1
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Jug R, Callum J, Ruijs T, Liu Y, Barty R, Thompson T. Intravenous albumin utilization audit at a large community hospital. Transfusion 2024; 64:39-46. [PMID: 38078484 DOI: 10.1111/trf.17610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/01/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND There is a literature gap in terms of albumin utilization practices. METHODS/MATERIALS We conducted a single-center retrospective observational electronic audit of adult admitted patients who received one or more vials of albumin (5% or 25%) between September 1, 2019 and August 31, 2020 at a large community hospital. The Research Ethics Board approval was obtained. Utilization data identified through the laboratory information system were independently adjudicated by two reviewers and resolved by consensus as appropriate-acceptable, appropriate-may be acceptable, or inappropriate. The primary objective of this audit is to determine the proportion of 5% and 25% intravenous albumin infusions meeting a priori appropriateness criteria for indication. Secondary outcomes include determining the patterns of practice surrounding intravenous albumin use: patient demographics, most responsible diagnosis, location at time of order, clinical outcomes of albumin recipients, and types, volumes, and cost of albumin infused. RESULTS The mean total albumin administered was 569.2 mL across 456 total recipients (58% male) with a 29% appropriateness rate. This cohort had an in-hospital mortality rate of 38%, with an average of 6 days from first dose of albumin to death. The mean length of stay was 14 days, with a mean intensive care length of stay of 8 days. The purchase cost of inappropriately transfused albumin was CAD $65,538. CONCLUSION Based on a lack of or an unacceptable indication provided, 71% of patients were inappropriately transfused. Albumin use deviating from guideline recommendations may be contributing to increased healthcare costs, pressure on limited supply, and potential patient harm.
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Affiliation(s)
- Rachel Jug
- University of Cincinnati, Cincinnati, Ohio, USA
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, Ontario, Canada
| | | | - Yang Liu
- Michael DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca Barty
- Ontario Regional Blood Coordinating Network (ORBCoN), Toronto, Ontario, Canada
| | - Troy Thompson
- Ontario Regional Blood Coordinating Network (ORBCoN), Toronto, Ontario, Canada
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2
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Rodríguez-Sosa E, De Miguel E, Borrás F, Andrés M. Filling gaps in female gout: a cross-sectional study of comorbidities in 192 037 hospitalised patients. RMD Open 2023; 9:rmdopen-2023-003191. [PMID: 37295841 DOI: 10.1136/rmdopen-2023-003191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE There is room for improvement in the knowledge of female gout, often noted at risk of gender blindness. This study aims to compare the prevalence of comorbidities in women versus men hospitalised with gout in Spain. METHODS This is an observational, multicentre, cross-sectional study in public and private Spanish hospitals analysing the minimum basic data set from 192 037 hospitalisations in people with gout (International Classification of Diseases, Ninth Revision (ICD-9) coding) from 2005 to 2015. Age and several comorbidities (ICD-9) were compared by sex, with a subsequent stratification of comorbidities by age group. The association between each comorbidity and sex was assessed using multivariable logistic regression. A clinical decision tree algorithm was constructed to predict the sex of patients with gout based on age and comorbidities alone. RESULTS Women with gout (17.4% of the sample) were significantly older than men (73.9±13.7 years vs 64.0±14.4 years, p<0.001). Obesity, dyslipidaemia, chronic kidney disease, diabetes mellitus, heart failure, dementia, urinary tract infection and concurrent rheumatic disease were more common in women. Female sex was strongly associated with increasing age, heart failure, obesity, urinary tract infection and diabetes mellitus, while male sex was associated with obstructive respiratory diseases, coronary disease and peripheral vascular disease. The decision tree algorithm built showed an accuracy of 74.4%. CONCLUSIONS A nationwide analysis of inpatients with gout in 2005-2015 confirms a different comorbidity profile between men and women. A different approach to female gout is needed to reduce gender blindness.
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Affiliation(s)
| | | | - Fernando Borrás
- Statistics, Mathematics and Informatics, Miguel Hernandez University of Elche, Sant Joan D'Alacant, Spain
| | - Mariano Andrés
- Clinical Medicine, Miguel Hernandez University of Elche, Sant Joan D'Alacant, Spain
- Rheumatology, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
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3
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Khandelwal A, Minuk L, Liu Y, Arnold DM, Heddle NM, Barty R, Hsia C, Solh Z, Shehata N, Thompson T, Tinmouth A, Perelman I, Skeate R, Kron AT, Callum J. Plasma transfusion practices: A multicentre electronic audit. Vox Sang 2022; 117:1211-1219. [PMID: 36102150 DOI: 10.1111/vox.13355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/02/2022] [Accepted: 08/16/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Plasma is often transfused to patients with bleeding or requiring invasive procedures and with abnormal tests of coagulation. Chart audits find half of plasma transfusions unnecessary, resulting in avoidable complications and costs. This multicentre electronic audit was conducted to determine the proportion of plasma transfused without an indication and/or at a sub-therapeutic dose. METHODS Data were extracted on adult inpatients in 2017 at five academic sites from the hospital electronic chart, laboratory information systems and the Canadian Institute for Health Information Discharge Abstract Database. Electronic criteria for plasma transfusion outside recommended indications were: (1) international normalized ratio (INR) < 1.5 with no to moderate bleeding; (2) INR ≥ 1.5, with no to mild bleeding and no planned procedures; and (3) no INR before or after plasma infusion. Sub-therapeutic dose was defined as ≤2 units transfused. RESULTS In 1 year, 2590 patients received 6088 plasma transfusions encompassing 11,490 units of plasma occurred at the five sites. 77.7% of events were either outside indications or under-dosed. Of these, 34.8% of plasma orders had no indication identified, and 62% of these occurred in non-bleeding patients and no planned procedure with an isolated elevated INR. 70.7% of transfusions were under-dosed. Most plasma transfusions occurred in the intensive care unit or the operating room. Inter-hospital variability in peri-transfusion testing and dosing was observed. CONCLUSION The majority of plasma transfusions are sub-optimal. Local hospital culture may be an important driver. Electronic audits, with definitions employed in this study, may be a practical alternative to costly chart audits.
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Affiliation(s)
- Aditi Khandelwal
- Canadian Blood Services, Toronto, Ontario, Canada.,The University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada
| | - Leigh Minuk
- Department of Internal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yang Liu
- McMaster Centre for Transfusion Research (MCTR), McMaster University, Hamilton, Ontario, Canada
| | - Donald M Arnold
- McMaster Centre for Transfusion Research (MCTR), McMaster University, Hamilton, Ontario, Canada.,Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nancy M Heddle
- McMaster Centre for Transfusion Research (MCTR), McMaster University, Hamilton, Ontario, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca Barty
- McMaster Centre for Transfusion Research (MCTR), McMaster University, Hamilton, Ontario, Canada.,Ontario Regional Blood Coordinating Network (ORBCoN), Toronto, Ontario, Canada
| | - Cyrus Hsia
- Department of Medicine, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada.,Transfusion Medicine Laboratories, London Health Sciences Centre, London, Ontario, Canada
| | - Ziad Solh
- Department of Medicine, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada.,Transfusion Medicine Laboratories, London Health Sciences Centre, London, Ontario, Canada
| | - Nadine Shehata
- The University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Troy Thompson
- Ontario Regional Blood Coordinating Network (ORBCoN), Toronto, Ontario, Canada
| | - Alan Tinmouth
- Ottawa Hospital Centre for Transfusion Research, Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Iris Perelman
- Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
| | - Robert Skeate
- Canadian Blood Services, Toronto, Ontario, Canada.,The University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada
| | - Amie T Kron
- The University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada.,Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jeannie Callum
- The University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada.,Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
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4
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Higgins H, Gupta N. Characterizing social and policy determinants of hospital length of stay among paediatric inpatients with diabetes using linked population-based data. Int J Popul Data Sci 2022; 6:1678. [PMID: 34970634 PMCID: PMC8678978 DOI: 10.23889/ijpds.v6i1.1678] [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] [Indexed: 11/22/2022] Open
Abstract
Background Evidence is limited on the non-medical factors influencing hospital length of stay (LOS) among paediatric inpatients with diabetes, notably potential social and policy correlates. This study aimed to characterize the associations of socioeconomic status and health policy environment with diabetes-attributable LOS to help inform accountability monitoring of a provincial comprehensive diabetes strategy aiming to minimize time in hospital among this high-risk population. Data and methods This retrospective population-based study drew on multiple linked administrative and geospatial databases among all children aged 18 and under with a diabetes-related hospitalization in the province of New Brunswick, Canada, during the four-year period following implementation of an insulin pump funding program. Multiple linear regression was used to assess the role of access to the public insulin pump resourcing scheme and relative neighbourhood deprivation as predictors of days spent in acute care, controlling for age, sex, and place of residence. Results Among the paediatric inpatient population (N = 386), 21% had accessed social resources made available through the insulin pump funding policy and 42% resided in the most materially deprived neighbourhoods. Diabetes-related hospital stays averaged 3.87 days. Paediatric inpatients having accessed resources through the social insurance policy spent significantly fewer days in hospital (1.34 days less [95% CI: 0.63–2.05]) than those who had not, all else being equal. Observed differences in LOS by neighbourhood socioeconomic deprivation were not found to be statistically significant in the multivariate analysis. Conclusion Findings from this context of universal medical coverage suggested that public policy for supplemental financing of assistive technologies among children with diabetes may be associated with reduced burden to the hospital system. The causes of socioenvironmental disparities in LOS require further investigation to inform interventions to mitigate preventable patient-level variations in hospital-based health outcomes.
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Affiliation(s)
- Heather Higgins
- University of New Brunswick, PO Box 4400, Fredericton, New Brunswick E3B 5A3, Canada
| | - Neeru Gupta
- University of New Brunswick, PO Box 4400, Fredericton, New Brunswick E3B 5A3, Canada
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5
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Mathe N, Ryan A, Cook A, Sargious P, Senior P, Johnson JA, Yeung RO. Enhancing diabetes surveillance across Alberta by adding laboratory and pharmacy data to the National Diabetes Surveillance System methods. Can J Diabetes 2021; 46:375-380. [DOI: 10.1016/j.jcjd.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 10/19/2022]
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6
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Gupta N, Sheng Z. Reduced Risk of Hospitalization With Stronger Community Belonging Among Aging Canadians Living With Diabetes: Findings From Linked Survey and Administrative Data. Front Public Health 2021; 9:670082. [PMID: 34055729 PMCID: PMC8160117 DOI: 10.3389/fpubh.2021.670082] [Citation(s) in RCA: 4] [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: 02/20/2021] [Accepted: 04/19/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Social isolation has been identified as a substantial health concern in aging populations, associated with adverse chronic disease outcomes and health inequalities; however, little is known about the interconnections between social capital, diabetes management, and hospital burdens. This study aimed to assess the role of community belonging with the risk of potentially avoidable hospitalization among aging adults living with diabetes in Canada. Methods: The study leveraged a novel resource available through Statistics Canada's Social Data Linkage Environment: the Canadian Community Health Survey linked to administrative health records from the hospital Discharge Abstract Database. A population-representative sample of 13,580 community-dwelling adults aged 45 and over with diabetes was identified. Multiple logistic regression was used to assess the association of individuals' sense of community belonging with the risk of diabetes-related hospitalization over the period 2006-2012. Results: Most (69.9%) adults with diabetes reported a strong sense of belonging to their local community. Those who reported weak community belonging were significantly more likely to have been hospitalized for diabetes (χ2 = 13.82; p < 0.05). The association between weak community attachment and increased risk of diabetes hospitalization remained significant [adjusted OR: 1.80 (95%CI: 1.12-2.90)] after controlling for age, education, and other sociodemographic and behavioral factors. Conclusion: The COVID-19 pandemic has resurfaced attention to the need to better address social capital and diabetes care in public health strategies. While the causal pathways are unclear, this national study highlighted that deficits in social attachments may place adults with diabetes at greater risk of acute complications leading to hospitalization.
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Affiliation(s)
- Neeru Gupta
- Department of Sociology, University of New Brunswick, Fredericton, NB, Canada
| | - Zihao Sheng
- Department of Economics, Dalhousie University, Halifax, NS, Canada
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7
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St Sauver JL, Chamberlain AM, Bobo WV, Boyd CM, Finney Rutten LJ, Jacobson DJ, McGree ME, Grossardt BR, Rocca WA. Implementing the US Department of Health and Human Services definition of multimorbidity: a comparison between billing codes and medical record review in a population-based sample of persons 40 -84 years old. BMJ Open 2021; 11:e042870. [PMID: 33895712 PMCID: PMC8074567 DOI: 10.1136/bmjopen-2020-042870] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the validity of the US Department of Health and Human Services (DHHS) definition of multimorbidity using International Classification of Diseases, ninth edition (ICD-9) codes from administrative data. DESIGN Cross-sectional comparison of two ICD-9 billing code algorithms to data abstracted from medical records. SETTING Olmsted County, Minnesota, USA. PARTICIPANTS An age-stratified and sex-stratified random sample of 1509 persons ages 40-84 years old residing in Olmsted County on 31 December 2010. STUDY MEASURES Seventeen chronic conditions identified by the US DHHS as important in studies of multimorbidity were identified through medical record review of each participant between 2006 and 2010. ICD-9 administrative billing codes corresponding to the 17 conditions were extracted using the Rochester Epidemiology Project records-linkage system. Persons were classified as having each condition using two algorithms: at least one code or at least two codes separated by more than 30 days. We compared the ICD-9 code algorithms with the diagnoses obtained through medical record review to identify persons with multimorbidity (defined as ≥2, ≥3 or ≥4 chronic conditions). RESULTS Use of a single code to define each of the 17 chronic conditions resulted in sensitivity and positive predictive values (PPV) ≥70%, and in specificity and negative predictive values (NPV) ≥70% for identifying multimorbidity in the overall study population. PPV and sensitivity were highest in persons 65-84 years of age, whereas NPV and specificity were highest in persons 40-64 years. The results varied by condition, and by age and sex. The use of at least two codes reduced sensitivity, but increased specificity. CONCLUSIONS The use of a single code to identify each of the 17 chronic conditions may be a simple and valid method to identify persons who meet the DHHS definition of multimorbidity in populations with similar demographic, socioeconomic, and health care characteristics.
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Affiliation(s)
- Jennifer L St Sauver
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alanna M Chamberlain
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - William V Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida, USA
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lila J Finney Rutten
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Debra J Jacobson
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Michaela E McGree
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Brandon R Grossardt
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Walter A Rocca
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Women's Health Research Center, Mayo Clinic, Rochester, MN, USA
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8
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Canney M, Birks P, Shao S, Parfrey P, Djurdjev O, Levin A. Temporal Trends in Hemoglobin, Use of Erythropoiesis Stimulating Agents, and Major Clinical Outcomes in Incident Dialysis Patients in Canada. Kidney Int Rep 2021; 6:1130-1140. [PMID: 33912762 PMCID: PMC8071619 DOI: 10.1016/j.ekir.2020.12.022] [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: 12/02/2020] [Accepted: 12/22/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Several jurisdictions have adopted a more conservative approach to anemia in patients receiving dialysis amid safety concerns from target hemoglobin studies. It is largely unknown if this has contributed to a change in clinical outcomes. Methods A national registry was used to identify 35,945 adult patients who initiated and were maintained on dialysis for ≥90 days in Canada from January 2007 to December 2015. Outcomes were ascertained until March 2017 via linkage with hospital discharge diagnoses. Cox proportional hazards models were used to investigate the association between the era of dialysis initiation and the primary composite outcome (acute myocardial infarction [AMI], stroke, or mortality). Results The mean hemoglobin at dialysis initiation decreased from 102.9 g/l in 2007 to 95.5 g/l in 2015, corresponding with a higher prevalence of hemoglobin <80 g/l (8% to 17%) and a reduction in erythropoiesis stimulating agent (ESA) use (49% to 44%). After multivariable adjustment, Era 3 (2013–2015) was associated with an 8% relative risk reduction in the primary outcome compared with Era 1 (2007–2009) (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.88–0.96), a 10% relative reduction in mortality (HR 0.90, 95% CI 0.85–0.94) but no significant change in AMI or stroke. In a model without era, neither hemoglobin nor ESA use was an independent predictor of outcome. Conclusion There have been modest declines in average hemoglobin values and ESA use among incident dialysis patients in Canada with no change in major cardiovascular outcomes. Patient survival has improved over time, likely for reasons other than anemia management.
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Affiliation(s)
- Mark Canney
- University of British Columbia, Division of Nephrology, Vancouver, British Columbia, Canada.,BC Renal, Provincial Health Services Authority, Vancouver, British Columbia, Canada.,Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Peter Birks
- BC Renal, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Selena Shao
- BC Renal, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Patrick Parfrey
- Memorial University Medical School, Department of Medicine, St. John's, Newfoundland, Canada
| | - Ognjenka Djurdjev
- BC Renal, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Adeera Levin
- University of British Columbia, Division of Nephrology, Vancouver, British Columbia, Canada.,BC Renal, Provincial Health Services Authority, Vancouver, British Columbia, Canada
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9
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Lee S, Li B, Martin EA, D'Souza AG, Jiang J, Doktorchik C, Southern DA, Lee J, Wiebe N, Quan H, Eastwood CA. CREATE: A New Data Resource to Support Cardiac Precision Health. CJC Open 2020; 3:639-645. [PMID: 34036259 PMCID: PMC8134941 DOI: 10.1016/j.cjco.2020.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/08/2020] [Indexed: 11/27/2022] Open
Abstract
Background The initiatives of precision medicine and learning health systems require databases with rich and accurately captured data on patient characteristics. We introduce the Clinical Registry, AdminisTrative Data and Electronic Medical Records (CREATE) database, which includes linked data from 4 population databases: Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH; a national clinical registry), Sunrise Clinical Manager (SCM) electronic medical record (city-wide), the Discharge Abstract Database (DAD), and the National Ambulatory Care Reporting System (NACRS). The intent of this work is to introduce a cardiovascular-specific database for pursuing precision health activities using big data analytics. Methods We used deterministic data linkage to link SCM electronic medical record data to APPROACH clinical registry data using patient identifier variables. The APPROACH-SCM data set was subsequently linked to DAD and NACRS to obtain inpatient and outpatient cohort data. We further validated the quality of the linkage, where applicable, in these databases by comparing against the Alberta Health Insurance Care Plan registry database. Results We achieved 99.96% linkage across these 4 databases. Currently, there are 30,984 patients with 35,753 catheterizations in the CREATE database. The inpatient cohort contained 65.75% (20,373/30,984) of the patient sample, whereas the outpatient cohort contained 29.78% (9226/30,984). The infrastructure and the process to update and expand the database has been established. Conclusions CREATE is intended to serve as a database for supporting big data analytics activities surrounding cardiac precision health. The CREATE database will be managed by the Centre for Health Informatics at the University of Calgary, and housed in a secure high-performance computing environment.
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Affiliation(s)
- Seungwon Lee
- Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Alberta Health Services, Calgary, Alberta, Canada.,Data Intelligence for Health Lab, University of Calgary, Calgary, Alberta, Canada
| | - Bing Li
- Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada.,Alberta Health Services, Calgary, Alberta, Canada
| | - Elliot A Martin
- Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada.,Alberta Health Services, Calgary, Alberta, Canada
| | - Adam G D'Souza
- Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada.,Alberta Health Services, Calgary, Alberta, Canada
| | - Jason Jiang
- Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada.,Alberta Health Services, Calgary, Alberta, Canada
| | - Chelsea Doktorchik
- Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Danielle A Southern
- Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Joon Lee
- Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Data Intelligence for Health Lab, University of Calgary, Calgary, Alberta, Canada.,Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Natalie Wiebe
- Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Hude Quan
- Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Cathy A Eastwood
- Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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10
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Pfister T, Rennert-May E, Ellison J, Bush K, Leal J. Clostridioides difficile infections in Alberta: The validity of administrative data using ICD-10 diagnostic codes for CDI surveillance versus clinical infection surveillance. Am J Infect Control 2020; 48:1431-1436. [PMID: 32810568 DOI: 10.1016/j.ajic.2020.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Clostridioides difficile infection (CDI) is one of the most common health care-associated infections. This study assessed the validity of the Discharge Abstract Database (DAD) compared to a traditional clinical surveillance method for identifying CDI. METHODS Retrospective analysis of all DAD records with International Statistical Classification of Diseases and Related Health Problems 10th Revision (ie, ICD-10) diagnostic code A04.7 (enterocolitis due to CDI) between April 2015 and March 2019 were compared to a clinical dataset of positive inpatient CDI for all acute care facilities in Alberta, Canada. Sensitivity and positive predictive values were calculated using R version 3.6.0. RESULTS The DAD had a sensitivity of 85.0% (95% confidence interval: 84.1%-85.8%) and a positive predictive value of 80.0% (95% confidence interval: 79.2%-80.0%). The CDI rate per 1,000 admissions over the study period was 28% higher in the DAD compared to Infection Prevention and Control surveillance. DISCUSSION The DAD does not distinguish symptomatic cases from asymptomatic cases and so indicators to identify symptomatic disease would need to be applied, potentially through a linkage to antibiotic treatment orders available in patient management systems. CONCLUSIONS The DAD is moderately sensitive for identifying symptomatic CDI cases in Alberta, Canada and caution should be applied when interpreting rates based on administrative data.
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Affiliation(s)
- Ted Pfister
- Infection Prevention and Control, Alberta Health Services, AB, Canada
| | - Elissa Rennert-May
- Community Health Sciences, University of Calgary, Calgary, AB, Canada; Department of Medicine, University of Calgary, Calgary, AB, Canada; Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - Jennifer Ellison
- Infection Prevention and Control, Alberta Health Services, AB, Canada
| | - Kathryn Bush
- Infection Prevention and Control, Alberta Health Services, AB, Canada
| | - Jenine Leal
- Infection Prevention and Control, Alberta Health Services, AB, Canada; Community Health Sciences, University of Calgary, Calgary, AB, Canada; Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
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11
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Gupta N, Sheng Z. Disparities in the hospital cost of cardiometabolic diseases among lesbian, gay, and bisexual Canadians: a population-based cohort study using linked data. Canadian Journal of Public Health 2020; 111:417-425. [PMID: 32112310 DOI: 10.17269/s41997-020-00296-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/03/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Sexual identity has been recognized as a social determinant of health; however, evidence is limited on sexual minority status as a possible contributor to inequalities in cardiometabolic outcomes and the related hospital burden. This study aimed to investigate the association between sexual identity and hospital costs for cardiometabolic diseases among a cohort of Canadians using linked survey and administrative data. METHODS Data from the 2007-2011 Canadian Community Health Survey were linked to acute-care inpatient records from the 2005/2006-2012/2013 Discharge Abstract Database. Multiple linear regression was used to assess the association between self-reported sexual identity and inpatient resource use for cardiometabolic diseases. RESULTS Among the population ages 18-59, 2.1% (95% CI 1.9-2.2) identified as lesbian, gay, or bisexual (LGB). LGB individuals more often reported having diabetes or heart disease compared with heterosexuals. The mean inflation-adjusted cost for cardiometabolic-related hospitalizations was found to be significantly higher among LGB patients (CAD$26,702; 95% CI 26,166-60,365) than among their heterosexual counterparts ($10,137; 95% CI 8,639-11,635), in part a reflection of longer hospital stays (13.6 days versus 5.1 days). Inpatient costs remained 54% (95% CI 8-119) higher among LGB patients after controlling for socio-demographics, health status, and health behaviours. CONCLUSION This study revealed a disproportionate cost for potentially avoidable hospitalizations for cardiometabolic conditions among LGB patients, suggesting important unmet healthcare needs even in the Canadian context of universal coverage.
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Affiliation(s)
- Neeru Gupta
- University of New Brunswick, 9 Macaulay Lane, PO Box 4400, Fredericton, New Brunswick, E3B 5A3, Canada.
| | - Zihao Sheng
- University of New Brunswick, 9 Macaulay Lane, PO Box 4400, Fredericton, New Brunswick, E3B 5A3, Canada
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Gupta N, Crouse DL, Balram A. Individual and community-level income and the risk of diabetes rehospitalization among women and men: a Canadian population-based cohort study. BMC Public Health 2020; 20:60. [PMID: 31937292 PMCID: PMC6961319 DOI: 10.1186/s12889-020-8159-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 01/06/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Marked disparities by socioeconomic status in the risk of potentially avoidable hospitalization for chronic illnesses have been observed in many contexts, including those with universal health coverage. Less well known is how gender mediates such differences. We conducted a population-based cohort study to describe associations between household and community-level income and rehospitalizations for types 1 and 2 diabetes mellitus among Canadian women and men. METHODS Our cohorts were drawn from respondents to the 2006 mandatory long-form census linked longitudinally to 3 years of nationally standardized hospital records. We included adults 30-69 years hospitalized with diabetes at least once during the study period. We used logistic regressions to estimate odds ratios for 12-month diabetes rehospitalization associated with indicators of household and community-level income, with separate models by gender, and controlling for a range of other sociodemographic characteristics. Since diabetes may not always be recognized as the main reason for hospitalization, we accounted for disease progression through consideration of admissions where diabetes was previously identified as a secondary diagnosis. RESULTS Among persons hospitalized at least once with diabetes (n = 41,290), 1.5% were readmitted within 12 months where the initial admission had diabetes as the primary diagnosis, and 1.8% were readmitted where the initial admission had diabetes as a secondary diagnosis. For men, being in the lowest household income quintile was associated with higher odds of rehospitalization in cases where the initial admission listed diabetes as either the primary diagnosis (OR = 2.21; 95% CI = 1.38-3.51) or a secondary diagnosis (OR = 1.51; 95% CI = 1.02-2.24). For women, we found no association with income and rehospitalization, but having less than university education was associated with higher odds of rehospitalization where diabetes was a secondary diagnosis of the initial admission (OR = 1.88; 95% CI = 1.21-2.92). We also found positive, but insignificant associations between community-level poverty and odds of rehospitalization. CONCLUSIONS Universal health coverage remains insufficient to eliminate socioeconomic inequalities in preventable diabetes-related hospitalizations, as illustrated in this Canadian context. Decision-makers should tread cautiously with gender-blind poverty reduction actions aiming to enhance population health that may inadequately respond to the different needs of disadvantaged women and men with chronic illness.
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Affiliation(s)
- Neeru Gupta
- Department of Sociology, University of New Brunswick, P.O. Box 4400, Fredericton, New Brunswick E3B 5A3 Canada
| | - Dan L. Crouse
- Department of Sociology, University of New Brunswick, P.O. Box 4400, Fredericton, New Brunswick E3B 5A3 Canada
| | - Adele Balram
- New Brunswick Institute for Research, Data and Training (NB-IRDT), P.O. Box 4400, Fredericton, New Brunswick E3B 5A3 Canada
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13
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Gupta N, Sheng Z. A population-based study of the association between food insecurity and potentially avoidable hospitalization among persons with diabetes using linked survey and administrative data. Int J Popul Data Sci 2019; 4:1102. [PMID: 32935031 PMCID: PMC7482516 DOI: 10.23889/ijpds.v4i1.1102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Studies have found food insecurity to be more prevalent among persons with diabetes mellitus. Other research using areal-based measures of socioeconomic status have pointed to a social gradient in diabetes hospitalizations, but without accounting for individuals’ health status. Linking person-level data from health surveys to population-based hospital records enables profiling of the role of food insecurity with hospital morbidity, focusing on the high-risk diabetic population. Objective This national study aims to assess the association between income-related household food insecurity and potentially avoidable hospital admissions among community-dwelling persons living with diagnosed diabetes. Methods We use three cycles of the Canadian Community Health Survey (2007, 2008, and 2011) linked to multiple years of hospital records from the Discharge Abstract Database (2005/06 to 2012/13), covering 12 of Canada’s 13 provinces and territories. We apply multiple logistic regression for testing the association of household food insecurity with the risk of hospitalization for diabetes and common comorbid ambulatory care sensitive conditions among persons aged 12 and over living with diabetes. Analysis Data linkage allowed us to analyze inpatient hospital records among 10,260 survey respondents with diabetes; 590 respondents had been hospitalized at least once for diabetes or a common comorbid chronic physical or mental illness. The regression results indicated that the odds of experiencing a preventable hospital admission were significantly higher among persons with diabetes who were food insecure compared to their counterparts who were food secure (OR=1.66 [95%CI=1.24-2.23]), after controlling for age, sex and other characteristics. Conclusion We found food insecurity to significantly increase the odds of hospital admission for ambulatory care sensitive conditions among Canadians living with diabetes. These results reinforce the need to consider food insecurity in public health and clinical strategies to reduce the hospital burden of diabetes and other nutrition-related chronic diseases, from primary prevention to post-discharge care.
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Affiliation(s)
- N Gupta
- Department of Sociology, University of New Brunswick, PO Box 4400, Fredericton, New Brunswick E3B 5A3, Canada
| | - Z Sheng
- Department of Sociology, University of New Brunswick, PO Box 4400, Fredericton, New Brunswick E3B 5A3, Canada
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Nanditha NGA, St-Jean M, Tafessu H, Guillemi SA, Hull MW, Lu M, Henry B, Barrios R, Montaner JSG, Lima VD. Missed opportunities for earlier diagnosis of HIV in British Columbia, Canada: A retrospective cohort study. PLoS One 2019; 14:e0214012. [PMID: 30897143 PMCID: PMC6428302 DOI: 10.1371/journal.pone.0214012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 03/05/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Late HIV diagnosis is associated with increased AIDS-related morbidity and mortality as well as an increased risk of HIV transmission. In this study, we quantified and characterized missed opportunities for earlier HIV diagnosis in British Columbia (BC), Canada. DESIGN Retrospective cohort. METHODS A missed opportunity was defined as a healthcare encounter due to a clinical manifestation which may be caused by HIV infection, or is frequently present among those with HIV infection, but no HIV diagnosis followed within 30 days. We developed an algorithm to identify missed opportunities within one, three, and five years prior to diagnosis. The algorithm was applied to the BC STOP HIV/AIDS population-based cohort. Eligible individuals were ≥18 years old, and diagnosed from 2001-2014. Multivariable logistic regression identified factors associated with missed opportunities. RESULTS Of 2119 individuals, 7%, 12% and 14% had ≥1 missed opportunity during one, three and five years prior to HIV diagnosis, respectively. In all analyses, individuals aged ≥40 years, heterosexuals or people who ever injected drugs, and those residing in Northern health authority had increased odds of experiencing ≥1 missed opportunity. In the three and five-year analysis, individuals with a CD4 count <350 cells/mm3 were at higher odds of experiencing ≥1 missed opportunity. Prominent missed opportunities were related to recurrent pneumonia, herpes zoster/shingles among younger individuals, and anemia related to nutritional deficiencies or unspecified cause. CONCLUSIONS Based on our newly-developed algorithm, this study demonstrated that HIV-diagnosed individuals in BC have experienced several missed opportunities for earlier diagnosis. Specific clinical indicator conditions and population sub-groups at increased risk of experiencing these missed opportunities were identified. Further work is required in order to validate the utility of this proposed algorithm by establishing the sensitivity, specificity, positive and negative predictive values corresponding to the incidence of the clinical indicator conditions among both HIV-diagnosed and HIV-negative populations.
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Affiliation(s)
- Ni Gusti Ayu Nanditha
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Martin St-Jean
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Hiwot Tafessu
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Silvia A. Guillemi
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Mark W. Hull
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Michelle Lu
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Bonnie Henry
- British Columbia Ministry of Health, Victoria, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Vancouver Coastal Health, Vancouver, Canada
| | - Julio S. G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Viviane D. Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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López-de-Andrés A, Perez-Farinos N, de Miguel-Díez J, Hernández-Barrera V, Jiménez-Trujillo I, Méndez-Bailón M, de Miguel-Yanes JM, Jiménez-García R. Type 2 diabetes and postoperative pneumonia: An observational, population-based study using the Spanish Hospital Discharge Database, 2001-2015. PLoS One 2019; 14:e0211230. [PMID: 30726277 PMCID: PMC6364970 DOI: 10.1371/journal.pone.0211230] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/09/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose We analyzed temporal trends, demographic and clinical characteristics and hospital mortality rates of postoperative pneumonia among type 2 diabetes mellitus (T2DM) patients in Spain from 2001 to 2015. We also compared the incidence, comorbidities and mortality between patients with and without T2DM suffering from postoperative pneumonia. Finally, we analyzed the factors involved in the prediction of in-hospital mortality among patients suffering postoperative pneumonia. Methods We used the Spanish National Hospital Discharge Database for the period 2001–2015. We analyzed patients aged 40 years or over who had been hospitalized for a surgical procedure and suffered pneumonia or ventilator-associated pneumonia during their hospital admission. We compared patients with and without T2DM. The main outcome measures were the type of surgical procedure, the presence of a comorbidity, the type of isolated pathogens, admission to the emergency room (ER) and in-hospital mortality (IHM). Results We selected 117,665 hospitalized patients who suffered postoperative pneumonia (16.9% with T2DM). After multivariable adjustment, T2DM patients had a 21% higher incidence of postoperative pneumonia than nondiabetic patients (IRR 1.21, 95% CI 1.03–1.42). The IHM was approximately 31% in both groups. Predictors of IHM included age, the presence of comorbidities, treatment with a pleural drainage tube, dialysis, blood transfusion, mechanical ventilation and admission to the ER. From 2001 to 2015, the IHM decreased significantly in both populations. Suffering from T2DM was not a predictor of IHM (OR 0.99, 95% CI 0.96–1.03) in our investigation. Conclusions T2DM patients have a higher incidence of postoperative pneumonia than those without this disease. The IHM decreased from 2001 to 2015, regardless of T2DM status. T2DM did not predict a higher IHM after suffering from postoperative pneumonia.
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Affiliation(s)
- Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit. Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Napoleon Perez-Farinos
- Public Health and Psychiatry Department, Faculty of Medicine, Universidad de Malaga, Malaga, Spain
- * E-mail:
| | - Javier de Miguel-Díez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit. Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Isabel Jiménez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit. Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Manuel Méndez-Bailón
- Internal Medicine Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - José M. de Miguel-Yanes
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit. Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
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IWAGAMI M, AOKI K, AKAZAWA M, ISHIGURO C, IMAI S, OOBA N, KUSAMA M, KOIDE D, GOTO A, KOBAYASHI N, SATO I, NAKANE S, MIYAZAKI M, KUBOTA K. Task Force Report on the Validation of Diagnosis Codes and Other Outcome Definitions in the Japanese Receipt Data . ACTA ACUST UNITED AC 2018. [DOI: 10.3820/jjpe.23.95] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Kotonari AOKI
- Real World Data Science Dept., Drug Safety Div., Chugai Pharmaceutical Co.Ltd
| | - Manabu AKAZAWA
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University
| | - Chieko ISHIGURO
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency
| | - Shinobu IMAI
- Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters
| | | | - Makiko KUSAMA
- Graduate School of Pharmaceutical Sciences, The University of Tokyo
- Current address:Japan Agency for Medical Research and Development(AMED)
| | - Daisuke KOIDE
- Graduate School of Medicine, The University of Tokyo
| | - Atsushi GOTO
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center
| | - Norihiro KOBAYASHI
- Digital Intelligence Department, Corporate Strategy Division, Shionogi & Co., Ltd
| | - Izumi SATO
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University
| | - Sayuri NAKANE
- Real World Data Science Dept., Drug Safety Div., Chugai Pharmaceutical Co.Ltd
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Jolley RJ, Liang Z, Peng M, Pendharkar SR, Tsai W, Chen G, Eastwood CA, Quan H, Ronksley PE. Identifying Cases of Sleep Disorders through International Classification of Diseases (ICD) Codes in Administrative Data. Int J Popul Data Sci 2018; 3:448. [PMID: 32935008 PMCID: PMC7299484 DOI: 10.23889/ijpds.v3i1.448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Prevalence, and associated morbidity and mortality of chronic sleep disorders have been limited to small cohort studies, however, administrative data may be used to provide representation of larger population estimates of disease. With no guidelines to inform the identification of cases of sleep disorders in administrative data, the objective of this study was to develop and validate a set of ICD-codes used to define sleep disorders including narcolepsy, insomnia, and obstructive sleep apnea (OSA) in administrative data. METHODS A cohort of adult patients, with medical records reviewed by two independent board-certified sleep physicians from a sleep clinic in Calgary, Alberta between January 1, 2009 and December 31, 2011, was used as the reference standard. We developed a general ICD-coded case definition for sleep disorders which included conditions of narcolepsy, insomnia, and OSA using: 1) physician claims data, 2) inpatient visit data, 3) emergency department (ED) and ambulatory care data. We linked the reference standard data and administrative data to examine the validity of different case definitions, calculating estimates of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS From a total of 1186 patients from the sleep clinic, 1045 (88.1%) were classified as sleep disorder positive, with 606 (51.1%) diagnosed with OSA, 407 (34.4%) with insomnia, and 59 (5.0%) with narcolepsy. The most frequently used ICD-9 codes were general codes of 307.4 (Nonorganic sleep disorder, unspecified), 780.5 (unspecified sleep disturbance) and ICD-10 codes of G47.8 (other sleep disorders), G47.9 (sleep disorder, unspecified). The best definition for identifying a sleep disorder was an ICD code (from physician claims) 2 years prior and 1 year post sleep clinic visit: sensitivity 79.2%, specificity 28.4%, PPV 89.1%, and NPV 15.6%. ICD codes from ED/ambulatory care data provided similar diagnostic performance when at least 2 codes appeared in a time period of 2 years prior and 1 year post sleep clinic visit: sensitivity 71.9%, specificity 54.6%, PPV 92.1%, and NPV 20.8%. The inpatient data yielded poor results in all tested ICD code combinations. CONCLUSION Sleep disorders in administrative data can be identified mainly through physician claims data and with some being determined through outpatient/ambulatory care data ICD codes, however these are poorly coded within inpatient data sources. This may be a function of how sleep disorders are diagnosed and/or reported by physicians in inpatient and outpatient settings within medical records. Future work to optimize administrative data case definitions through data linkage are needed.
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Affiliation(s)
- Rachel J Jolley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zhiying Liang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mingkai Peng
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sachin R Pendharkar
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Willis Tsai
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Guanmin Chen
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cathy A Eastwood
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Hude Quan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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López-de-Andrés A, Hernández-Barrera V, Martínez-Huedo MA, Villanueva-Martinez M, Jiménez-Trujillo I, Jiménez-García R. Type 2 diabetes and in-hospital complications after revision of total hip and knee arthroplasty. PLoS One 2017; 12:e0183796. [PMID: 28837689 PMCID: PMC5570305 DOI: 10.1371/journal.pone.0183796] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/13/2017] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To assess the effect of type 2 diabetes (T2DM) on hospital outcomes such as in hospital postoperative complications (IHPC), length of hospital stay (LOHS) and in-hospital mortality (IHM) after the revision of total hip arthroplasty (RHA) and total knee arthroplasty (RKA) and to identify factors associated with IHPC among T2DM patients undergoing these procedures. METHODS We performed a retrospective study using the Spanish National Hospital Discharge Database, 2005-2014. We included patients who were ≥40 years old that had undergone RHA and RKA. For each T2DM patient, we selected a year-, gender-, age- and Charlson Comorbidity Index-matched non-diabetic patient. RESULTS We identified 44,055 and 39,938 patients who underwent RHA (12.72% with T2DM) and RKA (15.01% with T2DM). We matched 4,700 and 5,394 couples with RHA and RKA, respectively. Any IHPC was more frequent among patients with T2DM than among non-T2DM patients (19% vs. 15.64% in the RHA cohort and 12.94% vs. 11.09% in the RKA cohort, respectively). For patients who underwent RHA, postoperative infection (4.51% vs. 2.94%, p<0.001), acute post-hemorrhagic anemia (9.53% vs. 7.70%, p<0.001), mean LOHS and IHM were significantly higher in patients with T2DM. Among RKA patients, the incidence of acute posthemorrhagic anemia (7.21% vs. 5.62%; p = 0.001) and urinary tract infection (1.13% vs. 0.72%; p = 0.029) was significantly higher in patients with diabetes. Older age, obesity, infection due to internal joint prosthesis, myocardial infarction, congestive heart failure, mild liver disease and renal disease and emergency room admission were significantly associated with a higher risk of IHPC in T2DM patients. IHPC decreased over time only in T2DM patients who underwent RHA (OR 0.94, 95%CI 0.89-0.98). CONCLUSIONS Patients with T2DM who underwent RHA and RKA procedures had more IHPC after controlling for the effects of possible confounders. LOHS and IHM were also higher among RHA patients with diabetes. Older age, comorbidity, obesity and emergency room admission were strong predictors of IHPC in diabetic patients.
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Affiliation(s)
- Ana López-de-Andrés
- Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, Nursing and Oral Medicine Department. Universidad Rey Juan Carlos. Alcorcón. Comunidad de Madrid. Spain
| | - Valentín Hernández-Barrera
- Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, Nursing and Oral Medicine Department. Universidad Rey Juan Carlos. Alcorcón. Comunidad de Madrid. Spain
| | | | - Manuel Villanueva-Martinez
- Unit of Revision Hip and Knee Arthroplasty. Unidad de Recambios Protésicos. Hospital Beata María. Madrid. Spain
| | - Isabel Jiménez-Trujillo
- Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, Nursing and Oral Medicine Department. Universidad Rey Juan Carlos. Alcorcón. Comunidad de Madrid. Spain
| | - Rodrigo Jiménez-García
- Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, Nursing and Oral Medicine Department. Universidad Rey Juan Carlos. Alcorcón. Comunidad de Madrid. Spain
- * E-mail:
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Wielgosz A, Dai S, Walsh P, McCrea-Logie J, Celebican E. Comorbid Conditions in Canadians Hospitalized Because of Diabetes. Can J Diabetes 2017; 42:106-111. [PMID: 28579199 DOI: 10.1016/j.jcjd.2017.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 02/28/2017] [Accepted: 03/07/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The number of hospital discharges involving type 1 or type 2 diabetes as the first-listed diagnosis has increased over the past few decades. Such cases are commonly associated with various comorbidities. We analyzed data collected from hospital separations in Canada to determine the number and proportion of comorbid conditions in Canadians hospitalized because of diabetes. METHODS The most responsible diagnosis (MRDx) of diabetes (ICD-10-CA: E10 [type 1 diabetes] or E11 [type 2 diabetes]) was identified from acute care hospital separations (Discharge Abstract Database) from 2013 to 2014 in all Canadian jurisdictions except Quebec. Hospital separations were calculated by 5-year age groups and sex. The most common comorbid (secondary) diagnoses were identified for hospital separations with diabetes as the MRDx, and the average lengths of stay associated with diabetes were determined. RESULTS The total number of hospital separations in 2013-2014 in Canada (excluding Quebec) with diabetes as the MRDx in all ages was 30,422, and males represented more than half (58.7%) of the separations. The median age group when diabetes is the MRDx is 60 to 64. For all patients hospitalized with an MRDx of diabetes, there were 2.2% deaths. Hypertension was the most common comorbid diagnosis in patients with diabetes as the MRDx, followed by glomerular disorders, peripheral angiopathy and acute renal failure. CONCLUSIONS Hospitalizations resulting from diabetes are associated with vascular comorbidities, and hypertension is the most common. Prevention of shared predisposing factors should reduce the burden of hospitalizations associated with diabetes.
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Affiliation(s)
- Andreas Wielgosz
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
| | - Sulan Dai
- Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Peter Walsh
- Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Jennifer McCrea-Logie
- Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Ece Celebican
- Ece Celebican, Faculty of Law, University of Ottawa, Ottawa, Ontario, Canada
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