada while hospitalizations, employment and days of assisted living were valued using Canadian unit costs. The outcomes of the CBA and CEA were expressed in terms of net benefit (NB) and incremental cost per life year gained (LYG), respectively. Scenario analyses were conducted to examine the impact of key assumptions. Costs are reported in 2019 Canadian dollars.ResultsBase case results indicated that EPI had a NB of 85,441(9585,441 (95% CI: 85,441(9541,140; 126,386)comparedtoTAUwhiletheincrementalcostperLYGwas126,386) compared to TAU while the incremental cost per LYG was 126,386)comparedtoTAUwhiletheincrementalcostperLYGwas26,366 (95% CI: EPI dominates TAU (less costs, more life years); 102,269).InallsensitivityanalysestheNBofEPIremainedpositiveandtheincrementalcostperLYGwaslessthan102,269). In all sensitivity analyses the NB of EPI remained positive and the incremental cost per LYG was less than 102,269).InallsensitivityanalysestheNBofEPIremainedpositiveandtheincrementalcostperLYGwaslessthan50,000.ConclusionsIn addition to EPI demonstrated clinical benefits, our results suggest that large-scale implementation of EPI in Canada would be desirable from an economic point of view .

Frontiers in Psychiatry, Jan 4, 2023

Disease Management & Health Outcomes, 2001

... team provides an integrated approach in which treatment issues (eg medications, physical heal... more ... team provides an integrated approach in which treatment issues (eg medications, physical healthcare, symptom ... of case management intensity are aimed at different levels of patientneeds.[75,76 ... evidence-based practice' in all areas of medi-cine, including mental health.[89] ...

In this final chapter, the major themes of the book are restated and the book's recommendatio... more In this final chapter, the major themes of the book are restated and the book's recommendations for future research are outlined. Concluding comments address the long-term scientific challenge of the national injury problem.

Knowledge Based Systems, Jul 1, 2022

Lecture Notes in Computer Science, 2022

Journal of Social Distress and Homelessness

Psychiatric Rehabilitation Journal

Smith, JO and Killackey, Eoin and Rinaldi, Miles and Nuechterlein, Keith and Latimer, Eric and Cr... more Smith, JO and Killackey, Eoin and Rinaldi, Miles and Nuechterlein, Keith and Latimer, Eric and Craig, Tom and Davis, Eric and Hember, Martin and Lau, Annie and Shepherd, Geoff and Shiers, David and Singh, Swaran and Sullivan, Sarah and Penn, David (2008) ...

Journal of Evaluation in Clinical Practice

RationaleImplementation of strengths model case management is increasing internationally. However... more RationaleImplementation of strengths model case management is increasing internationally. However, few studies have focused on its implementation process, and none have specifically addressed the implementation experience of direct‐service practitioners.ObjectiveThis paper presents factors that facilitate and impede the successful implementation of the strengths model, with a specific focus on practitioners who deliver the intervention directly to service recipients.MethodTo address this objective, a qualitative study of seven mental health agencies that implemented the model was conducted, involving a combination of participant observations and qualitative semistructured interviews with case managers, team supervisors, and senior managers. Qualitative data were analyzed using open coding followed by axial coding. Finally, the findings were aligned with an adapted Consolidated Framework for Implementation Research.ResultsImplementation of the strengths model involved a significant c...

Health & social care in the community, 2018

Many clinicians are concerned that competitive work may cause excessive stress for people with se... more Many clinicians are concerned that competitive work may cause excessive stress for people with severe mental health problems. Individual Placement and Support (IPS) is acknowledged as the most effective model of supported employment for this population. The manner in which IPS clients define and experience employment-related stress is poorly understood. This qualitative study aims to explore how people with mental health problems receiving IPS services define and experience employment-related stress. We purposively sampled and interviewed 16 clients of an IPS programme, who had been competitively employed for more than 1 month. Data were collected between September 2014 and July 2015 in Montreal, Canada. Transcripts of semi-structured interviews were analysed using grounded theory methodology. IPS clients often defined stress similar to its common understanding: the result of experiencing prolonged or/and cumulative strains, or of an incongruence between efforts and rewards, hopes a...

Background Few large and rigorous economic evaluations of Housing First programs have been conduc... more Background Few large and rigorous economic evaluations of Housing First programs have been conducted. Objectives To evaluate the effects on costs at one year of a Housing First intervention in five cities: Vancouver, Winnipeg, Toronto, Montreal and Moncton. Method As part of the At Home study, over 2,200 homeless people with mental illness entered a randomized trial of Housing First (HF) compared to treatment as usual (TAU). Participants with high needs (HN) received a more intensive clinical intervention than participants with moderate needs (MN). Service use and residential data were obtained through questionnaires administered at 6- and 3- month intervals. Actual costs of the intervention were used to replace self-reports, rendering our estimates of cost offsets more conservative. Total costs of health, social and justice service use, excluding medications, were estimated for three consecutive six-month periods starting six months prior to baseline. Results Follow-up rates exceed...

Early Intervention in Psychiatry, 2010

Aim: Unemployment is the major disability faced by people with psychotic illness. Unemployment ra... more Aim: Unemployment is the major disability faced by people with psychotic illness. Unemployment rates of 75–95% are found among those with schizophrenia. Unemployment is associated with poorer social and economic inclusion, greater symptomatology, decreased autonomy and generally poorer life functioning. Unemployment also makes up over half of the total costs associated with psychotic illness.Methods: A meeting was convened in London in June 2008. Invitees to this meeting included people from the USA, Canada and the UK interested in vocational intervention in early psychosis from either a research, clinical, economic or policy point of view. From this meeting a larger group – the International First Episode Vocational Recovery (iFEVR) group – has developed an international consensus statement about vocational recovery in first episode psychosis.Results: The document is a basic statement of the rights of young people with psychosis to pursue employment, education and training; the evi...

BMJ Open, Oct 1, 2021

The main harm reduction interventions for people who inject drugs (PWID) are supervised injection... more The main harm reduction interventions for people who inject drugs (PWID) are supervised injection facilities, needle and syringe programmes and opioid agonist treatment. Current evidence supporting their implementation and operation underestimates their usefulness by excluding skin, soft tissue and vascular infections (SSTVIs) and anoxic/toxicity-related brain injury from cost-effectiveness analyses (CEA). Our goal is to conduct a comprehensive CEA of harm reduction interventions in a setting with a large, dispersed, heterogeneous population of PWID, and include prevention of SSTVIs and anoxic/toxicity-related brain injury as measures of benefit in addition to HIV, hepatitis C and overdose morbidity and mortalities averted. Methods and analysis This protocol describes how we will develop an open, retrospective cohort of adult PWID living in Québec between 1 January 2009 and 31 December 2020 using administrative health record data. By complementing this data with non-linkable paramedic dispatch records, regional monthly needle and syringe dispensation counts and repeated cross-sectional biobehavioural surveys, we will estimate the hazards of occurrence and the impact of Montréal's harm reduction interventions on the incidence of drug-use-related injuries, infections and deaths. We will synthesise results from our empirical analyses with published evidence to simulate infections and injuries in a hypothetical population of PWID in Montréal under different intervention scenarios including current levels of use and scale-up, and assess the cost-effectiveness of each intervention from the public healthcare payer's perspective. Ethics and dissemination This study was approved by McGill University's Institutional Review Board (Study Number: A08-E53-19B). We will work with community partners to disseminate results to the public and scientific community via scientific conferences, a publicly accessible report, op-ed articles and open access peer-reviewed journals.

PubMed, 1995

The practice expense component of the Medicare fee schedule (MFS), which is currently based on hi... more The practice expense component of the Medicare fee schedule (MFS), which is currently based on historical charges and rewards physician procedures at the expense of cognitive services, is due to be changed by January 1, 1998. The Physician Payment Review Commission (PPRC) and others have proposed microcosting direct costs and allocating all indirect costs on a common basis, such as physician time or work plus direct costs. Without altering the treatment of direct costs, the service-class approach disaggregates indirect costs into six practice function costs. The practice function costs are then allocated to classes of services using cost-accounting and statistical methods. This approach would make the practice expense component more resource-based than other proposed alternatives.

PubMed, Oct 1, 1996

Objectives: In response to rising demand and increased costs for home care services for frail eld... more Objectives: In response to rising demand and increased costs for home care services for frail elderly and disabled Medicaid clients, New York City implemented cluster care, a shared-aide model of home care. Our objective: to evaluate the effects of cluster care on home care hours and costs, client functioning, depressive symptoms, and satisfaction. Data sources: Client interviews, conducted prior to implementation and again 16 months later; Medicaid claims records; home attendant payroll files; and vendor agency records. Study design: The study employed a pretest/posttest design, comparing 229 clients at the first seven demonstration sites to 175 clients at four comparison sites before and after cluster care implementation. Regression methods were used to analyze pre and post-intervention data. Principal findings: Cluster care reduced costs by about 10 percent. Most savings occurred among the more vulnerable clients (those with five or more ADL/IADL limitations). Clients at cluster care sites who started out with fewer than five limitations appeared to decline somewhat more slowly than similarly impaired clients at comparison sites, while those with more than five ADL/IADLs tended to decline more rapidly. This difference was small-less than one limitation per year. Cluster care is associated with a significant decline in satisfaction but appears unrelated to depressive symptoms. Conclusions: Cluster care appears benign for home care clients with fewer limitations. For the more vulnerable, we recommend experimentation with low-cost interventions that might augment service and improve outcomes without reverting to traditional one-on-one care.

The Canadian Journal of Psychiatry, Mar 21, 2022

BackgroundCompared to treatment as usual (TAU), early psychosis intervention programs (EPI) have ... more BackgroundCompared to treatment as usual (TAU), early psychosis intervention programs (EPI) have been shown to reduce mortality, hospitalizations and days of assisted living while improving employment status.AimsThe study aim was to conduct a cost-benefit analysis (CBA) and a cost-effectiveness analysis (CEA) to compare EPI and TAU in Canada.MethodsA decision-analytic model was used to estimate the 5-year costs and benefits of treating patients with a first episode of psychosis with EPI or TAU. EPI benefits were derived from randomized controlled trials (RCTs) and Canadian administrative data. The cost of EPI was based on a published survey of 52 EPI centers in Canada while hospitalizations, employment and days of assisted living were valued using Canadian unit costs. The outcomes of the CBA and CEA were expressed in terms of net benefit (NB) and incremental cost per life year gained (LYG), respectively. Scenario analyses were conducted to examine the impact of key assumptions. Costs are reported in 2019 Canadian dollars.ResultsBase case results indicated that EPI had a NB of 85,441(9585,441 (95% CI: 85,441(9541,140; 126,386)comparedtoTAUwhiletheincrementalcostperLYGwas126,386) compared to TAU while the incremental cost per LYG was 126,386)comparedtoTAUwhiletheincrementalcostperLYGwas26,366 (95% CI: EPI dominates TAU (less costs, more life years); 102,269).InallsensitivityanalysestheNBofEPIremainedpositiveandtheincrementalcostperLYGwaslessthan102,269). In all sensitivity analyses the NB of EPI remained positive and the incremental cost per LYG was less than 102,269).InallsensitivityanalysestheNBofEPIremainedpositiveandtheincrementalcostperLYGwaslessthan50,000.ConclusionsIn addition to EPI demonstrated clinical benefits, our results suggest that large-scale implementation of EPI in Canada would be desirable from an economic point of view .

Frontiers in Psychiatry, Jan 4, 2023

Disease Management & Health Outcomes, 2001

... team provides an integrated approach in which treatment issues (eg medications, physical heal... more ... team provides an integrated approach in which treatment issues (eg medications, physical healthcare, symptom ... of case management intensity are aimed at different levels of patientneeds.[75,76 ... evidence-based practice' in all areas of medi-cine, including mental health.[89] ...

In this final chapter, the major themes of the book are restated and the book's recommendatio... more In this final chapter, the major themes of the book are restated and the book's recommendations for future research are outlined. Concluding comments address the long-term scientific challenge of the national injury problem.

Knowledge Based Systems, Jul 1, 2022

Lecture Notes in Computer Science, 2022

Journal of Social Distress and Homelessness

Psychiatric Rehabilitation Journal

Smith, JO and Killackey, Eoin and Rinaldi, Miles and Nuechterlein, Keith and Latimer, Eric and Cr... more Smith, JO and Killackey, Eoin and Rinaldi, Miles and Nuechterlein, Keith and Latimer, Eric and Craig, Tom and Davis, Eric and Hember, Martin and Lau, Annie and Shepherd, Geoff and Shiers, David and Singh, Swaran and Sullivan, Sarah and Penn, David (2008) ...

Journal of Evaluation in Clinical Practice

RationaleImplementation of strengths model case management is increasing internationally. However... more RationaleImplementation of strengths model case management is increasing internationally. However, few studies have focused on its implementation process, and none have specifically addressed the implementation experience of direct‐service practitioners.ObjectiveThis paper presents factors that facilitate and impede the successful implementation of the strengths model, with a specific focus on practitioners who deliver the intervention directly to service recipients.MethodTo address this objective, a qualitative study of seven mental health agencies that implemented the model was conducted, involving a combination of participant observations and qualitative semistructured interviews with case managers, team supervisors, and senior managers. Qualitative data were analyzed using open coding followed by axial coding. Finally, the findings were aligned with an adapted Consolidated Framework for Implementation Research.ResultsImplementation of the strengths model involved a significant c...

Health & social care in the community, 2018

Many clinicians are concerned that competitive work may cause excessive stress for people with se... more Many clinicians are concerned that competitive work may cause excessive stress for people with severe mental health problems. Individual Placement and Support (IPS) is acknowledged as the most effective model of supported employment for this population. The manner in which IPS clients define and experience employment-related stress is poorly understood. This qualitative study aims to explore how people with mental health problems receiving IPS services define and experience employment-related stress. We purposively sampled and interviewed 16 clients of an IPS programme, who had been competitively employed for more than 1 month. Data were collected between September 2014 and July 2015 in Montreal, Canada. Transcripts of semi-structured interviews were analysed using grounded theory methodology. IPS clients often defined stress similar to its common understanding: the result of experiencing prolonged or/and cumulative strains, or of an incongruence between efforts and rewards, hopes a...

Background Few large and rigorous economic evaluations of Housing First programs have been conduc... more Background Few large and rigorous economic evaluations of Housing First programs have been conducted. Objectives To evaluate the effects on costs at one year of a Housing First intervention in five cities: Vancouver, Winnipeg, Toronto, Montreal and Moncton. Method As part of the At Home study, over 2,200 homeless people with mental illness entered a randomized trial of Housing First (HF) compared to treatment as usual (TAU). Participants with high needs (HN) received a more intensive clinical intervention than participants with moderate needs (MN). Service use and residential data were obtained through questionnaires administered at 6- and 3- month intervals. Actual costs of the intervention were used to replace self-reports, rendering our estimates of cost offsets more conservative. Total costs of health, social and justice service use, excluding medications, were estimated for three consecutive six-month periods starting six months prior to baseline. Results Follow-up rates exceed...

Early Intervention in Psychiatry, 2010

Aim: Unemployment is the major disability faced by people with psychotic illness. Unemployment ra... more Aim: Unemployment is the major disability faced by people with psychotic illness. Unemployment rates of 75–95% are found among those with schizophrenia. Unemployment is associated with poorer social and economic inclusion, greater symptomatology, decreased autonomy and generally poorer life functioning. Unemployment also makes up over half of the total costs associated with psychotic illness.Methods: A meeting was convened in London in June 2008. Invitees to this meeting included people from the USA, Canada and the UK interested in vocational intervention in early psychosis from either a research, clinical, economic or policy point of view. From this meeting a larger group – the International First Episode Vocational Recovery (iFEVR) group – has developed an international consensus statement about vocational recovery in first episode psychosis.Results: The document is a basic statement of the rights of young people with psychosis to pursue employment, education and training; the evi...

BMJ Open, Oct 1, 2021

The main harm reduction interventions for people who inject drugs (PWID) are supervised injection... more The main harm reduction interventions for people who inject drugs (PWID) are supervised injection facilities, needle and syringe programmes and opioid agonist treatment. Current evidence supporting their implementation and operation underestimates their usefulness by excluding skin, soft tissue and vascular infections (SSTVIs) and anoxic/toxicity-related brain injury from cost-effectiveness analyses (CEA). Our goal is to conduct a comprehensive CEA of harm reduction interventions in a setting with a large, dispersed, heterogeneous population of PWID, and include prevention of SSTVIs and anoxic/toxicity-related brain injury as measures of benefit in addition to HIV, hepatitis C and overdose morbidity and mortalities averted. Methods and analysis This protocol describes how we will develop an open, retrospective cohort of adult PWID living in Québec between 1 January 2009 and 31 December 2020 using administrative health record data. By complementing this data with non-linkable paramedic dispatch records, regional monthly needle and syringe dispensation counts and repeated cross-sectional biobehavioural surveys, we will estimate the hazards of occurrence and the impact of Montréal's harm reduction interventions on the incidence of drug-use-related injuries, infections and deaths. We will synthesise results from our empirical analyses with published evidence to simulate infections and injuries in a hypothetical population of PWID in Montréal under different intervention scenarios including current levels of use and scale-up, and assess the cost-effectiveness of each intervention from the public healthcare payer's perspective. Ethics and dissemination This study was approved by McGill University's Institutional Review Board (Study Number: A08-E53-19B). We will work with community partners to disseminate results to the public and scientific community via scientific conferences, a publicly accessible report, op-ed articles and open access peer-reviewed journals.

Résumé L’article décrit les contextes entourant les politiques qui soutiennent l’application du ... more Résumé

L’article décrit les contextes entourant les politiques qui soutiennent l’application du modèle d’intervention qui accorde la priorité au logement (Housing First) pour les personnes itinérantes présentant des troubles mentaux au Canada et en France. Le modèle consiste en une modalité d’intervention complexe qui élargit le concept de traitement en santé mentale pour y inclure la notion de logement. La démarche, axée sur le rétablissement, place le choix de l’usager quant au logement et aux services de soutien au centre de la philosophie de la prestation de soins. L’article décrit deux essais multicentriques liés à l’intervention qui se déroulent dans deux pays et précise en quoi ils se ressemblent ou diffèrent, compte tenu des particularités culturelles et sociales. Les essais pragmatiques portant sur des modalités d’intervention complexes représentent des défis et ont un pouvoir d’influence unique. C’est ce dont tiennent compte les deux études.

Abstract

This paper describes the policy environments supporting housing first as an intervention for those who are homeless and mentally ill in Canada and in France. Housing first is a complex intervention that expands mental health treatment to include a focus upon housing. A recovery orientation places the consumer’s choice of housing and supports at the center of the philosophy of care. The design of two, large multi-site intervention trials underway in both countries are described, noting similarities and differences related to the cultural and social context. Pragmatic trials of complex interventions have unique challenges and potential for influence, which both studies are addressing.