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Altabbaa G, Flemons W, Ocampo W, Babione JN, Kaufman J, Murphy S, Lamont N, Schaefer J, Boscan A, Stelfox HT, Conly J, Ghali WA. Deployment of a human-centred clinical decision support system for pulmonary embolism: evaluation of impact on quality of diagnostic decisions. BMJ Open Qual 2024; 13:e002574. [PMID: 38350673 PMCID: PMC10862276 DOI: 10.1136/bmjoq-2023-002574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024] Open
Abstract
Pulmonary embolism (PE) is a serious condition that presents a diagnostic challenge for which diagnostic errors often happen. The literature suggests that a gap remains between PE diagnostic guidelines and adherence in healthcare practice. While system-level decision support tools exist, the clinical impact of a human-centred design (HCD) approach of PE diagnostic tool design is unknown. DESIGN Before-after (with a preintervention period as non-concurrent control) design study. SETTING Inpatient units at two tertiary care hospitals. PARTICIPANTS General internal medicine physicians and their patients who underwent PE workups. INTERVENTION After a 6-month preintervention period, a clinical decision support system (CDSS) for diagnosis of PE was deployed and evaluated over 6 months. A CDSS technical testing phase separated the two time periods. MEASUREMENTS PE workups were identified in both the preintervention and CDSS intervention phases, and data were collected from medical charts. Physician reviewers assessed workup summaries (blinded to the study period) to determine adherence to evidence-based recommendations. Adherence to recommendations was quantified with a score ranging from 0 to 1.0 (the primary study outcome). Diagnostic tests ordered for PE workups were the secondary outcomes of interest. RESULTS Overall adherence to diagnostic pathways was 0.63 in the CDSS intervention phase versus 0.60 in the preintervention phase (p=0.18), with fewer workups in the CDSS intervention phase having very low adherence scores. Further, adherence was significantly higher when PE workups included the Wells prediction rule (median adherence score=0.76 vs 0.59, p=0.002). This difference was even more pronounced when the analysis was limited to the CDSS intervention phase only (median adherence score=0.80 when Wells was used vs 0.60 when Wells was not used, p=0.001). For secondary outcomes, using both the D-dimer blood test (42.9% vs 55.7%, p=0.014) and CT pulmonary angiogram imaging (61.9% vs 75.4%, p=0.005) was lower during the CDSS intervention phase. CONCLUSION A clinical decision support intervention with an HCD improves some aspects of the diagnostic decision, such as the selection of diagnostic tests and the use of the Wells probabilistic prediction rule for PE.
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Affiliation(s)
- Ghazwan Altabbaa
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ward Flemons
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Wrechelle Ocampo
- W21C Research and Innovation Centre, University of Calgary, Calgary, Alberta, Canada
| | | | - Jamie Kaufman
- W21C Research and Innovation Centre, University of Calgary, Calgary, Alberta, Canada
| | - Sydney Murphy
- W21C Research and Innovation Centre, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Lamont
- W21C Research and Innovation Centre, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey Schaefer
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alejandra Boscan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - John Conly
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - William A Ghali
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Januel JM, Southern DA, Ghali WA. Interpreting and coding causal relationships for quality and safety using ICD-11. BMC Med Inform Decis Mak 2023; 21:385. [PMID: 37974148 PMCID: PMC10655490 DOI: 10.1186/s12911-023-02363-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 11/02/2023] [Indexed: 11/19/2023] Open
Abstract
Many circumstances necessitate judgments regarding causation in health information systems, but these can be tricky in medicine and epidemiology. In this article, we reflect on what the ICD-11 Reference Guide provides on coding for causation and judging when relationships between clinical concepts are causal. Based on the use of different types of codes and the development of a new mechanism for coding potential causal relationships, the ICD-11 provides an in-depth transformation of coding expectations as compared to ICD-10. An essential part of the causal relationship interpretation relies on the presence of "connecting terms," key elements in assessing the level of certainty regarding a potential relationship and how to proceed in coding a causal relationship using the new ICD-11 coding convention of postcoordination (i.e., clustering of codes). In addition, determining causation involves using documentation from healthcare providers, which is the foundation for coding health information. The coding guidelines and examples (taken from the quality and patient safety domain) presented in this article underline how new ICD-11 features and coding rules will enhance future health information systems and healthcare.
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Affiliation(s)
- Jean-Marie Januel
- Department of Biomedical Informatics, Rouen University Hospital, 37 Boulevard Gambetta, Rouen, 76000, France.
- Translational Innovation in Medicine and Complexity (TIMC) Laboratory, Deep Care research chair, Multidisciplinary Institute in Artificial Intelligence, Université Grenoble Alpes (UGA) and Centre National de Recherche Scientifique (CNRS), Grenoble, France.
| | - Danielle A Southern
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - William A Ghali
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
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Ho C, Ocampo W, Southern DA, Sola D, Baylis B, Conly JM, Hogan DB, Kaufman J, Stelfox HT, Ghali WA. Effect of a Continuous Bedside Pressure Mapping System for Reducing Interface Pressures: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2316480. [PMID: 37266939 DOI: 10.1001/jamanetworkopen.2023.16480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Importance Continuous bedside pressure mapping (CBPM) technology can assist in detecting skin areas with excessive interface pressure and inform efficient patient repositioning to prevent the development of pressure injuries (PI). Objective To evaluate the efficacy of CBPM technology in reducing interface pressure and the incidence of PIs. Design, Setting, and Participants This parallel, 2-group randomized clinical trial was performed at a tertiary acute care center. The study started to enroll participants in December 2014 and was completed in May 2018. Participants included adults partially or completely dependent for bed mobility. Statistical analysis was performed from September 2018 to December 2022. Intervention Nursing staff using visual feedback from CBPM technology for 72 hours. Main Outcomes and Measures Absolute number of sensing points with pressure readings greater than 40 mm Hg, mean interface pressure across all sensing points under a patient's body, proportion of participants who had pressure readings greater than 40 mm Hg, and pressure-related skin and soft tissue changes. Results There were 678 patients recruited. After attrition, 260 allocated to the control group (151 [58.1%] male; mean [SD] age, 61.9 [18.5] years) and 247 in the intervention group (147 [59.5%] male; mean [SD] age, 63.6 [18.1] years) were included in analyses. The absolute number of sensing points with pressures greater than 40 mm Hg were 11 033 in the control group vs 9314 in the intervention group (P = .16). The mean (SD) interface pressure was 6.80 (1.63) mm Hg in the control group vs 6.62 (1.51) mm Hg in the intervention group (P = .18). The proportion of participants who had pressure readings greater than 40 mm Hg was 99.6% in both the control and intervention groups. Conclusions and Relevance In this randomized clinical trial to evaluate the efficacy of CBPM technology in the reduction of interface pressure and the incidence of PIs in a tertiary acute care center, no statistically significant benefit was seen for any of the primary outcomes. These results suggest that longer duration of monitoring and adequately powered studies where CBPM feedback is integrated into a multifaceted intervention to prevent PI are needed. Trial Registration ClinicalTrials.gov Identifier: NCT02325388.
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Affiliation(s)
- Chester Ho
- Division of Physical Medicine & Rehabilitation, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta and Alberta Health Services Neurosciences, Rehabilitation & Vision Strategic Clinical Network, Edmonton, Alberta, Canada
- W21C Research and Innovation Centre, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Wrechelle Ocampo
- W21C Research and Innovation Centre, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Danielle A Southern
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Darlene Sola
- W21C Research and Innovation Centre, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Barry Baylis
- Department of Medicine, Cumming School of Medicine, University of Calgary, and Alberta Health Services, Calgary, Alberta, Canada
- W21C Research and Innovation Centre, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - John M Conly
- Department of Medicine, Cumming School of Medicine, University of Calgary, and Alberta Health Services, Calgary, Alberta, Canada
- W21C Research and Innovation Centre, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Synder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - David B Hogan
- Department of Medicine, Cumming School of Medicine, University of Calgary, and Alberta Health Services, Calgary, Alberta, Canada
- W21C Research and Innovation Centre, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Jaime Kaufman
- W21C Research and Innovation Centre, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Henry Thomas Stelfox
- Department of Medicine, Cumming School of Medicine, University of Calgary, and Alberta Health Services, Calgary, Alberta, Canada
- W21C Research and Innovation Centre, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Departments of Critical Care Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Critical Care Medicine, Alberta Health Services, Calgary, Alberta, Canada
| | - William A Ghali
- Department of Medicine, Cumming School of Medicine, University of Calgary, and Alberta Health Services, Calgary, Alberta, Canada
- W21C Research and Innovation Centre, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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Forster AJ, Chute CG, Pincus HA, Ghali WA. ICD-11: A catalyst for advancing patient safety surveillance globally. BMC Med Inform Decis Mak 2023; 21:383. [PMID: 36894925 PMCID: PMC9999485 DOI: 10.1186/s12911-023-02134-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 02/06/2023] [Indexed: 03/11/2023] Open
Abstract
The World Health Organization's (WHO) international classification of disease version 11 (ICD-11) contains several features which enable improved classification of patient safety events. We have identified three suggestions to facilitate adoption of ICD-11 from the patient safety perspective. One, health system leaders at national, regional, and local levels should incorporate ICD-11 into all approaches to monitor patient safety. This will allow them to take advantage of the innovative patient safety classification methods embedded in ICD-11 to overcome several limitations related to existing patient safety surveillance methods. Two, application developers should incorporate ICD-11 into software solutions. This will accelerate adoption and utility of software-enabled clinical and administrative workflows relevant to patient safety management. This is enabled as a result of the ICD-11 application programming interface (or API) developed by the WHO. Third, health system leaders should adopt the ICD-11 using a continuous improvement framework. This will help leaders at national, regional and local levels to take advantage of specific existing initiatives which will be strengthened by ICD-11, including peer review comparisons, clinician engagement, and alignment of front-line safety efforts with post marketing surveillance of medical technologies. While the investment to adopt ICD-11 will be considerable, these will be offset by reducing the ongoing costs related to a lack of accurate routine information.
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Affiliation(s)
- Alan J Forster
- The Ottawa Hospital Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; and Faculty of Medicine, University of Ottawa, Ottawa, Canada.
| | - Christopher G Chute
- Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, USA
| | - Harold Alan Pincus
- Irving Institute for Clinical and Translational Research and Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - William A Ghali
- The Ottawa Hospital Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; and Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, USA
- Irving Institute for Clinical and Translational Research and Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
- Office of the Vice President Research; and, The O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
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Altabbaa G, Carpendale S, Flemons W, Hemmelgarn B, McLaughlin K, Zuk T, Ghali WA. Computerised clinical decision support system for the diagnosis of pulmonary thromboembolism: a preclinical pilot study. BMJ Open Qual 2023; 12:bmjoq-2022-001984. [PMID: 36927628 PMCID: PMC10030901 DOI: 10.1136/bmjoq-2022-001984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 03/04/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Recommendations for the diagnosis of pulmonary embolism are available for healthcare providers. Yet, real practice data show existing gaps in the translation of evidence-based recommendations. This is a study to assess the effect of a computerised decision support system (CDSS) with an enhanced design based on best practices in content and reasoning representation for the diagnosis of pulmonary embolism. DESIGN Randomised preclinical pilot study of paper-based clinical scenarios in the diagnosis of pulmonary embolism. Participants were clinicians (n=30) from three levels of experience: medical students, residents and physicians. Participants were randomised to two interventions for the diagnosis of pulmonary embolism: a didactic lecture versus a decision tree via a CDSS. The primary outcome of diagnostic pathway concordance (derived as a ratio of the number of correct diagnostic decision steps divided by the ideal number of diagnostic decision steps in diagnostic algorithms) was measured at baseline (five clinical scenarios) and after either intervention for a total of 10 clinical scenarios. RESULTS The mean of diagnostic pathway concordance improved in both study groups: baseline mean=0.73, post mean for the CDSS group=0.90 (p<0.001, 95% CI 0.10-0.24); baseline mean=0.71, post mean for didactic lecture group=0.85 (p<0.001, 95% CI 0.07-0.2). There was no statistically significant difference between the two study groups or between the three levels of participants. INTERPRETATION A computerised decision support system designed for both content and reasoning visualisation can improve clinicians' diagnostic decision-making.
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Affiliation(s)
- Ghazwan Altabbaa
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Ward Flemons
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Brenda Hemmelgarn
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kevin McLaughlin
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Torre Zuk
- Computer Sciences, University of Calgary, Calgary, Alberta, Canada
| | - William A Ghali
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Peng M, Southern DA, Ocampo W, Kaufman J, Hogan DB, Conly J, Baylis BW, Stelfox HT, Ho C, Ghali WA. Exploring data reduction strategies in the analysis of continuous pressure imaging technology. BMC Med Res Methodol 2023; 23:56. [PMID: 36859239 PMCID: PMC9976437 DOI: 10.1186/s12874-023-01875-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 02/21/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Science is becoming increasingly data intensive as digital innovations bring new capacity for continuous data generation and storage. This progress also brings challenges, as many scientific initiatives are challenged by the shear volumes of data produced. Here we present a case study of a data intensive randomized clinical trial assessing the utility of continuous pressure imaging (CPI) for reducing pressure injuries. OBJECTIVE To explore an approach to reducing the amount of CPI data required for analyses to a manageable size without loss of critical information using a nested subset of pressure data. METHODS Data from four enrolled study participants excluded from the analytical phase of the study were used to develop an approach to data reduction. A two-step data strategy was used. First, raw data were sampled at different frequencies (5, 30, 60, 120, and 240 s) to identify optimal measurement frequency. Second, similarity between adjacent frames was evaluated using correlation coefficients to identify position changes of enrolled study participants. Data strategy performance was evaluated through visual inspection using heat maps and time series plots. RESULTS A sampling frequency of every 60 s provided reasonable representation of changes in interface pressure over time. This approach translated to using only 1.7% of the collected data in analyses. In the second step it was found that 160 frames within 24 h represented the pressure states of study participants. In total, only 480 frames from the 72 h of collected data would be needed for analyses without loss of information. Only ~ 0.2% of the raw data collected would be required for assessment of the primary trial outcome. CONCLUSIONS Data reduction is an important component of big data analytics. Our two-step strategy markedly reduced the amount of data required for analyses without loss of information. This data reduction strategy, if validated, could be used in other CPI and other settings where large amounts of both temporal and spatial data must be analysed.
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Affiliation(s)
- Mingkai Peng
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Danielle A Southern
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Wrechelle Ocampo
- W21C Research and Innovation Centre, Cumming School of Medicine, GD01 Teaching Research & Wellness Building, University of Calgary, 3280 Hospital Drive, Calgary, NW, Canada
| | - Jaime Kaufman
- W21C Research and Innovation Centre, Cumming School of Medicine, GD01 Teaching Research & Wellness Building, University of Calgary, 3280 Hospital Drive, Calgary, NW, Canada
| | - David B Hogan
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.,W21C Research and Innovation Centre, Cumming School of Medicine, GD01 Teaching Research & Wellness Building, University of Calgary, 3280 Hospital Drive, Calgary, NW, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - John Conly
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.,W21C Research and Innovation Centre, Cumming School of Medicine, GD01 Teaching Research & Wellness Building, University of Calgary, 3280 Hospital Drive, Calgary, NW, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada.,Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Foothills Medical Centre, Special Services Building, Ground Floor, AGW5, Calgary, AB, T2N 2T9, Canada
| | - Barry W Baylis
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.,W21C Research and Innovation Centre, Cumming School of Medicine, GD01 Teaching Research & Wellness Building, University of Calgary, 3280 Hospital Drive, Calgary, NW, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Foothills Medical Centre, Special Services Building, Ground Floor, AGW5, Calgary, AB, T2N 2T9, Canada
| | - Henry T Stelfox
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Alberta, Canada
| | - Chester Ho
- Department of Medicine, Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - William A Ghali
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada. .,W21C Research and Innovation Centre, Cumming School of Medicine, GD01 Teaching Research & Wellness Building, University of Calgary, 3280 Hospital Drive, Calgary, NW, Canada. .,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Division of General Internal Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Eastwood CA, Southern DA, Khair S, Doktorchik C, Cullen D, Ghali WA, Quan H. Field testing a new ICD coding system: methods and early experiences with ICD-11 Beta Version 2018. BMC Res Notes 2022; 15:343. [DOI: 10.1186/s13104-022-06238-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Objective
A beta version (2018) of International Classification of Diseases, 11th Revision for MMS (ICD-11), needed testing. Field-testing involves real-world application of the new codes to examine usability. We describe creating a dataset and characterizing the usability of ICD-11 code set by coders. We compare ICD-11 against ICD-10-CA (Canadian modification) and a reference standard dataset of diagnoses. Real-world usability encompasses code selection and time to code a complete inpatient chart using ICD-11 compared with ICD-10-CA.
Methods and results
A random sample of inpatient records previously coded using ICD-10-CA was selected from hospitals in Calgary, Alberta (N = 2896). Nurses examined these charts for conditions and healthcare-related harms. Clinical coders re-coded the same charts using ICD-11 codes. Inter-rater reliability (IRR) and coding time improved with ICD-11 coding experience (23.6 to 9.9 min average per chart). Code structure comparisons and challenges encountered are described. Overall, 86.3% of main condition codes matched. Coder comments regarding duplicate codes, missing codes, code finding issues enabled improvements to the ICD-11 Browser, Coding Tool, and Reference Guide. Training is essential for solid IRR with 17,000 diagnostic categories in the new ICD-11. As countries transition to ICD-11, our coding experiences and methods can inform users for implementation or field testing.
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Perera T, Grewal E, Ghali WA, Tang KL. Perceived discharge quality and associations with hospital readmissions and emergency department use: a prospective cohort study. BMJ Open Qual 2022; 11:bmjoq-2022-001875. [PMID: 36375857 PMCID: PMC9664267 DOI: 10.1136/bmjoq-2022-001875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background At hospital discharge, care is handed over from providers to patients. Discharge encounters must prepare patients to self-manage their health, but have been found to be suboptimal. Our study objectives were to describe and determine the correlates of perceived discharge quality and to explore the association between perceived discharge quality and postdischarge outcomes. Methods We conducted a prospective cohort study in medical inpatients admitted to a tertiary care hospital in Calgary, Canada. Perceived discharge quality was measured by the Care Transitions Measure (CTM). Linkage to administrative databases provided data for the composite outcome—90-day hospital readmission or emergency department visit. Logistic regression modelling was used to determine the association between global CTM scores, and the individual CTM components, and the composite outcome. Results A total of 316 patients were included in the analysis. The median CTM score was 80.0 (IQR 66.6–100.0). The distribution of CTM scores were significantly different based on comorbidity burden, with the median and maximum CTM scores being lower and the IQR being narrower, for those with six or more comorbidities compared with those with fewer comorbidities. CTM scores were not associated with the composite outcome, though a single CTM item—not understanding warning signs and symptoms—was (adjusted OR 3.46 (95% CI 1.02 to 11.73)). Conclusion Perceived quality of discharge varies based on patient burden of comorbidities. While global perceived discharge quality was not associated with postdischarge outcomes, lack of patient understanding of warning symptoms was. Discharging healthcare teams should pay special attention to these priority patient groups and specific discharge process components.
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Affiliation(s)
- Tefani Perera
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Eshleen Grewal
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - William A Ghali
- Office of the Vice President (Research), University of Calgary, Calgary, Alberta, Canada.,O' Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Karen L Tang
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada .,O' Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Wu G, Eastwood C, Zeng Y, Quan H, Long Q, Zhang Z, Ghali WA, Bakal J, Boussat B, Flemons W, Forster A, Southern DA, Knudsen S, Popowich B, Xu Y. Developing EMR-based algorithms to Identify hospital adverse events for health system performance evaluation and improvement: Study protocol. PLoS One 2022; 17:e0275250. [PMID: 36197944 PMCID: PMC9534418 DOI: 10.1371/journal.pone.0275250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022] Open
Abstract
Background Measurement of care quality and safety mainly relies on abstracted administrative data. However, it is well studied that administrative data-based adverse event (AE) detection methods are suboptimal due to lack of clinical information. Electronic medical records (EMR) have been widely implemented and contain detailed and comprehensive information regarding all aspects of patient care, offering a valuable complement to administrative data. Harnessing the rich clinical data in EMRs offers a unique opportunity to improve detection, identify possible risk factors of AE and enhance surveillance. However, the methodological tools for detection of AEs within EMR need to be developed and validated. The objectives of this study are to develop EMR-based AE algorithms from hospital EMR data and assess AE algorithm’s validity in Canadian EMR data. Methods Patient EMR structured and text data from acute care hospitals in Calgary, Alberta, Canada will be linked with discharge abstract data (DAD) between 2010 and 2020 (n~1.5 million). AE algorithms development. First, a comprehensive list of AEs will be generated through a systematic literature review and expert recommendations. Second, these AEs will be mapped to EMR free texts using Natural Language Processing (NLP) technologies. Finally, an expert panel will assess the clinical relevance of the developed NLP algorithms. AE algorithms validation: We will test the newly developed AE algorithms on 10,000 randomly selected EMRs between 2010 to 2020 from Calgary, Alberta. Trained reviewers will review the selected 10,000 EMR charts to identify AEs that had occurred during hospitalization. Performance indicators (e.g., sensitivity, specificity, positive predictive value, negative predictive value, F1 score, etc.) of the developed AE algorithms will be assessed using chart review data as the reference standard. Discussion The results of this project can be widely implemented in EMR based healthcare system to accurately and timely detect in-hospital AEs.
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Affiliation(s)
- Guosong Wu
- Centre for Health Informatics, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cathy Eastwood
- Centre for Health Informatics, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yong Zeng
- Concordia Institute for Information Systems Engineering, Gina Cody School of Engineering and Computer Science, Concordia University, Montreal, Quebec, Canada
| | - Hude Quan
- Centre for Health Informatics, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Quan Long
- Department of Biochemistry and Molecular Biology, Department of Medical Genetics, Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Zilong Zhang
- Centre for Health Informatics, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - William A. Ghali
- Office of Vice President of Research & O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey Bakal
- Centre for Health Informatics, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Provincial Research Data Services, Data and Analytics, Alberta Health Services, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - Bastien Boussat
- Clinical Epidemiology and Quality of Care Unit, University Grenoble Alpes, Faculty of Medicine, Grenoble University Hospital, France
| | - Ward Flemons
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alan Forster
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Danielle A. Southern
- Centre for Health Informatics, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Søren Knudsen
- Digital Design Department, IT University of Copenhagen, Copenhagen, Denmark
| | - Brittany Popowich
- Centre for Health Informatics, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yuan Xu
- Centre for Health Informatics, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
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10
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Sundararajan V, Le Pogam MA, Southern DA, Pincus HA, Ghali WA. Coding mechanisms for diagnosis timing in the International Classification of Diseases, Version 11. BMC Med Inform Decis Mak 2022; 21:382. [PMID: 36114489 PMCID: PMC9479247 DOI: 10.1186/s12911-022-01990-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/09/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Diagnoses that arise after admission are of interest because they can represent complications of health care, acute conditions arising de novo, or acute decompensation of a chronic comorbidity occurring during the hospital stay. Three countries in the world have adopted diagnosis timing codes for a number of years. Their experience demonstrates the feasibility and utility of associating an International Classification of Diseases, Version 9 or International Classification of Diseases, Version 10 diagnostic code with information on diagnosis timing, either as part of a diagnostic field or as a separate field. However, diagnosis timing is not an integrated feature of these two classifications as it will be for International Classification of Diseases, Version 11.
Methods
We examine the different types of diagnosis timing that can be used to describe complex patients and present examples of how the new International Classification of Diseases, Version 11 codes may be used.
Results
Extension codes are one of the important new features of International Classification of Diseases, Version 11 and allow more specificity in diagnosis timing.
Conclusion
Imbedded and standardized diagnosis timing information is possible within the International Classification of Diseases, Version 11 classification system.
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11
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James MT, Har BJ, Tyrrell BD, Faris PD, Tan Z, Spertus JA, Wilton SB, Ghali WA, Knudtson ML, Sajobi TT, Pannu NI, Klarenbach SW, Graham MM. Effect of Clinical Decision Support With Audit and Feedback on Prevention of Acute Kidney Injury in Patients Undergoing Coronary Angiography: A Randomized Clinical Trial. JAMA 2022; 328:839-849. [PMID: 36066520 PMCID: PMC9449791 DOI: 10.1001/jama.2022.13382] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Contrast-associated acute kidney injury (AKI) is a common complication of coronary angiography and percutaneous coronary intervention (PCI) that has been associated with high costs and adverse long-term outcomes. OBJECTIVE To determine whether a multifaceted intervention is effective for the prevention of AKI after coronary angiography or PCI. DESIGN, SETTING, AND PARTICIPANTS A stepped-wedge, cluster randomized clinical trial was conducted in Alberta, Canada, that included all invasive cardiologists at 3 cardiac catheterization laboratories who were randomized to various start dates for the intervention between January 2018 and September 2019. Eligible patients were aged 18 years or older who underwent nonemergency coronary angiography, PCI, or both; who were not undergoing dialysis; and who had a predicted AKI risk of greater than 5%. Thirty-four physicians performed 7820 procedures among 7106 patients who met the inclusion criteria. Participant follow-up ended in November 2020. INTERVENTIONS During the intervention period, cardiologists received educational outreach, computerized clinical decision support on contrast volume and hemodynamic-guided intravenous fluid targets, and audit and feedback. During the control (preintervention) period, cardiologists provided usual care and did not receive the intervention. MAIN OUTCOMES AND MEASURES The primary outcome was AKI. There were 12 secondary outcomes, including contrast volume, intravenous fluid administration, and major adverse cardiovascular and kidney events. The analyses were conducted using time-adjusted models. RESULTS Of the 34 participating cardiologists who were divided into 8 clusters by practice group and center, the intervention group included 31 who performed 4327 procedures among 4032 patients (mean age, 70.3 [SD, 10.7] years; 1384 were women [32.0%]) and the control group included 34 who performed 3493 procedures among 3251 patients (mean age, 70.2 [SD, 10.8] years; 1151 were women [33.0%]). The incidence of AKI was 7.2% (310 events after 4327 procedures) during the intervention period and 8.6% (299 events after 3493 procedures) during the control period (between-group difference, -2.3% [95% CI, -0.6% to -4.1%]; odds ratio [OR], 0.72 [95% CI, 0.56 to 0.93]; P = .01). Of 12 prespecified secondary outcomes, 8 showed no significant difference. The proportion of procedures in which excessive contrast volumes were used was reduced to 38.1% during the intervention period from 51.7% during the control period (between-group difference, -12.0% [95% CI, -14.4% to -9.4%]; OR, 0.77 [95% CI, 0.65 to 0.90]; P = .002). The proportion of procedures in eligible patients in whom insufficient intravenous fluid was given was reduced to 60.8% during the intervention period from 75.1% during the control period (between-group difference, -15.8% [95% CI, -19.7% to -12.0%]; OR, 0.68 [95% CI, 0.53 to 0.87]; P = .002). There were no significant between-group differences in major adverse cardiovascular events or major adverse kidney events. CONCLUSIONS AND RELEVANCE Among cardiologists randomized to an intervention including clinical decision support with audit and feedback, patients undergoing coronary procedures during the intervention period were less likely to develop AKI compared with those treated during the control period, with a time-adjusted absolute risk reduction of 2.3%. Whether this intervention would show efficacy outside this study setting requires further investigation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03453996.
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Affiliation(s)
- Matthew T. James
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Bryan J. Har
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Benjamin D. Tyrrell
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- CK Hui Heart Centre, University of Alberta, Edmonton, Canada
| | | | - Zhi Tan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - John A. Spertus
- Departments of Biomedical and Health Informatics, University of Missouri, Kansas City
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Stephen B. Wilton
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - William A. Ghali
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Merril L. Knudtson
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tolulope T. Sajobi
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Neesh I. Pannu
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Scott W. Klarenbach
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Michelle M. Graham
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
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12
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Ludlow NC, de Grood J, Yang C, Murphy S, Berg S, Leischner R, McBrien KA, Santana MJ, Leslie M, Clement F, Cepoiu-Martin M, Ghali WA, McCaughey D. A multi-step approach to developing a health system evaluation framework for community-based health care. BMC Health Serv Res 2022; 22:889. [PMID: 35804388 PMCID: PMC9270820 DOI: 10.1186/s12913-022-08241-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background Community-based health care (CBHC) is a shift towards healthcare integration and community services closer to home. Variation in system approaches harkens the need for a conceptual framework to evaluate outcomes and impacts. We set out to develop a CBHC-specific evaluation framework in the context of a provincial ministry of health planning process in Canada. Methods A multi-step approach was used to develop the CBHC evaluation framework. Modified Delphi informed conceptualization and prioritization of indicators. Formative research identified evaluation framework elements (triple aim, global measures, and impact), health system levels (tiers), and potential CBHC indicators (n = 461). Two Delphi rounds were held. Round 1, panelists independently ranked indicators on CBHC relevance and health system tiering. Results were analyzed by coding agreement/disagreement frequency and central tendency measures. Round 2, a consensus meeting was used to discuss disagreement, identify Tier 1 indicators and concepts, and define indicators not relevant to CBHC (Tier 4). Post-Delphi, indicators and concepts were refined, Tier 1 concepts mapped to the evaluation framework, and indicator narratives developed. Three stakeholder consultations (scientific, government, and public/patient communities) were held for endorsement and recommendation. Results Round 1 Delphi results showed agreement for 300 and disagreement for 161 indicators. Round 2 consensus resulted in 103 top tier indicators (Tier 1 = 19, Tier 2 = 84), 358 bottom Tier 3 and 4 indicators, non-CBHC measure definitions, and eight Tier 1 indicator concepts—Mortality/Suicide; Quality of Life, and Patient Reported Outcome Measures; Global Patient Reported Experience Measures; Cost of Care, Access to Integrated Primary Care; Avoidable Emergency Department Use; Avoidable Hospitalization; and E-health Penetration. Post Delphi results refined Tier 3 (n = 289) and 4 (n = 69) indicators, and identified 18 Tier 2 and 3 concepts. When mapped to the evaluation framework, Tier 1 concepts showed full coverage across the elements. ‘Indicator narratives’ depicted systemness and integration for evaluating CBHC. Stakeholder consultations affirmed endorsement of the approach and evaluation framework; refined concepts; and provided key considerations to further operationalize and contextualize indicators, and evaluate CBHC as a health system approach. Conclusions This research produced a novel evaluation framework to conceptualize and evaluate CBHC initiatives. The evaluation framework revealed the importance of a health system approach for evaluating CBHC.
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Affiliation(s)
- Natalie C Ludlow
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Jill de Grood
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Connie Yang
- Department of Human Centered Design & Engineering, University of Washington, Seattle, USA
| | - Sydney Murphy
- Faculty of Law, University of Calgary, Calgary, AB, Canada
| | - Shannon Berg
- Department of Health, Government of Alberta, Edmonton, AB, Canada
| | - Rick Leischner
- Department of Health, Government of Alberta, Edmonton, AB, Canada
| | - Kerry A McBrien
- Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Maria J Santana
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Myles Leslie
- School of Public Policy and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Fiona Clement
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Monica Cepoiu-Martin
- Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - William A Ghali
- Office of the Vice-President (Research), University of Calgary, Calgary, AB, Canada
| | - Deirdre McCaughey
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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13
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White DE, Norris JM, Southern DA, Wasylak T, Ghali WA. Strategic Clinical Network Teams Improve Effectiveness, Team and Leadership Processes and Inputs: Theory-Based Longitudinal Survey. Healthc Q 2022; 25:54-62. [PMID: 36153685 DOI: 10.12927/hcq.2022.26888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Strategic Clinical Networks (SCNs) in Alberta include multidisciplinary teams that work toward health system innovation and improvement; however, what contributes to team effectiveness is unclear. This theory-informed longitudinal survey (n = 826) evaluated team effectiveness within SCNs and predictors of effectiveness. Satisfaction, inter-team relationships and seven predictors including team inputs and team and leadership processes improved over two years. Attitudinal outputs were predicted by the same factors over time, whereas performance outputs were predicted by different factors. This innovative study emphasizes that SCN teams and their effectiveness evolve over time and that team-based research can refine network evaluations.
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Affiliation(s)
- Deborah E White
- Dean and professor at the University of Calgary in Qatar, Doha. She can be reached by e-mail at
| | | | - Danielle A Southern
- A senior research associate at the Centre for Health Informatics at the University of Calgary in Calgary, AB
| | - Tracy Wasylak
- The chief program officer of Strategic Clinical Networks, Alberta Health Services, and adjunct professor in the Faculty of Nursing, University of Calgary in Calgary, AB
| | - William A Ghali
- Vice president (research) at the University of Calgary in Calgary, AB
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14
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Tang KL, Sajobi T, Santana MJ, Lawal O, Tesorero L, Ghali WA. Development and validation of a social vulnerabilities survey for medical inpatients. BMJ Open 2022; 12:e059788. [PMID: 36691233 PMCID: PMC9171274 DOI: 10.1136/bmjopen-2021-059788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/16/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Our objective was to validate a Social Vulnerabilities Survey that was developed to identify patient barriers in the following domains: (1) salience or priority of health; (2) social support; (3) transportation; and (4) finances. DESIGN Cross-sectional psychometric study.Questions for one domain (health salience) were developed de novo while questions for the other domains were derived from national surveys and/or previously validated questionnaires. We tested construct (ie, convergent and discriminative) validity for these new questions through hypothesis testing of correlations between question responses and patient characteristics. Exploratory factor analysis was conducted to determine structural validity of the survey as a whole. SETTING Patients admitted to the inpatient internal medicine service at a tertiary care hospital in Calgary, Canada. PARTICIPANTS A total of 406 patients were included in the study. RESULTS The mean age of respondents was 55.5 (SD 18.6) years, with the majority being men (55.4%). In feasibility testing of the first 107 patients, the Social Vulnerabilities Survey was felt to be acceptable, comprehensive and met face validity. Hypothesis testing of the health salience questions revealed that the majority of observed correlations were exactly as predicted. Exploratory factor analysis of the global survey revealed the presence of five factors (eigenvalue >1): social support, health salience, drug insurance, transportation barriers and drug costs. All but four questions loaded to these five factors. CONCLUSIONS The Social Vulnerabilities Survey has face, construct and structural validity. It can be used to measure modifiable social vulnerabilities, such that their effects on health outcomes can be explored and understood.
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Affiliation(s)
- Karen L Tang
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tolulope Sajobi
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maria-Jose Santana
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Oluwaseyi Lawal
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - William A Ghali
- Office of the Vice President (Research), University of Calgary, Calgary, Alberta, Canada
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15
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Southern DA, Harrison JE, Romano PS, Le Pogam MA, Pincus HA, Ghali WA. The three-part model for coding causes and mechanisms of healthcare-related adverse events. BMC Med Inform Decis Mak 2022; 21:376. [PMID: 35209889 PMCID: PMC8867615 DOI: 10.1186/s12911-022-01786-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/15/2022] [Indexed: 11/25/2022] Open
Abstract
ICD-11 provides a promising new way to capture healthcare-related harm or injury. In this paper, we elaborate on the framework for describing healthcare-related events where there is a presumed causal link between an event and underlying healthcare-related factors. The three-part model for describing healthcare-related harm or injury in ICD-11 consists of (1) a healthcare-related activity that is the cause of injury or other harm (selected from Chapter 23 of ICD-11); (2) a mode or mechanism of injury or harm, related to the underlying cause (also from Chapter 23 of ICD-11); and (3) the harmful consequences of the event to the patient, selected from any of Chapters 1 through 22 of ICD-11 (most importantly, the injury or harm experienced by the patient). Concepts from these three elements are linked/clustered through postcoordination to reflect the three-part model in a single coded expression. ICD-11 contains many novel features, and the three-part model described here for healthcare-related adverse events is a notable example.
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Affiliation(s)
- Danielle A Southern
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James E Harrison
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Patrick S Romano
- Division of General Medicine, University of California-Davis School of Medicine, Sacramento, CA, USA
| | - Marie-Annick Le Pogam
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Harold A Pincus
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA.,Irving Institute for Clinical and Translational Research, Columbia University and New York-Presbyterian Hospital, New York, NY, USA.,RAND Corporation, Pittsburgh, PA, USA
| | - William A Ghali
- Office of Vice President of Research, University of Calgary, Calgary, AB, Canada.
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16
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Tang KL, Ghali WA. Patient Navigation—Exploring the Undefined. JAMA Health Forum 2021; 2:e213706. [DOI: 10.1001/jamahealthforum.2021.3706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Karen L. Tang
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - William A. Ghali
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Office of the Vice President (Research), University of Calgary, Calgary, Alberta, Canada
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17
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Nobrega DB, Tang KL, Caffrey NP, De Buck J, Cork SC, Ronksley PE, Polachek AJ, Ganshorn H, Sharma N, Kastelic JP, Kellner JD, Ghali WA, Barkema HW. Prevalence of antimicrobial resistance genes and its association with restricted antimicrobial use in food-producing animals: a systematic review and meta-analysis. J Antimicrob Chemother 2021; 76:561-575. [PMID: 33146719 DOI: 10.1093/jac/dkaa443] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/28/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There is ongoing debate regarding potential associations between restrictions of antimicrobial use and prevalence of antimicrobial resistance (AMR) in bacteria. OBJECTIVES To summarize the effects of interventions reducing antimicrobial use in food-producing animals on the prevalence of AMR genes (ARGs) in bacteria from animals and humans. METHODS We published a full systematic review of restrictions of antimicrobials in food-producing animals and their associations with AMR in bacteria. Herein, we focus on studies reporting on the association between restricted antimicrobial use and prevalence of ARGs. We used multilevel mixed-effects models and a semi-quantitative approach based on forest plots to summarize findings from studies. RESULTS A positive effect of intervention [reduction in prevalence or number of ARGs in group(s) with restricted antimicrobial use] was reported from 29 studies for at least one ARG. We detected significant associations between a ban on avoparcin and diminished presence of the vanA gene in samples from animals and humans, whereas for the mecA gene, studies agreed on a positive effect of intervention in samples only from animals. Comparisons involving mcr-1, blaCTX-M, aadA2, vat(E), sul2, dfrA5, dfrA13, tet(E) and tet(P) indicated a reduced prevalence of genes in intervention groups. Conversely, no effects were detected for β-lactamases other than blaCTX-M and the remaining tet genes. CONCLUSIONS The available body of scientific evidence supported that restricted use of antimicrobials in food animals was associated with an either lower or equal presence of ARGs in bacteria, with effects dependent on ARG, host species and restricted drug.
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Affiliation(s)
- Diego B Nobrega
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada.,Mastitis Network, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Karen L Tang
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Niamh P Caffrey
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Jeroen De Buck
- Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Susan C Cork
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alicia J Polachek
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Heather Ganshorn
- Libraries and Cultural Resources, University of Calgary, Calgary, AB, Canada
| | - Nishan Sharma
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - John P Kastelic
- Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - James D Kellner
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - William A Ghali
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Herman W Barkema
- Mastitis Network, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada.,Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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18
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Tang KL, Kelly J, Sharma N, Ghali WA. Patient navigation programs in Alberta, Canada: an environmental scan. CMAJ Open 2021; 9:E841-E847. [PMID: 34493550 PMCID: PMC8428899 DOI: 10.9778/cmajo.20210004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patient navigation is a complex intervention that has garnered substantial interest and investment across Canada. We conducted an environmental scan to understand the landscape of patient navigation programs within the health care system in Alberta, Canada. METHODS We included patient navigation programs within Alberta Health Services (AHS) and Alberta's Primary Care Networks (PCNs). Key informants were asked in October 2016 to identify existing programs and their corresponding program contacts. These program contacts were invited to complete a telephone-based survey from October 2016 to July 2017, to provide program descriptions and eligibility criteria, and to identify gaps in navigation. Programs were included if they engaged patients on an individual basis, and either facilitated continuity of care or promoted patient and family empowerment. We tabulated results and calculated summary statistics for program characteristics. RESULTS Ninety-five potentially eligible programs were identified by key informants. The response rate to the study survey was 73% (n = 69). After excluding programs not meeting inclusion criteria, we included a total of 58 programs in the study: 43 AHS programs and 15 PCN programs. Nearly all programs (93%, n = 54) delivered navigation via an individual acting as a navigator. A minority of programs also included nonnavigator components, such as Web-based resources (7%, n = 4) and process or structural changes to facilitate navigation (22%, n = 13). Certain patient subgroups were particularly well-served by patient navigation; these included patients with cancer, substance use disorders or mental health concerns, and pediatric patients. Gaps identified in navigation fell under 4 domains: awareness, resources, geographic distribution and integration. INTERPRETATION Patient navigation programs are common and have extended beyond cancer care, from which the construct originated; however, gaps include a lack of awareness and inequitable access to the programs. These findings will be of interest to those developing and implementing patient navigation interventions in Alberta and other jurisdictions.
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Affiliation(s)
- Karen L Tang
- Department of Medicine (Tang); Department of Community Health Sciences (Tang, Sharma); O' Brien Institute for Public Health (Tang, Ghali); W21C Research and Innovation Centre, Cumming School of Medicine (Kelly, Sharma); Office of the Vice-President (Research) (Ghali), University of Calgary, Calgary, Alta.
| | - Jenny Kelly
- Department of Medicine (Tang); Department of Community Health Sciences (Tang, Sharma); O' Brien Institute for Public Health (Tang, Ghali); W21C Research and Innovation Centre, Cumming School of Medicine (Kelly, Sharma); Office of the Vice-President (Research) (Ghali), University of Calgary, Calgary, Alta
| | - Nishan Sharma
- Department of Medicine (Tang); Department of Community Health Sciences (Tang, Sharma); O' Brien Institute for Public Health (Tang, Ghali); W21C Research and Innovation Centre, Cumming School of Medicine (Kelly, Sharma); Office of the Vice-President (Research) (Ghali), University of Calgary, Calgary, Alta
| | - William A Ghali
- Department of Medicine (Tang); Department of Community Health Sciences (Tang, Sharma); O' Brien Institute for Public Health (Tang, Ghali); W21C Research and Innovation Centre, Cumming School of Medicine (Kelly, Sharma); Office of the Vice-President (Research) (Ghali), University of Calgary, Calgary, Alta
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19
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Boussat B, Quan H, Labarere J, Southern D, Couris CM, Ghali WA. Mitigating imperfect data validity in administrative data PSIs: a method for estimating true adverse event rates. Int J Qual Health Care 2021; 33:6129200. [PMID: 33544120 DOI: 10.1093/intqhc/mzab025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/22/2020] [Accepted: 02/04/2021] [Indexed: 11/12/2022] Open
Abstract
QUESTION Are there ways to mitigate the challenges associated with imperfect data validity in Patient Safety Indicator (PSI) report cards? FINDINGS Applying a methodological framework on simulated PSI report card data, we compare the adjusted PSI rates of three hospitals with variable quality of data and coding. This framework combines (i) a measure of PSI rates using existing algorithms; (ii) a medical record review on a small random sample of charts to produce a measure of hospital-specific data validity and (iii) a simple Bayesian calculation to derive estimated true PSI rates. For example, the estimated true PSI rate, for a theoretical hospital with a moderately good quality of coding, could be three times as high as the measured rate (for example, 1.4% rather than 0.5%). For a theoretical hospital with relatively poor quality of coding, the difference could be 50-fold (for example, 5.0% rather than 0.1%). MEANING Combining a medical chart review on a limited number of medical charts at the hospital level creates an approach to producing health system report cards with estimates of true hospital-level adverse event rates.
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Affiliation(s)
- Bastien Boussat
- Department of Community Health Sciences, Cumming School of Medicine, O'Brien Institute for Public Health, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 1N4, Canada.,Quality of Care Unit, Grenoble University Hospital, Boulevard de la Chantourne, 38043 cedex 09, Grenoble, France.,TIMC UMR 5525 CNRS, Computational and Mathematical Biology Team, Grenoble Alpes University, Boulevard de la Chantourne, Pavillon Taillefer, 38043 cedex 09, Grenoble, France
| | - Hude Quan
- Department of Community Health Sciences, Cumming School of Medicine, O'Brien Institute for Public Health, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 1N4, Canada
| | - Jose Labarere
- Quality of Care Unit, Grenoble University Hospital, Boulevard de la Chantourne, 38043 cedex 09, Grenoble, France.,TIMC UMR 5525 CNRS, Computational and Mathematical Biology Team, Grenoble Alpes University, Boulevard de la Chantourne, Pavillon Taillefer, 38043 cedex 09, Grenoble, France
| | - Danielle Southern
- Department of Community Health Sciences, Cumming School of Medicine, O'Brien Institute for Public Health, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 1N4, Canada
| | - Chantal M Couris
- Canadian Institute for Health Information, Indicator Research and Development Team, Research and Analysis Division, 4110 Yonge Street, Suite 300, Toronto, ON M2P 2B7, Canada
| | - William A Ghali
- Department of Community Health Sciences, Cumming School of Medicine, O'Brien Institute for Public Health, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 1N4, Canada
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Ori EM, Berry TR, McCormack GR, Brett KR, Lambros GA, Ghali WA. Leveraging Professional Sports Teams to Encourage Healthy Behavior: A Review of 4 Years of Calgary Flames Health Training Camp Events. Front Public Health 2020; 8:553434. [PMID: 33330306 PMCID: PMC7716346 DOI: 10.3389/fpubh.2020.553434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 10/15/2020] [Indexed: 11/13/2022] Open
Abstract
Professional sporting teams may be well-positioned to act as promoters of health behaviors given their fixture within a community, and association with physical activity, nutrition, and other healthy behaviors. Over 4 years, the Calgary Flames Sport and Entertainment Corporation in conjunction with local health promotion professionals, delivered a health promotion event to the public, The Calgary Flames Health Training Camp (FHTC) in Calgary, Alberta, Canada. The purpose of these annual events has been to inspire and encourage healthy behavior uptake and adherence. A description of the FHTC over each of 4 years (2015–2018), lessons learned, and some evaluative work done alongside the event on 2 of the 4 years. In 2017, self-report surveys were administered to event attendees to assess current health status including physical activity, socio-cognitive variables, health information preference, and intention to make healthful behavior change based on event attendance. Biometric data was collected including blood pressure, height, weight, and resting heart rate. Evaluations of the four consecutive events showed that the Calgary Flames Sport and Entertainment Corporation has an ability to attract substantial numbers of the general public to attend FHTC events. Self-report measures from 2017 suggest that already-active populations may be most interested in attending however, the events do appear to inspire attendees to consider behavioral changes for health. The events helped to identify individuals with health risks requiring medical attention but has not yet resulted in known behavior changes. Positive community health impacts may arise from collaboration between health promoters and professional sporting organizations.
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Affiliation(s)
- Elaine M Ori
- Faculty of Health, Community and Education, Mount Royal University, Calgary, AB, Canada.,Faculty of Kinesiology, Recreation and Sport, University of Alberta, Edmonton, AB, Canada
| | - Tanya R Berry
- Faculty of Kinesiology, Recreation and Sport, University of Alberta, Edmonton, AB, Canada
| | - Gavin R McCormack
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | | | | | - William A Ghali
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
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Lawal OA, Awosoga O, Santana MJ, James MT, Southern DA, Wilton SB, Graham MM, Knudtson M, Lu M, Quan H, Ghali WA, Norris CM, Sajobi T. Psychometric evaluation of a Canadian version of the Seattle Angina Questionnaire (SAQ-CAN). Health Qual Life Outcomes 2020; 18:377. [PMID: 33261627 PMCID: PMC7706021 DOI: 10.1186/s12955-020-01627-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/16/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The Seattle Angina Questionnaire (SAQ) is a widely-used patient-reported outcomes measure in patients with heart disease. This study assesses the validity and reliability of the SAQ in a Canadian cohort of individuals with stable angina. METHODS AND RESULTS Data are from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) registry, a population-based registry of patients who received cardiac catheterization in Alberta, Canada. The cohort consists of 4052 patients undergoing cardiac catheterization for stable angina and completed the SAQ within 2 weeks. Exploratory factor analysis and confirmatory factor analysis (CFA) were used to assess the factorial structure of the SAQ. Internal and test-retest reliabilities of a new measure (i.e., SAQ-CAN) was measured using Cronbach α and intraclass correlation coefficient, respectively. CFA model fit was assessed using the root mean square error of approximation (RMSEA) and comparative fit index (CFI). Construct validity of the SAQ-CAN was assessed in relation to Hospital Anxiety and Depression Scales (HADS), Euro Quality of life 5 dimension (EQ5D), and original SAQ. Of the 4052 patients included in this analysis, 3281 (80.97%) were younger than 75 years old, while 3239 (79.94%) were male. Both exploratory and confirmatory factor analyses revealed a four-factorial structure consisting of 16 items that provided a better fit to the data (RMSEA = 0.049 [90% CI = (0.047, 0.052)]; CFI = 0.975). The 16-item SAQ demonstrated good to excellent internal reliability (Cronbach's α range from 0.77 to 0.90), moderate to strong correlation with the Original SAQ and EQ5D but negligible correlations with HADS. CONCLUSION The SAQ-CAN has acceptable psychometric properties that are comparable to the original SAQ. We recommend its use for assessing coronary health outcomes in Canadian patients with Coronary Artery Disease.
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Affiliation(s)
- Oluwaseyi A Lawal
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada
| | | | - Maria J Santana
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada
| | - Matthew T James
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada
| | - Danielle A Southern
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada
| | - Stephen B Wilton
- Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Michelle M Graham
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Merrill Knudtson
- Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Mingshan Lu
- Department of Economics, University of Calgary, Calgary, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada
| | - William A Ghali
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada
| | | | - Tolulope Sajobi
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada.
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22
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Liu X, Bertazzon S, Villeneuve PJ, Johnson M, Stieb D, Coward S, Tanyingoh D, Windsor JW, Underwood F, Hill MD, Rabi D, Ghali WA, Wilton SB, James MT, Graham M, McMurtry MS, Kaplan GG. Temporal and spatial effect of air pollution on hospital admissions for myocardial infarction: a case-crossover study. CMAJ Open 2020; 8:E619-E626. [PMID: 33037069 PMCID: PMC7567508 DOI: 10.9778/cmajo.20190160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In studies showing associations between ambient air pollution and myocardial infarction (MI), data have been lacking on the inherent spatial variability of air pollution. The aim of this study was to determine whether the long-term spatial distribution of air pollution influences short-term temporal associations between air pollution and admission to hospital for MI. METHODS We identified adults living in Calgary who were admitted to hospital for an MI between 2004 and 2012. We evaluated associations between short-term exposure to air pollution (ozone [O3], nitrogen dioxide [NO2], sulfur dioxide [SO2], carbon monoxide [CO], particulate matter < 10 μm in diameter [PM10] and particulate matter < 2.5 μm in diameter [PM2.5]), and hospital admissions for MI using a time-stratified, case-crossover study design. Air Quality Health Index (AQHI) scores were calculated from a composition of O3, NO2 and PM2.5. Conditional logistic regression models were stratified by low, medium and high levels of neighbourhood NO2 concentrations derived from land use regression models; results of these analyses are presented as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS From 2004 to 2012, 6142 MIs were recorded in Calgary. Individuals living in neighbourhoods with higher long-term air pollution concentrations were more likely to be admitted to hospital for MI after short-term elevations in air pollution (e.g., 5-day average NO2: OR 1.20, 95% CI 1.03-1.40, per interquartile range [IQR]) as compared with regions with lower air pollution (e.g., 5-day average NO2: OR 0.90, 95% CI 0.78-1.04, per IQR). In high NO2 tertiles, the AQHI score was associated with MI (e.g., 5-day average OR 1.13, 95% CI 1.02-1.24, per IQR; 3-day average OR 1.13, 95% CI 1.04-1.23, per IQR). INTERPRETATION Our results show that the effect of air pollution on hospital admissions for MI was stronger in areas with higher NO2 concentrations than that in areas with lower NO2 concentrations. Individuals living in neighbourhoods with higher traffic-related pollution should be advised of the health risks and be attentive to special air quality warnings.
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Affiliation(s)
- Xiaoxiao Liu
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Stefania Bertazzon
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Paul J Villeneuve
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Markey Johnson
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Dave Stieb
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Stephanie Coward
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Divine Tanyingoh
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Joseph W Windsor
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Fox Underwood
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Michael D Hill
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Doreen Rabi
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - William A Ghali
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Stephen B Wilton
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Matthew T James
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Michelle Graham
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - M Sean McMurtry
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Gilaad G Kaplan
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta.
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Forbes N, Hilsden RJ, Lethebe BC, Maxwell CM, Lamidi M, Kaplan GG, James MT, Razik R, Hookey LC, Ghali WA, Bourke MJ, Heitman SJ. Prophylactic Endoscopic Clipping Does Not Prevent Delayed Postpolypectomy Bleeding in Routine Clinical Practice: A Propensity Score-Matched Cohort Study. Am J Gastroenterol 2020; 115:774-782. [PMID: 32167938 PMCID: PMC7192541 DOI: 10.14309/ajg.0000000000000585] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/03/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Delayed postpolypectomy bleeding (DPPB) is a relatively common adverse event. Evidence is conflicting on the efficacy of prophylactic clipping to prevent DPPB, and real-world effectiveness data are lacking. We aimed to determine the effectiveness of prophylactic clipping in preventing DPPB in a large screening-related cohort. METHODS We manually reviewed records of patients who underwent polypectomy from 2008 to 2014 at a screening facility. Endoscopist-, patient- and polyp-related data were collected. The primary outcome was DPPB within 30 days. All unplanned healthcare visits were reviewed; DPPB cases were adjudicated by committee using a criterion-based lexicon. Multivariable logistic regression was performed, yielding adjusted odds ratios (AORs) for the association between clipping and DPPB. Secondary analyses were performed on procedures where one polyp was removed, in addition to propensity score-matched and subgroup analyses. RESULTS In total, 8,366 colonoscopies involving polypectomy were analyzed, yielding 95 DPPB events. Prophylactic clipping was not associated with reduced DPPB (AOR 1.27; 0.83-1.96). These findings were similar in the single-polyp cohort (n = 3,369, AOR 1.07; 0.50-2.31). In patients with one proximal polyp ≥20 mm removed, there was a nonsignificant AOR with clipping of 0.55 (0.10-2.66). Clipping was not associated with a protective benefit in the propensity score-matched or other subgroup analyses. DISCUSSION In this large cohort study, prophylactic clipping was not associated with lower DPPB rates. Endoscopists should not routinely use prophylactic clipping in most patients. Additional effectiveness and cost-effectiveness studies are required in patients with proximal lesions ≥20 mm, in whom there may be a role for prophylactic clipping.
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Affiliation(s)
- Nauzer Forbes
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Robert J. Hilsden
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Brendan Cord Lethebe
- Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada;
| | - Courtney M. Maxwell
- Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Mubasiru Lamidi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Gilaad G. Kaplan
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthew T. James
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Roshan Razik
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - William A. Ghali
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael J. Bourke
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
| | - Steven J. Heitman
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alberta, Canada
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Ambasta A, Santana M, Ghali WA, Tang K. Discharge against medical advice: ‘deviant’ behaviour or a health system quality gap? BMJ Qual Saf 2019; 29:348-352. [DOI: 10.1136/bmjqs-2019-010332] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/28/2019] [Accepted: 12/11/2019] [Indexed: 11/04/2022]
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Sauro K, Ghali WA, Stelfox HT. Measuring safety of healthcare: an exercise in futility? BMJ Qual Saf 2019; 29:341-344. [PMID: 31796577 DOI: 10.1136/bmjqs-2019-009824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 11/18/2019] [Accepted: 11/21/2019] [Indexed: 01/29/2023]
Affiliation(s)
- Khara Sauro
- Departments of Community Health Sciences, Surgery & Oncology, the O'Brien Institute for Public Health & the Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - William A Ghali
- Departments of Community Health Sciences & Medicine, and the O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Henry Thomas Stelfox
- Departments of Critical Care Medicine & Community Health Sciences, and the O'Brien Institute for Public Health, Universty of Calgary, Calgary, Alberta, Canada
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Tang KL, Caffrey NP, Nóbrega DB, Cork SC, Ronksley PE, Barkema HW, Polachek AJ, Ganshorn H, Sharma N, Kellner JD, Checkley SL, Ghali WA. Comparison of different approaches to antibiotic restriction in food-producing animals: stratified results from a systematic review and meta-analysis. BMJ Glob Health 2019; 4:e001710. [PMID: 31543995 PMCID: PMC6730577 DOI: 10.1136/bmjgh-2019-001710] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/26/2019] [Accepted: 08/18/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND We have previously reported, in a systematic review of 181 studies, that restriction of antibiotic use in food-producing animals is associated with a reduction in antibiotic-resistant bacterial isolates. While informative, that report did not concretely specify whether different types of restriction are associated with differential effectiveness in reducing resistance. We undertook a sub-analysis of the systematic review to address this question. METHODS We created a classification scheme of different approaches to antibiotic restriction: (1) complete restriction; (2) single antibiotic-class restriction; (3) single antibiotic restriction; (4) all non-therapeutic use restriction; (5) growth promoter and prophylaxis restriction; (6) growth promoter restriction and (7) other/undetermined. All studies in the original systematic review that were amenable to meta-analysis were included into this substudy and coded by intervention type. Meta-analyses were conducted using random effects models, stratified by intervention type. RESULTS A total of 127 studies were included. The most frequently studied intervention type was complete restriction (n=51), followed by restriction of non-therapeutic (n=33) and growth promoter (n=19) indications. None examined growth promoter and prophylaxis restrictions together. Three and seven studies examined single antibiotic-class and single antibiotic restrictions, respectively; these two intervention types were not significantly associated with reductions in antibiotic resistance. Though complete restrictions were associated with a 15% reduction in antibiotic resistance, less prohibitive approaches also demonstrated reduction in antibiotic resistance of 9%-30%. CONCLUSION Broad interventions that restrict global antibiotic use appear to be more effective in reducing antibiotic resistance compared with restrictions that narrowly target one specific antibiotic or antibiotic class. Importantly, interventions that allow for therapeutic antibiotic use appear similarly effective compared with those that restrict all uses of antibiotics, suggesting that complete bans are not necessary. These findings directly inform the creation of specific policies to restrict antibiotic use in food-producing animals.
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Affiliation(s)
- Karen L Tang
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Niamh P Caffrey
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Diego B Nóbrega
- Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Susan C Cork
- Department of Ecosystem and Public Health, Faculty of Veterinary 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
| | - Herman W Barkema
- Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alicia J Polachek
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Heather Ganshorn
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Nishan Sharma
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James D Kellner
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sylvia L Checkley
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - William A Ghali
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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McIsaac DI, Hamilton GM, Abdulla K, Lavallée LT, Moloo H, Pysyk C, Tufts J, Ghali WA, Forster AJ. Validation of new ICD-10-based patient safety indicators for identification of in-hospital complications in surgical patients: a study of diagnostic accuracy. BMJ Qual Saf 2019; 29:209-216. [PMID: 31439760 DOI: 10.1136/bmjqs-2018-008852] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/15/2019] [Accepted: 08/07/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Administrative data systems are used to identify hospital-based patient safety events; few studies evaluate their accuracy. We assessed the accuracy of a new set of patient safety indicators (PSIs; designed to identify in hospital complications). STUDY DESIGN Prospectively defined analysis of registry data (1 April 2010-29 February 2016) in a Canadian hospital network. Assignment of complications was by two methods independently. The National Surgical Quality Improvement Programme (NSQIP) database was the clinical reference standard (primary outcome=any in-hospital NSQIP complication); PSI clusters were assigned using International Classification of Disease (ICD-10) codes in the discharge abstract. Our primary analysis assessed the accuracy of any PSI condition compared with any complication in the NSQIP; secondary analysis evaluated accuracy of complication-specific PSIs. PATIENTS All inpatient surgical cases captured in NSQIP data. ANALYSIS We assessed the accuracy of PSIs (with NSQIP as reference standard) using positive and negative predictive values (PPV/NPV), as well as positive and negative likelihood ratios (±LR). RESULTS We identified 12 898 linked episodes of care. Complications were identified by PSIs and NSQIP in 2415 (18.7%) and 2885 (22.4%) episodes, respectively. The presence of any PSI code had a PPV of 0.55 (95% CI 0.53 to 0.57) and NPV of 0.93 (95% CI 0.92 to 0.93); +LR 6.41 (95% CI 6.01 to 6.84) and -LR 0.40 (95% CI 0.37 to 0.42). Subgroup analyses (by surgery type and urgency) showed similar performance. Complication-specific PSIs had high NPVs (95% CI 0.92 to 0.99), but low to moderate PPVs (0.13-0.61). CONCLUSION Validation of the ICD-10 PSI system suggests applicability as a first screening step, integrated with data from other sources, to produce an adverse event detection pathway that informs learning healthcare systems. However, accuracy was insufficient to directly identify or rule out individual-level complications.
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Affiliation(s)
- Daniel I McIsaac
- Departments of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada .,Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Gavin M Hamilton
- Departments of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Karim Abdulla
- Departments of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Luke T Lavallée
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Surgery, Division of Urology, University of Ottawa, Ottawa, Ontario, Canada
| | - Husien Moloo
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Surgery, Division of General Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Chris Pysyk
- Departments of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jocelyn Tufts
- Performance Measurement, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - William A Ghali
- Department of Community Health Sciences, Calgary Institute for Population and Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Calgary Institute for Population and Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Alan J Forster
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Sajobi TT, Wang M, Awosoga O, Santana M, Southern D, Liang Z, Galbraith D, Wilton SB, Quan H, Graham MM, James MT, Ghali WA, Knudtson ML, Norris C. Trajectories of Health-Related Quality of Life in Coronary Artery Disease. Circ Cardiovasc Qual Outcomes 2019; 11:e003661. [PMID: 29545392 DOI: 10.1161/circoutcomes.117.003661] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 01/10/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) assessment is an important health outcome for measuring the efficacy of treatments and interventions for coronary artery disease (CAD). HRQOL is known to improve over the first year after interventions for CAD, but there is limited knowledge of the changes in HRQOL beyond 1 year. We investigated heterogeneity in long-term trajectories of HRQOL in patients with CAD. METHODS AND RESULTS Data were obtained from 6226 patients identified from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease with at least 1-vessel CAD who underwent their first catheterization between 2006 and 2009. HRQOL was assessed using the Seattle Angina Questionnaire, a 19-item disease-specific measure of HRQOL for patients with CAD. Group-based trajectory analysis was used to identify various subgroups of Seattle Angina Questionnaire trajectories over time while adjusting for missing data through a longitudinal multiple imputation model. Multinomial logistic regression was used to identify the predictors of differences among the identified subgroups. Our analysis revealed significant improvements in HRQOL across all the 5 domains of Seattle Angina Questionnaire overtime for the whole data. Multitrajectory analyses revealed 4 HRQOL trajectory subgroups including high (25.1%), largely increased (32.3%), largely decreased (25.0%), and low (17.6%) trajectories. Age, sex, body mass index, diabetes mellitus, previous history of myocardial infarction, smoking, depression, anxiety, type of treatment received, and perceived social support were significant predictors of differences among these trajectory subgroups. CONCLUSIONS This study highlights variations in longitudinal trajectories of HRQOL in patients with CAD. Despite overall improvements in HRQOL, about a quarter of our cohort experienced a significant decline in their HRQOL over the 5-year period. Understanding these HRQOL trajectories may help personalize prognostic information, identify patients and HRQOL domains on which clinical interventions are most beneficial, and support treatment decisions for patients with CAD.
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Affiliation(s)
- Tolulope T Sajobi
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada.
| | - Meng Wang
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Oluwagbohunmi Awosoga
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Maria Santana
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Danielle Southern
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Zhiying Liang
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Diane Galbraith
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Stephen B Wilton
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Hude Quan
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Michelle M Graham
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Matthew T James
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - William A Ghali
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Merrill L Knudtson
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Colleen Norris
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
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Tang KL, Caffrey NP, Nóbrega DB, Cork SC, Ronksley PE, Barkema HW, Polachek AJ, Ganshorn H, Sharma N, Kellner JD, Checkley SL, Ghali WA. Examination of unintended consequences of antibiotic use restrictions in food-producing animals: Sub-analysis of a systematic review. One Health 2019; 7:100095. [PMID: 31193679 PMCID: PMC6538949 DOI: 10.1016/j.onehlt.2019.100095] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 01/21/2023] Open
Abstract
Antimicrobial resistance is considered one of the greatest threats to global and public health today. The World Health Organization, the Food and Agriculture Organization, and the World Organisation for Animal Health, known as the Tripartite Collaboration, have called for urgent action. We have previously published a systematic review of 181 studies, demonstrating that interventions that restrict antibiotic use in food-producing animals are associated with a reduction in antibiotic resistant bacterial isolates in both animals and humans. What remains unknown, however, are whether (and what) unintended consequences may arise from such interventions. We therefore undertook a sub-analysis of the original review to address this research question. A total of 47 studies described potential consequences of antibiotic restrictions. There were no consistent trends to suggest clear harm. There may be increased bacterial contamination of food products, the clinical significance of which remains unclear. There is a need for rigorous evaluation of the unintended consequences of antibiotic restrictions in human health, food availability, and economics, given their possible widespread implications.
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Affiliation(s)
- Karen L. Tang
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
- O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - Niamh P. Caffrey
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - Diego B. Nóbrega
- Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - Susan C. Cork
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
- O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - Paul E. Ronksley
- O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - Herman W. Barkema
- Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
- O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - Alicia J. Polachek
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - Heather Ganshorn
- Libraries and Cultural Resources, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Nishan Sharma
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - James D. Kellner
- O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, Alberta T3B 6A8, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada
| | - Sylvia L. Checkley
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
- O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
- Department of Microbiology, Immunology, and Infectious Disease, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB T2N 4N1, Canada
- Alberta Provincial Laboratory for Public Health, Alberta Health Services, 3030 Hospital Drive, NW, Calgary, AB T2N 4W4, Canada
| | - William A. Ghali
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
- O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
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Abstract
There has been renewed concern about the state of public health in Canada, with several recent articles in this journal suggesting that the discipline of public health is under threat and that there has been a significant erosion of its core infrastructure. We strongly agree with the need for a well-resourced formal public health system and preservation of capacity to carry out core public health functions, while also positing a complementary narrative that emphasizes the possibility for a broad notion of public health to persevere and thrive in the face of these challenges. We consider what public health is, who public health is, and why public health exists, and suggest that the answers to these questions point to opportunities to strengthen the necessary interdisciplinary approaches that can best address current and future public health concerns.
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Affiliation(s)
- Jason L Cabaj
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Population Public & Indigenous Health, Alberta Health Services, Calgary, Alberta, Canada.
| | - Richard Musto
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - William A Ghali
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Graham AJ, Ocampo W, Southern DA, Falvi A, Sotiropoulos D, Wang B, Lonergan K, Vito B, Ghali WA, McFadden SDP. Evaluation of an electronic health record structured discharge summary to provide real time adverse event reporting in thoracic surgery. BMJ Qual Saf 2019; 28:310-316. [PMID: 30659062 DOI: 10.1136/bmjqs-2018-008090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 12/06/2018] [Accepted: 12/20/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND The reporting of adverse events (AE) remains an important part of quality improvement in thoracic surgery. The best methodology for AE reporting in surgery is unclear. An AE reporting system using an electronic discharge summary with embedded data collection fields, specifying surgical procedure and complications, was developed. The data are automatically transferred daily to a web-based reporting system. METHODS We determined the accuracy and sustainability of this electronic real time data collection system (ERD) by comparing the completeness of record capture on procedures and complications with coded discharge data (administrative data), and with the standard of chart audit at two intervals. All surgical procedures performed for 2 consecutive months at initiation (Ti) and 1 year later (T1yr) were audited by an objective trained abstractor. A second abstractor audited 10% of the charts. RESULTS The ERD captured 71/72 (99%) of charts at Ti and 56/65 (86%) at T1yr. Comparing the presence/absence of complications between ERD and chart audit demonstrated at Ti a high sensitivity and specificity, positive predictive value (PPV) of 95.5%, negative predictive value (NPV) of 93.9% with a kappa of 0.872 (95% CI 0.750 to 0.994), and at T1yr a sensitivity, specificity, PPV and NPV of 100% with a kappa of 1.0 (95% CI 1.0). Comparing the presence/absence of complications between administrative data and chart audit at Ti demonstrated a low sensitivity, high specificity and a kappa of 0.471 (95% CI 0.256 to 0.686), and at T1yr a low sensitivity, high specificity of 85% and a kappa of 0.479 (95% CI 0.245 to 0.714). CONCLUSIONS We found that the ERD can provide accurate real time AE reporting in thoracic surgery, has advantages over previous reporting methodologies and is an alternative system for surgical clinical teams developing AE reporting systems.
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Affiliation(s)
- Andrew J Graham
- Departments of Surgery and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Wrechelle Ocampo
- Departments of Community Health Sciences and Medicine, University of Calgary, W21C Research and Innovation Centre, Calgary, Alberta, Canada
| | | | - Anthony Falvi
- Department of Thoracic Surgery, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Dina Sotiropoulos
- Department of Thoracic Surgery, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Bruce Wang
- IT, Alberta Health Services, Calgary, Alberta, Canada
| | - Kevin Lonergan
- Analytics, Alberta Health Services, Calgary, Alberta, Canada
| | - Biraboneye Vito
- Clinical Informatics Services, Alberta Health Services, Calgary, Alberta, Canada
| | - William A Ghali
- Departments of Community Health Sciences and Medicine, and the Calgary Institute for Population and Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Sean Daniel Patrick McFadden
- Departments of Surgery and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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32
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Armstrong MJ, Rabi DM, Southern DA, Nanji A, Ghali WA, Sigal RJ. Clinical Utility of Pre-Exercise Stress Testing in People With Diabetes. Can J Cardiol 2018; 35:185-192. [PMID: 30760425 DOI: 10.1016/j.cjca.2018.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/30/2018] [Accepted: 11/14/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Although suggested by practice guidelines, the need for pre-exercise stress testing in asymptomatic people with diabetes remains controversial. We examined the utility of screening with pre-exercise stress testing in patients with diabetes. METHODS We completed a cohort study, evaluating patients with diabetes who attended an exercise program intake session between 2007 and 2012. The exposure of interest was referral for pre-exercise stress testing determined by an algorithm requiring sedentary patients with diabetes and ≥ 1 cardiac risk factor to undergo testing. Outcomes included cardiac catheterization, revascularization, cardiovascular-related admissions, mortality, and change in care. RESULTS Among 1705 people with diabetes, 676 (40%) were referred for pre-exercise stress testing. In patients who were referred for stress testing compared with those who were not, there was no difference in the composite of cardiovascular outcomes (revascularization, cardiovascular-related admissions, and cardiovascular-related death) within 1 year (2.8% vs 1.9%, P = 0.250), or subsequent to the first year (3.1% vs 4.6%, P = 0.164). Within 1 year, more revascularizations were performed in patients referred for stress testing compared with those who were not (2.1% vs 0.8%, P = 0.027) but not during longer-term follow-up (mean 3.4 years). CONCLUSIONS The rates of cardiovascular outcomes in both tested and untested patients were low. Patients undergoing stress testing had no difference in adverse cardiovascular outcomes over the follow-up periods. Referral for stress testing did not result in a change in care for most patients. Our findings suggest stress testing before beginning an exercise program is not necessary for most asymptomatic patients with diabetes.
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Affiliation(s)
- Marni J Armstrong
- Department of Cardiovascular & Respiratory Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Doreen M Rabi
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | | | | | - William A Ghali
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Ronald J Sigal
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Southern DA, James MT, Wilton SB, DeKoning L, Quan H, Knudtson ML, Ghali WA. Expanding the impact of a longstanding Canadian cardiac registry through data linkage: challenges and opportunities. Int J Popul Data Sci 2018; 3:441. [PMID: 32935018 PMCID: PMC7299492 DOI: 10.23889/ijpds.v3i3.441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) began as a province-wide inception cohort of all adult Alberta residents undergoing cardiac catheterization for ischemic heart disease. Strengths of the APPROACH initiative include the prospective collection of detailed clinical, procedural, and treatment information, measured at point-of-care. While this aspect of APPROACH provides data users with several advantages over use of typical administrative data, the ability to link APPROACH with data from multiple other sources has provided several unique opportunities to measure cardiovascular care and outcomes. As of June 2018, clinical information has been collected by APPROACH on over 240,000 adult Alberta residents. Linkage of this rich clinical data to administrative health data (eg. Vital statistics, hospitalizations, ambulatory events, prescription medications), secondary use clinical data (e.g. laboratory, ECG, rehabilitation, EMR, imaging) and other data sources (eg. Geospatial, crime data, meteorological) allows better study of the determinants of a patient's health trajectory. This paper describes applied examples of work that has leveraged the potential of linking several datasets with the APPROACH registry.
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Affiliation(s)
- Danielle A Southern
- Department of Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
| | - Matthew T James
- Department of Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
- Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
| | - Stephen B Wilton
- Libin Cardiovascular Institute of Alberta, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
| | - Lawrence DeKoning
- Department of Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
- Calgary Laboratory Services, 3535 Research Road NW, Calgary, AB, T2L 2K8
- Department of Paediatrics, Alberta Children's Hospital, 2888 Shaganappi Tr NW, Calgary, Alberta, T3B 6A8, Canada
| | - Hude Quan
- Department of Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
| | - Merril L Knudtson
- Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
| | - William A Ghali
- Department of Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
- Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
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Ghali WA, Schull MJ. The International Population Data Linkage Network – Banff and Beyond. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i1.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
We write to you, here in the pages of the International Journal of Population Data Science, for the second time in our capacity of co-directors of the International Population Data Linkage Network (IPDLN – www.ipdln.org). Time has certainly passed quickly since our first communication, where we introduced ourselves, and discussed planned initiatives for our tenure as leads of the IPDLN. Our network’s scientific community is steadily growing and thriving in an era of heightened interest around all things ‘data’. Indeed, there is great enthusiasm for all initiatives that explore ways of harnessing information systems and multisource data to enhance collective knowledge of health matters so that better decisions can be made by governments, system planners, providers, and patients. Never before have such initiatives attracted more attention.
It is in this context of heightened interest and relevance around IPDLN and its science that we prepare to convene in Banff, Alberta, Canada for the 5th biennial IPDLN Conference – September 11-14. The conference, to be held at the inspiring Banff Centre (www.banffcentre.ca), is almost sold out, with only limited space remaining for late registrants. A tremendous program has been created through the oversight of Scientific Program co-chairs, Drs. Astrid Guttman and Hude Quan. A compelling roster of plenary lectures from Drs. Diane Watson, Jennifer Walker, and Osmar Zaïane is eagerly anticipated, as are topical panel discussions, an entertaining Science Slam session, and a terrific social program. These sessions will be surrounded by rich scientific oral and poster presentations arising from the more than 450 scientific abstracts submitted for review. We are so pleased to see this vibrant scientific engagement from the IPDLN membership and students, and look forward to hosting all delegates in Banff.
The Banff conference will also be the venue at which we announce the new Directorship of the IPDLN for the next two years (2019 and 2020). As co-directors, we engaged with a number of individuals and organizations with interest in leading the IPDLN. In the end, two compelling Directorship applications were submitted – one a joint bid from Australia’s Population Health Research Network and the South Australia Northern Territory DataLink, and the other from the US-based Actionable Intelligence for Social Policy. IPDLN members submitted votes on these strong leadership bids through an online voting process, and while the excellence and appeal of both bids was apparent in strong voter support for both, a winning bid has been confirmed, and it will (as mentioned) be announced at the upcoming September conference.
As we look forward to the Banff meeting with great anticipation, we are compelled to acknowledge the growing IPDLN legacy created by past directors. We are particularly indebted to our immediate predecessor, Dr. David Ford, and his team at Swansea University. Their work in hosting the 2016 IPDLN conference has been an inspiration to us in the planning of this year’s conference, and their crucial and foundational work in creating an IT platform for the IPDLN website, the membership database, and the new International Journal for Population Data Science has brought the IPDLN to a new level of organizational sophistication. Over the last 18 months, our co-directorship teams from the Institute for Clinical Evaluative Sciences in Ontario and the O’Brien Institute for Public Health at the University of Calgary have built on the foundation established by prior directors to update/enhance the IPDLN website and membership database. The IPDLN has more members than ever before representing a greater number of countries, and we have a more formalized governance structure with the creation of an Executive Committee that will include immediate past-Directors in order to better ensure continuity. A new Executive Committee will be elected by the IPDLN membership following the Banff conference.
The waiting is almost over and IPDLN 2018 is upon us! Our scientific domain has never had the prominence or level of anticipation that we currently see. And the IPDLN has grown in its size, vibrancy and scientific scope. The opportunities for us are boundless, and the timing of our upcoming conference could not be better. We are honoured, with our respective organizations, to have had this opportunity to serve as co-directors over the past two years, and look forward to seeing many of you very soon. For those of you who are unable to travel to Canada’s Rocky Mountains this year, we look forward to connecting with you at a later time in the IPDLN’s continuing upward journey.
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Abstract
Administrative health data recorded for individual health episodes (such as births, deaths, physician visits, and hospital stays) are being widely used to study policy-relevant scientific questions about population health, health services, and quality of care. An increasing number of international health comparisons are undertaken with these data. An essential pre-requisite to such international comparative work is a detailed characterization of existing international health data resources, so that they can be more readily used for comparisons across counties. A major challenge to such international comparative work is the variability across countries in the extent, content, and validity of existing administrative data holdings. Recognizing this, we have undertaken an international proof of concept pilot compiling detailed data about data – i.e., a “meta-data catalogue” – for existing international administrative health data holdings. We describe the methodological process for collecting these meta-data, along with some general descriptive results for selected countries included in the pilot.
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Affiliation(s)
- Gabriel E Fabreau
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta.,Cumming School of Medicine, University of Calgary, Calgary, Alberta.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta
| | - Evan P Minty
- Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Danielle A Southern
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta
| | - Hude Quan
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta
| | - William A Ghali
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta.,Cumming School of Medicine, University of Calgary, Calgary, Alberta.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta
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36
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Forster AJ, Bernard B, Drösler SE, Gurevich Y, Harrison J, Januel JM, Romano PS, Southern DA, Sundararajan V, Quan H, Vanderloo SE, Pincus HA, Ghali WA. A World Health Organization field trial assessing a proposed ICD-11 framework for classifying patient safety events. Int J Qual Health Care 2018; 29:548-556. [PMID: 28934402 DOI: 10.1093/intqhc/mzx070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/31/2017] [Indexed: 12/20/2022] Open
Abstract
Objective To assess the utility of the proposed World Health Organization (WHO)'s International Classification of Disease (ICD) framework for classifying patient safety events. Setting Independent classification of 45 clinical vignettes using a web-based platform. Study participants The WHO's multi-disciplinary Quality and Safety Topic Advisory Group. Main outcome measure(s) The framework consists of three concepts: harm, cause and mode. We defined a concept as 'classifiable' if more than half of the raters could assign an ICD-11 code for the case. We evaluated reasons why cases were nonclassifiable using a qualitative approach. Results Harm was classifiable in 31 of 45 cases (69%). Of these, only 20 could be classified according to cause and mode. Classifiable cases were those in which a clear cause and effect relationship existed (e.g. medication administration error). Nonclassifiable cases were those without clear causal attribution (e.g. pressure ulcer). Of the 14 cases in which harm was not evident (31%), only 5 could be classified according to cause and mode and represented potential adverse events. Overall, nine cases (20%) were nonclassifiable using the three-part patient safety framework and contained significant ambiguity in the relationship between healthcare outcome and putative cause. Conclusions The proposed framework enabled classification of the majority of patient safety events. Cases in which potentially harmful events did not cause harm were not classifiable; additional code categories within the ICD-11 are one proposal to address this concern. Cases with ambiguity in cause and effect relationship between healthcare processes and outcomes remain difficult to classify.
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Affiliation(s)
- Alan J Forster
- The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Box 684, ASB-1 Room 1-008, Ottawa, ON, Canada K1Y 4E9.,Ottawa Hospital Research Institute, Clinical Epidemiology Program, 501 Smyth Box 511, Ottawa, ON, Canada K1H 8L6.,University of Ottawa, 75 Laurier Avenue East, Ottawa, ON, Canada K1N 6N5
| | - Burnand Bernard
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - Saskia E Drösler
- Faculty of Health Care, Niederrhein University of Applied Sciences, Reinarzstrasse 49, Krefeld 47805, Germany
| | - Yana Gurevich
- Canadian Institute of Health Information, 4110 Yonge Street, Suite 300, Toronto, Ontario, Canada M2P 2B7
| | - James Harrison
- Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Jean-Marie Januel
- Quality & Safety, Host team in Healthcare Organization Management, Institute of Management, EHESP - School of Public Heath, Maison des Sciences de l'Homme (MSH) - Paris Nord 20 avenue Georges Sand, Paris, France 93210
| | - Patrick S Romano
- Division of General Medicine, University of California-Davis School of Medicine, 4150 V Street; Suite 2400, Sacramento, CA 95817, USA
| | - Danielle A Southern
- Department of Community Health Sciences and the O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6
| | - Vijaya Sundararajan
- Department of Medicine, St. Vincent's Hospital, Level 4, Daly Wing, University of Melbourne, Fitzroy VIC 3065, Australia.,Department of Medicine, Southern Clinical School, Monash University, Victoria 3800, Australia
| | - Hude Quan
- Department of Community Health Sciences and the O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6
| | - Saskia E Vanderloo
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, 501 Smyth Box 511, Ottawa, ON, Canada K1H 8L6
| | - Harold A Pincus
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.,Irving Institute for Clinical and Translational Research at Columbia University and New York-Presbyterian Hospital, 622 West 168 Street, Floor 10, Suite 305, New York, NY 10032, USA.,RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA
| | - William A Ghali
- Department of Community Health Sciences and the O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6
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Tang KL, Pilote L, Behlouli H, Godley J, Ghali WA. An exploration of the subjective social status construct in patients with acute coronary syndrome. BMC Cardiovasc Disord 2018; 18:22. [PMID: 29409448 PMCID: PMC5801903 DOI: 10.1186/s12872-018-0759-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 01/26/2018] [Indexed: 03/21/2023] Open
Abstract
Background Perception of low subjective social status (SSS) relative to others in society or in the community has been associated with increased risk of cardiovascular disease. Our objectives were to determine whether low SSS in society was associated with barriers to access to care or hospital readmission in patients with established cardiovascular disease, and whether perceptions of discordantly high SSS in the community modified this association. Methods We conducted a prospective cohort study from 2009 to 2013 in Canada, United States, and Switzerland in patients admitted to hospital with acute coronary syndrome (ACS). Data on access to care and SSS variables were obtained at baseline. Readmission data were obtained 12 months post-discharge. We conducted multivariable logistic regression to model the odds of access to care and readmission outcomes in those with low versus high societal SSS. Results One thousand ninety patients admitted with ACS provided both societal and community SSS rankings. The low societal SSS cohort had greater odds of reporting that their health was affected by lack of health care access (OR 1.48, 95% CI 1.11, 1.97) and of experiencing cardiac readmissions (1.88, 95% CI 1.15, 3.06). Within the low societal SSS cohort, there was a trend toward fewer access to care barriers for those with discordantly high community SSS though findings varied based on the outcome variable. There were no statistically significant differences in readmissions based on community SSS rankings. Conclusion Low societal SSS is associated with increased barriers to access to care and cardiac readmissions. Though attenuated, these trends remained even when adjusting for clinical and sociodemographic factors, suggesting that perceived low societal SSS has health effects above and beyond objective socioeconomic factors. Furthermore, high community SSS may potentially mitigate the risk of experiencing barriers to access to health care in those with low societal SSS, though these associations were not statistically significant. Subjective social status relative to society versus relative to the community seem to represent distinct concepts. Insight into the differences between these two SSS constructs is imperative in the understanding of cardiovascular health and future development of public health policies. Electronic supplementary material The online version of this article (10.1186/s12872-018-0759-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karen L Tang
- Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
| | - Louise Pilote
- Division of Clinical Epidemiology, Research Institute of McGill University Health Centre, 687 Pine Ave West, Montreal, Quebec, H3A 1A1, Canada.,Division of General Internal Medicine, McGill University Health Centre, 687 Pine Ave West, Montreal, Quebec, H3A 1A1, Canada
| | - Hassan Behlouli
- Division of Clinical Epidemiology, Research Institute of McGill University Health Centre, 687 Pine Ave West, Montreal, Quebec, H3A 1A1, Canada
| | - Jenny Godley
- Department of Sociology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.,O' Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - William A Ghali
- Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.,O' Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.,Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
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Lacny S, Wilson T, Clement F, Roberts DJ, Faris P, Ghali WA, Marshall DA. Kaplan–Meier survival analysis overestimates cumulative incidence of health-related events in competing risk settings: a meta-analysis. J Clin Epidemiol 2018; 93:25-35. [DOI: 10.1016/j.jclinepi.2017.10.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 08/15/2017] [Accepted: 10/10/2017] [Indexed: 02/03/2023]
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Abstract
OBJECTIVE To complete an economic evaluation within a randomised controlled trial (RCT) comparing the use of an electronic discharge communication tool (eDCT) compared with usual care. SETTING Patients being discharged from a single tertiary care centre's internal medicine Medical Teaching Units. PARTICIPANTS Between January 2012 and December 2013, 1399 patients were randomised to a discharge mechanism. Forty-five patients were excluded from the economic evaluation as they did not have data for the index hospitalisation cost; 1354 patients contributed to the economic evaluation. INTERVENTION eDCT generated at discharge containing structured content on reason for admission, details of the hospital stay, treatments received and follow-up care required. The control group was discharged via traditional dictation methods. PRIMARY AND SECONDARY OUTCOME MEASURES The primary economic outcome was the cost per quality-adjusted life year (QALY) gained. Secondary outcomes included the cost per death avoided and the cost per readmission avoided. RESULTS The average transcription cost was $C22.28 per patient, whereas the estimated cost of the eDCT was $C13.33 per patient. The cost per QALY gained was $C239 933 in the eDCT arm compared with usual care due to the very small gains in effectiveness and approximately $C800difference in resource utilisation costs. The bootstrap analyses resulted in eDCT being more effective and more costly in 29.2% of samples, less costly and more effective in 29.2% of samples, less effective and more costly in 23.9% of samples and finally, less costly and less effective in 17.7% of samples. CONCLUSIONS The eDCT reduced per patient costs of the generation of discharge summaries. The bootstrap estimates demonstrate considerable uncertainty supporting the finding of neutrality reported in the clinical component of the RCT. The immediate transcription cost savings and previously documented provider and patient satisfaction may increase the impetus for organisations to invest in such systems, provided they have a foundation of eHealth infrastructure and readiness. TRIAL REGISTRATION NUMBER NCT01402609.
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Affiliation(s)
- Laura K Sevick
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maria-Jose Santana
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Medical Ward of the 21st Century, University of Calgary, Calgary, Alberta, Canada
| | - William A Ghali
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Medical Ward of the 21st Century, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fiona Clement
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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40
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Tang KL, Caffrey NP, Nóbrega DB, Cork SC, Ronksley PE, Barkema HW, Polachek AJ, Ganshorn H, Sharma N, Kellner JD, Ghali WA. Restricting the use of antibiotics in food-producing animals and its associations with antibiotic resistance in food-producing animals and human beings: a systematic review and meta-analysis. Lancet Planet Health 2017; 1:e316-e327. [PMID: 29387833 PMCID: PMC5785333 DOI: 10.1016/s2542-5196(17)30141-9] [Citation(s) in RCA: 433] [Impact Index Per Article: 61.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND Antibiotic use in human medicine, veterinary medicine, and agriculture has been linked to the rise of antibiotic resistance globally. We did a systematic review and meta-analysis to summarise the effect that interventions to reduce antibiotic use in food-producing animals have on the presence of antibiotic-resistant bacteria in animals and in humans. METHODS On July 14, 2016, we searched electronic databases (Agricola, AGRIS, BIOSIS Previews, CAB Abstracts, MEDLINE, Embase, Global Index Medicus, ProQuest Dissertations, Science Citation Index) and the grey literature. The search was updated on Jan 27, 2017. Inclusion criteria were original studies that reported on interventions to reduce antibiotic use in food-producing animals and compared presence of antibiotic-resistant bacteria between intervention and comparator groups in animals or in human beings. We extracted data from included studies and did meta-analyses using random effects models. The main outcome assessed was the risk difference in the proportion of antibiotic-resistant bacteria. FINDINGS A total of 181 studies met inclusion criteria. Of these, 179 (99%) described antibiotic resistance outcomes in animals, and 81 (45%) of these studies were included in the meta-analysis. 21 studies described antibiotic resistance outcomes in humans, and 13 (62%) of these studies were included in the meta-analysis. The pooled absolute risk reduction of the prevalence of antibiotic resistance in animals with interventions that restricted antibiotic use commonly ranged between 10 and 15% (total range 0-39), depending on the antibiotic class, sample type, and bacteria under assessment. Similarly, in the human studies, the pooled prevalence of antibiotic resistance reported was 24% lower in the intervention groups compared with control groups, with a stronger association seen for humans with direct contact with food-producing animals. INTERPRETATION Interventions that restrict antibiotic use in food-producing animals are associated with a reduction in the presence of antibiotic-resistant bacteria in these animals. A smaller body of evidence suggests a similar association in the studied human populations, particularly those with direct exposure to food-producing animals. The implications for the general human population are less clear, given the low number of studies. The overall findings have directly informed the development of WHO guidelines on the use of antibiotics in food-producing animals. FUNDING World Health Organization.
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Affiliation(s)
- Karen L Tang
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Niamh P Caffrey
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Diego B Nóbrega
- Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Susan C Cork
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Paul E Ronksley
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Herman W Barkema
- Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alicia J Polachek
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Heather Ganshorn
- Libraries and Cultural Resources, University of Calgary, Calgary, AB, Canada
| | - Nishan Sharma
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James D Kellner
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - William A Ghali
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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41
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Santana MJ, Holroyd-Leduc J, Southern DA, Flemons WW, O'Beirne M, Hill MD, Forster AJ, White DE, Ghali WA. A randomised controlled trial assessing the efficacy of an electronic discharge communication tool for preventing death or hospital readmission. BMJ Qual Saf 2017; 26:993-1003. [PMID: 28821597 DOI: 10.1136/bmjqs-2017-006635] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/09/2017] [Accepted: 06/17/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the efficacy of an electronic discharge communication tool (e-DCT) for preventing death or hospital readmission, as well as reducing patient-reported adverse events after hospital discharge. The e-DCT assessed has already been shown to yield high-quality discharge summaries with high levels of patient and physician satisfaction. METHODS This two-arm randomised controlled trial was conducted in a Canadian tertiary care centre's internal medicine medical teaching units. Out of the 1953 patients approached and screened for inclusion, 1399 were randomised and available for data linkage for determination of the primary outcome. Participants were randomly assigned to e-DCT versus usual care (traditional discharge communication generated by dictation). The primary outcome was a composite of death or readmission within 90 days. The secondary outcome included any patient-reported adverse events within 30 days of discharge. RESULTS Among 1399 randomised participants, 230 of 701 participants (32.8%) in the e-DCT group experienced the primary composite outcome of death or readmission within 90 days vs 205 of 698 participants (29.4%) in the usual care group (p=0.166). The incidence at 30 days of patient-reported adverse outcomes (35% for e-DCT vs 34% for usual care) and adverse events (2.1% for e-DCT vs 1.8% for usual care) also did not differ significantly between groups. CONCLUSIONS The e-DCT tested did not reduce the composite endpoint of death or readmission at 90 days, nor the incidence of patient-reported adverse events at 30 days. This neutral finding for hard clinical endpoints needs to be considered in the context of high patient and physician satisfaction, and high quality of discharge summaries.
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Affiliation(s)
- Maria J Santana
- Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Danielle A Southern
- Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ward W Flemons
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maeve O'Beirne
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael D Hill
- Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alan J Forster
- Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Deborah E White
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - William A Ghali
- Departments of Community Health Sciences and Medicine, and the Calgary Institute for Population and Public Health, University of Calgary, Calgary, Alberta, Canada
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Okoniewska B, Santana MJ, Holroyd-Leduc J, Flemons W, O'Beirne M, White D, Ocampo W, Ghali WA, Forster AJ. Erratum to: A framework to assess patient-reported adverse outcomes arising during hospitalization. BMC Health Serv Res 2017; 17:563. [PMID: 28814298 PMCID: PMC5558767 DOI: 10.1186/s12913-017-2392-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 06/16/2017] [Indexed: 01/04/2024] Open
Affiliation(s)
- B Okoniewska
- W21C Research and Innovation Centre, G-01- TRW Building, 3280 Hospital Drive, NW, Calgary, AB, T2N 4Z6, Canada
| | - M J Santana
- Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor, 3-36E, TRW Building, 3280 Hospital Drive, NW, Calgary, AB, T2N 4Z6, Canada.
| | - J Holroyd-Leduc
- Department of Medicine, Cumming School of Medicine, University of Calgary, 1403 29 St NW, Calgary, AB, T2N 2 T9, Canada
| | - W Flemons
- Department of Medicine, Cumming School of Medicine, University of Calgary, 1403 29 St NW, Calgary, AB, T2N 2 T9, Canada
| | - M O'Beirne
- Family Medicine and Primary Care Research Office, University of Calgary, G012, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4 N1, Canada
| | - D White
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1 N4, Canada
| | - W Ocampo
- W21C Research and Innovation Centre, G-01- TRW Building, 3280 Hospital Drive, NW, Calgary, AB, T2N 4Z6, Canada
| | - W A Ghali
- Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor, 3-36E, TRW Building, 3280 Hospital Drive, NW, Calgary, AB, T2N 4Z6, Canada
| | - A J Forster
- Department of Medicine, University of Ottawa, Civic Campus 1053 Carling Avenue, Box 684, Ottawa, ON, K1Y 4E9, Canada
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Sevick LK, Esmail R, Tang K, Lorenzetti DL, Ronksley P, James M, Santana M, Ghali WA, Clement F. A systematic review of the cost and cost-effectiveness of electronic discharge communications. BMJ Open 2017; 7:e014722. [PMID: 28674136 PMCID: PMC5734286 DOI: 10.1136/bmjopen-2016-014722] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The transition between acute care and community care can be a vulnerable period in a patients' treatment due to the potential for postdischarge adverse events. The vulnerability of this period has been attributed to factors related to the miscommunication between hospital-based and community-based physicians. Electronic discharge communication has been proposed as one solution to bridge this communication gap. Prior to widespread implementation of these tools, the costs and benefits should be considered. OBJECTIVE To establish the cost and cost-effectiveness of electronic discharge communications compared with traditional discharge systems for individuals who have completed care with one provider and are transitioning care to a new provider. METHODS We conducted a systematic review of the published literature, using best practices, to identify economic evaluations/cost analyses of electronic discharge communication tools. Inclusion criteria were: (1) economic analysis and (2) electronic discharge communication tool as the intervention. Quality of each article was assessed, and data were summarised using a component-based analysis. RESULTS One thousand unique abstracts were identified, and 57 full-text articles were assessed for eligibility. Four studies met final inclusion criteria. These studies varied in their primary objectives, methodology, costs reported and outcomes. All of the studies were of low to good quality. Three of the studies reported a cost-effectiveness measure ranging from an incremental daily cost of decreasing average discharge note completion by 1 day of $0.331 (2003 Canadian), a cost per page per discharge letter of €9.51 and a dynamic net present value of €31.1 million for a 5-year implementation of the intervention. None of the identified studies considered clinically meaningful patient or quality outcomes. DISCUSSION Economic analyses of electronic discharge communications are scarcely reported, and with inconsistent methodology and outcomes. Further studies are needed to understand the cost-effectiveness and value for patient care.
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Affiliation(s)
- Laura K Sevick
- The Department Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Rosmin Esmail
- The Department Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Health Technology Assessment and Adoption, Alberta Health Services, Calgary, Alberta, Canada
| | - Karen Tang
- The Department Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Diane L Lorenzetti
- The Department Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Paul Ronksley
- The Department Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Matthew James
- The Department Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Alberta, Calgary, Canada
| | - Maria Santana
- The Department Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Medical Ward of the 21stCentury, University of Calgary, Alberta, Calgary, Canada
| | - William A Ghali
- The Department Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Alberta, Calgary, Canada
- Medical Ward of the 21stCentury, University of Calgary, Alberta, Calgary, Canada
| | - Fiona Clement
- The Department Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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Ocampo W, Cheung A, Baylis B, Clayden N, Conly JM, Ghali WA, Ho CH, Kaufman J, Stelfox HT, Hogan DB. Economic Evaluations of Strategies to Prevent Hospital-Acquired Pressure Injuries. Adv Skin Wound Care 2017; 30:319-333. [PMID: 28617751 PMCID: PMC5482558 DOI: 10.1097/01.asw.0000520289.89090.b0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GENERAL PURPOSE To provide information from a review of literature about economic evaluations of preventive strategies for pressure injuries (PIs). TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant should be better able to:1. Identify the purpose and methods used for this study.2. Compare costs and effectiveness related to preventative strategies for PIs. ABSTRACT BACKGROUND: Pressure injuries (PIs) are a common and resource-intensive challenge for acute care hospitals worldwide. While a number of preventive strategies have the potential to reduce the cost of hospital-acquired PIs, it is unclear what approach is the most effective. OBJECTIVE The authors performed a narrative review of the literature on economic evaluations of preventive strategies to survey current findings and identify important factors in economic assessments. DATA SOURCES Ovid, MEDLINE, NHS Economic Evaluation Databases, and the Cochrane Database of Systematic ReviewsSELECTION CRITERIA: Potentially relevant original research articles and systematic reviews were considered. DATA EXTRACTION Selection criteria included articles that were written in English, provided data on cost or economic evaluations of preventive strategies of PIs in acute care, and published between January 2004 and September 2015. Data were abstracted from the articles using a standardized approach to evaluate how the items on the Consolidated Health Economic Evaluation Reporting Standards checklist were addressed. DATA SYNTHESIS The searches identified 192 references. Thirty-three original articles were chosen for full-text reviews. Nineteen of these articles provided clear descriptions of interventions, study methods, and outcomes considered. CONCLUSIONS Limitations in the available literature prevent firm conclusions from being reached about the relative economic merits of the various approaches to the prevention of PIs. The authors' review revealed a need for additional high-quality studies that adhere to commonly used standards of both currently utilized and emerging ways to prevent hospital-acquired PIs.
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Affiliation(s)
- Wrechelle Ocampo
- Wrechelle Ocampo, MBT • Research Associate • W21C Research and Innovation Centre, Cumming School of Medicine • University of Calgary • Calgary, Alberta • Canada Amanda Cheung, MBT, BS • Research Assistant • W21C Research and Innovation Centre, Cumming School of Medicine • University of Calgary • Calgary, Alberta • Canada Barry Baylis, MD • Executive Codirector • W21C Research and Innovation Centre, Cumming School of Medicine • University of Calgary • Calgary, Alberta • Canada • Clinical Associate Professor • Department of Medicine • University of Calgary Nancy Clayden, EMT-P • Research Associate • W21C Research and Innovation Centre, Cumming School of Medicine • University of Calgary • Calgary, Alberta • Canada John M. Conly, MD • Medical Director • W21C Research and Innovation Centre, Cumming School of Medicine • University of Calgary • Calgary, Alberta • Canada • Professor • Departments of Medicine, Pathology and Laboratory Medicine, and Microbiology, Immunology and Infectious Diseases • University of Calgary William A. Ghali, MD • Scientific Director • O'Brien Institute for Public Health • University of Calgary • Calgary, Alberta • Canada • Professor • Division of General Internal Medicine, Departments of Medicine and Community Health Sciences • Cumming School of Medicine • University of Calgary Chester H. Ho, MD • Associate Professor and Head • Department of Clinical Neurosciences • University of Calgary • Calgary, Alberta • Canada Jaime Kaufman, PhD • Manager • W21C Strategic Programs • W21C Research and Innovation Centre • Cumming School of Medicine • University of Calgary • Calgary, Alberta • Canada Henry T. Stelfox, MD, PhD • Associate Professor • Departments of Community Health Sciences, Medicine, and Critical Care Medicine • University of Calgary • Calgary, Alberta • Canada David B. Hogan, MD • Brenda Stafford Foundation Chair • Geriatric Medicine • Calgary, Alberta • Canada • Professor • Departments of Medicine, Clinical Neurosciences, and Community Health Sciences • Cumming School of Medicine • University of Calgary • Calgary, Alberta • Canada
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Walker RL, Ghali WA, Chen G, Khalsa TK, Mangat BK, Campbell NRC, Dixon E, Rabi D, Jette N, Dhanoa R, Quan H. ACSC Indicator: testing reliability for hypertension. BMC Med Inform Decis Mak 2017. [PMID: 28651587 PMCID: PMC5485699 DOI: 10.1186/s12911-017-0487-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With high-quality community-based primary care, hospitalizations for ambulatory care sensitive conditions (ACSC) are considered avoidable. The purpose of this study was to test the inter-physician reliability of judgments of avoidable hospitalizations for one ACSC, uncomplicated hypertension, derived from medical chart review. METHODS We applied the Canadian Institute for Health Information's case definition to obtain a random sample of patients who had an ACSC hospitalization for uncomplicated hypertension in Calgary, Alberta. Medical chart review was conducted by three experienced internal medicine specialists. Implicit methods were used to judge avoidability of hospitalization using a validated 5-point scale. RESULTS There was poor agreement among three physicians raters when judging the avoidability of 82 ACSC hospitalizations for uncomplicated hypertension (κ = 0.092). The κ also remained low when assessing agreement between raters 1 and 3 (κ = 0.092), but the κ was lower (less than chance agreement) for raters 1 and 2 (κ = -0.119) and raters 2 and 3 (κ = -0.008). When the 5-point scale was dichotomized, there was fair agreement among three raters (κ = 0.217). The proportion of ACSC hospitalizations for uncomplicated hypertension that were rated as avoidable was 32.9%, 6.1% and 26.8% for raters 1, 2, and 3, respectively. CONCLUSIONS This study found a low proportion of ACSC hospitalization were rated as avoidable, with poor to fair agreement of judgment between physician raters. This suggests that the validity and utility of this health indicator is questionable. It points to a need to abandon the use of ACSC entirely; or alternatively to work on the development of explicit criteria for judging avoidability of hospitalization for ACSC such as hypertension.
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Affiliation(s)
- Robin L Walker
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada
| | - William A Ghali
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.,Department of Medicine, University of Calgary, Calgary, Canada
| | - Guanmin Chen
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Tej K Khalsa
- Department of Medicine, University of Calgary, Calgary, Canada
| | | | - Norm R C Campbell
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.,Department of Medicine, University of Calgary, Calgary, Canada.,Department of Physiology and Pharmacology, University of Calgary, Calgary, Canada
| | - Elijah Dixon
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.,Department of Surgery, University of Calgary, Calgary, Canada
| | - Doreen Rabi
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.,Department of Medicine, University of Calgary, Calgary, Canada
| | - Nathalie Jette
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Robyn Dhanoa
- Faculty of Nursing, University of Calgary, Calgary, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada. .,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.
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Ho CH, Cheung A, Southern D, Ocampo W, Kaufman J, Hogan DB, Baylis B, Conly JM, Stelfox HT, Ghali WA. A Mixed-methods Study to Assess Interrater Reliability and Nurse Perception of the Braden Scale in a Tertiary Acute Care Setting. Ostomy Wound Manage 2016; 62:30-38. [PMID: 28054924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Research regarding the reliability of the Braden Scale and nurses' perspectives on the instrument for predicting pressure ulcer (PU) risk in acute care settings is limited. A mixed-methods study was conducted in a tertiary acute care facility to examine interrater reliability (IRR) of the Braden Scale and its subscales, and a qualitative survey using semi-structured interviews was conducted among nurses caring for patients in acute care units to gain nurse perspective regarding scale usability. Data were extracted from a previous retrospective, randomized, controlled trial involving adult patients with compromised mobility receiving care in a tertiary acute care hospital in Canada. One-way, intraclass correlation coefficients (ICCs) were calculated on item and total scores, and kappa statistics were used to determine reliability of categorizing patients on their risk. Interview results were categorized by common themes. Reliability was assessed on 64 patients, where nurses and research staff independently assessed enrolled participants at baseline and after 72 hours using the Braden Scale as it appeared on an electronic medical record. IRR for the total score was high (ICC = 0.807). The friction and shear item had the lowest reliability (ICC = 0.266). Reliability of categorizing patients' level of risk had moderate agreement (κ = 0.408). Three (3) major and 12 subthemes emerged from the 14 nurse interviews; nurses were aware of the scale's purpose but were uncertain of its effectiveness, some items were difficult to rate, and questions were raised as to whether using the scale enhanced patient care. Aspects identified by nurses to enhance usability included: 1) changes to the electronic version (incorporating the scale into daily assessment documents with readily available item descriptions), 2) additional training, and 3) easily available resource material to improve reliability and usability of scale. These findings need to be considered when using the Braden Scale in clinical practice. Further study of the value of the total Braden Scale and its subscales is warranted.
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Affiliation(s)
- Chester H Ho
- Cumming School of Medicine, University of Calgary; and Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, University of Calgary and Alberta Health Services at the Foothills Medical Centre, Calgary, AB, Canada
| | - Amanda Cheung
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary
| | - Danielle Southern
- O'Brien Institute of Public Health; and W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary
| | - Wrechelle Ocampo
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary
| | - Jaime Kaufman
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary
| | - David B Hogan
- the Brenda Strafford Foundation in Geriatric Medicine, University of Calgary
| | - Barry Baylis
- W21C Research and Innovation Centre; and Department of Medicine, Division of General Internal Medicine, Cumming School of Medicine, University of Calgary
| | - John M Conly
- W21C Research and Innovation Centre, Cumming School of Medicine; Departments of Medicine and Infection Prevention and Control, Alberta Health Services; and O'Brien Institute for Public Health, University of Calgary
| | - Henry T Stelfox
- Alberta Health Services' Critical Care Strategic Clinical Network; the Departments of Critical Care Medicine, Medicine and Community Health Sciences, University of Calgary; and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary
| | - William A Ghali
- O'Brien Institute for Public Health, Foothills Medical Centre, University of Calgary; W21C Research and Innovation Centre; and Departments of Community Health Sciences and General Internal Medicine, Cumming School of Medicine
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Butalia S, Patel AB, Johnson JA, Ghali WA, Rabi DM. Geographic Clustering of Acute Complications and Sociodemographic Factors in Adults with Type 1 Diabetes. Can J Diabetes 2016; 41:132-137. [PMID: 27887926 DOI: 10.1016/j.jcjd.2016.08.224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 03/18/2016] [Accepted: 08/24/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To assess the geographic distribution of acute complications in patients with type 1 diabetes in a large urban centre; and to assess the association between acute complications and community-level sociodemographic factors. METHODS Adults (aged ≥18 years old) with type 1 diabetes and acute complications were identified between 2004 and 2008 by using a diabetes centre clinical database or discharge abstracts for acute complications (diabetic ketoacidosis or hypoglycemia). Using a geographic information system, hot-spot analysis was used to identify spatial clusters of acute complications in a large urban centre. The association between acute complications and community-level sociodemographic factors were assessed by Spearman rank correlation. RESULTS We identified 1779 patients with type 1 diabetes, of whom 456 had been hospitalized for acute complications. The mean age of patients was 40.9±16.0 years, and men were more likely to have acute complications (59.2% vs. 52.3%; p<0.01). Spatial clusters of high values and low values were identified. Higher median family income (r=-0.36; p<0.0001) and higher education levels (r=-0.30; p<0.0001) were associated with lower rates of acute complications. CONCLUSIONS This study demonstrated geographic clusters of hospitalizations for acute complications and important community sociodemographic factors. Prevention strategies and interventions targeting these geographic and sociodemographic disparities need to be explored as a means of minimizing hospitalizations for acute complications.
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Affiliation(s)
- Sonia Butalia
- Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
| | - Alka B Patel
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - William A Ghali
- Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Doreen M Rabi
- Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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Coffin CS, Saunders C, Thomas CM, Loewen AHS, Ghali WA, Campbell NRC. Validity of ICD-9-CM Administrative Data for Determining Eligibility for Pneumococcal Vaccination Triggers. Am J Med Qual 2016; 20:158-63. [PMID: 15951522 DOI: 10.1177/1062860604274380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to evaluate the efficacy of medical record administrative data as coded by the International Classification of Diseases, Ninth Revision, for triggering pneumococcal vaccination reminders of patients following discharge from a tertiary care adult teaching hospital. A retrospective computerized search was conducted using administrative discharge data to detect patients admitted to the medical teaching unit who met clinical criteria for pneumococcal vaccination according to Canadian immunization guidelines. For identification of persons eligible for vaccination, administrative discharge data showed a sensitivity of 83% (confidence interval [CI], 0.73-0.92) and a specificity of 78% (CI, 0.64-0.91), with a positive predictive value of 87% (CI, 0.83-0.90) and a negative predictive value of 72% (CI, 0.58-0.86). The reasonably high specificity and sensitivity of diagnostic codes in administrative data could be used to trigger appropriate pneumococcal vaccination among eligible patients after hospital discharge.
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Affiliation(s)
- Carla S Coffin
- Department of Medicine, University of Calgary, Alberta T2N 4N1, Canada
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49
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Okoniewska B, Santana MJ, Holroyd-Leduc J, Flemons W, O'Beirne M, White D, Ocampo W, Ghali WA, Forster AJ. A framework to assess patient-reported adverse outcomes arising during hospitalization. BMC Health Serv Res 2016; 16:357. [PMID: 27494991 PMCID: PMC4974809 DOI: 10.1186/s12913-016-1526-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 06/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The assessment of adverse events from a patient-centered view includes patient-reported adverse outcomes. An adverse outcome refers to any suboptimal outcome experienced by the patient; when adverse outcomes are identified through a patient interview these are called patient-reported adverse outcomes. An adverse event is an adverse outcome that is more likely due to the processes of medical care rather than to the mere progression of disease. In the context of a large-scale study assessing post-hospitalization adverse events, we developed a conceptual framework to assess patient-reported adverse outcomes (PRAOs). This methodological manuscript describes this conceptual framework. METHODS The PRAO framework builds on a validated adverse event ascertainment method including three phases: Phase 1 involves an inquiry to ascertain the occurrence of any patient-reported adverse outcome. It is completed by a structured telephone interview to obtain details - from a patient perspective - on symptoms that developed and/or worsened after hospitalization. Phase 2 involves the classification of PRAOs by physicians not involved in the patient care. Physician-reviewers then rate the PRAOs using well-adopted scales to determine whether the occurrence was the natural progression of the underlying illness or due to medical care. When the PRAO is rated as "due to medical care", it is then classified as an "adverse event". Phase 3 involves the classification of adverse events as preventable or ameliorable. RESULTS Out of the 1347 patients contacted at 1-month post-discharge, 469 reported AOs and after reviewing 369 cases, 29 were classified as AEs. Observed agreement levels between raters were 87.3, 85.5, and 85.2 % respectively displaying a good agreement (k > 0.60). CONCLUSION The framework incorporates PRAOs as a way to identify cases that need to be evaluated for adverse events. Further validation of this framework is warrant with the final aim of implementation at larger scale. The implementation of this framework will enable clinicians, researchers and healthcare institutions to compare outcome rates across providers and over time.
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Affiliation(s)
- Barbara Okoniewska
- W21C Research and Innovation Centre, G-01- TRW Building, 3280 Hospital Drive, NW, Calgary, AB, T2N 4Z6, Canada
| | - Maria Jose Santana
- Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor, 3-36E, TRW Building, 3280 Hospital Drive, NW, Calgary, AB, T2N 4Z6, Canada.
| | - Jayna Holroyd-Leduc
- Department of Medicine, Cumming School of Medicine, University of Calgary, 1403 29 St NW, Calgary, AB, T2N 2 T9, Canada
| | - Ward Flemons
- Department of Medicine, Cumming School of Medicine, University of Calgary, 1403 29 St NW, Calgary, AB, T2N 2 T9, Canada
| | - Maeve O'Beirne
- Family Medicine and Primary Care Research Office, University of Calgary, G012, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4 N1, Canada
| | - Deborah White
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1 N4, Canada
| | - Wrochelle Ocampo
- W21C Research and Innovation Centre, G-01- TRW Building, 3280 Hospital Drive, NW, Calgary, AB, T2N 4Z6, Canada
| | - William A Ghali
- Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor, 3-36E, TRW Building, 3280 Hospital Drive, NW, Calgary, AB, T2N 4Z6, Canada
| | - Alan J Forster
- Department of Medicine, University of Ottawa, Civic Campus 1053 Carling Avenue, Box 684, Ottawa, ON, K1Y 4E9, Canada
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50
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Wilcox ME, Freiheit EA, Faris P, Hogan DB, Patten SB, Anderson T, Ghali WA, Knudtson M, Demchuk A, Maxwell CJ. Depressive symptoms and functional decline following coronary interventions in older patients with coronary artery disease: a prospective cohort study. BMC Psychiatry 2016; 16:277. [PMID: 27491769 PMCID: PMC4973530 DOI: 10.1186/s12888-016-0986-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/28/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Depressive symptoms are prevalent in patients with coronary artery disease (CAD). It is unclear, however, how depressive symptoms change over time and the impact of these changes on long-term functional outcomes. We examined the association between different trajectories of depressive symptoms over 1 year and change in functional status over 30 months among patients undergoing coronary angiography. METHODS This was a prospective cohort study of 350 patients aged 60 and older undergoing non-emergent cardiac catheterization (October 2003-February 2007). A dynamic measure of significant depressive symptoms (i.e., Geriatric Depression Scale score 5+) capturing change over 12 months was derived that categorized patients into the following groups: (i) no clinically important depressive symptoms (at baseline, 6 and 12 months); (ii) baseline-only symptoms (at baseline but not at 6 and 12 months); (iii) new onset symptoms (not at baseline but present at either 6 or 12 months); and, (iv) persistent symptoms (at baseline and at either 6 or 12 month assessment). Primary outcomes were mean change in Older Americans Resources and Services (OARS) instrumental (IADL) and basic activities of daily living (BADL) scores (range 0-14 for each) across baseline (pre-procedure) and 6, 12, and 30 months post-procedure visits. RESULTS Estimates for the symptom categories were 71 % (none), 9 % (baseline only), 8 % (new onset) and 12 % (persistent). In adjusted models, patients with persistent symptoms showed a significant decrease in mean IADL and BADL scores from baseline to 6 months (-1.32 [95 % CI -1.78 to -0.86] and -0.63 [-0.97 to -0.30], respectively) and from 12 to 30 months (-0.79 [-1.27 to -0.31] and -1.00 [-1.35 to -0.65], respectively). New onset symptoms were associated with a significant decrease in mean IADL scores at 6 months and from 6 to 12 months. Patients with no depressive symptoms showed little change in scores whereas those with baseline only symptoms showed significant improvement in mean IADL at 6 months. CONCLUSIONS Patients with persistent depressive symptoms were at greatest risk for worse functional status 30 months following coronary interventions. Proactive screening and follow-up for depression in this population offers prognostic value and may facilitate the implementation of targeted interventions.
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Affiliation(s)
- M. Elizabeth Wilcox
- Department of Medicine, Division of Respirology, University Health Network, Toronto, Canada ,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | | | - Peter Faris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Research, Innovation and Analytics, Alberta Health Services, Foothills Medical Centre, Calgary, Canada
| | - David B. Hogan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Medicine (Division of Geriatric Medicine), Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Scott B. Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Psychiatry and Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Todd Anderson
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - William A. Ghali
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Merril Knudtson
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Andrew Demchuk
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Colleen J. Maxwell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, N2L 3G1 ON Canada ,Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
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