scholarly journals Cohort profile: CROSS-TRACKS: a population-based open cohort across healthcare sectors in Denmark

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e039996
Author(s):  
Anders Hammerich Riis ◽  
Pia Kjær Kristensen ◽  
Matilde Grøndahl Petersen ◽  
Ninna Hinchely Ebdrup ◽  
Simon Meyer Lauritsen ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Primary Care ◽  
Hospital Admissions ◽  
Smoking Status ◽  
Population Based ◽  
Fertility Treatment ◽  
Study Patient ◽  
Transfer Payment ◽  
Sociodemographic Characteristics ◽  
Patient Pathways

PurposeThis paper describes the open cohort CROSS-TRACKS, which comprises population-based data from primary care, secondary care and national registries to study patient pathways and transitions across sectors while adjusting for sociodemographic characteristics.ParticipantsA total of 221 283 individuals resided in the four Danish municipalities that constituted the catchment area of Horsens Regional Hospital in 2012–2018. A total of 96% of the population used primary care, 35% received at least one transfer payment and 66% was in contact with a hospital at least once in the period. Additional clinical information is available for hospital contacts (eg, alcohol intake, smoking status, body mass index and blood pressure). A total of 23% (n=8191) of individuals aged ≥65 years had at least one potentially preventable hospital admission, and 73% (n=5941) of these individuals had more than one.Findings to dateThe cohort is currently used for research projects in epidemiology and artificial intelligence. These projects comprise a prediction model for potentially preventable hospital admissions, a clinical decision support system based on artificial intelligence, prevention of medication errors in the transition between sectors, health behaviour and sociodemographic characteristics of men and women prior to fertility treatment, and a recently published study applying machine learning methods for early detection of sepsis.Future plansThe CROSS-TRACKS cohort will be expanded to comprise the entire Central Denmark Region consisting of 1.3 million residents. The cohort can provide new knowledge on how to best organise interventions across healthcare sectors and prevent potentially preventable hospital admissions. Such knowledge would benefit both the individual citizen and society as a whole.

scholarly journals Cohort profile: CROSS-TRACKS - a population-based open cohort across healthcare sectors in Denmark

2020 ◽  
Author(s):  
Anders Hammerich Riis ◽  
Pia Kjaer Kristensen ◽  
Matilde Groendahl Petersen ◽  
Ninna Hinchely Ebdrup ◽  
Simon Meyer Lauritsen ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Primary Care ◽  
Hospital Admissions ◽  
Smoking Status ◽  
Population Based ◽  
Fertility Treatment ◽  
Study Patient ◽  
Transfer Payment ◽  
Sociodemographic Characteristics ◽  
Patient Pathways

Purpose This paper describes the open cohort CROSS-TRACKS, which was set up in Denmark in 2015. The cohort comprises population-based data from primary care, secondary care, and national registries. In addition, the paper outlines the new research opportunities provided by the cohort; the possibility to study patient pathways and transitions across sectors while adjusting for sociodemographic characteristics. The new data source is especially interesting for studies of potentially preventable admissions and readmissions. Participants A total of 221,283 individuals resided in the four Danish municipalities that constituted the catchment area of Horsens Regional Hospital in 2012-2018. A total of 96% of the population used primary care, 35% received at least one transfer payment, and 66% was in contact with a hospital at least once in the period. Additional clinical information is available for hospital contacts (eg alcohol intake, smoking status, body mass index, and blood pressure). A total of 27% (n=9,986) of individuals aged ≥65 years had at least one potentially preventable hospital admission, and 69% (n=6,881) of these individuals had more than one. Findings to date The cohort is currently used for research projects in epidemiology and artificial intelligence. These projects comprise a prediction model for potentially preventable hospital admissions, a clinical decision support system based on artificial intelligence, prevention of medication errors in the transition between sectors, health behaviour and sociodemographic characteristics of men and women prior to fertility treatment, and a recently published study applying machine learning methods for early detection of sepsis. Future plans The CROSS-TRACKS cohort will be expanded to comprise the entire Central Denmark Region consisting of 1.3 million residents. The cohort can provide new knowledge on how to best organise interventions across healthcare sectors and prevent potentially preventable hospital admissions. Such knowledge would benefit both the individual citizen and society as a whole.

scholarly journals Self-harm presentation across healthcare settings by sex in young people

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Amanda Marchant ◽  
Samantha Turner ◽  
Lloyd Balbuena ◽  
Evyn Peters ◽  
Dave Williams ◽  
...  
Keyword(s):  
Primary Care ◽  
Linked Data ◽  
Hospital Admissions ◽  
Population Level ◽  
Population Based ◽  
Service Planning ◽  
Individual Level ◽  
Healthcare Data ◽  
Healthcare Settings ◽  
Self Harm

BackgroundAccurate data on self-harm is crucial to suicide prevention efforts. It has been previously found that around twice as many people who self-harm seek help in primary care than in secondary care. Little is known about how contacts for self-harm differ across settings at a population level. This study utilised individual-level linked data across GP, Emergency Departments (ED), outpatients and hospital admissions examining contacts across settings and time by sex for self-harm in 10-24 year olds. MethodsA whole-population based e-cohort study of routinely collected healthcare data was conducted. Rates of self-harm across settings over time by sex were examined. Individuals were categorised based on the service(s) to which they presented. ResultsA total of 937,697 individuals aged 10-24 years contributed 5,369,794 person years of data from the 01.01.2003-30.09.2015. There were differences in self-harm contacts by demographic variables particularly with regards to sex and admissions to hospital following ED attendance. ConclusionThis is the first study to compare self-harm in people aged 10-24 years across primary care, EDs, and hospital settings in the UK. The high rates of self-harm in primary care and for young men in EDs highlight these as important settings for intervention. Understanding patterns of presentation will inform service planning and configuration for follow-up care and could inform tailored support, for example for males in ED. Linked data provides important evidence to support the development of interventions across healthcare settings.

scholarly journals Trends in healthcare use in children aged less than 15 years: a population-based cohort study in England from 2007 to 2017

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e033761 ◽  
Author(s):  
Judith Ruzangi ◽  
Mitch Blair ◽  
Elizabeth Cecil ◽  
Geva Greenfield ◽  
Alex Bottle ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Hospital Admissions ◽  
Population Based ◽  
Urgent Care ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Emergency Hospital ◽  
Outpatient Visits ◽  
Ed Visits

ObjectiveTo describe changing use of primary care in relation to use of urgent care and planned hospital services by children aged less than 15 years in England in the decade following major primary care reforms from 2007 to 2017DesignPopulation-based retrospective cohort study.MethodsWe used linked data from the Clinical Practice Research Datalink to study children’s primary care consultations and use of hospital care including emergency department (ED) visits, emergency and elective admissions to hospital and outpatient visits to specialists.ResultsBetween 1 April 2007 and 31 March 2017, there were 7 604 024 general practitioner (GP) consultations, 981 684 ED visits, 287 719 emergency hospital admissions, 2 253 533 outpatient visits and 194 034 elective admissions among 1 484 455 children aged less than 15 years. Age-standardised GP consultation rates fell (−1.0%/year) to 1864 per 1000 child-years in 2017 in all age bands except infants rising by 1%/year to 6722 per 1000/child-years in 2017. ED visit rates increased by 1.6%/year to 369 per 1000 child-years in 2017, with steeper rises of 3.9%/year in infants (780 per 1000 child-years in 2017). Emergency hospital admission rates rose steadily by 3%/year to 86 per 1000 child-years and outpatient visit rates rose to 724 per 1000 child-years in 2017.ConclusionsOver the past decade since National Health Service primary care reforms, GP consultation rates have fallen for all children, except for infants. Children’s use of hospital urgent and outpatient care has risen in all ages, especially infants. These changes signify the need for better access and provision of specialist and community-based support for families with young children.

scholarly journals Risk Diagrams Based on Primary Care Electronic Medical Records and Linked Real-Time PCR Data to Monitor Local COVID-19 Outbreaks During the Summer 2020: A Prospective Study Including 7,671,862 People in Catalonia

2021 ◽  
Vol 9 ◽  
Author(s):  
Marti Catala ◽  
Ermengol Coma ◽  
Sergio Alonso ◽  
Enrique Álvarez-Lacalle ◽  
Silvia Cordomi ◽  
...  
Keyword(s):  
Primary Care ◽  
Intensive Care ◽  
Electronic Medical Records ◽  
Early Identification ◽  
Medical Records ◽  
Hospital Admissions ◽  
Nursing Home Residents ◽  
Population Based ◽  
Local Hospital ◽  
Potential Growth

Monitoring transmission is a prerequisite for containing COVID-19. We report on effective potential growth (EPG) as a novel measure for the early identification of local outbreaks based on primary care electronic medical records (EMR) and PCR-confirmed cases. Secondly, we studied whether increasing EPG precedes local hospital and intensive care (ICU) admissions and mortality. Population-based cohort including all Catalan citizens' PCR tests, hospitalization, intensive care (ICU) and mortality between 1/07/2020 and 13/09/2020; linked EMR covering 88.6% of the Catalan population was obtained. Nursing home residents were excluded. COVID-19 counts were ascertained based on EMR and PCRs separately. Weekly empirical propagation (ρ7) and 14-day cumulative incidence (A14) and 95% confidence intervals were estimated at care management area (CMA) level, and combined as EPG = ρ7 × A14. Overall, 7,607,201 and 6,798,994 people in 43 CMAs were included for PCR and EMR measures, respectively. A14, ρ7, and EPG increased in numerous CMAs during summer 2020. EMR identified 2.70-fold more cases than PCRs, with similar trends, a median (interquartile range) 2 (1) days earlier, and better precision. Upticks in EPG preceded increases in local hospital admissions, ICU occupancy, and mortality. Increasing EPG identified localized outbreaks in Catalonia, and preceded local hospital and ICU admissions and subsequent mortality. EMRs provided similar estimates to PCR, but some days earlier and with better precision. EPG is a useful tool for the monitoring of community transmission and for the early identification of COVID-19 local outbreaks.

scholarly journals Quantifying the incidence and cost of acute gastrointestinal illness in Sweden, 2013–2014

2016 ◽  
Vol 144 (13) ◽  
pp. 2831-2839 ◽  
Author(s):  
M. EDELSTEIN ◽  
H. MERK ◽  
C. DEOGAN ◽  
A. CARNAHAN ◽  
A. WALLENSTEN
Keyword(s):  
Primary Care ◽  
Hospital Admissions ◽  
Productivity Loss ◽  
Gastrointestinal Symptoms ◽  
Population Based ◽  
Incidence Rates ◽  
Gastrointestinal Illness ◽  
Age Group ◽  
Acute Gastrointestinal Illness ◽  
Direct Healthcare Costs

SUMMARYIn Sweden, acute gastrointestinal illness (AGI) incidence, severity, impact on productivity, related healthcare usage and associated costs are not ascertained. We measured these in 2013–2014 using a population-based cohort reporting weekly. We defined AGI as ⩾3 episodes of loose stools or vomiting/24 h; or loose stools or vomiting with ⩾2 other gastrointestinal symptoms. After each AGI episode, we collected information about perceived severity, healthcare use and absenteeism. We calculated incidence rates, AGI absenteeism and costs comprising direct healthcare costs and productivity loss due to work/school absenteeism. A total of 3241 participants reported 1696 AGI episodes [incidence 360/1000 person-years, 95% confidence interval (CI) 326–395; highest in the <5 years age group]. In the <5 years age group, 31% of episodes were perceived as mild, 61% as moderate and 8% as severe; 9·4% led to primary-care consultations, and 1·4% to hospital admissions. In the ⩾5 years age group, 18% of episodes were perceived as mild, 64% as moderate and 18% as severe; 6·4% led to primary-care consultations, and 1·9% to hospital admissions. AGI caused 8 891 000 days of absenteeism (95% CI 6 009 000–12 780 000). AGI cost €1 005 885 000 (95% CI 754 309 000–1 257 195 000) nationally for the year. In Sweden, a minority of cases perceive AGI as a mild illness. AGI is a burden on the healthcare system and causes productivity loss, with high costs. Countries may consider these estimates when prioritizing health interventions.

The Association between Depressive Symptoms and Cigarette Smoking in An Urban Primary Care Sample

2000 ◽  
Vol 30 (1) ◽  
pp. 15-26 ◽  
Author(s):  
Charlotte Brown ◽  
Pamela A. F. Madden ◽  
Deena R. Palenchar ◽  
Lisa Cooper-Patrick
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
Cigarette Smoking ◽  
Nicotine Dependence ◽  
Primary Care Physicians ◽  
Employment Status ◽  
Smoking Status ◽  
Smoking Behavior ◽  
Depression Scale ◽  
Population Based

Objective: To examine the relationship between cigarette smoking and depressive symptoms in an urban primary care sample. Methods: Eligible participants were 526 patients aged eighteen to sixty-four presenting in the waiting rooms of two university affiliated internal medicine clinics. Participants were asked to complete a brief interview which ascertained current depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D), demographic information, and smoking status using a modified version of the Fagerstrom Test for Nicotine Dependence (FTND). Results: Smoking status differed significantly by age, gender, education, and employment status. Mean level of depressive severity also differed by smoking status. Current smokers with nicotine dependence symptoms had significantly higher CES-D scores than those who had never smoked, ex-smokers, and non-dependent smokers. Logistic regression analyses indicated that gender, employment status, age, and smoking status were significantly associated with CES-D scores ≥16. Exploratory analyses suggested that among smokers with a symptom of nicotine dependence, significantly more women than men had clinically significant levels of depressive symptoms. Conclusions: The association between smoking behavior and depressive symptoms in the present study is consistent with that reported in population-based and psychiatric samples. Symptoms of nicotine dependence were significantly associated with clinical levels of depressive symptoms. Primary care physicians may wish to inquire about depressive symptoms among smokers, because these symptoms may interfere with patients' efforts to quit.

scholarly journals Are primary care and continuity of care associated with asthma-related acute outcomes amongst children? A retrospective population-based study

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Sarah Cooper ◽  
Elham Rahme ◽  
Sze Man Tse ◽  
Roland Grad ◽  
Marc Dorais ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Continuity Of Care ◽  
Hospital Admissions ◽  
Population Based ◽  
Logistic Regression Models ◽  
Children With Asthma ◽  
Care Models ◽  
Ed Visits ◽  
Asthma Outcomes

Abstract Background Having a primary care provider and a continuous relationship may be important for asthma outcomes. In this study, we sought to determine the association between 1) having a usual provider of primary care (UPC) and asthma-related emergency department (ED) visits and hospitalization in Québec children with asthma and 2) UPC continuity of care and asthma outcomes. Methods Population-based retrospective cohort study using Québec provincial health administrative data, including children 2-16 years old with asthma (N = 39, 341). Exposures and outcomes were measured from 2010-2011 and 2012-2013, respectively. Primary exposure was UPC stratified by the main primary care models in Quebec (team-based Family Medicine Groups, family physicians not in Family Medicine Groups, pediatricians, or no assigned UPC). For those with an assigned UPC the secondary exposure was continuity of care, measured by the UPC Index (high, medium, low). Four multivariate logistic regression models examined associations between exposures and outcomes (ED visits and hospitalizations). Results Overall, 17.4% of children had no assigned UPC. Compared to no assigned UPC, having a UPC was associated with decreased asthma-related ED visits (pediatrician Odds Ratio (OR): 0.80, 95% Confidence Interval (CI) [0.73, 0.88]; Family Medicine Groups OR: 0.84, 95% CI [0.75,0.93]; non-Family Medicine Groups OR: 0.92, 95% CI [0.83, 1.02]) and hospital admissions (pediatrician OR: 0.66, 95% CI [0.58, 0.75]; Family Medicine Groups OR: 0.82, 95% CI [0.72, 0.93]; non-Family Medicine Groups OR: 0.76, 95% CI [0.67, 0.87]). Children followed by a pediatrician were more likely to have high continuity of care. Continuity of care was not significantly associated with asthma-related ED visits. Compared to low continuity, medium and high continuity of care decreased asthma-related hospital admissions, but none of these associations were significant. Conclusion Having a UPC was associated with reduced asthma-related ED visits and hospital admissions. However, continuity of care was not significantly associated with outcomes. The current study provides ongoing evidence for the importance of primary care in children with asthma.

scholarly journals Self-harm presentation across healthcare settings by sex in young people: an e-cohort study using routinely collected linked healthcare data in Wales, UK

2019 ◽  
Vol 105 (4) ◽  
pp. 347-354 ◽  
Author(s):  
Amanda Marchant ◽  
Samantha Turner ◽  
Lloyd Balbuena ◽  
Evyn Peters ◽  
Dave Williams ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Hospital Admissions ◽  
Population Based ◽  
Age Group ◽  
Individual Level ◽  
Healthcare Data ◽  
Self Harm ◽  
The Uk ◽  
Over Time

BackgroundThis study used individual-level linked data across general practice, emergency departments (EDs), outpatients and hospital admissions to examine contacts across settings and time by sex for self-harm in individuals aged 10–24 years old in Wales, UK.MethodsA whole population-based e-cohort study of routinely collected healthcare data was conducted. Rates of self-harm across settings over time by sex were examined. Individuals were categorised based on the service(s) to which they presented.ResultsA total of 937 697 individuals aged 10–24 years contributed 5 369 794 person years of data from 1 January 2003 to 30 September 2015. Self-harm incidence was highest in primary care but remained stable over time (incident rate ratio (IRR)=1.0; 95% CI 0.9 to 1.1). Incidence of ED attendance increased over time (IRR=1.3; 95% CI 1.2 to 1.5) as did hospital admissions (IRR=1.4; 95% CI 1.1 to 1.6). Incidence in the 15–19 years age group was the highest across all settings. The largest increases were seen in the youngest age group. There were increases in ED attendances for both sexes; however, females are more likely than males to be admitted following this. This was most evident in individuals 10–15 years old, where 76% of females were admitted compared with just 49% of males. The majority of associated outpatient appointments were under a mental health specialty.ConclusionsThis is the first study to compare self-harm in people aged 10–24 years across primary care, EDs and hospital settings in the UK. The high rates of self-harm in primary care and for young men in EDs highlight these as important settings for intervention.

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