Canadian Institute For Health Information Research Articles

A cost effectiveness analysis of two treatment strategies for trigeminal neuralgia in Ontario

Background: Trigeminal neuralgia (TN) is a debilitating disease with an annual incidence of approximately 4–27/100,000. In Ontario, over 2000 patients receive interventions for profound pain, including medical and surgical therapies. The global expected cost of these approaches is unknown. This study aims to analyze the cost-effectiveness of one surgical therapy, microvascular decompression (MVD), compared with the best medical therapy (carbamazepine) as first-line therapy. Methods: Costs were gathered from the Canadian Institute for Health Information, Ontario Drug Benefit Formulary, and Ontario Ministry of Health Schedule of Benefits for Physician Services. Academic literature was used to estimate unavailable items. A cost-benefit Markov model was created for each strategy with literature-based rates for annual cycles from years 1 to 5, followed by a linear recurrent cycle from years 6 to 10. Incremental cost-effectiveness ratios (ICERs) were calculated based on the incremental cost in 2022 Canadian Dollars (CAD) per pain-free year. Results: Base case cost per patient was $10,866 at 10 years in the “MVD first” group and $10,710 in the “carbamazepine first” group. Ten-year ICER was $1,104 for “MVD first,” with strict superiority beyond this time point. One-way deterministic sensitivity analysis for multiple factors suggested the highest cost variability and ICER variability were due to surgery cost, medication failure rate, and medication cost. Conclusion: Economic benefit is established for a “MVD first” strategy in the Ontario context with strict superiority beyond the 10-year horizon. If a cost-effectiveness threshold of $50,000 per pain-controlled year is used, the benefit is established at 4 years.

Diabetes mellitus in pregnancy across Canada

BackgroundContemporary estimates of diabetes mellitus (DM) rates in pregnancy are lacking in Canada. Accordingly, this study examined trends in the rates of type 1 (T1DM), type 2 (T2DM) and gestational (GDM) DM in Canada over a 15-year period, and selected adverse pregnancy outcomes.MethodsThis study used repeated cross-sectional data from the Canadian Institute of Health Information (CIHI) hospitalization discharge abstract database (DAD). Maternal delivery records were linked to their respective birth records from 2006 to 2019. The prevalence of T1DM, T2DM and GDM were calculated, including relative changes over time, assessed by a Cochrane-Armitage test. Also assessed were differences between provinces and territories in the prevalence of DM.ResultsOver the 15-year study period, comprising 4,320,778 hospital deliveries in Canada, there was a statistically significant increase in the prevalence of GDM and T1DM and T2DM. Compared to pregnancies without DM, all pregnancies with any form of DM had higher rates of hypertension and Caesarian delivery, and also adverse infant outcomes, including major congenital anomalies, preterm birth and large-for-gestational age birthweight.ConclusionAmong 4.3 million pregnancies in Canada, there has been a rise in the prevalence of DM. T2DM and GDM are expected to increase further as more overweight women conceive in Canada.

Substance-related poisoning hospitalizations and homelessness in Canada: a descriptive study.

The objective of this analysis is to describe patient demographics, the context, characteristics and outcomes of a substance-related poisoning, and the recorded mental disorder of people with housing and those experiencing homelessness. Hospitalization data for Canada (except Quebec) from 1 April 2019 to 31 March 2020 were retrieved from the Canadian Institute for Health Information (CIHI) Discharge Abstract Database using ICD-10-CA codes for up to 25 diagnoses for substance-related poisonings, homelessness status and other characteristics relevant to the patient's hospitalization. We compared the characteristics of people experiencing homelessness with those of people who were housed, and their substance-related poisoning hospitalizations, using chi-square, t tests and Fisher exact test. There was a higher proportion of males, younger individuals and people with recorded mental disorders among people experiencing homelessness hospitalized for a substance-related poisoning than among their housed counterparts. Substance-related poisonings among people experiencing homelessness were more likely to be accidental, involve opioids and stimulants (most frequently fentanyl and its analogues and heroin), result in lengthier hospitalizations and end with leaving the hospital against medical advice. These findings can be used to strengthen strategies and interventions to reduce substance-related harms in priority populations, particularly those experiencing homelessness.

Estimating additional health and social costs in eating disorder care for young people during the COVID-19 pandemic: implications for surveillance and system transformation

BackgroundThe impact of the COVID-19 pandemic on young people with eating disorders (EDs) and their families was profound, with surging rates of hospitalizations and referrals reported internationally. This paper provides an account of the additional health and social costs of ED care for young people living in Canada incurred during the COVID-19 pandemic, drawing attention to the available data to inform these estimates while noting gaps in data capacities to account for a full view of the ED system of care.MethodsThree methodologies were used to capture costs: (1) provincial administrative data holdings available at the Canadian Institute of Health Information (CIHI) were used by Deloitte Access Economics to conduct analyses on costs related to hospitalizations, emergency room visits, outpatient visits with physicians and loss of well-being from being on a waitlist. These were examined across three fiscal years (April 1 to March 31, 2019–2022) to compare costs from one year before to two years after the onset of the pandemic, (2) data collected on support-based community ED organizations and, (3) costs identified by young people, caregivers and health care professionals.ResultsEstimates of additional health care costs and social costs arising from ED care waitlists were estimated to have increased by 21% across the two years after the onset of the pandemic and is likely to represent an underestimate of costs. Costs related to some standard ED care services (e.g. day treatment programs) and support-based community ED organizations that saw a 118% increase in services during this time, are some examples of costs not captured in the current cost estimate.ConclusionsThis paper provides a first account of the additional health and social ED care costs associated with the pandemic, which indicate at minimum, a 21% increase. The results invite discussion for more investments in ED services for young people in Canada, as it is unclear if needs are expected to remain elevated. We suggest a call for a national surveillance strategy to improve data holdings to aid in managing services and informing policy. A robust strategy could open the door for much-needed, data-informed, system transformation efforts that can improve ED care for youth, families and clinicians.

Administrative data ICD-10 diagnostic codes identifies most lab-confirmed SARS-CoV-2 admissions but misses many discharged from the Emergency Department

We estimated the operating characteristics of ICD-10 code U07.1, introduced by the World Health Organization in 2020, to identify lab-confirmed SARS-CoV-2. CCEDRRN is a national research registry of adults (March 2020–August 2021) with suspected/confirmed SARS-CoV-2 identified in Canadian emergency departments (EDs) using chart review (symptoms, clinical information, and lab test results including SARS-CoV-2 polymerase chain reaction, PCR results). CCEDRRN data were linked to administrative hospitalization discharge and ED ICD-10 diagnostic codes (accessed centrally via the Canadian Institute for Health Information). We identified ICD-10 diagnostic codes in CCEDRRN participants. We defined lab-confirmed SARS-CoV-2 based on at least one positive PCR in the 0–14 days before the ED presentation and/or during hospitalization (in those admitted from ED). We performed separate analyses for CCEDRRN participants discharged from ED and those hospitalized from the ED. Additional analyses were stratified by province, sex, age, and (for hospitalized patients) timing of the first PCR test. The sensitivity of ICD-10 code U07.1 for a positive SARS-CoV-2 test was 93.6% (95% CI 93.0–94.1%) in those hospitalized from ED and 83.0% (95% CI 82.1–83.9%) in those discharged from the ED. Sensitivity was similar across provinces and demographics, but in each stratified analysis, values were higher in those hospitalized versus those discharged from ED. The ICD-10 diagnostic code for U07.1 within administrative data identified most lab-confirmed SARS-CoV-2 within persons hospitalized from ED, although a significant number of cases discharged from ED were missed. This should be considered when using administrative data for research and public health planning.

Incidence and trends in the treatment of kidney stones in Canada

Introduction: Our objective was to assess the incidence of kidney stones requiring acute care, trends in the surgical treatment of stones, and the demographics of stone formers in Canada. Methods: We conducted a population-based, retrospective cohort study using administrative data from the Canadian Institute for Health Information. We included Canadian residents age >18, outside of Quebec, who presented between January 1, 2013, and December 31, 2018, with a kidney stone episode. This was defined as a kidney stone resulting in hospital admission, emergency department visit, or stone intervention, specifically shockwave lithotripsy (SWL), ureteroscopy (URS), or percutaneous nephrolithotomy (PCNL). Results: There were 471 824 kidney stone episodes, including 184 373 interventions. The number of kidney stone episode increased from 277/100 000 in 2013 to 290/100 000 in 2018. The median age was 53 (interquartile range 41–65) and 59.9% were male. The crude rate for stone intervention was 877/100 000. The age- and gender-standardized rate for interventions was highest in Nova Scotia and Newfoundland and Labrador and lowest in Prince Edward Island. The most common intervention in Canada was URS (73.5%), followed by SWL (19.8%) and PCNL (6.7%). The percent utilization of SWL was highest in Manitoba, whereas for URS, it was highest in Prince Edward Island and Alberta. Conclusions: Our study provides the first population-based data on the demographics of stone formers and treatment trends across Canada. There has been a 4.7% increase in kidney stone episodes over the study period. Those presenting to hospital or requiring intervention for a kidney stone are more likely to be male, age 41–65, and undergo URS.

Primary Care Physicians in Nova Scotia: Are They Where They Need To Be?

Purpose: Accessible primary health care (PHC) is a key area of interest for policy and research as accessible PHC is associated with better health outcomes and lower health system costs. A critical dimension of accessible PHC is an adequate supply of family physicians (FPs) or general practitioners (GPs). Our study sought to analyze the geographic distribution of FP/GPs practicing in Nova Scotia (NS) and to provide an in-depth analysis of the distribution of FP/GPs in relation to population PHC needs. Methods: Using data from the College of Physicians & Surgeons of Nova Scotia’s registry and 2019 annual license renewal survey, we provide a descriptive analysis of physician distribution, demographics and practice structure characteristics across the four Nova Scotia Health management zones (Central, Eastern, Northern, Western) for the population of FP/GPs practicing in NS in 2019. Additionally, we provided a descriptive analysis of PHC demand indicators and population demographics derived from the Canadian Institute for Health Information, the Canadian Community Health Survey, and the Canadian Census. These population PHC need indicators include hospitalization rates for ambulatory care sensitive conditions (ACSC), perceived health, the Canadian Index of Multiple Deprivation (CIMD), and the percentage of the population aged 65 and over across Nova Scotia Health management zones. Results: FP/GPs practising outside the Central zone are less numerous, older, and more likely to be male and international medical graduates. FP/GPs practicing outside the Central zone are more likely to have solo practices, practice in rural areas and not provide care through technology. Additionally, there is a greater potential demand for PHC outside of the Central zone, indicated by lower physician-to-100,000 population ratios, higher rates of hospitalizations for ACSC, a larger percentage of individuals living in rural areas, aged 65 and over, rating their health as fair or poor, and in the most deprived quintile of the situational vulnerability and economic dependency dimensions of the CIMD. Conclusions: These findings indicate a geographic maldistribution of physicians across NS and potential gaps in access to FP/GPs compared to population health needs across Nova Scotia Health management zones. The findings have implications for targeted physician resources planning and policy.

STOPPING OLDER PERSON GENDER-BASED VIOLENCE IN WOMEN 55+ THROUGH PROMISING PRACTICES: A SCOPING REVIEW

Abstract Background Intimate partner and family violence (IPFV) disproportionately affect women of all ages, but are often understudied in older populations. Older women also face numerous barriers to reporting these types of abuse. A scoping review was undertaken to: (1) synthesize current knowledge about the utility and suitability of screening and intervention tools for older women (55+) experiencing IPFV; and (2) identify existing policy, practice, and research gaps with regard to current screening and intervention tools. Methods A comprehensive search of the databases Medline, CINAHL, PsychINFO, AgeLine, ASSIA, and Sociological Abstracts was conducted. In addition, grey literature sources were searched using Google Scholar, ISI Social Sciences Citation Index, ISI Conference Proceedings Citation Index-Social Science & Humanities, Dissertations & Theses: Full Text, Canadian Institute for Health Information (CIHI), and National Institute of Health (NIH). After screening and selection, 42 documents were included for data extraction. Results There were five major themes that emerged: (1) older women were not the specific targets of the studies/tools; (2) screening and intervention tools should address health outcomes; (3) tools identified were used or developed for some diverse populations; (4) two or more tools were used in combination; and (5) intervention tools should focus on social support and empowerment. Conclusions Older women, especially those with intersectional identities, are rarely represented in studies of IPFV, and are even less frequently the primary focus. Screening and intervention tools should address health outcomes, social support, and empowerment. Effective screening and intervention may stem from utilizing multiple tools in combination.

P182: Effects of Physical Environment on Quality of Life of Residents in Dementia Facilities in Canada & South Korea: A Longitudinal Observational Study

Approximately 44% of new residents of care facilities in Korea were diagnosed with dementia (Song, Park & Kim, 2013), and in Canada, about one-third of older adults younger than 80 who have been diagnosed with dementia live in long-term care facilities (Canadian Institute for Health Information, 2018). Due to the rapid increase of these figures in the future, continuing to provide assistance services and appropriate environment for residents with dementia could be challenging for both countries.This longitudinal observational study aims to examine whether residents with dementia in long-term care facilities with variability in physical environment attributions in Vancouver (N=11), Canada and Seoul (N=9), South Korea had a distinction in their quality of life (QoL). Physical environmental assessment was conducted using the Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH) (Sloane et al., 2002). QoL was assessed three times over one year using Dementia Care Mapping tool (DCM) (University of Bradford, 2010). The results of the study demonstrated that the residents with dementia living in an institutional large-scale setting showed statistically more withdrawn behavior and spent more time to be negative mood or affect compared to the ones in a small-scale setting. This study also found that the number of potential positive behaviors of residents in a small-scale setting was three times higher than that of residents in an institutional large-scale setting. When looking at the distinction between two countries in the behavior category with a large average time difference, the residents with dementia in Korea had shorter meal/dessert times compared to those in Canada. The study supports that the small-scale homelike environment is intensely associated with a therapeutic environment for older adults with dementia.

Distribution and Migration of Recent Healthcare Graduates in Canada.

Although data on new graduates are available and typically included in the health workforce planning (HWP) model, information on their interprovincial migration pattern is less known. This paper aims to understand the mobility pattern of recent healthcare graduates - family physicians and regulated nurses - across the different Canadian jurisdictions. Health workforce data from the Canadian Institute for Health Information (CIHI) were used to identify recent family physician and regulated nurse graduates. We identified new graduates (between 2015 and 2019) in a particular province and distributed them according to the province/territory in which they registered to practise. The jurisdiction where they are trained is a key factor in determining their migration rates. For both professions, Ontario and British Columbia have the lowest rates of new graduate out-migration and the highest rates of in-migration, leaving them with a positive net interprovincial migration. This analysis can be used to inform better HWP at the jurisdictional level in these professions. Working and community conditions matter to keep and attract new graduates.

Prognosis after cerebral venous thrombosis: Mortality during initial admission and at 30 days and one year after discharge in a large Canadian population-based cohort

BackgroundPrognosis following cerebral venous thrombosis (CVT) is more favorable than other stroke types, but longer-term literature is limited, and trends over time are under-explored. ObjectiveUsing administrative data, we examined factors associated with mortality in the inpatient setting, at 30 days and at one year following hospital discharge among a large consecutive cohort of Canadian patients with CVT. Design/methodsCVT patients from British Columbia (BC), Canada from 2000 to 2017 were identified using ICD diagnosis codes from the BC subset of the Canadian Institute for Health Information's Discharge Abstract Database. Logistic regression was used to investigate factors associated with inpatient mortality and survival analysis with Cox regression was used to explore factors associated with mortality at 30 days and one year. ResultsOf 554 incident CVT patients identified, 508 (92 %) survived their index admission. Older age (OR 1.04, 95 % CI 1.03–1.06, p < 0.01) and the presence of seizures (OR 2.31, 95 % CI 1.08–4.94, p = 0.03) or intracranial bleeding (OR 2.28, 95 % CI 1.08–4.85, p = 0.03) were associated with increased odds of inpatient mortality. Mortality after hospital discharge was 3.0 % at 30 days and 9.4 % at one year. Older age (HR 1.05, 95 % CI 1.02–1.08, p < 0.01 at 30 days; HR 1.05, 95 % CI 1.04–1.07, p < 0.01 at 1 year) and having recent or active malignancy (HR 4.17, 95 % CI 1.51–11.52, p < 0.01 at 30 days; HR 4.60, 95 % CI 2.60–8.11, p < 0.01 at 1 year) were significantly associated with higher risks of mortality at 30 days and one year after discharge. There were decreases in inpatient mortality over the study period, but this was offset by higher mortality within 30 days after discharge in the later study epochs. ConclusionsAmong patients discharged with a diagnosis of CVT, one-year mortality was high at 9.4 %. Older age and a history of cancer were associated with higher mortality after discharge.

Emergency Department Overcrowding in Canada

What Is the Issue?&#x0D; &#x0D; Emergency departments (EDs) across Canada are under strain and experiencing overcrowding, a situation that arises when the demand for health services in the ED exceeds the capacity of the health system — which includes the ED, hospital, and community — to provide quality care in a reasonable amount of time.&#x0D; ED overcrowding is contributing to a deteriorating standard of care as health care providers and staff become overworked and burned out, is putting health and lives at risk, and is placing additional strain on an already overwhelmed health care system.&#x0D; &#x0D; What Did We Do?&#x0D; &#x0D; The CADTH Health Technology Expert Review Panel (HTERP) convened to develop objective, impartial, trusted pan-Canadian guidance to inform decisions about which evidence-informed solutions should be considered to help alleviate ED overcrowding in Canada.&#x0D; &#x0D; What Is HTERP’s Position on ED Overcrowding?&#x0D; &#x0D; ED overcrowding is a complex health system issue. EDs operate within hospitals and broader health and social systems, which means that accountability for causes, impacts, and solutions do not lie solely within the ED and its operations.&#x0D; Output factors (e.g., misalignment between acute care bed capacity within the hospital and population needs) and input factors (e.g., misalignment between care available in the community and population needs, including care outside of regular business hours) respectively, are the main contributors to ED overcrowding in Canada. Health system capacity is not aligned with, nor has kept pace with, the growing and changing health care needs of the population, which results in overcrowded EDs.&#x0D; Health systems will observe better results by implementing strategies that improve patient flow and focus on output and input factors relative to throughput factors.&#x0D; &#x0D; What Is HTERP’s Guidance to Help Alleviate ED Overcrowding?&#x0D; &#x0D; Interventions to alleviate overcrowding need to align with the main contributing factors to ED overcrowding in the particular context in which they will be implemented.&#x0D; Understanding the context in which ED overcrowding is occurring, with attention to bottlenecks to patient flow, should be the first step to identify evidence-informed solutions.&#x0D; Transparency and accountability should be key principles in ED, hospital, and health system operations. HTERP recommends identifying and ensuring clear roles, responsibilities, and reporting relationships embedded within an accountability framework for ED overcrowding across health system partners, including a commitment to act on data.&#x0D; Each province and territory should mandate consistent and comprehensive reporting by all hospitals to the Canadian Institute of Health Information’s National Ambulatory Care Reporting System (NACRS) database.&#x0D; HTERP’s guidance includes an Evidence Navigation Guide to support identification of evidence-informed interventions to help alleviate ED overcrowding.&#x0D;

The Physician Anesthesia Workforce in Canada From 1996 to 2018: A Longitudinal Analysis of Health Administrative Data.

A robust anesthesia workforce is essential to the provision of safe surgical, obstetrical, and critical care but information describing the physician anesthesia workforce and volume of clinical services delivered in Canada is limited. This study examines the Canadian physician anesthesia workforce, exploring trends in physician characteristics and activity levels over time. Practice patterns of specialist anesthesiologists and family physician anesthetists (FPAs) working in urban and rural communities were of particular interest. Physicians who provided anesthesia care between 1996 and 2018 were identified using health administrative data from the Canadian Institute of Health Information (CIHI). In addition, data from the Canadian Post-MD Education Registry (CAPER) were used to characterize physicians pursuing postgraduate anesthesia training (1996-2019). Descriptive analyses of physician demographics, training, location, specialty designations, and volume of clinical services were undertaken. Between 1996 and 2018, the anesthesia workforce grew 1.8-fold to 3681 physicians, including 536 FPAs. Over the same time, nerve block services increased 7-fold, and payments for other anesthesia services increased 5-fold. The average age of the anesthesiology workforce increased by 2.3 years and the annual retirement rate was 3%. The workforce has become more gender balanced but remains predominantly male (73% in 2018). The proportion of physicians who were trained internationally (about 30%; 38% in rural areas) remained stable (and higher than that in the overall physician workforce). FPAs provided most anesthesia care in rural Canada and their attrition rate was generally 2- to 3-fold higher than specialists. Physicians in the rural anesthesia workforce provided anesthesia services more intensively over time. Relatively few FPAs who left the anesthesia workforce entered full retirement and they instead contributed other medical services to their communities. This study provides foundational information regarding anesthesia workforce capacity over a 22-year period, including insights into demographics, locations of practice, and clinical volumes. The results do not quantify the gap between service capacity and need; however, they support the need for a national workforce strategy to achieve equitable access to sustainable anesthesia services in Canada, particularly for rural communities.

Opportunistic Salpingectomy Between 2017 and 2020: A Descriptive Analysis

ObjectivesOpportunistic salpingectomy (OS) is the removal of fallopian tubes during another pelvic surgery for the purpose of ovarian cancer prevention. Herein, we describe the rates of OS at the time of hysterectomy and tubal sterilization between 2017 and 2020. MethodsThis study uses the Canadian Institute of Health Information’s Discharge Abstract Database and National Ambulatory Care Reporting System for all Canadian provinces and territories except for Quebec between the fiscal years 2017 and 2020. A descriptive analysis on all people aged 15 years and older who had hysterectomies or tubal sterilizations was conducted to determine the proportion of hysterectomies that included bilateral salpingectomy (OS) and the proportion of tubal sterilizations that were OS compared to tubal ligation. ResultsThere were 174 006 people included in the study. The proportion of hysterectomies that included OS increased from 31.7% in 2017 to 39.9% by 2020. With respect to tubal sterilizations, rates of OS increased from 26.3% of all tubal sterilizations in 2017 to 42.5% in 2020. British Columbia remained the jurisdiction with the highest rates of OS, but rates increased significantly in many jurisdictions, particularly at the time of tubal sterilization. ConclusionThe rates of OS have continued to increase in all Canadian jurisdictions following the official Society of Obstetricians and Gynaecologists of Canada recommendation to consider OS in 2015. Assuming that all tubal ligations could have been OS and 75% of hysterectomies with ovarian conservation could have included OS, our data indicate 76 932 missed opportunities for ovarian cancer prevention.

Abstract 219: Determining the Proportion of Patients with Poor Premorbid mRS presenting with Large Volume Stroke

Introduction Several lines of evidence demonstrate the effectiveness of endovascular treatment (EVT) for large volume stroke (LVS) as defined by Alberta Stroke Program Early CT Score (ASPECTS) of &lt;6 in decreasing severe disability and death. However EVT cannot improve the degree of disability as measured by modified Rankin Scale to be better than premorbid levels. Despite this limitation, patients with severe disabilities are transferred to acute care facilities for consideration of EVT and are hospitalized resulting in over‐medicalization during a terminal event. We aim to determine the proportion of patients with LVS who have poor premorbid mRS (4‐5) and the number of days this subset spent in hospital prior to palliation/death. Methods 2485 CT angiograms of head and neck and CT Head examinations performed between 2018‐2021 were obtained from the picture archiving and communication system (PACS). Cases presenting with ASPECTS&lt;6 as assigned by a neuroradiologist were identified. Functional outcome data, as defined by mRS, was obtained prior to the acute presenting event (premorbid mRS) and on discharge (outcome mRS). All patients with a documented outcome mRS were included in the analysis. Patients were excluded if presenting ASPECTS was &gt;=6, if stroke symptoms were attributable to etiology other than large vessel or tandem occlusion, or if the studies had been duplicated. Number of days spent hospitalized was calculated based on admission date and discharge date. Further subgroup analysis was performed to compare the cost of hospitalization with return to long term care (LTC) based on the Canadian national average of $7803 for hospitalization and $2406 for long term care as provided by Canadian Institute of Health Information and Ministry of long term care of Ontario. Results From the 2485 examinations, 62 had a baseline ASPECTS&lt;6 and 22 cases met exclusion criteria. 40 cases were available for analysis [premorbid mRS (n): 0=(18), 1=(5), 3=(6), 4=(7), 5=(2), ?=(2); age range: 28‐93; 19 male, 21 female]. 23% (9/40) of patients had premorbid mRS of 4‐5, and of these, 78% (7/9) were from LTC or a retirement home. On average, 5.9 days were spent hospitalized [range 4‐9 days]and $5397/person was spent per hospitalization. Conclusion LVS secondary to a LVO can be an acutely terminal illness. 23% of patients presenting with LVS had a poor premorbid mRS. 78% of these patients resided in long term care centers and spent an average of 5.9 days ($5397/person) being hospitalized prior to their demise/palliation.

Towards a universal patient-centric health record sharing platform

ObjectivesThis paper provides a practical approach to evaluate health record sharing platforms in terms of their ability to deliver interoperable healthcare of quality at a systems level. We use our previously published interoperability evaluation framework to evaluate our proposed System-level Record Sharing (SLRS) platform against four other common categories of health record sharing platforms in Canada, the United States, and Norway. MethodsIn this paper, we compare the SLRS platform architecture that we previously developed against 4 health record sharing platform categories. We conducted this comparative evaluation of 5 categories of healthcare platforms: SLRS, Commercial-Multi (CM), Commercial-Independent (CI), Governmental-Multi (GM), and Governmental-Independent (GI) using our proposed evaluation framework that is built upon quadruple aim, triple aim and Canadian Institute for Health Information (CIHI) health platform evaluation frameworks. ResultsSLRS and platforms managed by government organizations that provide a technology-independent or compatible platform were the most effective in terms of satisfying data interoperability, providing meaningful and effective information exchange, being compliant with health privacy regulations across a range of contexts, and having many of the costs paid for at a central level. All platforms struggled with context and process interoperability requirements, as well as providing evidence-based information across an entire health system. ConclusionTo optimize health management, both clinicians and patients need sharing of personal health information (PHI) across applications. Our findings indicate that commercial platforms in this study need to improve their governance structure and employ a consistent ontology that can be adopted by all EHR applications across a health system. Our proposed SLRS platform can support the sharing of health data across multiple health care organizations at a system-level, allowing clinicians to access patient health data to inform treatment and care decisions. Public interest abstractHealthcare organizations face barriers when exchanging information across their boundaries. Many obstacles are caused by varying technical requirements of the EHR applications they have, and their contextual regulations. Most healthcare organizations have a portal in which the patients can view their care history. However, the breadth of the information provided limits to the number of healthcare providers subscribed to that specific platform. Viewing the full history across the entire health system, requires maintaining multiple accounts.In this paper we refer to a new framework for sharing health information and its prototyped platform (SLRS) that we have previously developed in our lab. In this paper we report on how we evaluated the SLRS platform against four prominent practices of Health Information Exchange. We used our interoperability evaluation framework that was developed based on well-acknowledged criteria from literature and practice. We found areas of improvement for existing health information platforms so they can share their records across an entire health system.

Emergency department visits and hospital admissions for suicidal ideation, self-poisoning and self-harm among adolescents in Canada during the COVID-19 pandemic.

The COVID-19 pandemic had profound effects on the mental wellbeing of adolescents. We sought to evaluate pandemic-related changes in health care use for suicidal ideation, self-poisoning and self-harm. We obtained data from the Canadian Institute for Health Information on emergency department visits and hospital admissions from April 2015 to March 2022 among adolescents aged 10-18 years in Canada. We calculated the quarterly percentage of emergency department visits and hospital admissions for a composite outcome comprising suicidal ideation, self-poisoning and self-harm relative to all-cause emergency department visits and hospital admissions. We used interrupted time-series methods to compare changes in levels and trends of these outcomes between the prepandemic (Apr. 1, 2015-Mar. 1, 2020) and pandemic (Apr. 1, 2020-Mar. 31, 2022) periods. The average quarterly percentage of emergency department visits for suicidal ideation, self-poisoning and self-harm relative to all-cause emergency department visits was 2.30% during the prepandemic period and 3.52% during the pandemic period. The level (0.08%, 95% confidence interval [CI] -0.79% to 0.95%) or trend (0.07% per quarter, 95% CI -0.14% to 0.28%) of this percentage did not change significantly between periods. The average quarterly percentage of hospital admissions for the composite outcome relative to all-cause admissions was 7.18% during the prepandemic period and 8.96% during the pandemic period. This percentage showed no significant change in level (-0.70%, 95% CI -1.90% to 0.50%), but did show a significantly increasing trend (0.36% per quarter; 95% 0.07% to 0.65%) during the pandemic versus prepandemic periods, specifically among females aged 10-14 years (0.76% per quarter, 95% CI 0.22% to 1.30%) and females aged 15-18 years (0.56% per quarter, 95% CI 0.31% to 0.81%). The quarterly change in the percentage of hospital admissions for suicidal ideation, self-poisoning and self-harm increased among adolescent females in Canada during the first 2 years of the COVID-19 pandemic. This underscores the need to promote public health policies that mitigate the impact of the pandemic on adolescent mental health.

Profiling medical specialties and informing aspiring physicians: a data-driven approach.

A detailed, unbiased perspective of the inter-relations among medical fields could help students make informed decisions on their future career plans. Using a data-driven approach, the inter-relations among different medical fields were decomposed and clustered based on the similarity of their working environments.Publicly available, aggregate databases were merged into a single rich dataset containing demographic, working environment and remuneration information for physicians across Canada. These data were collected from the Canadian Institute for Health Information, the Canadian Medical Association, and the Institute for Clinical Evaluative Sciences, primarily from 2018 to 2019. The merged dataset includes 25 unique medical specialties, each with 36 indicator variables. Latent Profile Analysis (LPA) was used to group specialties into distinct clusters based on relatedness.The 25 medical specialties were decomposed into seven clusters (latent variables) that were chosen based on the Bayesian Information Criterion. The Kruskal-Wallis test identified eight indicator variables that significantly differed between the seven profiles. These variables included income, work settings and payment styles. Variables that did not significantly vary between profiles included demographics, professional satisfaction, and work-life balance satisfaction.The 25 analyzed medical specialties were grouped in an unsupervised manner into seven profiles via LPA. These profiles correspond to expected and meaningful groups of specialties that share a common theme and set of indicator variables (e.g. procedurally-focused, clinic-based practice). These profiles can help aspiring physicians narrow down and guide specialty choice.

Breast Cancer After Reduction Mammoplasty: A Population-Based Analysis of Incidence, Treatment and Screening Patterns.

The risk of breast cancer may be decreased in women who undergo reduction mammoplasty. The purpose of this study was to describe the incidence and treatment of breast cancer after reduction mammoplasty and to better understand the use of breast cancer screening modalities in these patients. This population-based retrospective analysis utilized the Discharge Abstract Database held by the Canadian Institute for Health Information and the National Ambulatory Care Reporting System to identify all women aged 20 years or older who underwent reduction mammoplasty in Alberta, Canada. The incidence and treatment of breast cancer were compared among patients who underwent reduction mammoplasty and age-sex-matched controls. Imaging utilization, including the use of mammography, ultrasound, and breast biopsy, was also compared. Between 2003 and 2007, 8021 patients over 20 years old underwent reduction mammoplasty in Alberta. Patients were followed for an average of 12.6 years. Eighty-nine (1.1%) patients who underwent reduction mammoplasty developed breast cancer after surgery, compared to 453 (1.9%) controls (P < 0.0001). Among patients diagnosed with breast cancer, there was no difference in patient and tumor characteristics. Women who underwent reduction mammoplasty were more likely to undergo mastectomy for cancer (41.6% vs 1.5%; P < 0.0001) and were more likely to undergo mammography (66.7% vs 58.7%; P < 0.0001), ultrasound (29.2% vs 26.2%; P < 0.0001) and biopsy for benign disease (7.2% vs 6%, P < 0.0001) compared to controls. Despite an increased frequency of breast cancer screening, the incidence of breast cancer is lower after reduction mammoplasty compared with women who did not undergo breast reduction. After a diagnosis of breast cancer, surgical treatment patterns differ between groups, whereby mastectomy is more common after reduction mammoplasty.

Measuring Potentially Avoidable Acute Care Transfers From Long-Term Care Homes in Quebec: a Cross Sectional Study.

Potentially avoidable emergency department transfers (PAEDTs) and hospitalizations (PAHs) from long-term care (LTC) homes are two key quality improvement metrics. We aimed to: 1) Measure proportions of PAEDTs and PAHs in a Quebec sample; and 2) Compare them with those reported for the rest of Canada. We conducted a repeated cross-sectional study of residents who were received at one tertiary hospital between April 2017 and March 2019 from seven LTC homes in Quebec, Canada. The MedUrge emergency department database was used to extract transfers and resident characteristics. Using published definitions, PAEDTs and PAHs were identified from principal emergency department and hospitalization diagnoses, respectively. PAEDT and PAH proportions were compared to those reported by the Canadian Institute for Health Information. A total of 1,233 transfers by 692 residents were recorded, among which 36.3% were classified as being potentially avoidable: 22.8% 'PAEDT only', 11.6% 'both PAEDT & PAH', and 1.9% 'PAH only'. Shortness of breath was the most common reason for transfer. Pneumonia was the most common diagnosis from the 'both PAEDT & PAH' category. PAEDTs and PAHs accounted for 95% and 37% of potentially avoidable transfers, respectively. Among 533 hospitalizations, 31.3% were PAHs. These proportions were comparable to the rest of Canada, with some differences in proportions of transfers due to congestive heart failure, urinary tract infection, and implanted device management. PAEDTs far outweigh PAHs in terms of frequency, and their monitoring is important for quality assurance as they may inform LTC-level interventions aimed at their reduction.