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Foster N, Raby E, Wood FM, Fear M, Pavlos N, Edgar DW. Evaluation of the accuracy of diagnostic coding and clinical documentation for traumatic heterotopic ossification diagnoses in Western Australian hospitals. Injury 2024; 55:111329. [PMID: 38296757 DOI: 10.1016/j.injury.2024.111329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Traumatic heterotopic ossification (tHO) refers to the pathological formation of ectopic bone in soft tissues that can occur following burn, neurological ororthopaedic trauma. As completeness and accuracy of medical diagnostic coding can vary based on coding practices and depend on the institutional culture of clinical documentation, it is important to assess diagnostic coding in that local context. To the authors' knowledge, there is no prior study evaluating the accuracy of medical diagnostic coding or specificity of clinical documentation for tHO diagnoses across Western Australia (WA) trauma centres or across the full range of inciting injury and surgical events. OBJECTIVE To evaluate and compare the clinical documentation and the diagnostic accuracy of ICD-10-AM coding for tHO in trauma populations across 4 WA hospitals. METHODS A retrospective data search of the WA trauma database was conducted to identify patients with tHO admitted to WA hospitals following burn, neurological or orthopaedic trauma. Patient demographic and tHO diagnostic characteristics were assessed for all inpatient and outpatient tHO diagnoses. The frequency and distribution of M61 (HO-specific) and broader, musculoskeletal (non-specific) ICD-10-AM codes were evaluated for tHO cases in each trauma population. RESULTS HO-specific M61 ICD-10-AM codes failed to identify more than a third of true tHO cases, with a high prevalence of non-specific HO codes (19.4 %) and cases identified via manual chart review (25.4 %). The sensitivity of M61 codes for correctly diagnosing tHO after burn injury was 50 %. ROC analysis showed that M61 ICD-10-AM codes as a predictor of a true positive tHO diagnosis were a less than favourable method (AUC=0.731, 95 % CI=0.561-0.902, p = 0.012). Marked variability in clinical documentation for tHO was identified across the hospital network. CONCLUSION Coding inaccuracies may, in part, be influenced by insufficiencies in clinical documentation for tHO diagnoses, which may have implications for future research and patient care. Clinicians should consistently employ standardised clinical terminology from the point of care to increase the likelihood of accurate medical diagnostic coding for tHO diagnoses.
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Affiliation(s)
- Nichola Foster
- Burn Injury Research Node, Institute for Health Research / School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, 6160, Australia; Burn Injury Research Unit and Fiona Wood Foundation, University of Western Australia, Nedlands, Western Australia, 6009, Australia; Physiotherapy Department, Sir Charles Gairdner Osborne Park Health Care Group, North Metropolitan Health Service, Nedlands, Western Australia, 6009, Australia.
| | - Edward Raby
- Burn Injury Research Unit and Fiona Wood Foundation, University of Western Australia, Nedlands, Western Australia, 6009, Australia; State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, 6150, Australia
| | - Fiona M Wood
- Burn Injury Research Unit and Fiona Wood Foundation, University of Western Australia, Nedlands, Western Australia, 6009, Australia; State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, 6150, Australia
| | - Mark Fear
- Burn Injury Research Unit and Fiona Wood Foundation, University of Western Australia, Nedlands, Western Australia, 6009, Australia
| | - Nathan Pavlos
- School of Biomedical Sciences, University of Western Australia, Nedlands, Western Australia, 6009, Australia
| | - Dale W Edgar
- Burn Injury Research Node, Institute for Health Research / School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, 6160, Australia; Burn Injury Research Unit and Fiona Wood Foundation, University of Western Australia, Nedlands, Western Australia, 6009, Australia; State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, 6150, Australia; Safety and Quality Unit, Armadale Kalamunda Group Health Service, East Metropolitan Health Service, Mt Nasura, Western Australia, 6112, Australia
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Kabir A, Randall D, Newall AT, Moore HC, Jayasinghe S, Fathima P, Liu B, McIntyre P, Gidding HF. Incremental effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumonia hospitalisation among Australian Indigenous children: A record linkage study. Vaccine 2023; 41:5454-5460. [PMID: 37507273 DOI: 10.1016/j.vaccine.2023.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND The impact of pneumococcal conjugate vaccines (PCVs) on pneumonia in children is well-documented but data on 23-valent pneumococcal polysaccharide vaccine (PPV23) are lacking. Between 2001 and 2011, Indigenous children in Western Australia (WA) were recommended to receive PPV23 at 18-24 months of age following 3 doses of 7-valent PCV. We evaluated the incremental effectiveness of PPV23 against pneumonia hospitalisation. METHODS Indigenous children born in WA between 2001 and 2012 who received PCV dose 3 by 12 months of age were followed from 18 to 60 months of age for the first episode of pneumonia hospitalisation (all-cause and 3 subgroups: presumptive pneumococcal, other specified causes, and unspecified). We used Cox regression modelling to estimate hazard ratios (HRs) for pneumonia hospitalisation among children who had, versus had not, received PPV23 between 18 and 30 months of age after adjustment for confounders. RESULTS 11,120 children had 327 first episodes of all-cause pneumonia hospitalisation, with 15 (4.6%) coded as presumptive pneumococcal, 46 (14.1%) as other specified causes and 266 (81.3%) unspecified. No statistically significant reduction in all-cause pneumonia was seen with PPV23 (HR 1.11; 95% CI: 0.87-1.43), but the direction of the association differed for presumptive pneumococcal (HR 0.47; 95% CI: 0.16-1.35) and specified (HR 0.89; 95% CI: 0.49-1.62) from unspecified causes (HR 1.13; 95% CI: 0.86-1.49). During the baseline period before PPV23 vaccination (12-18 months), all-cause pneumonia risk was higher among PPV23-vaccinated than unvaccinated children (RR: 1.73; 95% CI: 1.30-2.28). CONCLUSION In this high-risk population, no statistically significant incremental effect of a PPV23 booster at 18-30 months was observed against hospitalised all-cause pneumonia or the more specific outcome of presumptive pneumococcal pneumonia. Confounding by indication may explain the slight trend towards an increased risk against all-cause pneumonia. Larger studies with better control of confounding are needed to further inform PPV23 vaccination.
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Affiliation(s)
- Alamgir Kabir
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; The University of Sydney Northern Clinical School, NSW, Australia; Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia; Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia.
| | - Deborah Randall
- The University of Sydney Northern Clinical School, NSW, Australia; Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Anthony T Newall
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, WA, Australia; School of Population Health, Curtin University, Perth, Western, Australia
| | - Sanjay Jayasinghe
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia; Discipline of Child and Adolescent Health, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, WA, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Australia
| | - Bette Liu
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Peter McIntyre
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - Heather F Gidding
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; The University of Sydney Northern Clinical School, NSW, Australia; Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia; National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Australia
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Chughtai AA, He WQ, Liu B. Associations between severe and notifiable respiratory infections during the first trimester of pregnancy and congenital anomalies at birth: a register-based cohort study. BMC Pregnancy Childbirth 2023; 23:203. [PMID: 36964492 PMCID: PMC10037767 DOI: 10.1186/s12884-023-05514-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/13/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Evidence regarding the association between acute respiratory infections during pregnancy and congenital anomalies in babies, is limited and conflicting. The aim of this study was to examine the association between acute respiratory infections during the first trimester of pregnancy and congenital anomalies in babies using record linkage. METHODS We linked a perinatal register to hospitalisation and disease notifications in the Australian state of New South Wales (NSW) between 2001 to 2016. We quantified the risk of congenital anomalies, identified from the babies' linked hospital record in relation to notifiable respiratory and other infections during pregnancy using generalized Estimating Equations (GEE) adjusted for maternal sociodemographic and other characteristics. RESULTS Of 1,453,037 birth records identified from the perinatal register between 2001 and 2016, 11,710 (0.81%) mothers were hospitalised for acute respiratory infection, 2850 (0.20%) had influenza and 1011 (0.07%) had high risk infections (a record of cytomegalovirus, rubella, herpes simplex, herpes zoster, toxoplasmosis, syphilis, chickenpox (varicella) and zika) during the pregnancy. During the first trimester, acute respiratory infection, influenza and high-risk infections were reported by 1547 (0.11%), 399 (0.03%) and 129 (0.01%) mothers. There were 15,644 (1.08%) babies reported with major congenital anomalies, 2242 (0.15%) with cleft lip/ plate, 7770 (0.53%) with all major cardiovascular anomalies and 1746 (0.12%) with selected major cardiovascular anomalies. The rate of selected major cardiovascular anomalies was significantly higher if the mother had an acute respiratory infection during the first trimester of pregnancy (AOR 3.64, 95% CI 1.73 to 7.66). The rates of all major congenital anomalies and all major cardiovascular anomalies were also higher if the mother had an acute respiratory infection during the first trimester of pregnancy, however the difference was no statistically significant. Influenza during the first trimester was not associated with major congenital anomalies, selected major cardiovascular anomalies or all major cardiovascular anomalies in this study. CONCLUSION This large population-based study found severe acute respiratory infection in first trimester of pregnancy was associated with a higher risk of selected major cardiovascular anomalies in babies. These findings support measures to prevent acute respiratory infections in pregnant women including through vaccination.
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Affiliation(s)
- Abrar A Chughtai
- School of Population Health, University of New South Wales, Samuels Building, Kensington Campus, Sydney, NSW, 2052, Australia.
| | - Wen-Qiang He
- School of Population Health, University of New South Wales, Samuels Building, Kensington Campus, Sydney, NSW, 2052, Australia
| | - Bette Liu
- School of Population Health, University of New South Wales, Samuels Building, Kensington Campus, Sydney, NSW, 2052, Australia
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Rosales BM, De La Mata N, Vajdic CM, Kelly PJ, Wyburn K, Webster AC. Cancer Mortality in People Receiving Dialysis for Kidney Failure: An Australian and New Zealand Cohort Study, 1980-2013. Am J Kidney Dis 2022; 80:449-461. [PMID: 35500725 DOI: 10.1053/j.ajkd.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/11/2022] [Indexed: 02/07/2023]
Abstract
RATIONALE & OBJECTIVE Cancer is a significant cause of morbidity in the population with kidney failure; however, cancer mortality in people undergoing dialysis has not been well described. We sought to compare cancer mortality in people on dialysis for kidney failure with cancer mortality in the general population. STUDY DESIGN A retrospective cohort study using linked health-administrative and dialysis registry data. SETTING & PARTICIPANTS All people receiving dialysis represented in the Australian and New Zealand Dialysis and Transplantation Registry, 1980-2013. EXPOSURE Dialysis; hemodialysis (HD) and peritoneal dialysis (PD). OUTCOME Death and underlying cause of death ascertained using health administrative data and classified using International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) codes. ANALYTICAL APPROACH Indirect standardization on age at death, sex, year, and country to estimate standardized mortality ratios (SMR). RESULTS Over 269,598 person years of observation, 34,100 deaths occurred among 59,648 people on dialysis, including 3,677 cancer deaths. The relative risk of all-site cancer death in dialysis was twice (SMR, 2.4 [95% CI, 2.33-2.49]) that of the general population and highest for oral and pharynx cancers (SMR, 24.3 [95% CI, 18.0-31.5]) and multiple myeloma (SMR, 22.5 [95% CI, 20.3-23.9]). Women on dialysis had a significantly higher risk of all-site cancer mortality (SMR, 2.7 [95% CI, 2.59-2.89]) compared with men (SMR, 2.3 [95% CI, 2.17-2.36]) (P < 0.001). People on HD (SMR, 2.2 [95% CI, 2.11-2.30]) experienced greater excess deaths from all-site cancer compared with people on PD (SMR, 1.3 [95% CI, 1.23-1.44]). Excess deaths have gradually decreased over time for all-site, multiple myeloma, and kidney cancers (P < 0.001) but have not kept up with improvements in the general population. By contrast, among people receiving dialysis, excess deaths increased for colorectal and lung cancers (P < 0.001). LIMITATIONS Confirmation of cancer diagnoses and population incidence data were not available; inability to exclude pre-existing cancers. CONCLUSIONS People on dialysis experience excess all-site and site-specific cancer mortality compared with the general population. Mortality differs by modality type, age, and sex. Understanding the role of kidney failure and other morbidities in the treatment of cancer is important for shared decision-making regarding cancer treatments and identifying potential approaches to improve outcomes.
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Affiliation(s)
| | | | - Claire M Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | | | - Kate Wyburn
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Angela C Webster
- Sydney School of Public Health, Sydney, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia
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Torlot F, Yew CY, Reilly JR, Phillips M, Weber DG, Corcoran TB, Ho KM, Toner AJ. External validity of four risk scores predicting 30-day mortality after surgery. BJA OPEN 2022; 3:100018. [PMID: 37588588 PMCID: PMC10430818 DOI: 10.1016/j.bjao.2022.100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/23/2022] [Indexed: 08/18/2023]
Abstract
Background Surgical risk prediction tools can facilitate shared decision-making and efficient allocation of perioperative resources. Such tools should be externally validated in target populations before implementation. Methods Predicted risk of 30-day mortality was retrospectively derived for surgical patients at Royal Perth Hospital from 2014 to 2021 using the Surgical Outcome Risk Tool (SORT) and the related NZRISK (n=44 031, 53 395 operations). In a sub-population (n=31 153), the Physiology and Operative Severity Score for the enumeration of Mortality (POSSUM) and the Portsmouth variant of this (P-POSSUM) were matched from the Copeland Risk Adjusted Barometer (C2-Ai, Cambridge, UK). The primary outcome was risk score discrimination of 30-day mortality as evaluated by area-under-receiver operator characteristic curve (AUROC) statistics. Calibration plots and outcomes according to risk decile and time were also explored. Results All four risk scores showed high discrimination (AUROC) for 30-day mortality (SORT=0.922, NZRISK=0.909, P-POSSUM=0.893; POSSUM=0.881) but consistently over-predicted risk. SORT exhibited the best discrimination and calibration. Thresholds to denote the highest and second-highest deciles of SORT risk (>3.92% and 1.52-3.92%) captured the majority of deaths (76% and 13%, respectively) and hospital-acquired complications. Year-on-year SORT calibration performance drifted towards over-prediction, reflecting a decrease in 30-day mortality over time despite an increase in the surgical population risk. Conclusions SORT was the best performing risk score in predicting 30-day mortality after surgery. Categorising patients based on SORT into low, medium (80-90th percentile), and high risk (90-100th percentile) might guide future allocation of perioperative resources. No tools were sufficiently calibrated to support shared decision-making based on absolute predictions of risk.
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Affiliation(s)
| | | | - Jennifer R. Reilly
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Australia
- Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia
| | | | - Dieter G. Weber
- Royal Perth Hospital, Perth, Australia
- University of Western Australia, Perth, Australia
| | - Tomas B. Corcoran
- Royal Perth Hospital, Perth, Australia
- University of Western Australia, Perth, Australia
| | - Kwok M. Ho
- Royal Perth Hospital, Perth, Australia
- University of Western Australia, Perth, Australia
| | - Andrew J. Toner
- Royal Perth Hospital, Perth, Australia
- University of Western Australia, Perth, Australia
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Chami J, Nicholson C, Strange G, Baker D, Cordina R, Celermajer DS. Hospital discharge codes and substantial underreporting of congenital heart disease. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Nghiem S, Afoakwah C, Scuffham P, Byrnes J. A baseline profile of the Queensland Cardiac Record Linkage Cohort (QCard) study. BMC Cardiovasc Disord 2022; 22:35. [PMID: 35120447 PMCID: PMC8817516 DOI: 10.1186/s12872-022-02478-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background Cardiovascular disease (CVD) is one of the leading causes of death in Australia. Longitudinal record linkage studies have the potency to influence clinical decision making to improve cardiac health. This paper describes the baseline characteristics of the Queensland Cardiac Record Linkage Cohort study (QCard).
Methods International Classification of Disease, 10th Revision Australian Modification (ICD-10-AM) diagnosis codes were used to identify CVD and comorbidities. Cost and adverse health outcomes (e.g., comorbidities, hospital-acquired complications) were compared between first-time and recurrent admissions. Descriptive statistics and standard tests were used to analyse the baseline data. Results There were 132,343 patients with hospitalisations in 2010, of which 47% were recurrent admissions, and 53% were males. There were systematic differences between characteristics of recurrent and first-time hospitalisations. Patients with recurrent episodes were nine years older (70 vs. 61; p < 0.001) and experienced a twice higher risk of multiple comorbidities (3.17 vs. 1.59; p < 0.001). CVD index hospitalisations were concentrated in large metropolitan hospitals. Conclusions Our study demonstrates that linked administrative health data provide an effective tool to investigate factors determining the progress of heart disease. Our main finding suggests that recurrent admissions were associated with higher hospital costs and a higher risk of having adverse outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02478-z.
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Affiliation(s)
- Son Nghiem
- Centre for Applied Health Economics, Griffith University, 117 Kessels Road, Nathan, Brisbane, QLD, 4111, Australia.
| | - Clifford Afoakwah
- Centre for Applied Health Economics, Griffith University, 117 Kessels Road, Nathan, Brisbane, QLD, 4111, Australia
| | - Paul Scuffham
- Centre for Applied Health Economics, Griffith University, 117 Kessels Road, Nathan, Brisbane, QLD, 4111, Australia.,Menzies Health Institute Queensland, Griffith University, Level 8.86, G40-Griffith Health Centre, Gold Coast, QLD, 4222, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, 117 Kessels Road, Nathan, Brisbane, QLD, 4111, Australia
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Pérez Chacón G, Fathima P, Jones M, Barnes R, Richmond PC, Gidding HF, Moore HC, Snelling TL. Pertussis immunisation in infancy and atopic outcomes: A protocol for a population-based cohort study using linked administrative data. PLoS One 2021; 16:e0260388. [PMID: 34874968 PMCID: PMC8651097 DOI: 10.1371/journal.pone.0260388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/06/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The burden of IgE-mediated food allergy in Australian born children is reported to be among the highest globally. This illness shares risk factors and frequently coexists with asthma, one of the most common noncommunicable diseases of childhood. Findings from a case-control study suggest that compared to immunisation with acellular pertussis vaccine, early priming of infants with whole-cell pertussis vaccine may be associated with a lower risk of subsequent IgE-mediated food allergy. If whole-cell vaccination is protective of food allergy and other atopic diseases, especially if protective against childhood asthma, the population-level effects could justify its preferential recommendation. However, the potential beneficial effects of whole-cell pertussis vaccination for the prevention of atopic diseases at a population-scale are yet to be investigated. METHODS AND ANALYSIS Analyses of population-based record linkage data will be undertaken to compare the rates of admissions to hospital for asthma in children aged between 5 and 15 years old, who were born in Western Australia (WA) or New South Wales (NSW) between 1997 and 1999 (329,831) when pertussis immunisation in Australia transitioned from whole-cell to acellular only schedules. In the primary analysis we will estimate hazard ratios and 95% confidence intervals for the time-to-first-event (hospital admissions as above) using Cox proportional hazard models in recipients of a first dose of whole-cell versus acellular pertussis-containing vaccine before 112 days old (~4 months of age). Similarly, we will also fit time-to-recurrent events analyses using Andersen-Gill models, and robust variance estimates to account for potential within-child dependence. Hospitalisations for all-cause anaphylaxis, food anaphylaxis, venom, all-cause urticaria and atopic dermatitis will also be examined in children who received at least one dose of pertussis-containing vaccine by the time of the cohort entry, using analogous statistical methods. Presentations to the emergency departments will be assessed separately using the same statistical approach.
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Affiliation(s)
- Gladymar Pérez Chacón
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- Faculty of Health Science, Curtin School of Population Health, Curtin University, Bentley, WA, Australia
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Mark Jones
- Faculty of Medicine and Health, Health and Clinical Analytics Lab, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Rosanne Barnes
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Peter C. Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- Division of Paediatrics, University of Western Australia, Perth, WA, Australia
| | - Heather F. Gidding
- Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
- Women and Babies Health Research, Kolling Institute, Northern Sydney Local Health District, Sydney, NSW, Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Hannah C. Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- Faculty of Health Science, Curtin School of Population Health, Curtin University, Bentley, WA, Australia
| | - Thomas L. Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- Faculty of Health Science, Curtin School of Population Health, Curtin University, Bentley, WA, Australia
- Faculty of Medicine and Health, Health and Clinical Analytics Lab, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
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Uddin S, Imam T, Hossain ME, Gide E, Sianaki OA, Moni MA, Mohammed AA, Vandana V. Intelligent type 2 diabetes risk prediction from administrative claim data. Inform Health Soc Care 2021; 47:243-257. [PMID: 34672859 DOI: 10.1080/17538157.2021.1988957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Type 2 diabetes is a chronic, costly disease and is a serious global population health problem. Yet, the disease is well manageable and preventable if there is an early warning. This study aims to apply supervised machine learning algorithms for developing predictive models for type 2 diabetes using administrative claim data. Following guidelines from the Elixhauser Comorbidity Index, 31 variables were considered. Five supervised machine learning algorithms were used for developing type 2 diabetes prediction models. Principal component analysis was applied to rank variables' importance in predictive models. Random forest (RF) showed the highest accuracy (85.06%) among the algorithms, closely followed by the k-nearest neighbor (84.48%). The analysis further revealed RF as a high performing algorithm irrespective of data imbalance. As revealed by the principal component analysis, patient age is the most important predictor for type 2 diabetes, followed by a comorbid condition (i.e., solid tumor without metastasis). This study's finding of RF as the best performing classifier is consistent with the promise of tree-based algorithms for public data in other works. Thus, the outcome can guide in designing automated surveillance of patients at risk of forming diabetes from administrative claim information and will be useful to health regulators and insurers.
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Affiliation(s)
- Shahadat Uddin
- Complex Systems Research Group, Faculty of Engineering, The University of Sydney, Darlington, NSW, Australia
| | - Tasadduq Imam
- School of Business and Law, CQUniversity, Melbourne, VIC, Australia
| | - Md Ekramul Hossain
- Complex Systems Research Group, Faculty of Engineering, The University of Sydney, Darlington, NSW, Australia
| | - Ergun Gide
- School of Engineering and Technology, CQUniversity, Sydney, NSW, Australia
| | - Omid Ameri Sianaki
- College of Engineering and Science, Victoria University, Sydney, NSW, Australia.,Victoria University Business School, Melbourne, Victoria, Australia
| | - Mohammad Ali Moni
- School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia
| | | | - Vandana Vandana
- College of Engineering and Science, Victoria University, Sydney, NSW, Australia
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Chami J, Strange G, Nicholson C, Celermajer DS. Towards a Unified Coding System for Congenital Heart Diseases. Circ Cardiovasc Qual Outcomes 2021; 14:e008216. [PMID: 34176294 DOI: 10.1161/circoutcomes.121.008216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jason Chami
- Sydney Medical School, University of Sydney, Camperdown, NSW, Australia (J.C.)
| | - Geoff Strange
- School of Medicine, University of Notre Dame Australia, Freemantle, WA, Australia (G.S.)
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Wabe N, Li L, Lindeman R, Post JJ, Dahm MR, Li J, Westbrook JI, Georgiou A. Evaluation of the accuracy of diagnostic coding for influenza compared to laboratory results: the availability of test results before hospital discharge facilitates improved coding accuracy. BMC Med Inform Decis Mak 2021; 21:168. [PMID: 34022851 PMCID: PMC8141245 DOI: 10.1186/s12911-021-01531-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 05/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Assessing the accuracy of diagnostic coding is essential to ensure the validity and reliability of administrative coded data. The aim of the study was to evaluate the accuracy of assigned International Classification of Diseases version 10-Australian Modification (ICD-10-AM) codes for influenza by comparing with patients’ results of their polymerase chain reaction (PCR)-based laboratory tests. Method A retrospective study was conducted across seven public hospitals in New South Wales, Australia. A total of 16,439 patients who were admitted and tested by either cartridge-based rapid PCR or batched multiplex PCR between January 2016 and December 2017 met the inclusion criteria. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ICD-10-AM coding using laboratory results as a gold standard. Separate analyses were conducted to determine whether the availability of test results at the time of hospital discharge influenced diagnostic coding accuracy. Results Laboratory results revealed 2759 positive influenza cases, while ICD-10-AM coding identified 2527 patients. Overall, 13.7% (n = 378) of test positive patients were not assigned an ICD-10-AM code for influenza. A further 5.8% (n = 146) patients with negative test results were incorrectly assigned an ICD-10-AM code for influenza. The sensitivity, specificity, PPV and NPV of ICD-10-AM coding were 93.1%; 98.9%; 94.5% and 98.6% respectively when test results were received before discharge and 32.7%; 99.2%; 87.8% and 89.8% respectively when test results were not available at discharge. The sensitivity of ICD-10-AM coding varied significantly across hospitals. The use of rapid PCR or hospitalisation during the influenza season were associated with greater coding accuracy. Conclusion Although ICD-10-AM coding for influenza demonstrated high accuracy when laboratory results were received before discharge, its sensitivity was substantially lower for patients whose test results were not available at discharge. The timely availability of laboratory test results during the episode of care could contribute to improved coding accuracy. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01531-9.
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Affiliation(s)
- Nasir Wabe
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, 2109, Australia.
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, 2109, Australia
| | - Robert Lindeman
- New South Wales Health Pathology, St Leonards, NSW, 2065, Australia
| | - Jeffrey J Post
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, NSW, 2031, Australia.,Prince of Wales Clinical School, University of New South Wales, Kensington, NSW, 2052, Australia
| | - Maria R Dahm
- Institute for Communication in Health Care, The Australian National University, 110 Ellery Crescent, Acton, ACT, 2601, Australia
| | - Julie Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, 2109, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, 2109, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, 2109, Australia
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12
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Wabe N, Hardie R, Lindeman R, Scowen C, Eigenstetter A, Georgiou A. Potentially redundant repeat liver function test ordering practices in australian hospitals: A 5-year multicentre retrospective observational study. Int J Clin Pract 2021; 75:e14004. [PMID: 33400343 PMCID: PMC8243922 DOI: 10.1111/ijcp.14004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/03/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Repeat Liver Function Tests (LFTs) are often necessary for monitoring purposes, but retesting within a short time interval may suggest potentially redundant repeat test (PRRT) ordering practices. We aimed to determine the proportion of potentially redundant repeat LFT ordering and identify associated factors in hospitals. METHODS A 5-year (2014-2018) retrospective cohort study in six hospitals in New South Wales, Australia. A total of 131 885 patient admissions with repeat LFTs in the general ward (n = 102 852) and intensive care unit (ICU) (n = 29 033) met the inclusion criteria. Existing guidelines do not support retesting LFT for at least 48-72 hours. We used 24 hours as a conservative minimum retesting interval to examine PRRT ordering. We fit binary logistic regression to identify factors associated with PRRT ordering in two conditions with the highest repeat LFTs. RESULTS There were a total of 298 567 repeat LFTs (medians of 2 repeats/admission and retesting interval of 25.6 hours) in the general ward and 205 929 (medians of 4 repeats/admission and retesting interval of 24.1 hours) in the ICU. The proportions of PRRT ordering were 35.2% (105 227/298 567) and 47.7% (98 307/205 929) in the general ward and ICU, respectively. The proportions of patients who received at least one PRRT were 52.3% (53 766/102 852) and 83.9% (24 365/29 033) in the general ward and ICU, respectively. Age, gender and the number of comorbidities and procedures were associated with the likelihood of ordering PRRT depending on the settings. CONCLUSION Repeat LFT testing is common in Australian hospitals, often within 24 hours, despite guidelines not supporting too-early repeat testing. Further research should be conducted to understand whether better adherence to existing guidelines is required, or if there is any case for guidelines to be updated based on certain patient subpopulations.
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Affiliation(s)
- Nasir Wabe
- Centre for Health Systems and Safety ResearchAustralian Institute of Health InnovationMacquarie UniversityNorth RydeNSWAustralia
| | - Rae‐Anne Hardie
- Centre for Health Systems and Safety ResearchAustralian Institute of Health InnovationMacquarie UniversityNorth RydeNSWAustralia
| | - Robert Lindeman
- NSW Health PathologySt LeonardsNSWAustralia
- School of MedicineUniversity of New South WalesKensingtonNSWAustralia
| | | | | | - Andrew Georgiou
- Centre for Health Systems and Safety ResearchAustralian Institute of Health InnovationMacquarie UniversityNorth RydeNSWAustralia
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Effectiveness of Oseltamivir in reducing 30-day readmissions and mortality among patients with severe seasonal influenza in Australian hospitalized patients. Int J Infect Dis 2021; 104:232-238. [PMID: 33434667 DOI: 10.1016/j.ijid.2021.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 12/28/2020] [Accepted: 01/05/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Worldwide, seasonal influenza causes significant mortality and poses a significant economic burden. Oseltamivir is an effective treatment, but benefits beyond immediate hospitalization are unknown. METHODS This retrospective multicenter study included adult hospitalized influenza patients from two major teaching hospitals in Australia. Patients who received Oseltamivir <48 h of admission (prompt-treatment group) were compared with those who either did not receive treatment or if treatment was delayed by >48 h (delayed/no-treatment group). Propensity-score matching was used to balance confounders between two groups. Primary outcomes included 30-day readmissions, 30-day mortality, composite-outcome (30-day mortality and readmissions), in-hospital mortality, and hospital length of stay (LOS). RESULTS Between January 2016-March 2020, 1828 adult patients mean (SD) age 66.4 (20.1), 52.9% females, were hospitalized with influenza. Four hundred and forty-eight (24.5%) received prompt-treatment with Oseltamivir, while 1380 (75.5%) patients were in the delayed/no-treatment group. The median (IQR) time from onset of symptoms to the administration of Oseltamivir was three (1-5) days. The propensity-score model included 245 matched patients in each group (standardized mean difference of <10%). Both 30-day readmissions and the composite-outcome were, respectively, 5.7% (P = 0.03) and 6.5% (P = 0.02) lower in patients who received prompt-treatment with Oseltamivir when compared to the delayed/no-treatment group. LOS showed a significant reduction, and in-hospital mortality showed a trend towards improvement among patients who received prompt-treatment when compared to the other group. CONCLUSIONS Early administration of Oseltamivir was associated with a reduction in 30-days readmissions and composite-outcome of 30-day readmissions and mortality in adult hospitalized influenza patients when compared to delayed/no-treatment.
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14
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Sharma Y, Horwood C, Chua A, Hakendorf P, Thompson C. Prognostic impact of high sensitive troponin in predicting 30-day mortality among patients admitted to hospital with influenza. IJC HEART & VASCULATURE 2020; 32:100682. [PMID: 33354619 PMCID: PMC7744942 DOI: 10.1016/j.ijcha.2020.100682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 11/05/2022]
Abstract
Background Worldwide, seasonal influenza causes significant mortality and severe infections may cause cardiac injury. High-sensitive-troponins (hsTnT) are sensitive and specific markers of myocardial damage. This study investigated the prognostic impact of hsTnT on 30-day mortality in hospitalised influenza patients. Methods This retrospective study included influenza patients ≥ 18 years, who had hsTnT performed during admission in two tertiary-hospitals in South Australia. Diagnosis of influenza was confirmed by polymerase–chain-reaction (PCR) test and hsTnT > 14 ng/L with a change of > 20% during admission was considered to be indicative of acute-cardiac injury. Clinical characteristics, complications and 30-day mortality were compared among four groups of patients: hsTnT unavailable, hsTnT negative, chronically elevated hsTnT and acutely elevated hsTnT. Cox-proportional hazard regression determined the hazard of death at 30-days following hospital discharge after adjustment for co-variates. Results Between January 2016 -March 2020, 1828 influenza patients, mean age 66.4 years, were hospitalised. Troponin results were available for 617 (47.7%) patients, of whom, 62 (10%) had acute myocardial injury and 232 (37.6%) had chronic hsTnT elevation. Both inpatient and 30-day mortality were significantly higher among patients with acute (P < 0.001) and chronic hsTnT (P < 0.001) when compared to other groups. When compared to patients with negative hsTnT, acute but not chronic hsTnT elevation was significantly associated with 30-day mortality after adjustment for various co-variates (HR 8.30, 1.80–17.84, P value = 0.013). Conclusions This is the largest available analysis of cardiac-specific biomarker hsTnT in patients with influenza. An acutely elevated hsTnT was associated with 30-day mortality among hospitalised influenza patients.
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Affiliation(s)
- Yogesh Sharma
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Department of General Medicine, Division of Medicine, Cardiac & Critical Care, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Chris Horwood
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Angela Chua
- Department of Medicine, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Paul Hakendorf
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Campbell Thompson
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
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15
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Betts KS, Kisely S, Alati R. Predicting neonatal respiratory distress syndrome and hypoglycaemia prior to discharge: Leveraging health administrative data and machine learning. J Biomed Inform 2020; 114:103651. [PMID: 33285308 DOI: 10.1016/j.jbi.2020.103651] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES A major challenge for hospitals and clinicians is the early identification of neonates at risk of developing adverse conditions. We develop a model based on routinely collected administrative data, which accurately predicts two common disorders among early term and preterm (<39 weeks) neonates prior to discharge. STUDY DESIGN The data included all inpatient live births born prior to 39 weeks (n = 154,755) occurring in the Australian state of Queensland between January 2009 and December 2015. Predictor variables included all maternal data captured in administrative records from the beginning of gestation up to, and including, the delivery, as well as neonatal data recorded at the delivery. Gradient boosted trees were used to predict neonatal respiratory distress syndrome and hypoglycaemia prior to discharge, with model performance benchmarked against a logistic regression models. RESULTS The gradient boosted trees model achieved very high discrimination for respiratory distress syndrome [AUC = 0.923, 95% CI (0.917, 0.928)] and good discrimination for hypoglycaemia [AUC = 0.832, 95% CI (0.827, 0.837)] in the validation data, as well as outperforming the logistic regression models. CONCLUSION Our study suggests that routinely collected health data have the potential to play an important role in assisting clinicians to identify neonates at risk of developing selected disorders shortly after birth. Despite achieving high levels of discrimination, many issues remain before such models can be implemented in practice, which we discuss in relation to our findings.
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Affiliation(s)
- Kim S Betts
- School of Public Health, Building 400, Kent Street, Bentley, Curtin University, WA 6101, Australia.
| | - Steve Kisely
- School of Medicine, University of Queensland, Brisbane, Australia.
| | - Rosa Alati
- School of Public Health, Building 400, Kent Street, Bentley, Curtin University, WA 6101, Australia.
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16
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Sharma Y, Horwood C, Hakendorf P, Thompson C. Clinical characteristics and outcomes of influenza A and B virus infection in adult Australian hospitalised patients. BMC Infect Dis 2020; 20:913. [PMID: 33261559 PMCID: PMC7705848 DOI: 10.1186/s12879-020-05670-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/27/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Influenza B is often perceived as a less severe strain of influenza. The epidemiology and clinical outcomes of influenza B have been less thoroughly investigated in hospitalised patients. The aims of this study were to describe clinical differences and outcomes between influenza A and B patients admitted over a period of 4 years. METHODS We retrospectively collected data of all laboratory confirmed influenza patients ≥18 years at two tertiary hospitals in South Australia. Patients were confirmed as influenza positive if they had a positive polymerase-chain-reaction (PCR) test of a respiratory specimen. Complications during hospitalisation along with inpatient mortality were compared between influenza A and B. In addition, 30 day mortality and readmissions were compared. Logistic regression model compared outcomes after adjustment for age, Charlson index, sex and creatinine levels. RESULTS Between January 2016-March 2020, 1846 patients, mean age 66.5 years, were hospitalised for influenza. Of whom, 1630 (88.3%) had influenza A and 216 (11.7%) influenza B. Influenza B patients were significantly younger than influenza A. Influenza A patients were more likely be smokers with a history of chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD) than influenza B. Complications, including pneumonia and acute coronary syndrome (ACS) were similar between two groups, however, septic shock was more common in patients with influenza B. Adjusted analyses showed similar median length of hospital stay (LOS), in hospital mortality, 30-day mortality and readmissions between the two groups. CONCLUSIONS Influenza B is less prevalent and occurs mostly in younger hospitalised patients than influenza A. Both strains contribute equally to hospitalisation burden and complications. TRIAL REGISTRATION Australia and New Zealand Clinical Trial Registry (ANZCR) no ACTRN12618000451202 date of registration 28/03/2018.
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Affiliation(s)
- Yogesh Sharma
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
- Department of General Medicine, Division of Medicine, Cardiac & Critical Care, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia.
| | - Chris Horwood
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Paul Hakendorf
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Campbell Thompson
- Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia
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Bowers AP, Bradford N, Chan RJ, Herbert A, Yates P. Analysis of health administration data to inform health service planning for paediatric palliative care. BMJ Support Palliat Care 2020; 12:e671-e679. [PMID: 33051310 DOI: 10.1136/bmjspcare-2020-002449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/27/2020] [Accepted: 09/15/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Health service planning in paediatric palliative care is complex, with the diverse geographical and demographic characteristics adding to the challenge of developing services across different nations. Accurate and reliable data are essential to inform effective, efficient and equitable health services. AIM To quantify health service usage by children and young people aged 0-21 years with a life-limiting condition admitted to hospital and health service facilities in Queensland, Australia during the 2011 and 2016 calendar years, and describe the clinical and demographic characteristics associated with health services usage. DESIGN Retrospective health administrative data linkage of clinical and demographic information with hospital admissions was extracted using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision Australian Modification (ICD-10-AM) diagnostic codes. Data were analysed using descriptive statistics. SETTING/PARTICIPANTS Individuals aged 0-21 years with a life-limiting condition admitted to a Queensland Public Hospital and Health Service or private hospital. RESULTS Hospital admissions increased from 17 955 in 2011 to 23 273 in 2016, an increase of 5318 (29.6%). The greatest percentage increase in admissions were for those aged 16-18 years (58.1%, n=1050), and those with non-oncological conditions (36.2%, n=4256). The greatest number of admissions by ICD-10-AM chapter for 2011 and 2016 were by individuals with neoplasms (6174, 34.4% and 7206, 31.0% respectively). Overall, the number of admissions by Indigenous children and young people increased by 70.2% (n=838). CONCLUSIONS Administrative data are useful to describe clinical and demographic characteristics and quantify health service usage. Available data suggest a growing demand for health services by children eligible for palliative care that will require an appropriate response from health service planners.
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Affiliation(s)
- Alison Pauline Bowers
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia .,Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Centre for Children's Health Research, Queensland University of Technology (QUT), South Brisbane, Queensland, Australia
| | - Natalie Bradford
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Centre for Children's Health Research, Queensland University of Technology (QUT), South Brisbane, Queensland, Australia
| | - Raymond Javan Chan
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Anthony Herbert
- Paediatric Palliative Care, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Patsy Yates
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Centre for Children's Health Research, Queensland University of Technology (QUT), South Brisbane, Queensland, Australia
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A Systematic Review of Network Studies Based on Administrative Health Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072568. [PMID: 32283623 PMCID: PMC7177895 DOI: 10.3390/ijerph17072568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 11/17/2022]
Abstract
Effective and efficient delivery of healthcare services requires comprehensive collaboration and coordination between healthcare entities and their complex inter-reliant activities. This inter-relation and coordination lead to different networks among diverse healthcare stakeholders. It is important to understand the varied dynamics of these networks to measure the efficiency of healthcare delivery services. To date, however, a work that systematically reviews these networks outlined in different studies is missing. This article provides a comprehensive summary of studies that have focused on networks and administrative health data. By summarizing different aspects including research objectives, key research questions, adopted methods, strengths and weaknesses, this research provides insights into the inherently complex and interlinked networks present in healthcare services. The outcome of this research is important to healthcare management and may guide further research in this area.
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Henderson J, Gallagher R, Brown P, Smith D, Tang K. Emergency department after-hours primary contact physiotherapy service reduces analgesia and orthopaedic referrals while improving treatment times. AUST HEALTH REV 2020; 44:485-492. [PMID: 32040938 DOI: 10.1071/ah18259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 08/23/2019] [Indexed: 11/23/2022]
Abstract
Objective The aims of this study were to identify: (1) whether an after-hours emergency department (ED) collaborative care service using primary contact physiotherapists (PCPs) improves treatment times for musculoskeletal and simple orthopaedic presentations; and (2) differences in orthopaedic referral rates and analgesia prescription for patients managed by PCPs compared with secondary contact physiotherapists. Methods A prospective observational study was conducted of diagnosed, matched patients seen in a 4-day week after-hours ED primary contact physiotherapy service in a tertiary referral ED. Patients presenting with a musculoskeletal or simple orthopaedic diagnosis reviewed by a physiotherapist as either the primary or secondary physiotherapy contact between 1630 and 2030 hours from Saturday to Tuesday were included in the analysis. Outcome measures collected included ED length of stay, orthopaedic referrals in the ED, follow-up plan on discharge from the ED and analgesia prescriptions. Results There were no adverse events, missed diagnoses or re-presentations for any patients managed by an ED PCP. Mean (±s.d.) treatment time for patients seen by an ED PCP was 130±76min, compared with 240±115min for those seen by a secondary contact physiotherapist (P<0.001). There were significant differences between patients managed by PCP versus secondary contact physiotherapists, with decreases of 20.4% for referrals to orthopaedics in the ED, 21.2% for orthopaedic clinic referrals on discharge and 8.5% in analgesia prescriptions for patients managed by an ED PCP (P<0.001). In addition to these reductions, there was a 17.5% increase in general practitioner referrals on discharge for patients managed by an ED PCP (P<0.001). Conclusion An after-hours ED physiotherapy service is a safe service that reduces ED treatment times, as well as analgesia prescriptions and orthopaedic referrals for patients managed by a PCP. What is known about the topic? PCPs are capable of providing safe and effective care to patients in the ED who present with musculoskeletal complaints. Patients managed by physiotherapists as the primary contact require fewer X-rays and have reduced treatment times. What does this paper add? Compared with previously published articles, this study demonstrates similar reductions in ED treatment times in an after-hours setting for patients managed by an ED PCP. However, this was achieved by physiotherapists who have less reported experience. Furthermore, this study found that management of patients by PCPs resulted in a reduction in the amount of analgesia prescribed and orthopaedic input required for these patients. What are the implications for practitioners? PCPs can be trained to operate in the ED with minor or no prior ED experience while facilitating reductions in the amount of analgesia prescribed, orthopaedic referrals required (in ED and on discharge) and reducing treatment times for patients.
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Affiliation(s)
- Judith Henderson
- Physiotherapy Department, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia. ; ; ; and Corresponding author.
| | - Ryan Gallagher
- Physiotherapy Department, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia. ; ;
| | - Peter Brown
- Physiotherapy Department, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia. ; ;
| | - Damien Smith
- Physiotherapy Department, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia. ; ;
| | - Kevin Tang
- Emergency Department, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia.
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Joe A, Dickins M, Enticott J, Ogrin R, Lowthian J. Community-Dwelling Older Women: The Association Between Living Alone and Use of a Home Nursing Service. J Am Med Dir Assoc 2020; 21:1273-1281.e2. [PMID: 31889634 DOI: 10.1016/j.jamda.2019.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/10/2019] [Accepted: 11/12/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the use of home nursing by community-dwelling older women to determine the nature of services required by those living alone. DESIGN A retrospective cohort study using routinely collected data. SETTING AND PARTICIPANTS Women aged 55 years and older living in metropolitan Melbourne who received an episode of nursing care from a large community home-based nursing service provider between January 1, 2006 and December 31, 2015. METHODS Descriptive and inferential statistical analyses were used to examine the relationship between client- and service-related factors and use of community nursing services. The primary outcome of interest was the hours of service received in a care episode. RESULTS A total of 134,396 episodes of care were analyzed, in which 51,606 (38.4%) episodes involved a woman who lived alone. The median hours of care per episode to women who lived alone was almost 70% more than that for women who lived with others. Multivariable regression identified factors influencing the amount of service use: living alone status, cognitive health status, and number of required home nursing activities. After adjusting for confounding and interactions, living alone was associated with at least 13% more hours of care than is provided to those not living alone. Compared with women who lived with others, women living alone required almost double the amount of assistance with medication management and were 30% more likely to experience a deterioration in their condition or be discharged from home nursing care into an acute hospital. From 2006 to 2015, for all women there was a trend toward fewer hours of nursing service provided per episode. CONCLUSIONS AND IMPLICATIONS Community-dwelling older women who live alone have greater service needs and higher rates of discharge to hospital. This knowledge will help guide provision of services and strategies to prevent clinical deterioration for this population.
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Affiliation(s)
- Angela Joe
- Bolton Clarke Research Institute, Bolton Clarke, Bentleigh, Victoria, Australia.
| | - Marissa Dickins
- Bolton Clarke Research Institute, Bolton Clarke, Bentleigh, Victoria, Australia; Southern Synergy, Department of Psychiatry at Monash Health, Southern Clinical School, Monash University, Dandenong, Victoria, Australia
| | - Joanne Enticott
- Southern Synergy, Department of Psychiatry at Monash Health, Southern Clinical School, Monash University, Dandenong, Victoria, Australia; Department of General Practice, School of Primary and Allied Health Care, Monash University, Notting Hill, Victoria, Australia
| | - Rajna Ogrin
- Bolton Clarke Research Institute, Bolton Clarke, Bentleigh, Victoria, Australia; Department of International Business and Asian Studies, Griffith University, Gold Coast, Queensland, Australia; Biosignals for Affordable Healthcare, Royal Melbourne Institute of Technology University, Melbourne, Victoria, Australia; Austin Health Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia
| | - Judy Lowthian
- Bolton Clarke Research Institute, Bolton Clarke, Bentleigh, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia; Institute of Future Environments, Queensland University of Technology, Brisbane, Queensland, Australia
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Rosales BM, De La Mata N, Vajdic CM, Kelly PJ, Wyburn K, Webster AC. Cancer mortality in kidney transplant recipients: An Australian and New Zealand population-based cohort study, 1980-2013. Int J Cancer 2019; 146:2703-2711. [PMID: 31340063 DOI: 10.1002/ijc.32585] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/04/2019] [Indexed: 01/03/2023]
Abstract
Cancer burden is increasing in kidney transplant recipients, but differences in mortality compared to the general population remain unclear. We sought to compare cancer mortality in paediatric and adult kidney transplant recipients with the general population and describe any differences, by site, age and sex, country and over time. We included kidney transplant recipients from the Australian and New Zealand Dialysis and Transplantation Registry, 1980-2013. Date of death and underlying cause of death were ascertained by data-linkage and classified using ICD10AM codes. Indirect standardisation was used to estimate standardised mortality ratios (SMR). There were 5,284 deaths in 17,628 kidney transplant recipients over 175,084 person-years of observation, including 1,061 (20%) cancer deaths. Relative cancer mortality was higher than the general population for all-site (SMR 2.9, 95% CI 2.7-3.1) cancer and highest for nonmelanoma skin cancer (SMR 50.9, 95% CI 43.5-59.6) and lymphoma (SMR 42.2, 95% CI 35.3-50.5). Relative cancer mortality decreased with increasing age in men (p < 0.001) and women (p = 0.001) but never reached parity with the general population. Relative mortality did not change with age for skin and lip, or colorectal cancers (p-value >0.1). Only relative colorectal cancer mortality increased over time (p = 0.002). Our study shows cancer mortality in kidney transplant recipients was higher than expected in the general population. The magnitude of excess mortality varied by cancer site, age and sex. Further evidence is needed to identify whether this variation is due to differences at diagnosis or access and effectiveness of cancer treatments in this population.
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Affiliation(s)
- Brenda M Rosales
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Nicole De La Mata
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Claire M Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Kensington, NSW, Australia
| | - Patrick J Kelly
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Kate Wyburn
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia.,Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Angela C Webster
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Department of Renal Medicine and Transplantation, Westmead Hospital, Sydney, NSW, Australia
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22
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Moore HC, de Klerk N, Blyth CC, Gilbert R, Fathima P, Zylbersztejn A, Verfürden M, Hardelid P. Temporal trends and socioeconomic differences in acute respiratory infection hospitalisations in children: an intercountry comparison of birth cohort studies in Western Australia, England and Scotland. BMJ Open 2019; 9:e028710. [PMID: 31110110 PMCID: PMC6530403 DOI: 10.1136/bmjopen-2018-028710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Acute respiratory infections (ARIs) are a global cause of childhood morbidity. We compared temporal trends and socioeconomic disparities for ARI hospitalisations in young children across Western Australia, England and Scotland. DESIGN Retrospective population-based cohort studies using linked birth, death and hospitalisation data. SETTING AND PARTICIPANTS Population birth cohorts spanning 2000-2012 (Western Australia and Scotland) and 2003-2012 (England). OUTCOME MEASURES ARI hospitalisations in infants (<12 months) and children (1-4 years) were identified through International Classification of Diseases, 10th edition diagnosis codes. We calculated admission rates per 1000 child-years by diagnosis and jurisdiction-specific socioeconomic deprivation and used negative binomial regression to assess temporal trends. RESULTS The overall infant ARI admission rate was 44.3/1000 child-years in Western Australia, 40.7/1000 in Scotland and 40.1/1000 in England. Equivalent rates in children aged 1-4 years were 9.0, 7.6 and 7.6. Bronchiolitis was the most common diagnosis. Compared with the least socioeconomically deprived, those most deprived had higher ARI hospitalisation risk (incidence rate ratio 3.9 (95% CI 3.5 to 4.2) for Western Australia; 1.9 (1.7 to 2.1) for England; 1.3 (1.1 to 1.4) for Scotland. ARI admissions in infants were stable in Western Australia but increased annually in England (5%) and Scotland (3%) after adjusting for non-ARI admissions, sex and deprivation. CONCLUSIONS Admissions for ARI were higher in Western Australia and displayed greater socioeconomic disparities than England and Scotland, where ARI rates are increasing. Prevention programmes focusing on disadvantaged populations in all three countries are likely to translate into real improvements in the burden of ARI in children.
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Affiliation(s)
- Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Nicholas de Klerk
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Department of Infectious Diseases, PrincessMargaret Hospital for Children, Perth, Western Australia, Australia
- PathWest Laboratory Medicine WA, QE11 Medical Centre, Perth, Western Australia, Australia
| | - Ruth Gilbert
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Ania Zylbersztejn
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Maximiliane Verfürden
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Pia Hardelid
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
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23
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Westphal DW, Lehmann D, Williams SA, Richmond PC, Lannigan FJ, Fathima P, Blyth CC, Moore HC. Australian Aboriginal children have higher hospitalization rates for otitis media but lower surgical procedures than non-Aboriginal children: A record linkage population-based cohort study. PLoS One 2019; 14:e0215483. [PMID: 31013285 PMCID: PMC6478284 DOI: 10.1371/journal.pone.0215483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/02/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Otitis media (OM) is one of the most common infectious diseases affecting children globally and the most common reason for antibiotic prescription and paediatric surgery. Australian Aboriginal children have higher rates of OM than non-Aboriginal children; however, there are no data comparing OM hospitalization rates between them at the population level. We report temporal trends for OM hospitalizations and in-hospital tympanostomy tube insertion (TTI) in a cohort of 469,589 Western Australian children born between 1996 and 2012. Materials and methods We used the International Classification of Diseases codes version 10 to identify hospitalizations for OM or TTI recorded as a surgical procedure. Using age-specific population denominators, we calculated hospitalization rates per 1,000 child-years by age, year and level of socio-economic deprivation. Results There were 534,674 hospitalizations among 221,588 children hospitalized at least once before age 15 years. Aboriginal children had higher hospitalization rates for OM than non-Aboriginal children (23.3/1,000 [95% Confidence Interval (CI) 22.8,24.0] vs 2.4/1,000 [95% CI 2.3,2.4] child-years) with no change in disparity over time. Conversely non-Aboriginal children had higher rates of TTI than Aboriginal children (13.5 [95% CI 13.2,13.8] vs 10.1 [95% CI 8.9,11.4]). Children from lower socio-economic backgrounds had higher OM hospitalization rates than those from higher socio-economic backgrounds, although for Aboriginal children hospitalization rates were not statistically different across all levels of socio-economic disadvantage. Hospitalizations for TTI among non-Aboriginal children were more common among those from higher socio-economic backgrounds. This was also true for Aboriginal children; however, the difference was not statistically significant. There was a decline in OM hospitalization rates between 1998 and 2005 and remained stable thereafter. Conclusion Aboriginal children and children from lower socio-economic backgrounds were over-represented with OM-related hospitalizations but had fewer TTIs. Despite a decrease in OM and TTI hospitalization rates during the first half of the study for all groups, the disparity between Aboriginal and non-Aboriginal children and between those of differing socioeconomic deprivation remained.
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Affiliation(s)
- Darren W. Westphal
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- National Centre for Epidemiology & Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
- * E-mail:
| | - Deborah Lehmann
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Stephanie A. Williams
- National Centre for Epidemiology & Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Peter C. Richmond
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Francis J. Lannigan
- Division of Surgery, Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
- Sidra Medicine, Doha, Qatar
| | - Parveen Fathima
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Christopher C. Blyth
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Perth, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia, Australia
| | - Hannah C. Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
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Homaira N, Briggs N, Oei JL, Hilder L, Bajuk B, Snelling T, Chambers GM, Jaffe A. Impact of influenza on hospitalization rates in children with a range of chronic lung diseases. Influenza Other Respir Viruses 2019; 13:233-239. [PMID: 30701672 PMCID: PMC6468072 DOI: 10.1111/irv.12633] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/19/2018] [Accepted: 12/31/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Data on burden of severe influenza in children with a range of chronic lung diseases (CLDs) remain limited. METHOD We performed a cohort study to estimate burden of influenza-associated hospitalization in children with CLDs using population-based linked data. The cohort comprised all children in New South Wales, Australia, born between 2001 and 2010 and was divided into five groups, children with: (a) severe asthma; (b) bronchopulmonary dysplasia (BPD); (c) cystic fibrosis (CF); (d) other congenital/chronic lung conditions; and (e) children without CLDs. Incidence rates and rate ratios for influenza-associated hospitalization were calculated for 2001-2011. Average cost/episode of hospitalization was estimated using public hospital cost weights. RESULTS Our cohort comprised 888 157 children; 11 058 (1.2%) had one of the CLDs. The adjusted incidence/1000 child-years of influenza-associated hospitalization in children with CLDs was 3.9 (95% CI: 2.6-5.2) and 0.7 (95% CI: 0.5-0.9) for children without. The rate ratio was 5.4 in children with CLDs compared to children without. The adjusted incidence/1000 child-years (95% CI) in children with severe asthma was 1.1 (0.6-1.6), with BPD was 6.0 (3.7-8.3), with CF was 7.4 (2.6-12.1), and with other congenital/chronic lung conditions was 6.9 (4.9-8.9). The cost/episode (95% CI) of influenza-associated hospitalization was AUD 19 704 (95% CI: 11 715-27 693) for children with CLDs compared to 4557 (95% CI: 4129-4984) for children without. DISCUSSION This large population-based study suggests a significant healthcare burden associated with influenza in children with a range of CLDs.
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Affiliation(s)
- Nusrat Homaira
- Faculty of Medicine, Discipline of Pediatrics, School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Respiratory Department, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Nancy Briggs
- Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Ju-Lee Oei
- Faculty of Medicine, Discipline of Pediatrics, School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Lisa Hilder
- Faculty of Medicine, Discipline of Pediatrics, School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Centre for Big Data Research in Health UNSW Sydney, Sydney, New South Wales, Australia
| | - Barbara Bajuk
- NSW Pregnancy and Newborn Services Network, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Tom Snelling
- Princess Margaret Hospital, Perth, Western Australia, Australia.,Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Georgina M Chambers
- Faculty of Medicine, Discipline of Pediatrics, School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Centre for Big Data Research in Health UNSW Sydney, Sydney, New South Wales, Australia.,National Perinatal Epidemiology and Statistics Unit (NPESU), Kensington, New South Wales, Australia
| | - Adam Jaffe
- Faculty of Medicine, Discipline of Pediatrics, School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Respiratory Department, Sydney Children's Hospital, Sydney, New South Wales, Australia
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25
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Harriss LR, Thompson F, Lawson K, O Loughlin M, McDermott R. Preventable hospitalisations in regional Queensland: potential for primary health? AUST HEALTH REV 2018; 43:371-381. [PMID: 30071920 DOI: 10.1071/ah18033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 04/17/2018] [Indexed: 11/23/2022]
Abstract
Objective The aims of this study were to: (1) use local health data to examine potentially preventable hospitalisations (PPHs) as a proportion of total hospital separations and estimated costs to a large regional hospital in northern Queensland, including differences associated with Indigenous status; and (2) identify priority conditions and discuss issues related to strategic local primary health intervention. Methods A cross-sectional analysis was conducted using Queensland Hospital Admitted Patient Data Collection data (July 2012-June 2014) restricted to 51087 separations generated by 29485 local residents. PPHs were identified from the International Statistical Classification of Diseases and Related Health Problems 10th Revision Australian Modification (ICD-10-AM) and procedure codes using National Healthcare Agreement definitions. Age-standardised separation rates were calculated using Australian 2001 reference population and associated economic costs were estimated using Australian-refined diagnosis related groups. Results Eleven per cent (n=5488) of all hospital separations were classified as PPH, and most were for common chronic (n=2486; 45.3%) and acute (n=2845; 51.8%) conditions. Because many acute presentations reflect chronic underlying disease, chronic conditions account for up to 76.5% of all PPHs. Age-standardised PPH rates were 3.4-fold higher for Indigenous than non-Indigenous people. Associated 2-year costs were AU$32.7million, which was 10.7% of estimated total health care expenditure for hospital separations, and were higher for Indigenous (14.9%) than non-Indigenous (9.7%) people. Conclusions High hospitalisation rates and costs for common preventable chronic conditions represent opportunities for primary healthcare interventions. In particular, community-level health services need to be more responsive to the needs of local Indigenous families. What is known about the topic? PPH rates are used as a measure of timely access to quality primary health care, and are incrementally higher in regional and remote areas than in major cities. Investment in primary healthcare services has been shown to significantly reduce costs associated with avoidable hospitalisations. What does this paper add? This study used local health data to identify the most common PPH conditions presenting to a large regional hospital in northern Queensland, including estimation of costs and differences associated with Indigenous status. Recommendations are made to strengthen primary healthcare and reduce hospital-related costs. What are the implications for practitioners? Interventions to address high PPH rates should be tailored to meet the needs of the local population. Primary health strategies targeting common chronic conditions provide the greatest opportunity to reduce avoidable hospitalisations and costs in this regional area. Investment in collaborative, evidence-based interventions is recommended and justified, especially for Indigenous Australians.
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Affiliation(s)
- Linton R Harriss
- James Cook University, Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, Centre for Chronic Disease Prevention, PO Box 6811, Cairns, Qld, 4870 Australia.
| | - Fintan Thompson
- James Cook University, Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, Centre for Chronic Disease Prevention, PO Box 6811, Cairns, Qld, 4870 Australia.
| | - Kenny Lawson
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Locked Bag 1797, Penrith NSW, 2751, Australia. Email
| | - Mary O Loughlin
- James Cook University, Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, Centre for Chronic Disease Prevention, PO Box 6811, Cairns, Qld, 4870 Australia.
| | - Robyn McDermott
- James Cook University, Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, Centre for Chronic Disease Prevention, PO Box 6811, Cairns, Qld, 4870 Australia.
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26
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Manners S, Ng JQ, Kemp-Casey A, Chow K, Kang CY, Preen DB. Retinal detachment surgery in Western Australia (2000-2013): a whole-population study. Br J Ophthalmol 2017; 101:1679-1682. [PMID: 28391239 DOI: 10.1136/bjophthalmol-2016-310070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/22/2017] [Accepted: 03/15/2017] [Indexed: 11/03/2022]
Abstract
AIMS To determine the background incidence rate of retinal detachment (RD) in Western Australia (WA) between 2000 and 2013, identify sociodemographic features associated with increased risk of incident RD and examine trends in surgical repair technique. METHODS A whole-population retrospective observational study of all people in WA was carried out using linked hospital inpatient records. Cases of RD were identified using a combination of International Classification of Diseases, Ninth revision, Clinical Modification (ICD-9-CM) and ICD-10-AM (Australian modification) diagnosis and procedure codes from routinely collected hospital inpatient data provided by the WA Data Linkage Branch. A Poisson regression model was used to examine the influence of age group, gender, season and year of surgery on RD incidence rates. MAIN OUTCOME MEASURES Age-standardised and sex-standardised incidence of first-eye RD and incidence rate ratio (IRR) of first-eye RD associated with age, sex and season. Counts of RD repair according to surgical technique. RESULTS There were 4376 first-eye RD between 2000 and 2013. Age-standardised incidence ranged between 12.78 and 16.20 cases per 1 00 000 person-years. After adjusting for age, year and season, males had a higher risk than females for incident detachment (IRR 1.82, 95% CI (CI) 1.71 to 1.93), as did those aged 60-79 years (IRR 33.26, 95% CI 27.60 to 40.08) compared with those aged less than 20 years. RD repair with vitrectomy alone increased by 59% over the study period. CONCLUSION The incidence of first-eye RD remained stable between 2000 and 2013. The risk was higher in males and with older age.
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Affiliation(s)
- Siobhan Manners
- School of Population Health, The University of Western Australia, Perth, Australia.,Eye & Vision Epidemiology Research (EVER) Group, Perth, Australia
| | - Jonathon Q Ng
- School of Population Health, The University of Western Australia, Perth, Australia.,Eye & Vision Epidemiology Research (EVER) Group, Perth, Australia
| | - Anna Kemp-Casey
- School of Population Health, The University of Western Australia, Perth, Australia.,Eye & Vision Epidemiology Research (EVER) Group, Perth, Australia
| | - Kyle Chow
- Eye & Vision Epidemiology Research (EVER) Group, Perth, Australia.,Curtin-Monash Accident Research Centre (C-MARC), Curtin University, Perth, Australia
| | - Chee-Yiong Kang
- Eye & Vision Epidemiology Research (EVER) Group, Perth, Australia
| | - David B Preen
- School of Population Health, The University of Western Australia, Perth, Australia.,Eye & Vision Epidemiology Research (EVER) Group, Perth, Australia
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Harriss LR, Thompson F, Dey A, Mills J, Watt K, McDermott R. When chronic conditions become emergencies - a report from regional Queensland. Aust J Rural Health 2016; 24:392-401. [PMID: 27596837 PMCID: PMC5215535 DOI: 10.1111/ajr.12320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2016] [Indexed: 11/28/2022] Open
Abstract
Objective To describe chronic conditions and injuries as a proportion of total emergency presentations to a large public hospital in regional Queensland, and to investigate differences in presentation rates associated with Indigenous status. Design Cross‐sectional analysis using Emergency Department Information System data between 1 July 2012 and 30 June 2014. Setting Regional Queensland, Australia. Participants A total of 95 238 emergency presentations were generated by 50 083 local residents living in the 10 statistical local areas (SLAs) immediately around the hospital. Main outcome measures Emergency presentations for chronic conditions and injuries identified from discharge ICD‐10‐AM principal diagnosis. Age‐standardised presentation rates were calculated using the Australian 2001 reference population. Results Approximately half of all presentations were for chronic conditions (20.2%) and injuries (28.8%). Two‐thirds of all chronic condition presentations were for mental and behavioural disorders (34.6%) and circulatory diseases (33.2%). Head injuries accounted for the highest proportion of injuries (18.9%). Age‐standardised rates for major diagnostic groups were consistently higher for Indigenous residents, whose presentations were lower in mean age (95% CI) by 7.7 (7.3–8.1) years, 23% less likely to be potentially avoidable GP‐type presentations [RR (95% CI) = 0.77 (0.75–0.80)], 30% more likely to arrive by ambulance [1.31 (1.28–1.33)] and 11% more likely to require hospital admission [1.11 (1.08–1.13)]. Conclusions Opportunities exist to enhance current coordinated hospital avoidance and primary health services in regional Queensland targeting common mental and circulatory disorders, especially for Indigenous Australians.
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Affiliation(s)
- Linton R Harriss
- Centre for Chronic Disease Prevention, AITHM, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia.,School of Health Sciences, Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Fintan Thompson
- Centre for Chronic Disease Prevention, AITHM, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Arindam Dey
- Centre for Chronic Disease Prevention, AITHM, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Jane Mills
- College of Healthcare Sciences, James Cook University, Cairns, Queensland, Australia
| | - Kerrianne Watt
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Robyn McDermott
- Centre for Chronic Disease Prevention, AITHM, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia.,School of Health Sciences, Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
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Nadathur S, Groom A. Coding and DRG Relationships in Stroke and Transient Ischaemic Attack (TIA). HEALTH INF MANAG J 2016; 35:38-44. [DOI: 10.1177/183335830603500106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The selection of cohorts from national and state databases in Australia usually relies on patient diagnoses according to International Classification of Disease (ICD) codes and/or Diagnosis Related Groups (DRGs). The aim of this study was to select a specific cohort consisting of stroke and transient ischaemic attack (TIA) episodes, thereby allowing the researcher to examine current process of care using State level hospital admissions datasets. Difficulties in accurately selecting the specified cohort were encountered, due to various interpretations of ICD codes and DRGs as well as the placement of codes to DRGs and different classifications used. These difficulties highlighted several issues regarding the relationships between ICD coding and DRGs in stroke and TIA and are the focus of this paper.
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Tse T, Carey L, Cadilhac D, Koh GCH, Baum C. Application of the World Stroke Organization health system indicators and performance in Australia, Singapore, and the USA. Int J Stroke 2016; 11:852-859. [DOI: 10.1177/1747493016660104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Aim To examine how Australia, Singapore and the United States of America (USA) match to the World Stroke Organization Global Stroke Services health system monitoring indicators (HSI). Design Descriptive comparative study Participants The health systems of Australia, Singapore, the USA. Outcome measures Published data available from each country were mapped to the 10 health system monitoring indicators proposed by the World Stroke Organization. Results Most health system monitoring indicators were at least partially met in each country. Thrombolytic agents were available for use in acute stroke. Stroke guidelines and stroke registry data were available in all three countries. Stroke incidence, prevalence, and mortality rates were available but at non-uniform times post-stroke. The International Classification of Disease 9 or 10 coding systems are used in all three countries. Standardized clinical audits are routine in Australia and the USA, but not in Singapore. The use of the modified Rankin Scale is collected sub-acutely but not at one year post-stroke in all three countries. Conclusions The three developed countries are performing well against the World Stroke Organization health system monitoring indicators for acute and sub-acute stroke care. However, improvements in stroke risk assessment and at one-year post-stroke outcome measurement are needed.
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Affiliation(s)
- Tamara Tse
- Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health, La Trobe University, Victoria, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health Heidelberg, Victoria, Australia
| | - Leeanne Carey
- Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health, La Trobe University, Victoria, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health Heidelberg, Victoria, Australia
| | - Dominique Cadilhac
- Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health, La Trobe University, Victoria, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Victoria, Australia
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System
| | - Carolyn Baum
- Washington University in St Louis, St Louis, MO, USA
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30
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Creighton N, Walton R, Roder D, Aranda S, Currow D. Validation of administrative hospital data for identifying incident pancreatic and periampullary cancer cases: a population-based study using linked cancer registry and administrative hospital data in New South Wales, Australia. BMJ Open 2016; 6:e011161. [PMID: 27371553 PMCID: PMC4947808 DOI: 10.1136/bmjopen-2016-011161] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 05/24/2016] [Accepted: 06/03/2016] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Informing cancer service delivery with timely and accurate data is essential to cancer control activities and health system monitoring. This study aimed to assess the validity of ascertaining incident cases and resection use for pancreatic and periampullary cancers from linked administrative hospital data, compared with data from a cancer registry (the 'gold standard'). DESIGN, SETTING AND PARTICIPANTS Analysis of linked statutory population-based cancer registry data and administrative hospital data for adults (aged ≥18 years) with a pancreatic or periampullary cancer case diagnosed during 2005-2009 or a hospital admission for these cancers between 2005 and 2013 in New South Wales, Australia. METHODS The sensitivity and positive predictive value (PPV) of pancreatic and periampullary cancer case ascertainment from hospital admission data were calculated for the 2005-2009 period through comparison with registry data. We examined the effect of the look-back period to distinguish incident cancer cases from prevalent cancer cases from hospital admission data using 2009 and 2013 as index years. RESULTS Sensitivity of case ascertainment from the hospital data was 87.5% (4322/4939), with higher sensitivity when the cancer was resected (97.9%, 715/730) and for pancreatic cancers (88.6%, 3733/4211). Sensitivity was lower in regional (83.3%) and remote (85.7%) areas, particularly in areas with interstate outflow of patients for treatment, and for cases notified to the registry by death certificate only (9.6%). The PPV for the identification of incident cases was 82.0% (4322/5272). A 2-year look-back period distinguished the majority (98%) of incident cases from prevalent cases in linked hospital data. CONCLUSIONS Pancreatic and periampullary cancer cases and resection use can be ascertained from linked hospital admission data with sufficient validity for informing aspects of health service delivery and system-level monitoring. Limited tumour clinical information and variation in case ascertainment across population subgroups are limitations of hospital-derived cancer incidence data when compared with population cancer registries.
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Affiliation(s)
| | - Richard Walton
- Cancer Institute NSW, Sydney, New South Wales, Australia
| | - David Roder
- Cancer Institute NSW, Sydney, New South Wales, Australia
- Centre for Population Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Sanchia Aranda
- Cancer Council Australia, Sydney, New South Wales, Australia
| | - David Currow
- Cancer Institute NSW, Sydney, New South Wales, Australia
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Werner AK, Watt K, Cameron CM, Vink S, Page A, Jagals P. All-age hospitalization rates in coal seam gas areas in Queensland, Australia, 1995-2011. BMC Public Health 2016; 16:125. [PMID: 26852381 PMCID: PMC4744625 DOI: 10.1186/s12889-016-2787-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 01/27/2016] [Indexed: 02/04/2023] Open
Abstract
Background Unconventional natural gas development (UNGD) is expanding globally, with Australia expanding development in the form of coal seam gas (CSG). Residents and other interest groups have voiced concerns about the potential environmental and health impacts related to CSG. This paper compares objective health outcomes from three study areas in Queensland, Australia to examine potential environmentally-related health impacts. Methods Three study areas were selected in an ecologic study design: a CSG area, a coal mining area, and a rural/agricultural area. Admitted patient data, as well as population data and additional factors, were obtained for each calendar year from 1995 through 2011 to calculate all-age hospitalization rates and age-standardized rates in each of these areas. The three areas were compared using negative binomial regression analyses (unadjusted and adjusted models) to examine increases over time of hospitalization rates grouped by primary diagnosis (19 ICD chapters), with rate ratios serving to compare the within-area regression slopes between the areas. Results The CSG area did not have significant increases in all-cause hospitalization rates over time for all-ages compared to the coal and rural study areas in adjusted models (RR: 1.02, 95 % CI: 1.00–1.04 as compared to the coal mining area; RR: 1.01, 95 % CI: 0.99–1.04 as compared to the rural area). While the CSG area did not show significant increases in specific hospitalization rates compared to both the coal mining and rural areas for any ICD chapters in the adjusted models, the CSG area showed increases in hospitalization rates compared only to the rural area for neoplasms (RR: 1.09, 95 % CI: 1.02–1.16) and blood/immune diseases (RR: 1.14, 95 % CI: 1.02–1.27). Conclusions This exploratory study of all-age hospitalization rates for three study areas in Queensland suggests that certain hospital admissions rates increased more quickly in the CSG study area than in other study areas, particularly the rural area, after adjusting for key sociodemographic factors. These findings are an important first step in identifying potential health impacts of CSG in the Australian context and serve to generate hypotheses for future studies. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-2787-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Angela K Werner
- Sustainable Minerals Institute, The University of Queensland, Sir James Foots Bldg (47a), Level 6, CWiMI, Corner Staffhouse and College Roads, St. Lucia, QLD, 4072, Australia.
| | - Kerrianne Watt
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia. .,School of Public Health, The University of Queensland, Herston, QLD, Australia.
| | - Cate M Cameron
- CONROD Injury Research Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, Australia.
| | - Sue Vink
- Sustainable Minerals Institute, The University of Queensland, Sir James Foots Bldg (47a), Level 6, CWiMI, Corner Staffhouse and College Roads, St. Lucia, QLD, 4072, Australia.
| | - Andrew Page
- Centre for Health Research, Western Sydney University, Penrith, NSW, Australia.
| | - Paul Jagals
- School of Public Health, The University of Queensland, Herston, QLD, Australia.
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Worrall-Carter L, McEvedy S, Wilson A, Rahman MA. Gender Differences in Presentation, Coronary Intervention, and Outcomes of 28,985 Acute Coronary Syndrome Patients in Victoria, Australia. Womens Health Issues 2016; 26:14-20. [DOI: 10.1016/j.whi.2015.09.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/03/2015] [Accepted: 09/04/2015] [Indexed: 01/08/2023]
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Chen Y, Liu BC, Glass K, Kirk MD. High incidence of hospitalisation due to infectious gastroenteritis in older people associated with poor self-rated health. BMJ Open 2015; 5:e010161. [PMID: 26719326 PMCID: PMC4710819 DOI: 10.1136/bmjopen-2015-010161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To estimate the incidence and risk factors for gastroenteritis-related hospitalisations in older adults. DESIGN Longitudinal cohort study. PARTICIPANTS The 45 and Up Study is a large-scale Australian prospective study of adults aged ≥ 45 years (mean 62.7 years) at recruitment in 2006-2009. Self-reported demographic, health and dietary information at recruitment from 265,440 participants were linked to infectious gastroenteritis hospitalisation data. OUTCOME MEASURES We estimated the incidence of hospitalisation for infectious gastroenteritis, and calculated HRs using Cox regression, adjusting for sociodemographic, health and behavioural variables, with age as the underlying time variable. RESULTS There were 6077 incident infectious gastroenteritis admissions over 1,111,000 person-years. Incidence increased exponentially with increasing age; from 2.4 per 1000 (95% CI 2.2 to 2.5) in individuals aged 45-54 years to 9.5 per 1000 (95% CI 9.2 to 9.8) in those aged 65+ years. After adjustment, hospitalisation due to infectious gastroenteritis was significantly more common in those reporting use of proton pump inhibitors (HR 1.6, 95% CI 1.5 to 1.7), and those with poorer self-rated health (HR 4.2, 95% CI 3.6 to 4.9). CONCLUSIONS Infectious gastroenteritis results in hospitalisation of approximately 1% of people ≥ 65 years old each year. Early recognition and supportive treatment of diarrhoea in older patients with poorer self-rated health may prevent subsequent hospitalisation.
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Affiliation(s)
- Yingxi Chen
- Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Bette C Liu
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Kathryn Glass
- Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Martyn D Kirk
- Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
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Worrall-Carter L, McEvedy S, Wilson A, Rahman MA. Impact of comorbidities and gender on the use of coronary interventions in patients with high-risk non-ST-segment elevation acute coronary syndrome. Catheter Cardiovasc Interv 2015; 87:E128-36. [PMID: 26277889 DOI: 10.1002/ccd.26117] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 05/06/2015] [Accepted: 07/05/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To determine the impact of gender and comorbidity on use of coronary interventions in patients diagnosed with high-risk non-ST-segment acute coronary syndrome (NSTEACS). BACKGROUND Guidelines recommend the use of coronary angiography for all patients diagnosed with NSTEACS with high-risk features, except in the presence of severe comorbidities. However, little is understood about the relationship between gender, comorbidity, and the use of coronary interventions. METHODS Retrospective analyses of the Victorian Admitted Episodes Data Set (VAED) including all patients diagnosed with NSTEACS with high-risk features on their first admission for ACS between June 2007 and July 2009. Hierarchical logistic regression models and correspondence analyses were used to understand the relationship between gender, comorbidities, and the use of coronary interventions. RESULTS Out of 16,771 NSTEACS patients with high-risk features, 6,338 (38%) were female. Females were older than males (aged ≥75: 62% vs 39%, p < 0.001) and more likely to have multiple comorbidities (≥2: 66% vs 59%, p < 0.001). After adjusting for potential confounders, females were more likely to receive no coronary intervention than males with a similar number of comorbid conditions (no comorbidities: OR 1.62, 95% CI 1.28-2.05; 1 comorbidity: OR 1.67, 95% CI 1.44-1.93; 2 comorbidities: OR 1.93, 95% CI 1.66-2.23; ≥3 comorbidities: OR 1.42, 95% CI 1.27-1.60). CONCLUSIONS Lower rates of coronary intervention in females persisted after adjusting for number of comorbidities which suggests that gender may bias decisions regarding referral for coronary intervention in high-risk NSTEACS independent of other factors.
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Affiliation(s)
- Linda Worrall-Carter
- St Vincent's Centre for Nursing Research (SVCNR), Australian Catholic University, Melbourne, Australia.,St Vincent's Hospital, Melbourne, Australia.,The Cardiovascular Research Centre (CvRC), Australian Catholic University, Melbourne, Australia
| | - Samantha McEvedy
- St Vincent's Centre for Nursing Research (SVCNR), Australian Catholic University, Melbourne, Australia
| | - Andrew Wilson
- St Vincent's Hospital, Melbourne, Australia.,The Cardiovascular Research Centre (CvRC), Australian Catholic University, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia.,Department of Health, VicHealth, Victorian Cardiology Clinical Network, Melbourne, Australia
| | - Muhammad Aziz Rahman
- St Vincent's Centre for Nursing Research (SVCNR), Australian Catholic University, Melbourne, Australia.,The Cardiovascular Research Centre (CvRC), Australian Catholic University, Melbourne, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
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Chan V, Mann RE, Pole JD, Colantonio A. Children and youth with 'unspecified injury to the head': implications for traumatic brain injury research and surveillance. Emerg Themes Epidemiol 2015; 12:9. [PMID: 26113870 PMCID: PMC4480889 DOI: 10.1186/s12982-015-0031-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 06/15/2015] [Indexed: 11/10/2022] Open
Abstract
Background The case definition for traumatic brain injury (TBI) often includes ‘unspecified injury to the head’ diagnostic codes. However, research has shown that the inclusion of these codes leads to false positives. As such, it is important to determine the degree to which inclusion of these codes affect the overall numbers and profiles of the TBI population. The objective of this paper was to profile and compare the demographic and clinical characteristics, intention and mechanism of injury, and discharge disposition of hospitalized children and youth aged 19 years and under using (1) an inclusive TBI case definition that included ‘unspecified injury to the head’ diagnostic codes, (2) a restricted TBI case definition that excluded ‘unspecified injury to the head ‘diagnostic codes, and (3) the ‘unspecified injury to the head’ only case definition. Methods The National Ambulatory Care Reporting System and the Discharge Abstract Database from Ontario, Canada, were used to identify cases between fiscal years 2003/04 and 2009/10. Results The rate of TBI episodes of care using the inclusive case definition for TBI (2,667.2 per 100,000) was 1.65 times higher than that of the restricted case definition (1,613.3 per 100,000). ‘Unspecified injury to the head’ diagnostic codes made up of 39.5 % of all cases identified with the inclusive case definition. Exclusion of ‘unspecified injury to the head’ diagnostic code in the TBI case definition resulted in a significantly higher proportion of patients in the intensive care units (p < .0001; 18.5 % vs. 22.2 %) and discharged to a non-home setting (p < .0001; 9.9 % vs. 11.6 %). Conclusion Inclusion of ‘unspecified injury to the head’ diagnostic codes resulted in significant changes in numbers, healthcare use, and causes of TBI. Careful consideration of the inclusion of ‘unspecified injury to the head’ diagnostic codes in the case definition of TBI for the children and youth population is important, as it has implications for the numbers used for policy, resource allocation, prevention, and planning of healthcare services. This paper can inform future work on reaching consensus on the diagnostic codes for defining TBI in children and youth.
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Affiliation(s)
- Vincy Chan
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON Canada ; Rehabilitation Sciences Institute, University of Toronto, Toronto, ON Canada ; Pediatric Oncology Group of Ontario, Toronto, ON Canada
| | - Robert E Mann
- Centre for Addiction and Mental Health, Toronto, ON Canada ; Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Jason D Pole
- Pediatric Oncology Group of Ontario, Toronto, ON Canada ; Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Angela Colantonio
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON Canada ; Rehabilitation Sciences Institute, University of Toronto, Toronto, ON Canada ; Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
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Chan V, Thurairajah P, Colantonio A. Defining pediatric traumatic brain injury using International Classification of Diseases Version 10 Codes: a systematic review. BMC Neurol 2015; 15:7. [PMID: 25648197 PMCID: PMC4335539 DOI: 10.1186/s12883-015-0259-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 01/07/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Although healthcare administrative data are commonly used for traumatic brain injury (TBI) research, there is currently no consensus or consistency on the International Classification of Diseases Version 10 (ICD-10) codes used to define TBI among children and youth internationally. This study systematically reviewed the literature to explore the range of ICD-10 codes that are used to define TBI in this population. The identification of the range of ICD-10 codes to define this population in administrative data is crucial, as it has implications for policy, resource allocation, planning of healthcare services, and prevention strategies. METHODS The databases MEDLINE, MEDLINE In-Process, Embase, PsychINFO, CINAHL, SPORTDiscus, and Cochrane Database of Systematic Reviews were systematically searched. Grey literature was searched using Grey Matters and Google. Reference lists of included articles were also searched for relevant studies. Two reviewers independently screened all titles and abstracts using pre-defined inclusion and exclusion criteria. A full text screen was conducted on articles that met the first screen inclusion criteria. All full text articles that met the pre-defined inclusion criteria were included for analysis in this systematic review. RESULTS A total of 1,326 publications were identified through the predetermined search strategy and 32 articles/reports met all eligibility criteria for inclusion in this review. Five articles specifically examined children and youth aged 19 years or under with TBI. ICD-10 case definitions ranged from the broad injuries to the head codes (ICD-10 S00 to S09) to concussion only (S06.0). There was overwhelming consensus on the inclusion of ICD-10 code S06, intracranial injury, while codes S00 (superficial injury of the head), S03 (dislocation, sprain, and strain of joints and ligaments of head), and S05 (injury of eye and orbit) were only used by articles that examined head injury, none of which specifically examined children and youth. CONCLUSION This review provides evidence for discussion on how best to use ICD codes for different goals. This is an important first step in reaching an appropriate definition and can inform future work on reaching consensus on the ICD-10 codes to define TBI for this vulnerable population.
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Affiliation(s)
- Vincy Chan
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
- Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- Acquired Brain Injury Research Lab, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
| | - Pravheen Thurairajah
- Acquired Brain Injury Research Lab, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
| | - Angela Colantonio
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
- Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- Acquired Brain Injury Research Lab, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
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Gaughwin P. Has the Diagnostic and statistical manual of mental illnesses (fifth edition) jumped the shark and is it now time for Australia to reconsider reliance on it? Australas Psychiatry 2014; 22:470-2. [PMID: 25139250 DOI: 10.1177/1039856214545548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this article is to consider whether, in light of the significant controversy surrounding the Diagnostic and statistical manual of mental illnesses (fifth edition) (DSM-5), it may be time for Australia to reconsider the influence of, and its past reliance on, the DSM. Also considered is whether it is now time, with the imminent publication of the The international statistical classification of diseases and related health problems (eleventh edition) (ICD-11), to move to the ICD-11 as the primary instrument for diagnosis and research in Australia. CONCLUSION That DSM-5 begins its life in an unprecedented plethora of criticism, not only from lay people but also from mental health professionals, which should sound a note of caution for continued reliance on it in Australia.
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Affiliation(s)
- Peter Gaughwin
- Board Member, Guardianship Board of South Australia; Member, South Australian Health Practitioners Tribunal, Prospect, SA, Australia
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Bohensky M, Ackerman I, de Steiger R, Gorelik A, Brand C. Lifetime Risk of Total Hip Replacement Surgery and Temporal Trends in Utilization: A Population-Based Analysis. Arthritis Care Res (Hoboken) 2014; 66:1213-9. [DOI: 10.1002/acr.22279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 12/31/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Megan Bohensky
- Melbourne EpiCentre, Royal Melbourne Hospital, and University of Melbourne; Melbourne, Victoria Australia
| | - Ilana Ackerman
- Melbourne EpiCentre, Royal Melbourne Hospital, and University of Melbourne; Melbourne, Victoria Australia
| | | | - Alexandra Gorelik
- Melbourne EpiCentre and Royal Melbourne Hospital; Melbourne, Victoria Australia
| | - Caroline Brand
- Melbourne EpiCentre, Royal Melbourne Hospital, University of Melbourne, and Monash University; Melbourne, Victoria Australia
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Duke GJ, Barker A, Knott CI, Santamaria JD. Outcomes of older people receiving intensive care in Victoria. Med J Aust 2014; 200:323-6. [PMID: 24702089 DOI: 10.5694/mja13.10132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 10/25/2013] [Indexed: 11/17/2022]
Abstract
UNLABELLED OBJECTIVE To assess trends in service use and outcome of critically ill older people (aged ≥ 65 years) admitted to an intensive care unit (ICU). DESIGN, PATIENTS AND SETTING Retrospective cohort analysis of administrative data on older patients discharged from ICUs at all 23 adult public hospitals with onsite ICUs in Victoria between 1 July 1999 and 30 June 2011. Subgroups examined included those aged ≥ 80 years, major diagnosis categories, and those receiving mechanical ventilation. MAIN OUTCOME MEASURES Resource use and hospital survival; also length of stay (LOS) and discharge destination trends. RESULTS Over 12 years, 108,171 people aged ≥ 65 years were admitted to ICUs; of these, 49,912 (46.1%) received mechanical ventilation and 17,772 (16.4%) died. Despite an increase in the older age population (2.5% per annum) and acute care admissions (7.3% per annum) over the period studied, there was a net reversal in prevalence trends for ICU admissions (- 1.7% per annum; P = 0.04) and admissions of patients requiring mechanical ventilation (- 1.6% per annum) in the 8 years since 2004. Annual risk-adjusted mortality fell (odds ratio, 0.97 per year; 95% CI, 0.96-0.97 per year; P < 0.001) without prolongation of hospital or ICU LOS (P = 0.49) or discharge to residential aged care (RAC). Similar trends were noted in all a priori subgroups. CONCLUSIONS Improved hospital survival without an increase in demand for ICU admission or RAC or an increase in LOS suggests there has been improvement in the care of the older age population.
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Affiliation(s)
| | - Anna Barker
- Centre of Research Execllence in Patient Safety, Monash University, Melbourne, VIC, Australia
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Coiera E, Wang Y, Magrabi F, Concha OP, Gallego B, Runciman W. Predicting the cumulative risk of death during hospitalization by modeling weekend, weekday and diurnal mortality risks. BMC Health Serv Res 2014; 14:226. [PMID: 24886152 PMCID: PMC4053268 DOI: 10.1186/1472-6963-14-226] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 04/25/2014] [Indexed: 11/26/2022] Open
Abstract
Background Current prognostic models factor in patient and disease specific variables but do not consider cumulative risks of hospitalization over time. We developed risk models of the likelihood of death associated with cumulative exposure to hospitalization, based on time-varying risks of hospitalization over any given day, as well as day of the week. Model performance was evaluated alone, and in combination with simple disease-specific models. Method Patients admitted between 2000 and 2006 from 501 public and private hospitals in NSW, Australia were used for training and 2007 data for evaluation. The impact of hospital care delivered over different days of the week and or times of the day was modeled by separating hospitalization risk into 21 separate time periods (morning, day, night across the days of the week). Three models were developed to predict death up to 7-days post-discharge: 1/a simple background risk model using age, gender; 2/a time-varying risk model for exposure to hospitalization (admission time, days in hospital); 3/disease specific models (Charlson co-morbidity index, DRG). Combining these three generated a full model. Models were evaluated by accuracy, AUC, Akaike and Bayesian information criteria. Results There was a clear diurnal rhythm to hospital mortality in the data set, peaking in the evening, as well as the well-known ‘weekend-effect’ where mortality peaks with weekend admissions. Individual models had modest performance on the test data set (AUC 0.71, 0.79 and 0.79 respectively). The combined model which included time-varying risk however yielded an average AUC of 0.92. This model performed best for stays up to 7-days (93% of admissions), peaking at days 3 to 5 (AUC 0.94). Conclusions Risks of hospitalization vary not just with the day of the week but also time of the day, and can be used to make predictions about the cumulative risk of death associated with an individual’s hospitalization. Combining disease specific models with such time varying- estimates appears to result in robust predictive performance. Such risk exposure models should find utility both in enhancing standard prognostic models as well as estimating the risk of continuation of hospitalization.
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Affiliation(s)
- Enrico Coiera
- Centre for Health Informatics, Australian Institute for Health Innovation, University of New South Wales, Sydney 2052, Australia.
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Bohensky MA, Ackerman I, DeSteiger R, Gorelik A, Brand CA. Lifetime Risk of Total Knee Replacement and Temporal Trends in Incidence by Health Care Setting, Socioeconomic Status, and Geographic Location. Arthritis Care Res (Hoboken) 2014; 66:424-31. [DOI: 10.1002/acr.22122] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 08/08/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Megan A. Bohensky
- Melbourne EpiCentre, Royal Melbourne Hospital, and The University of Melbourne; Parkville, Victoria Australia
| | - Ilana Ackerman
- Melbourne EpiCentre, Royal Melbourne Hospital, and The University of Melbourne; Parkville, Victoria Australia
| | | | - Alexandra Gorelik
- Melbourne EpiCentre, Royal Melbourne Hospital; Parkville, Victoria Australia
| | - Caroline A. Brand
- Melbourne EpiCentre, Royal Melbourne Hospital, and The University of Melbourne; Parkville, Victoria Australia
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The impact of therapeutic procedure innovation on hospital patient longevity: Evidence from Western Australia, 2000–2007. Soc Sci Med 2013. [DOI: 10.1016/j.socscimed.2012.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Feng Y, Abdel-Latif ME, Bajuk B, Lui K, Oei JL. Causes of death in infants admitted to Australian neonatal intensive care units between 1995 and 2006. Acta Paediatr 2013; 102:e17-23. [PMID: 23009702 DOI: 10.1111/apa.12039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 07/09/2012] [Accepted: 09/18/2012] [Indexed: 11/29/2022]
Abstract
AIM To compare causes and rates of mortality among infants admitted to 10 Australian neonatal intensive care units (NICUs) between 1995 and 2006. METHODS De-identified perinatal data from the Neonatal Intensive Care Units' (NICUS) Data Collection for 24 131 infants were examined for causes and rates of death. The study period was divided into two epochs: I (1995-2000, n = 11 185 infants) and II (2001-2006, n = 12 946 infants). RESULTS A total of 2224 (9.2%) infants died in hospital. Mortality decreased from 10.3% (1152/11 185) in epoch I to 8.3% (1072/12 946) in epoch II (p < 0.001) due to improved survival in term infants. Extreme prematurity also decreased as a primary cause of death (118 (10.2%) vs 76 (7.1%), p = 0.008). No infant >42-week gestation was admitted in epoch II. Congenital abnormalities were the most common cause of death (>20%) in both epochs, mostly in term rather than preterm infants (40.7% vs 13.9%, p < 0.001). Age of death was unchanged between the two epochs (median 4, 1st, 3rd quartiles: 1,16 days). CONCLUSION Mortality rates have continued to decrease but improvement is predominantly due to improved survival of term infants and prevention of postdate deliveries. Congenital abnormalities continue to be the most common cause of death.
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Affiliation(s)
- Yvonne Feng
- School of Women's and Children's Heath; University of New South Wales; Kensington; NSW; Australia
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Moore HC, de Klerk N, Jacoby P, Richmond P, Lehmann D. Can linked emergency department data help assess the out-of-hospital burden of acute lower respiratory infections? A population-based cohort study. BMC Public Health 2012; 12:703. [PMID: 22928805 PMCID: PMC3519642 DOI: 10.1186/1471-2458-12-703] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 08/23/2012] [Indexed: 11/13/2022] Open
Abstract
Background There is a lack of data on the out-of-hospital burden of acute lower respiratory infections (ALRI) in developed countries. Administrative datasets from emergency departments (ED) may assist in addressing this. Methods We undertook a retrospective population-based study of ED presentations for respiratory-related reasons linked to birth data from 245,249 singleton live births in Western Australia. ED presentation rates <9 years of age were calculated for different diagnoses and predictors of ED presentation <5 years were assessed by multiple logistic regression. Results ED data from metropolitan WA, representing 178,810 births were available for analysis. From 35,136 presentations, 18,582 (52.9%) had an International Classification of Diseases (ICD) code for ALRI and 434 had a symptom code directly relating to an ALRI ICD code. A further 9600 presentations had a non-specific diagnosis. From the combined 19,016 ALRI presentations, the highest rates were in non-Aboriginal children aged 6–11 months (81.1/1000 child-years) and Aboriginal children aged 1–5 months (314.8/1000). Croup and bronchiolitis accounted for the majority of ALRI ED presentations. Of Aboriginal births, 14.2% presented at least once to ED before age 5 years compared to 6.5% of non-Aboriginal births. Male sex and maternal age <20 years for Aboriginal children and 20–29 years for non-Aboriginal children were the strongest predictors of presentation to ED with ALRI. Conclusions ED data can give an insight into the out-of-hospital burden of ALRI. Presentation rates to ED for ALRI were high, but are minimum estimates due to current limitations of the ED datasets. Recommendations for improvement of these data are provided. Despite these limitations, ALRI, in particular bronchiolitis and croup are important causes of presentation to paediatric EDs.
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Affiliation(s)
- Hannah C Moore
- Division of Population Sciences, Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Australia.
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Einarsdóttir K, Preen DB, Emery JD, Holman CDJ. Regular primary care plays a significant role in secondary prevention of ischemic heart disease in a Western Australian cohort. J Gen Intern Med 2011; 26:1092-7. [PMID: 21347875 PMCID: PMC3181311 DOI: 10.1007/s11606-011-1665-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 12/22/2010] [Accepted: 02/07/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Secondary prevention for established ischaemic heart disease (IHD) involves medication therapy and a healthier lifestyle, but adherence is suboptimal. Simply having scheduled regular appointments with a primary care physician could confer a benefit for IHD patients possibly through increased motivation and awareness, but this has not previously been investigated in the literature. OBJECTIVE To estimate the association between regular general practitioner (GP) visitation and rates of all-cause death, IHD death or repeat hospitalisation for IHD in older patients in Western Australia (WA). DESIGN A retrospective cohort design. PARTICIPANTS Patients aged ≥ 65 years (n = 31,841) with a history of hospitalisation for IHD from 1992-2006 were ascertained through routine health data collected on the entire WA population and included in the analysis. MAIN MEASURES Frequency and regularity of GP visits was determined during a three-year exposure period at commencement of follow-up. A regularity score (range 0-1) measured the regularity of intervals between the GP visits and was divided into quartiles. Patients were then followed for a maximum of 11.5 years for outcome determination. Hazard ratios and 95% confidence intervals were calculated using Cox proportional hazards models. KEY RESULTS Compared with the least regular quartile, patients with greater GP visit regularity had significantly decreased risks of all-cause death (2(nd) least, 2(nd) most and most regular: HR = 0.76, 0.71 and 0.71); and IHD death (2(nd) least, 2(nd) most and most regular: HR = 0.70, 0.68 and 0.65). Patients in the 2(nd) least regular quartile also appeared to experience decreased risk of any repeat IHD hospitalisation (HR = 0.83, 95%CI 0.71-0.96) as well as emergency hospitalisation (HR = 0.81, 95%CI 0.67-0.98), compared with the least regular quartile. CONCLUSIONS Some degree of regular GP visitation offers a small but significant protection against morbidity and mortality in older people with established IHD. The findings indicate the importance of scheduled, regular GP visits for the secondary prevention of IHD.
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Early predictors of hospital admission in emergency department patients with chronic obstructive pulmonary disease. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.aenj.2011.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Considine J, Botti M, Thomas S. Emergency department management of exacerbation of chronic obstructive pulmonary disease: audit of compliance with evidence-based guidelines. Intern Med J 2011; 41:48-54. [PMID: 19811556 DOI: 10.1111/j.1445-5994.2009.02065.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Emergency departments (ED) play a key role in management of exacerbation of chronic obstructive airways disease (COPD). Current guidelines for management of exacerbation of COPD showed highest levels of evidence (Level A and B) were related to use of medications and non-invasive positive pressure ventilation (NIPPV). AIMS The aim of this study was to examine compliance with high level evidence for management of exacerbation of COPD during the first 4 h of ED care. METHODS A retrospective medical record audit was conducted at four public and one private ED in Melbourne, Australia. Participants were adult patients with COPD presenting to the ED with a primary complaint of shortness of breath from July 2006 to July 2007. Outcome measures were compliance with evidence-based recommendations regarding use of bronchodilators, methylxanthines, steroids and NIPPV. RESULTS Of 273 patients in this study, 72.4% received short-acting beta-agonist bronchodilators, 37.8% received an inhaled short-acting anticholinergic medication and 56.6% received systemic steroid therapy. NIPPV was used in 21 patients, 15 of whom had documentation of acidosis and/or hypercapnia). CONCLUSIONS There was variation in the use of high level evidence for the ED management of exacerbation of COPD. The highest rate of compliance was non-use of methylxanthines and the greatest deficit was poor compliance with evidence related to NIPPV. There was also scope for improvement in the use of bronchodilators and systemic steroids.
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Affiliation(s)
- J Considine
- School of Nursing, Deakin University-Northern Health Clinical Partnership, Melbourne, Victoria, Australia.
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Nadathur SG. Maximising the value of hospital administrative datasets. AUST HEALTH REV 2010; 34:216-23. [PMID: 20497736 DOI: 10.1071/ah09801] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 11/25/2009] [Indexed: 11/23/2022]
Abstract
Mandatory and standardised administrative data collections are prevalent in the largely public-funded acute sector. In these systems the data collections are used for financial, performance monitoring and reporting purposes. This paper comments on the infrastructure and standards that have been established to support data collection activities, audit and feedback. The routine, local and research uses of these datasets are described using examples from Australian and international literature. The advantages of hospital administrative datasets and opportunities for improvement are discussed under the following headings: accessibility, standardisation, coverage, completeness, cost of obtaining clinical data, recorded Diagnostic Related Groups and International Classification of Diseases codes, linkage and connectivity. In an era of diminishing resources better utilisation of these datasets should be encouraged. Increased study and scrutiny will enhance transparency and help identify issues in the collections. As electronic information systems are increasingly embraced, administrative data collections need to be managed as valuable assets and powerful operational and patient management tools.
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Affiliation(s)
- Shyamala G Nadathur
- Department of Medicine, Monash Medical Centre, Monash University, Clayton, VIC 3168, Australia.
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Green JP, Eagar K. The health of people in Australian immigration detention centres. Med J Aust 2010; 192:65-70. [PMID: 20078404 DOI: 10.5694/j.1326-5377.2010.tb03419.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2008] [Accepted: 08/30/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the health status of people in Australian immigration detention centres and the effect of time in, and reason for, detention. DESIGN, SETTING AND SUBJECTS An analysis of the health records of 720 of the 7375 people in detention in the financial year 1 July 2005-30 June 2006, with oversampling of those detained for > 3 months. MAIN OUTCOME MEASURES Health encounters and health condition categories; estimated incidence rates of new health conditions, new mental health conditions, and new injuries for each cohort (defined by time in, and reason for, detention). RESULTS People in detention had an estimated 1.2 (95% CI, 1.18-1.27) health encounters per person-week. Those detained for > 24 months had particularly poor health, both mental and physical. Asylum seekers had more health problems than other people in detention. The main health problems varied depending on the length of time in detention, but included dental, mental health, and musculoskeletal problems, and lacerations. Both time in, and reason for, detention were significantly related to the rate of new mental health problems (P = 0.018 and P < 0.001, respectively). The relationship between these variables and the incidence rates of physical health problems was more complex. CONCLUSION People in immigration detention are frequent users of health services, and there is a clear association between time in detention and rates of mental illness. Government policies internationally should be informed by evidence from studies of the health of this marginalised and often traumatised group.
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Affiliation(s)
- Janette P Green
- Centre for Health Service Development, University of Wollongong, Wollongong, NSW, Australia
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Considine J, Botti M, Thomas S. Descriptive analysis of emergency department oxygen use in acute exacerbation of chronic obstructive pulmonary disease. Intern Med J 2010; 42:e38-47. [DOI: 10.1111/j.1445-5994.2010.02220.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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