scholarly journals First steps in demonstrating an impact on health service use of the Welsh Government Supporting People homelessness prevention programme using linked administrative data

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Sarah Lowe ◽  
Laura McGinn ◽  
Martin Heaven ◽  
Lucie Griffiths ◽  
Kerry Bailey
Keyword(s):  
Comparative Analysis ◽  
Administrative Data ◽  
Service Use ◽  
Hospital Admissions ◽  
Health Service Use ◽  
Prevention Programme ◽  
Control Groups ◽  
Health Events ◽  
Homelessness Prevention ◽  
Linked Administrative Data

ABSTRACT ObjectivesTo assess the feasibility of using linked administrative data to deliver a quantitative component to the evaluation of the national homelessness prevention programme in Wales, Supporting People. Specifically, to establish whether any impact of Supporting People on the use of health services could be demonstrated. Approach: Data on the Supporting People programme was acquired from two pathfinder Local Authorities in Wales and anonymously linked to the routine health records held in the SAIL Databank at Swansea University. Any bias in linking rates was examined and health events analysed for the period 12 months before and 12 months after the point when homelessness prevention support began (the ‘crisis point’). The study evaluated a range of possible control groups that could be created using administrative data and undertook some preliminary comparative analysis. ResultsThe results of the study are due to be published on 10th March 2016 so detailed results will be available for August. We will briefly explore the unique contribution of data linking to researching the hard-to-reach and/or vulnerable groups supported by the intervention (e.g. people with substance misuse problems, women experiencing domestic violence and people with a criminal offending history) and the challenges of delivering a quantitative evaluation using linked administrative data. Findings will be reported on linking rates including any potential areas where particular service groups were relatively less well represented. Patterns of the following health events will be reported around the ‘crisis point’: i) number of days when GP events occurred; ii) number of A&E visits and iii) number of emergency hospital admissions. Interpretations are made of consistent patterns of health events across different service user subgroups. The GP diagnosis codes, GP prescribing codes, reasons for visiting A&E and reasons for emergency hospital admissions that showed the greatest decrease after the intervention will be reported. A brief discussion will be presented of the suitability of different control groups and the findings of the preliminary comparative analysis. ConclusionsUsing primary research methods, demonstrating the impact of a homelessness prevention programme on outcomes like health service use represents an insuperable challenge. The use of data linking data delivers a challenging but potentially robust method to demonstrate impact and the feasibility study was able to take the first steps towards demonstrating improved health outcomes for individuals.

scholarly journals Examining the link between family health events and pupil performance in Wales

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Phil Murphy ◽  
Samuel Brown
Keyword(s):  
Educational Attainment ◽  
Administrative Data ◽  
Hospital Admissions ◽  
Family Health ◽  
Strong Relationship ◽  
World Health ◽  
Health Events ◽  
Depth Analysis ◽  
Icd 10 ◽  
The Uk

Background with rationale There is evidence of a strong relationship between health (and mother’s health) and early educational attainment. With access to administrative data this relationship can be explored to greater depth for the UK. Main Aim To explore the effects of a pupil’s and their mother’s health (split into 22 categories) upon the pupil’s educational attainment through the use of administrative data. Methods/Approach Health events were found through hospital admissions and then converted into the World Health Organisation’s ICD-10 health events. Two year lags were also created for these health events. Probit and ordered probit analyses were then used to explore the effects of these health events on a binary pass/fail core subject indicator and on a teacher assessed grade for Maths, Science and English. Analysis was split by gender and keystage. Results Few of the health events affect the educational attainment of the pupil. The health of male pupils has little impact on education, with the mother’s health having a stronger impact. The mother’s past health events have the greatest impact upon the male pupil’s education. The male pupil’s past health effects keystage 2 pupils the most, with little effect for keystage 1 and 3 pupils. Female pupils’ health has little impact at keystage 1, with increasing importance at keystage 2 and 3. Mother’s health (including past health) seems to have the opposite effect, being more important at keystage 1 and less at keystage 2 and 3. The female pupil’s past health has a small but consistent impact across all keystages. Conclusion By splitting health into ICD-10 categories, the health events that affect education have been more clearly identified. Most importantly, however, is the contribution of administrative data, allowing for in-depth analysis of health on education.

scholarly journals Predicting who applies to Public Housing using Linked Administrative Data

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Aynslie Hinds ◽  
Brian Bechtel ◽  
Jino Distasio ◽  
Leslie L Roos ◽  
Lisa Lix
Keyword(s):  
Health Service ◽  
Public Housing ◽  
Administrative Data ◽  
Low Income ◽  
Service Use ◽  
Conditional Logistic Regression ◽  
Health Service Use ◽  
Income Differences ◽  
The Public ◽  
Income Assistance

ABSTRACT ObjectivePublic housing residents, who live in low income government rental housing, are often in poorer health than the rest of the population. However, few studies have been able to untangle the relationships between health and public housing residency, and to assess whether health contributes to the decision to apply. We used linked population-based administrative data from one Canadian province to compare the health and health service use of people who applied to public housing to that of people who did not apply. ApproachAdministrative data housed in the Manitoba Centre for Health Policy’s Population Health Research Data Repository were used to identify a cohort of individuals who applied to public housing in 2005 and 2006. They were matched one-to-one to a cohort from the general population using socio-demographic variables. A population registry provided demographic and geographic characteristics. Economic measures included receipt of income assistance and an area-level measure from the Statistics Canada Census. Measures of health and health service use were derived from hospital, physician, emergency department, and prescription drug databases. Conditional logistic regression was used to test the association between a public housing application and health status and health service use, after controlling for income. ResultsThere were 10,324 individuals in each of the public housing applicant and matched cohorts; the majority were female (72.4%), young (62% less than 40 years), urban residents (61.2%), and received income assistance (52.8%). A higher percent of the public housing applicant cohort had physician-diagnosed physical and mental health conditions and used more health services compared to the matched cohort. Having a physician-diagnosed respiratory illness (odds ratio [OR] = 1.14, 95% confidence interval [CI] 1.05,1.25), diabetes (OR = 1.24, 95% CI 1.09,1.40), schizophrenia (OR = 1.58, 95% CI 1.30,1.92), affective disorders (OR = 1.37, 95% CI 1.27,1.48), and substance abuse disorders (OR = 1.46, 95% CI 1.25,1.71) were associated with an increased likelihood of applying for public housing, while being diagnosed with cancer (OR = 0.76, 95% CI 0.61,0.96) was associated with a decreased likelihood of applying, after controlling for income differences. High health service users were also more likely to apply for public housing, after controlling for income differences. ConclusionIndividuals who move into public housing are in poor health before they apply. Health and social service supports that are co-located with public housing facilities may help to ensure that residents have successful tenancies.

scholarly journals Maternal assault admissions are associated with increased risk of child protection involvement

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Carol Orr ◽  
David B Preen ◽  
Rebecca Glauert ◽  
Melissa O'Donnell ◽  
Colleen Fisher ◽  
...  
Keyword(s):  
Child Maltreatment ◽  
Young Children ◽  
Administrative Data ◽  
Hospital Admissions ◽  
Cox Regression ◽  
Small Sample ◽  
Prenatal Period ◽  
Increased Risk ◽  
Linked Administrative Data ◽  
Aboriginal Children

IntroductionAlmost half of Australian women assaulted by their partner have children in their care. Evidence suggests a link between children’s exposure to violence, and subsequent maltreatment allegations. However, this evidence is limited by small sample sizes. Linked administrative data present an opportunity to further investigate this sensitive topic. Objectives and ApproachThis study investigated the relationship between assaults on mothers and subsequent child maltreatment allegations. The sample included all live births in Western Australia from 1990 to 2009 (N=524,534) and their parents, with follow up to 2013. Linked administrative data on child maltreatment allegations and mothers’ assault-related hospital admissions were obtained. Multivariate Cox regression estimated the risk of maltreatment allegation following maternal assault admission. Adjusted and unadjusted hazard ratios (HR) and 95\% confidence intervals (CI) were calculated for the risk of maltreatment allegation, and time (in months) between assault admission and the first maltreatment allegation. ResultsOne in five children whose mother had an assault admission had a subsequent maltreatment allegation, increasing to more than one in three children when restricted to assault admissions in the prenatal period. More than half of the children who had a maltreatment allegation after their mother was admitted for assault were Aboriginal. After adjusting for covariates, children whose mother had an assault admission had two-fold increased risk of having a maltreatment allegation. The risk of maltreatment allegation was greatest in young children, 5.5-year-old (SD=4.6), when restricted to maternal assault admissions in the prenatal period the children were younger at 4-year-old (SD=4.1). The time from maternal assault admission to maltreatment allegation was around 12 months longer for Aboriginal children than for non-Aboriginal children. Conclusion/ImplicationsChildren of mothers who have been assaulted are at higher risk of child maltreatment allegation. Targeted early intervention is required for families with young children, and pregnant women experiencing violence. The time to maltreatment allegation for Aboriginal children warrants community developed culturally-safe partnerships between Aboriginal communities and government services.

scholarly journals Resource use and costs associated with epilepsy in the Queensland hospital system: protocol for a population-based data linkage study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e050070
Author(s):  
Ruth Tulleners ◽  
Robin Blythe ◽  
Sasha Dionisio ◽  
Hannah Carter
Keyword(s):  
Health Service ◽  
Service Use ◽  
Data Linkage ◽  
Hospital Admissions ◽  
Population Based ◽  
Health Service Use ◽  
Mortality Data ◽  
Service Utilisation ◽  
Indigenous Status ◽  
Hospital System

IntroductionEpilepsy places a large burden on health systems, with hospitalisations for seizures alone occurring more frequently than those related to diabetes. However, the cost of epilepsy to the Australian health system is not well understood. The primary aim of this study is to quantify the health service use and cost of epilepsy in Queensland, Australia. Secondary aims are to identify differences in health service use and cost across population and disease subgroups, and to explore the associations between health service use and common comorbidities.Methods and analysisThis project will use data linkage to identify the health service utilisation and costs associated with epilepsy. A base cohort of patients will be identified from the Queensland Hospital Admitted Patient Data Collection. We will select all patients admitted between 2014 and 2018 with a diagnosis classification related to epilepsy. Two comparison cohorts will also be identified. Retrospective hospital admissions data will be linked with emergency department presentations, clinical costing data, specialist outpatient and allied health occasions of service data and mortality data. The level of health service use in Queensland, and costs associated with this, will be quantified using descriptive statistics. Difference in health service costs between groups will be explored using logistic regression. Linear regression will be used to model the associations of interest. The analysis will adjust for confounders including age, sex, comorbidities, indigenous status, and remoteness.Ethics and disseminationEthical approval has been obtained through the QUT University Human Research Ethics Committee (1900000333). Permission to waive consent has been granted under the Public Health Act 2005, with approval provided by all relevant data custodians. Findings of the proposed research will be communicated through presentations at national and international conferences, presentations to key stakeholders and decision-makers, and publications in international peer-reviewed journals.

scholarly journals Education and social service use patterns of children and youth with neurodevelopmental disorders

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Ruiting Jia ◽  
Christine Werk ◽  
Daniel O'Brien ◽  
Robert Jagodzinski ◽  
Carley Piatt
Keyword(s):  
Administrative Data ◽  
Service Use ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Children And Youth ◽  
Government Service ◽  
Use Patterns ◽  
Children With Asd ◽  
Linked Administrative Data ◽  
Over Time

IntroductionThis study uses linked administrative data to identify Albertan children and youth (aged 0 to 25 years) with Autism Spectrum Disorder (ASD), Cerebral Palsy (CP) or Fetal Alcohol Spectrum Disorder (FASD), and to examine their government service use patterns from 2005/06 to 2010/11. Objectives and ApproachThe analysis looks at whether children with ASD, CP and FASD have similar government service use patterns and how their service use patterns changed over time. Six Government of Alberta ministries’ data were linked (Health, Justice, Education, Advanced Education, Children’s Services and Community and Social Services). Individuals were defined as having ASD, CP or FASD if, at any point during the study period, they had a diagnostic code for one of three conditions (ASD, CP or FASD) from a health service (i.e., physician visits, or emergency room visits, or hospitalizations), or accessed disability support programs for ASD, CP or FASD. ResultsThe results showed different service use patterns for the three conditions: (1) a higher proportion of children with ASD were students with special needs compared to children with FASD and CP; (2) a lower proportion of children with FASD received FSCD services compared to children with ASD and CP; (3) a higher proportion of children with FASD were involved in the Child Intervention system and were Income Support recipients compared to children with ASD and CP. Moreover, the study showed that there was a decrease in accessing services and programming from Persons with Development Disabilities (PDD) for young Albertans with ASD, CP and FASD from 2005/06 to 2010/11. In contrast, the use of another adult disability program that provides only financial assistance, Assured Income for Severely Handicapped, increased over time. Conclusion/ImplicationsThe use of population-based linked administrative data allows a comprehensive and comparative study for government service use patterns. The findings have implications for cross-ministry policy and program development, resource allocation, and service coordination and delivery to young Albertans with ASD, CP and FASD.

scholarly journals Quantifying morbidity attributable to traumatic injury using a population-based matched cohort in Australia

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Rebecca Mitchell ◽  
Cate Cameron ◽  
Rod McClure
Keyword(s):  
Health Service ◽  
Service Use ◽  
Injury Severity ◽  
Negative Binomial ◽  
Hospital Admissions ◽  
Traumatic Injury ◽  
South Australia ◽  
Population Based ◽  
Health Service Use ◽  
Matched Cohort

ABSTRACT ObjectiveThis study aims to quantify 12-month morbidity attributable to traumatic injury using a population-based matched cohort in Australia. ApproachA population-based matched cohort study of individuals ≥18 years using linked emergency department (ED) presentation, hospital separation and mortality records from three Australian states during 1 January 2008 to 31 December 2010. Injury admissions were identified using a principal diagnosis of injury (ICD-10-AM: S00-T75 or T79). The first injury-related hospital admission during 2009 was identified as the index injury admission and pre and post-index injury health service use was examined. The non-injured comparison cohort was randomly selected from the electoral roll and was matched 1:1 on age, gender, and postcode of residence at the date of the index injury admission of their matched counterpart. Comorbidities were identified using diagnosis classifications and a 1-year lookback period. Injury severity was estimated using the International Classification of Injury Severity Score (ICISS): minor (≥0.99), moderate (0.942-<0.99) and serious (<0.942). Negative binomial and Poisson regression methods will be used to quantify associations between injury and counts of hospital admissions 12-month post-index injury health service use. ResultsThere were 166,032 individuals injured in 2009 and admitted to hospital in New South Wales, South Australia or Queensland with a matched comparison. Males represented 57% of those injured, 30.1% were aged 18-34 years, 37.9% were aged 35-64 years, 32.1% were aged ≥65 years and 65.1% resided in an urban location. Comorbidities were more common in the injured cohort (χ² =9384.5, df (2), p<0.0001). The most common injuries were fall-related (38.4%) and as a result of road trauma (12.4%). The majority of injuries were minor (43.9%) or moderate (37.2%), with 18.9% serious injuries. Attributable risk and adjusted rate ratios for injured versus matched non-injured comparison will be presented for pre and post health service use controlling for key confounding characteristics. ConclusionThrough the use of national data linkage, this study contributes to informing research efforts on better quantifying the attributable burden of injury-related disability in Australia.

scholarly journals Analysing complex linked administrative data in health services research: Issues and solutions

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Rachael Rachael ◽  
David David ◽  
Mark Harris
Keyword(s):  
Health Service ◽  
Administrative Data ◽  
Random Effects ◽  
Service Use ◽  
Ascertainment Bias ◽  
Health Service Use ◽  
Care Hospital ◽  
Reverse Causality ◽  
Research Issues ◽  
The Impact

IntroductionLinked administrative data are increasingly being used to evaluate the impact of health policy on health-service use/cost because they can comprehensively capture whole of population interactions with the health system. These analyses are complex comprising unbalanced panels and are at risk of endogeneity and associated problems. Objectives and ApproachWe evaluated the impact of changes in regularity of general practitioner contact on diabetes related hospitalisation before and after care coordination policies using whole of population, person-level linked primary care, hospital, Electoral Roll and death records. Complex panel random-effects modelling techniques were required due to the unbalanced structure of the data (individuals could exit and re-enter the study repeatedly), over-dispersion and high proportion of zeros, changes in availability of tests (ascertainment bias), the likelihood of prior health service use influencing the dependent variable (initial conditions and simultaneity/reverse causality bias) and likely correlation of observed and unobserved variables. ResultsMultivariable zero-inflated negative binomial and Cragg-hurdle clustered robust regression, which include separate components to model zero and non-zero outcomes, were required for these data. Mundlak variables (group-means of time-varying variables) were used to relax the assumption in the random-effects estimator that the observed variables were uncorrelated with the unobserved ones. Prior health service use was adjusted for using 4-year lags of GP contact and one-year lag of hospitalisation. The initial value of the dependent variable resolved the “initial condition” problem. Ascertainment bias was addressed using the number of years available for identification for each person as a covariate. AIC/BIC values were used to identify the best model. We found that more regular GP contact was associated with fewer hospitalisations, however this attenuated over time. Conclusion/ImplicationsAvailability of linked data, together with increases in computing power, has vastly increased its potential for use. This has also increased the complexity of analyses being undertaken necessitating recognizing and addressing problems, such as endogeneity, that arise due to the observational nature of the studies undertaken.

scholarly journals Evaluation of a National Broadband Network-enabled Telehealth trial for older people with chronic disease

2016 ◽  
Vol 40 (6) ◽  
pp. 641 ◽  
Author(s):  
Susan Nancarrow ◽  
Annie Banbury ◽  
Jennene Buckley
Keyword(s):  
Chronic Disease ◽  
Health Service ◽  
Older People ◽  
Self Efficacy ◽  
Service Use ◽  
Hospital Admissions ◽  
Vital Signs ◽  
Health Service Use ◽  
Local Hospital ◽  
Vital Signs Monitoring

Objective The aim of the present study was to evaluate the effect of a high-speed telemonitoring project for older people with chronic disease in a regional Australian town. Participants’ vital signs were monitored and triaged daily by a telehealth nurse. Methods A prospective, uncontrolled study design evaluated the effect of home-based telemonitoring on older people with chronic disease. Evaluation included surveys (including the Stanford Chronic Disease Self-Efficacy tool and the Self-Rated Health Questionnaire), self-reported health service use and interviews and focus groups exploring client experiences. Results Participants reported an improved understanding of their vital signs monitoring (48%) and consequently better self-management of health (48%) and that they were better informed (44%) and more confident (25%) to discuss health with their doctor. Patients also reported making medication changes (17%), positive dietary changes (34%) and increasing their physical activity (33%). Overall, patients’ self-rated general health improved (mean (± s.d.) improvement 0.30 ± 0.80; 95% confidence interval (CI) 0.16–0.45; 118 d.f.; P < 0.001), with more participants reporting that their health is ‘excellent’ or ‘very good’ at the end of the trial. Patients also reported fewer doctor visits (P < 0.001), fewer visits to the local hospital emergency department (P = 0.021) and fewer non-local hospital admissions (P < 0.001) compared with the preceding year. There was no significant reduction in local hospital admissions (P = 0.171). Conclusions The findings of the present study suggest that telemonitoring with videoconferencing empowers older people to better understand and manage their own health, and is associated with improved health outcomes and reduced service use. Having regular, daily access to a Telehealth nurse reassured participants, and triggered changes to services and behaviour that are likely to have positively affected patient outcomes. What is known about this topic? Telehealth is increasingly being used in the care of older people with chronic conditions and can reduce health service use. Previous research has indicated that telehealth has the potential to provide patients with greater knowledge and understanding of their condition. What this paper adds? Our research demonstrates that older people with limited experience of technology can be taught to successfully use telehealth equipment. We observed regular contact with telehealth nurses enables health promoting behaviour messages to be tailored to patients’ needs. What are the implications for practitioners? Providing older people with tailored health support alongside an understanding of vital signs readings can enhance self-efficacy.

scholarly journals What is the timeliness and extent of health service use of Victorian (Australia) children in the year after entry to out-of-home care? Protocol for a retrospective cohort study using linked administrative data

2019 ◽  
Vol 3 (1) ◽  
pp. e000400
Author(s):  
Karen McLean ◽  
Harriet Hiscock ◽  
Dorothy Scott ◽  
Sharon Goldfeld
Keyword(s):  
Health Service ◽  
Health Services ◽  
Home Care ◽  
Child Protection ◽  
Retrospective Cohort ◽  
Service Use ◽  
Hospital Admissions ◽  
Health Service Use ◽  
Out Of Home Care ◽  
Care Protocol

IntroductionChildren entering out-of-home care have high rates of health needs across all domains of health. To identify these needs early and optimise long-term outcomes, routine health assessment on entry to care is recommended by child health experts and included in policy in many jurisdictions. If effective, this ought to lead to high rates of health service use as needs are addressed. Victoria (Australia) has no state-wide approach to deliver routine health assessments and no data to describe the timing and use of health service visits for children in out-of-home care. This retrospective cohort data linkage study aims to describe the extent and timeliness of health service use by Victorian children (aged 0–12 years) who entered out-of-home care for the first time between 1 April 2010 and 31 December 2015, in the first 12 months of care.Methods and analysisThe sample will be identified in the Victorian Child Protection database. Child and placement variables will be extracted. Linked health databases will provide additional data: six state databases that collate data about hospital admissions, emergency department presentations and attendances at dental, mental and community health services and public hospital outpatients. The federal Medicare Benefits Schedule claims dataset will provide information on visits to general practitioners, specialist physicians (including paediatricians), optometrists, audiologists and dentists. The number, type and timing of visits to different health services will be determined and benchmarked to national standards. Multivariable logistic regression will examine the effects of child and system variables on the odds of timely health visits, and proportional-hazards regression will explore the effects on time to first health visits.Ethics and disseminationEthical and data custodian approval has been obtained for this study. Dissemination will include presentation of findings to policy and service stakeholders in addition to scientific papers.

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