Impact of the diabetes Canada guideline dissemination strategy on dispensed vascular protective medications for older patients in Ontario, Canada: a linked EMR and administrative data study

ObjectiveIdentification of older patients at risk, among those accessing the emergency department (ED), may support clinical decision-making. To this purpose, we developed and validated the Dynamic Silver Code (DSC), a score based on real-time linkage of administrative data.Design and settingThe ‘Silver Code National Project (SCNP)’, a non-concurrent cohort study, was used for retrospective development and internal validation of the DSC. External validation was obtained in the ‘Anziani in DEA (AIDEA)’ concurrent cohort study, where the DSC was generated by the software routinely used in the ED.ParticipantsThe SCNP contained 281 321 records of 180 079 residents aged 75+ years from Tuscany and Lazio, Italy, admitted via the ED to Internal Medicine or Geriatrics units. The AIDEA study enrolled 4425 subjects aged 75+ years (5217 records) accessing two EDs in the area of Florence, Italy.InterventionsNone.Outcome measuresPrimary outcome: 1-year mortality. Secondary outcomes: 7 and 30-day mortality and 1-year recurrent ED visits.ResultsAdvancing age, male gender, previous hospital admission, discharge diagnosis, time from discharge and polypharmacy predicted 1-year mortality and contributed to the DSC in the development subsample of the SCNP cohort. Based on score quartiles, participants were classified into low, medium, high and very high-risk classes. In the SCNP validation sample, mortality increased progressively from 144 to 367 per 1000 person-years, across DSC classes, with HR (95% CI) of 1.92 (1.85 to 1.99), 2.71 (2.61 to 2.81) and 5.40 (5.21 to 5.59) in class II, III and IV, respectively versus class I (p<0.001). Findings were similar in AIDEA, where the DSC predicted also recurrent ED visits in 1 year. In both databases, the DSC predicted 7 and 30-day mortality.ConclusionsThe DSC, based on administrative data available in real time, predicts prognosis of older patients and might improve their management in the ED.

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Monitoring adverse events in older hospitalized patients: A retrospective cross-sectional study using validated screening criteria with administrative data

Journal of Hospital Administration ◽

10.5430/jha.v7n6p7 ◽

2018 ◽

Vol 7 (5) ◽

pp. 7

Author(s):

Stacy A. Ackroyd-Stolarz ◽

Susan K. Bowles ◽

Lorri Giffin

Keyword(s):

Administrative Data ◽

Older Patients ◽

Adverse Drug Events ◽

Pressure Ulcers ◽

Cross Sectional Study ◽

System Level ◽

Drug Event ◽

Sectional Study ◽

Cross Sectional ◽

Screening Criteria

Objective: Older patients are at higher risk of experiencing an adverse event (AE) during an acute hospitalization. The objective of the current study was to use routinely collected administrative data to characterize AEs and their system-level impact for older patients hospitalized in one Canadian health authority.Methods: This retrospective cross-sectional study occurred in the Capital District Health Authority in Nova Scotia, Canada between April 1, 2012 and March 31, 2013. The primary outcome was identification of pressure ulcers, fall-related injuries and adverse drug events in patients 65 years of age and older admitted to an acute inpatient service. AEs were identified using validated screening criteria. Data were analyzed using standard descriptive statistics.Results: There were 11,747 hospitalizations during the study period. A total of 330 (2.8%) AEs in 325 patients were identified using the screening criteria. This included 55 (16.7% of 330) pressure ulcers, 25 (7.6%) fall-related injuries and 250 (75.8%) adverse drug events. The average length of stay was significantly higher in patients with a pressure ulcer (35.8 ± 47.3 vs. 9.0 ± 14.8 days, p < .0001), fall-related injury (30.3 ± 23.2 vs. 9.0 ± 15.2 days, p < .0001), or adverse drug event (14.6 ± 14.4 vs. 9.0 ± 15.2 days, p < .0001) during their acute hospitalization.Conclusions:Use of validated screening criteria with administrative hospitalization data provides important information for monitoring the system-level impact of common AEs in older patients. Significant and clinically important differences in healthcare utilization underscore the value in monitoring these AEs in this growing patient population.

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Comparison of Administrative Data and Medical Records to Measure the Quality of Medical Care Provided to Vulnerable Older Patients

Medical Care ◽

10.1097/01.mlr.0000196960.12860.de ◽

2006 ◽

Vol 44 (2) ◽

pp. 141-148 ◽

Cited By ~ 29

Author(s):

Catherine H. MacLean ◽

Rachel Louie ◽

Paul G. Shekelle ◽

Carol P. Roth ◽

Debra Saliba ◽

...

Keyword(s):

Medical Care ◽

Administrative Data ◽

Medical Records ◽

Older Patients ◽

Quality Of Medical Care

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Changes in mammography screening in Ontario and Alberta following national guideline dissemination: an interrupted time series analysis

F1000Research ◽

10.12688/f1000research.55004.1 ◽

2021 ◽

Vol 10 ◽

pp. 1044

Author(s):

Christine Fahim ◽

Natasha Wiebe ◽

Rosane Nisenbaum ◽

Jemila S. Hamid ◽

Joycelyne E. Ewusie ◽

...

Keyword(s):

Time Series ◽

Time Series Analysis ◽

Interrupted Time Series ◽

National Guideline ◽

Income Quintile ◽

Interrupted Time Series Analysis ◽

Dissemination Strategy ◽

Series Analysis ◽

Guideline Dissemination ◽

Mammography Use

Background: In November 2011, the Canadian Task Force on Preventive Health Care released guidelines for screening women at average breast cancer risk. Weak recommendations (framed using GRADE methodology) were made for screening women aged 50 to 74 years every two to three years, and for not screening women aged 40 to 49 years. Methods: We conducted an interrupted time series analysis using administrative data to examine bilateral mammography use before and after a national guideline dissemination strategy targeting primary care physicians. Women aged 40 to 74 years living in Ontario or Alberta from 30th November 2008 to 30th November 2014 were included. Strata included age, region of residence, neighbourhood income quintile, immigration status, and education level. Results: In both provinces, mammography use rates were lower in the post-intervention period (527 vs. 556 and 428 vs. 465/1000 participant-months - the monthly screening rate/1000 - in Ontario and Alberta, respectively). In Ontario, mammography trends decreased following guideline release to align with recommendations for women aged 40 to 74 (decrease of 2.21/1000 women, SE 0.26/1000, p<0.0001). In Alberta, mammography trends decreased for women aged 40 to 49 years (3/1000 women, SE 0.32, p<0.001) and 50 to 69 (2.9/1000 women, SE 0.79, p<0.001), but did not change for women aged 70 to 74 (0.7/1000 women, SE 1.23, p=0.553). In both provinces, trends in mammography use rates were sustained for up to three years after guideline release. Conclusions: The guideline dissemination strategy appeared to increase uptake of guideline-concordant screening practice in women aged 40 to 49 years in Ontario and Alberta and for women aged 50 to 74 years in Ontario. Further work is required to understand these findings and whether shared decision making about mammography between women and providers increased among women considering mammography.

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