scholarly journals Quebec Integrated Chronic Disease Surveillance System (QICDSS), an innovative approach

2014 ◽  
Vol 34 (4) ◽  
pp. 226-235 ◽  
Author(s):  
C Blais ◽  
S Jean ◽  
C Sirois ◽  
L Rochette ◽  
C Plante ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Chronic Diseases ◽  
Surveillance System ◽  
Disease Surveillance ◽  
Selection Criterion ◽  
Population Based ◽  
Administrative Databases ◽  
Case Definitions ◽  
Public Health Decision ◽  
Disease Surveillance System

Introduction With the growing burden of chronic diseases, surveillance will play an essential role in improving their prevention and control. The Institut national de santé publique du Québec has developed an innovative chronic disease surveillance system, the Quebec Integrated Chronic Disease Surveillance System (QICDSS). We discuss the primary features, strengths and limitations of this system in this report. Methodology The QICDSS was created by linking five health administrative databases. Updated annually, it currently covers the period from January 1, 1996, to March 31, 2012. The operational model comprises three steps: (1) extraction and linkage of health administrative data according to specific selection criteria; (2) analysis (validation of case definitions essentially) and production of surveillance measures; and (3) data interpretation, submission and dissemination of information. The QICDSS allows the surveillance of the following chronic diseases: diabetes, cardiovascular diseases, respiratory diseases, osteoporosis, osteoarticular diseases, mental disorders, Alzheimer's disease and related disorders. The system also lends itself to the analysis of multimorbidity and polypharmacy. Results For 2011–2012, the QICDSS contained information on 7 995 963 Quebecers with an average age of 40.8 years. Of these, 95.3% met at least one selection criterion allowing the application of case definitions for chronic disease surveillance. The actual proportion varied with age, from 90.1% for those aged 19 years or less to 99.3% for those aged 65 years or over. Conclusion The QICDSS provides a way of producing population-based data on the chronic disease burden, health services and prescription drug uses. The system facilitates the integrated study of several diseases in combination, an approach rarely implemented until now in the context of population surveillance. The QICDSS possesses all the essential features of a surveillance system and supports the dissemination of information to public health decision-makers for future actions.

scholarly journals The Canadian Chronic Disease Surveillance System: A model for collaborative surveillance

2018 ◽  
Vol 3 (3) ◽  
Author(s):  
Lisa Lix ◽  
James Ayles ◽  
Sharon Bartholomew ◽  
Charmaine Cooke ◽  
Joellyn Ellison ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Surveillance System ◽  
Disease Surveillance ◽  
Health Agency ◽  
Population Based ◽  
Population Characteristics ◽  
Administrative Databases ◽  
Distributed Model ◽  
Case Definitions ◽  
Disease Surveillance System

Chronic diseases have a major impact on populations and healthcare systems worldwide. Administrative health data are an ideal resource for chronic disease surveillance because they are population-based and routinely collected. For multi-jurisdictional surveillance, a distributed model is advantageous because it does not require individual-level data to be shared across jurisdictional boundaries. Our objective is to describe the process, structure, benefits, and challenges of a distributed model for chronic disease surveillance across all Canadian provinces and territories (P/Ts) using linked administrative data. The Public Health Agency of Canada (PHAC) established the Canadian Chronic Disease Surveillance System (CCDSS) in 2009 to facilitate standardized, national estimates of chronic disease prevalence, incidence, and outcomes. The CCDSS primarily relies on linked health insurance registration files, physician billing claims, and hospital discharge abstracts. Standardized case definitions and common analytic protocols are applied to the data for each P/T; aggregate data are shared with PHAC and summarized for reports and open access data initiatives. Advantages of this distributed model include: it uses the rich data resources available in all P/Ts; it supports chronic disease surveillance capacity building in all P/Ts; and changes in surveillance methodology can be easily developed by PHAC and implemented by the P/Ts. However, there are challenges: heterogeneity in administrative databases across jurisdictions and changes in data quality over time threaten the production of standardized disease estimates; a limited set of databases are common to all P/Ts, which hinders potential CCDSS expansion; and there is a need to balance comprehensive reporting with P/T disclosure requirements to protect privacy. The CCDSS distributed model for chronic disease surveillance has been successfully implemented and sustained by PHAC and its P/T partners. Many lessons have been learned about national surveillance involving jurisdictions that are heterogeneous with respect to healthcare databases, expertise and analytical capacity, population characteristics, and priorities.

scholarly journals LO021: Use of health services among non-institutionalized frail elderly with fracture: preliminary results

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S37-S37
Author(s):  
V. Fillion ◽  
S. Jean ◽  
M. Sirois ◽  
P. Gamache
Keyword(s):  
Chronic Disease ◽  
General Practitioner ◽  
Health Services ◽  
Surveillance System ◽  
Disease Surveillance ◽  
Administrative Databases ◽  
Assessment Index ◽  
Preliminary Results ◽  
Disease Surveillance System ◽  
Use Of Health Services

Introduction: Frail older adults experience an increased risk of a number of adverse health outcomes such as comorbidity, disability, dependency, institutionalization, falls, fractures, hospitalization, and mortality. Identification of frail adults is important. The objective of this study is to examine the association between frailty and use of health services (emergency, general practitioner, hospitalization) prior to and following a visit for a fracture in non-institutionalized seniors. Methods: This study is a population-based cohort build from the Quebec Integrated Chronic Disease Surveillance System, an innovative chronic disease surveillance system linking five health care administrative databases. Algorithms using data from this system are accurate and reliable for identifying fractures. The sample includes 179,734 seniors ≥ 65 years old, non-institutionalized in the year before the fracture. Their frailty status was measured using the elderly risk assessment index. Poisson regression models were used to compare use of health services (emergency, general practitioner, hospitalization) 1 year before and 1 year after a visit for a fracture (adjusting for age, sex, comorbidities, social deprivation, material deprivation and site of fracture). Results: Overall, preliminary results show that the use of health services increased significantly in the year following the fracture in frail non-institutionalized elderly vs the non-frail one (p < 0.05). Conclusion: This study suggests that frail seniors with a fracture require more health services after their incident fracture. Furthermore, using a frailty assessment index in health administrative databases can help identify seniors that are at high risk of needing more health services and, therefore, improve their care.

scholarly journals Trends in prevalence, incidence and mortality of diagnosed and silent coronary heart disease in Quebec

2015 ◽  
Vol 35 (10) ◽  
pp. 184-193 ◽  
Author(s):  
C. Blais ◽  
L. Rochette
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Disease Surveillance ◽  
Population Based ◽  
Administrative Databases ◽  
Case Definitions ◽  
Disease Surveillance System ◽  
Incidence And Mortality ◽  
Causes Of Mortality ◽  
Incident Cases

Introduction Of all cardiovascular causes of mortality, coronary heart disease (CHD) remains the leading cause of death. Our objectives were to establish trends in the prevalence and incidence of CHD in the province of Quebec, and to determine the proportion of CHD mortality that had no previous CHD diagnosis. Methods Trends in prevalence, incidence and mortality were examined with a population-based study using the Quebec Integrated Chronic Disease Surveillance System, which links several health administrative databases. Data are presented using two case definitions for Quebecers aged 20 years and over: 1) a validated definition, and 2) CHD causes of death codes added to estimate the proportion of deaths that occurred without any previous CHD diagnosis as a proxy for sudden cardiac death (SCD). Results In 2012/2013, the crude prevalence of CHD was 9.4% with the first definition (593 000 people). Between 2000/2001 and 2012/2013, the age-standardized prevalence increased by 14%, although it has been decreasing slightly since 2009/2010. Agestandardized incidence and mortality rates decreased by 46% and 26% respectively, and represented a crude rate of 6.9 per 1000 and 5.2% in 2012/2013. The proportion identified only by CHD mortality, our SCD proxy, was only significant for the incident cases (0.38 per 1000 in 2009/2010) and declined over the study period. Conclusion The prevalence of CHD has tended to decrease in recent years, and incidence and mortality have been declining in Quebec. Most CHD mortality occurs in previously diagnosed patients and only a small proportion of incident cases were not previously identified.

scholarly journals The Canadian Chronic Disease Surveillance System: A Distributed Surveillance Model

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Lisa Lix ◽  
Kim Reimer
Keyword(s):  
Health Insurance ◽  
Chronic Disease ◽  
Surveillance System ◽  
Disease Surveillance ◽  
Feasibility Studies ◽  
Mental Illnesses ◽  
Population Characteristics ◽  
Case Definitions ◽  
Disease Surveillance System ◽  
Disease Case

ObjectiveTo describe the process, benefits, and challenges of implementinga distributed model for chronic disease surveillance across thirteenCanadian jurisdictions.IntroductionThe Public Health Agency of Canada (PHAC) established theCanadian Chronic Disease Surveillance System (CCDSS) in 2009 tofacilitate national estimates of chronic disease prevalence, incidence,and health outcomes. The CCDSS uses population-based linkedhealth administrative databases from all provinces/territories (P/Ts)and a distributed analytic protocol to produce standardized diseaseestimates.MethodsThe CCDSS is founded on deterministic linkage of threeadministrative health databases in each Canadian P/T: health insuranceregistration files, physician billing claims, and hospital dischargeabstracts. Data on all residents who are eligible for provincial orterritorial health insurance (about 97% of the Canadian population) arecaptured in the health insurance registration files. Thus, the CCDSScoverage is near-universal. Disease case definitions are developed byexpert Working Groups after literature reviews are completed andvalidation studies are undertaken. Feasibility studies are initiatedin selected P/Ts to identify challenges when implementing thedisease case definitions. Analytic code developed by PHAC is thendistributed to all P/Ts. Data quality surveys are routinely conductedto identify database characteristics that may bias disease estimatesover time or across P/Ts or affect implementation of the analytic code.The summary data produced in each P/T are approved by ScientificCommittee and Technical Committee members and then submitted toPHAC for further analysis and reporting.ResultsNational surveillance or feasibility studies are currently ongoing fordiabetes, hypertension, selected mental illnesses, chronic respiratorydiseases, heart disease, neurological conditions, musculoskeletalconditions, and stroke. The advantages of the distributed analyticprotocol are (Figure 1): (a) changes in methodology can be easilymade, and (b) technical expertise to implement the methodology is notrequired in each P/T. Challenges in the use of the distributed analyticprotocol are: (a) heterogeneity in healthcare databases across P/Tsand over time, (b) the requirement that each P/T use the minimum setof data elements common to all jurisdictions when producing diseaseestimates, and (c) balancing disclosure guidelines to ensure dataconfidentiality with comprehensive reporting. Additional challenges,which include incomplete data capture for some databases and poormeasurement validity of disease diagnosis codes for some chronicconditions, must be continually addressed to ensure the scientificrigor of the CCDSS methodology.ConclusionsThe CCDSS distributed analytic protocol offers one model fornational chronic disease surveillance that has been successfullyimplemented and sustained by PHAC and its P/T partners. Manylessons have been learned about national chronic disease surveillanceinvolving jurisdictions that are heterogeneous with respect tohealthcare databases, expertise, and population characteristics.

scholarly journals Estimating multimorbidity prevalence with the Canadian Chronic Disease Surveillance System

2017 ◽  
Vol 37 (7) ◽  
pp. 215-222 ◽  
Author(s):  
Allison Feely ◽  
Lisa M. Lix ◽  
Kim Reimer
Keyword(s):  
Chronic Disease ◽  
Chronic Diseases ◽  
Surveillance System ◽  
Disease Surveillance ◽  
Chronic Conditions ◽  
Health Agency ◽  
Health Data ◽  
Fiscal Year ◽  
Administrative Health Data ◽  
Disease Surveillance System

Introduction The Public Health Agency of Canada’s Canadian Chronic Disease Surveillance System (CCDSS) uses a validated, standardized methodology to estimate prevalence of individual chronic diseases, such as diabetes. Expansion of the CCDSS for surveillance of multimorbidity, the co-occurrence of two or more chronic diseases, could better inform health promotion and disease prevention. The objective of this study was to assess the feasibility of using the CCDSS to estimate multimorbidity prevalence. Methods We used administrative health data from seven provinces and three territories and five validated chronic conditions (i.e. cardiovascular disease, respiratory disease, mental illness, hypertension and diabetes) to estimate multimorbidity prevalence. We produced age-standardized (using Canada’s 1991 population) and age-specific estimates for two multimorbidity definitions: (1) two or more conditions, and (2) three or more conditions from the five validated conditions, by sex, fiscal year and geography. Results Among Canadians aged 40 years and over in the fiscal year 2011/12, the prevalence of two or more and three or more chronic conditions was 26.5% and 10.2%, respectively, which is comparable to other estimates based on administrative health data. The increase in multimorbidity prevalence with increasing age was similar across provinces. The difference in prevalence for males and females varied by province and territory. We observed substantial variation in estimates over time. Results were consistent for the two definitions of multimorbidity. Conclusion The CCDSS methodology can produce comparative estimates of multimorbidity prevalence across provinces and territories, but there are challenges in using it to estimate temporal trends. Further expansion of the CCDSS in the number and breadth of validated case definitions will improve the accuracy of multimorbidity surveillance for the Canadian population.

scholarly journals The Canadian Chronic Disease Surveillance System: The Benefits and Challenges of a Distributed Model for National Disease Surveillance

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Lisa Lix ◽  
Kim Reimer
Keyword(s):  
Chronic Disease ◽  
Surveillance System ◽  
Disease Surveillance ◽  
Feasibility Studies ◽  
Population Characteristics ◽  
Distributed Model ◽  
Case Definitions ◽  
Disease Surveillance System ◽  
Disease Case ◽  
Over Time

ABSTRACT ObjectivesThe Public Health Agency of Canada (PHAC) established the Canadian Chronic Disease Surveillance System (CCDSS) in 2009 to facilitate national estimates of chronic disease prevalence, incidence, and health outcomes. The CCDSS uses population-based linked health administrative databases from all provinces/territories (P/Ts) and a distributed analytic protocol to produce standardized disease estimates. Our purpose is to describe the process, benefits, and challenges of implementing a distributed model for disease surveillance across thirteen jurisdictions with unique healthcare databases. ApproachThe CCDSS is founded on deterministic linkage of three administrative health databases in each Canadian P/T: health insurance registration files, physician billing claims, and hospital discharge abstracts. Disease case definitions are developed by expert Working Groups after literature reviews are completed and validation studies are undertaken. Feasibility studies are initiated in selected P/Ts to identify challenges when implementing the disease case definitions. Analytic code developed by PHAC is then distributed to all P/Ts. Data quality surveys are routinely conducted to identify database characteristics that may bias disease estimates over time or across P/Ts or affect implementation of the analytic code. The summary data produced in each P/T are approved by Scientific Committee and Technical Committee members and then submitted to PHAC for further analysis and reporting. ResultsNational surveillance or feasibility studies are currently ongoing for diabetes, hypertension, selected mental illnesses, chronic respiratory diseases, heart disease, neurological conditions, musculoskeletal conditions, and stroke. The advantages of the distributed analytic protocol are: (a) changes in methodology can be easily made, and (b) technical expertise to implement the methodology is not required in each P/T. Challenges in the use of the distributed analytic protocol are: (a) heterogeneity in healthcare databases across P/Ts and over time, (b) the requirement that each P/T use the minimum set of data elements common to all jurisdictions when producing disease estimates, and (c) balancing disclosure guidelines to ensure data confidentiality with comprehensive reporting. Additional challenges, which include incomplete data capture for some databases and poor measurement validity of disease diagnosis codes for some chronic conditions, must be continually addressed to ensure the scientific rigor of the CCDSS methodology. ConclusionsThe CCDSS distributed analytic protocol offers one model for national chronic disease surveillance that has been successfully implemented and sustained by PHAC and its P/T partners. Many lessons have been learned about national chronic disease surveillance involving jurisdictions that are heterogeneous with respect to healthcare databases, expertise, and population characteristics.

scholarly journals Establishing the Incidence and Prevalence of Multiple Sclerosis in Saskatchewan

2018 ◽  
Vol 45 (3) ◽  
pp. 295-303 ◽  
Author(s):  
Lina H. Al-Sakran ◽  
Ruth Ann Marrie ◽  
David F. Blackburn ◽  
Katherine B. Knox ◽  
Charity D. Evans
Keyword(s):  
Multiple Sclerosis ◽  
Administrative Data ◽  
Predictive Value ◽  
Disease Surveillance ◽  
Population Based ◽  
Case Definition ◽  
Case Definitions ◽  
Health Administrative Data ◽  
Disease Surveillance System ◽  
Definition Of

AbstractObjective: To validate a case definition of multiple sclerosis (MS) using health administrative data and to provide the first province-wide estimates of MS incidence and prevalence for Saskatchewan, Canada. Methods: We used population-based health administrative data between January 1, 1996 and December 31, 2015 to identify individuals with MS using two potential case definitions: (1) ≥3 hospital, physician, or prescription claims (Marrie definition); (2) ≥1 hospitalization or ≥5 physician claims within 2 years (Canadian Chronic Disease Surveillance System [CCDSS] definition). We validated the case definitions using diagnoses from medical records (n=400) as the gold standard. Results: The Marrie definition had a sensitivity of 99.5% (95% confidence interval [CI] 92.3-99.2), specificity of 98.5% (95% CI 97.3-100.0), positive predictive value (PPV) of 99.5% (95% CI 97.2-100.0), and negative predictive value (NPV) of 97.5% (95% CI 94.4-99.2). The CCDSS definition had a sensitivity of 91.0% (95% CI 81.2-94.6), specificity of 99.0% (95% CI 96.4-99.9), PPV of 98.9% (95% CI 96.1-99.9), and NPV of 91.7% (95% CI 87.2-95.0). Using the more sensitive Marrie definition, the average annual adjusted incidence per 100,000 between 2001 and 2013 was 16.5 (95% CI 15.8-17.2), and the age- and sex-standardized prevalence of MS in Saskatchewan in 2013 was 313.6 per 100,000 (95% CI 303.0-324.3). Over the study period, incidence remained stable while prevalence increased slightly. Conclusion: We confirm Saskatchewan has one of the highest rates of MS in the world. Similar to other regions in Canada, incidence has remained stable while prevalence has gradually increased.

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