Health Assessment Data Research Articles

Statin therapy and mortality among new long-term care residents in Ontario, Canada: the contribution of clinical assessment data to a population-based cohort study

ABSTRACTObjectiveThere is limited evidence from randomized trials and observational studies to guide clinical practice regarding the use of statins in long-term care (LTC); the effectiveness of statins among those with limited life expectancy is not clear and there is concern that the risk of drug-related adverse events might outweigh any benefit. We examined the impact of initiating statin therapy on mortality for patients newly admitted to LTC.
 ApproachPopulation-based health administrative data from Ontario, Canada were used to conduct a retrospective cohort study of newly admitted LTC residents, aged 66+ years and no statin use in the previous year, between January 1 2011 and December 31 2014. This cohort was linked to Resident Assessment Instrument (interRAI) data to capture clinical and functional characteristics (including frailty, activities of daily living, and cognitive function). The primary exposure was statin use within 30 days following LTC entry; residents who died or did not receive an interRAI assessment within 30 days were excluded. A propensity score for receiving statins was computed using resident demographic, clinical and functional characteristics. We matched exposed to unexposed patients on the basis of age (±1 year), sex, prior myocardial infarction(MI)/stroke hospitalization, frailty and propensity score (±0.2 standard deviations). Patients were followed in an intention-to-treat manner from the end of the exposure window until the earliest of death or March 31 2015. Cox regression was used to compare mortality between the study groups.
 ResultsWe identified 39,560 newly admitted LTC residents aged 66+ years with no statin use in the previous year, of which 1,953 (4.9%) were prescribed a statin within 30 days of LTC entry. Propensity score matching resulted in 1,710 pairs of exposed and unexposed patients. In the matched cohort, those receiving statins had a lower rate of mortality compared with those not receiving statins (Hazard Ratio 0.77; 95% Confidence Interval [CI] 0.70-0.85). In pre-specified subgroup analyses, the association between statin use and reduced mortality persisted among those with and without a prior MI/stroke hospitalization and among those categorized as frail and not frail.
 ConclusionOur data suggest initiating statins may be beneficial in reducing mortality risk among LTC residents, despite the complexity and advanced age of the patients. By linking rich resident-level health and functional assessment data with health administrative data we were able to characterize the association between demographic and clinical characteristics (including frailty) and exposure to statins more fully than with administrative data alone.

VTE and physical health assessment upon admission to acute functional and organic psychiatric in-patient wards: An audit

IntroductionVenous thromboembolism (VTE) is a condition that causes a blood clot to form within the venous blood system. If this blood clot forms in the peripheral venous system it can cause symptoms such as calf pain and swelling. If this clot becomes dislodged, it may travel through the vessels into the pulmonary artery which can have much more severe consequences.ObjectivesThere has been a great deal of effort in recent years to increase the percentage of in-patients receiving a VTE assessment; and for those patients to receive appropriate VTE prophylaxis. VTE is a significant cause of inpatient deaths. This audit aims to compare current working practice to local standards and identify learning points.MethodsVTE and physical health assessment data was collected by checking electronic admission summaries from three acute psychiatric in-patient wards on a random date in 2016. The local pathway for the management of physical health and wellbeing states that the VTE assessment and Physical Health Assessment should be completed within 6 hours of admission. NICE guidelines also state that all patients should be assessed on admission, with a standard of 100%.Results60% of patients had a VTE assessment and 54% of patients had a physical health assessment done within 6 hours of admission.ConclusionsThis audit shows that the necessary standards are not met. Importance of these assessments has been communicated during induction programmes for all staff.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Longitudinal Changes and High-Risk Subgroups for Obesity and Overweight/Obesity Among Refugees in Buffalo, NY, 2004-2014.

Very few studies have been conducted on non-communicable diseases among resettled refugees. The purpose of the study was to examine longitudinal changes in obesity and overweight/obesity rates among resettled refugees and identify high-risk subgroups. Longitudinal health assessment data of 818 children (2-18years) and 1055 adults (≥19years) were used from a refugee clinic in Buffalo, NY, during 2004-2014. Univariate and bivariate analyses were performed. Risk factors of obesity and overweight/obesity were assessed using multivariate regression models. Obesity (8.7 to 12.7%) and overweight/obesity (16.9 to 26.7%) rates increased among children over 4.5years (p<0.01). Over 3.9years, overweight/obesity rates increased in men (39.6 to 58.6%, p<0.01) and women (55.1 to 73.5%, p<0.01), exceeding the prevalence of overweight/obesity of 65.8% in US-born women. Interestingly, longitudinal overweight/obesity rates decreased among Middle Eastern (81.4 vs 78.0%, p<0.01) and East European (75.0 vs 70.8%, p<0.01) women. African children had 2.31-folds (odds ratio [OR]=2.31; 95% confidence interval [CI]=1.46-3.67) greater overweight/obesity risk than Asians. African girls who were not overweight or obese at baseline had the highest risk of becoming obese at follow-up visits (OR=0.21; 95%CI=0.09-0.52). For each additional year refugees lived in the USA, overweight/obesity risk among men (OR=1.23; 95%CI=1.09-1.39) and women (OR=1.18; 95%CI=1.04-1.35) increased. Obesity and overweight/obesity rates increased among refugees, but significant variations existed. Overweight/obesity rate among refugee women surpassed the US average. African origin, baseline weight, and longer duration of stay in the USA were risk factors. Culturally tailored programs are needed to prevent obesity and reduce health disparities among refugees.

'I'm not sure it paints an honest picture of where my health's at' - identifying community health and research priorities based on health assessments within an Aboriginal and Torres Strait Islander community: a qualitative study.

Aboriginal and Torres Strait Islander health assessments are conducted annually in Australian primary care to detect risk factors, chronic diseases and implement preventive health measures. At the Inala Indigenous Health Service, health assessment data have also been used for research purposes. This research has been investigator-driven, which risks misinterpreting or ignoring community priorities compared with community-led research. The objective of this research was to learn about the Aboriginal and Torres Strait Islander community's health priorities that could be translated into research themes, and investigate these using health assessment data. A thematic analysis of data was conducted from 21 semi-structured interviews with purposively selected key informants from an urban Aboriginal and Torres Strait Islander community. Key informants articulated an authoritative understanding of how interrelated, inter-generational, social, cultural and environmental determinants operated in a 'cycle' to influence the community's health. Key informant views supported the inclusion of these determinants in health assessments, reinforced the importance of comprehensive primary healthcare and strengthened referral pathways to community resources. Some key informants were ambivalent about Aboriginal and Torres Strait Islander health assessments because of their biomedical emphasis. This research also revealed limitations of health assessment-based research and the biomedical emphasis of the health system more broadly.

Comorbidity of gynecological and non-gynecological diseases with adenomyosis and endometriosis.

ObjectiveAdenomyosis and endometriosis are relatively common gynecological diseases that exhibit many common features. This study identified gynecological and non-gynecological diseases that exhibited comorbidity with adenomyosis and endometriosis in Korean women.MethodsWe used Health Insurance Review and Assessment data from 2009 to 2011 and searched for adenomyosis and endometriosis (coded as N80.1 and D25 in International Classification of Disease, 10th revision [ICD-10], respectively). We selected records from patients who had independent disease occurrences in each year, and comorbidities were estimated using Fisher's exact test. We computed each year's similarities and combined 3 years' results using Fisher's P-value summation method.ResultsA total of 61,516 patients' data were collected during the study period. The prevalence of adenomyosis and endometriosis were similar each year: 12.4% and 9.3% in 2009, 12.5% and 9.4% in 2010 and 13.3% and 9.1% in 2011, respectively. Meta-analysis revealed that 31 ICD-10 codes were significantly related with adenomyosis, and 44 ICD-10 codes were related with endometriosis. Gynecological diseases, such as leiomyoma and benign ovarian tumor, were significantly related to adenomyosis and endometriosis. Non-gynecological diseases, such as anemia and hypercholesterolemia, were also related to adenomyosis and endometriosis.ConclusionWe must monitor for the presence of gynecological and non-gynecological diseases with co-morbidities during evaluations and follow-up of patients with adenomyosis or endometriosis.

The Use Pattern and Clinical Impact of New Antiplatelet Agents Including Prasugrel and Ticagrelor on 30-day Outcomes after Acute Myocardial Infarction in Korea: Korean Health Insurance Review and Assessment Data.

Background and ObjectivesDespite the favorable efficacy of new antiplatelet agents demonstrated in randomized controlled trials, their clinical implications in Korea are unclear. The purpose of this study was to investigate trends in antiplatelet agent use for acute myocardial infarction (AMI) and their impact on 30-day clinical outcomes.MethodsAMI patients undergoing percutaneous coronary intervention between 2010 and 2015 were assessed using claim data from the Health Insurance Review and Assessment Service.ResultsThe use of new antiplatelet agents has rapidly increased since 2013 and has been preferred over clopidogrel (Plavix; Bristol-Myers Squibb/Sanofi Pharmaceuticals) since 2015. Both prasugrel (Effient; Eli Lilly and Company) (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.31–0.67; p<0.001) and ticagrelor (Brilinta; AstraZeneca Pharmaceuticals LP) (OR, 0.84; 95% CI, 0.71–0.98; p=0.032) had an independent effect on lowering 30-day mortality in a weighted multivariable logistic regression model. However, new antiplatelet agents had no significant effect on other clinical outcomes including myocardial infarction, stroke, bleeding, and readmission within 30 days.ConclusionThe use of new antiplatelet agents is rapidly increasing, and they have been used more commonly than clopidogrel since 2015. We demonstrated that new antiplatelet agents have a favorable effect on reducing 30-day mortality in AMI patients in Korea.

Towards Actualizing the Value Potential of Korea Health Insurance Review and Assessment (HIRA) Data as a Resource for Health Research: Strengths, Limitations, Applications, and Strategies for Optimal Use of HIRA Data.

Health Insurance and Review Assessment (HIRA) in South Korea, also called National Health Insurance (NHI) data, is a repository of claims data collected in the process of reimbursing healthcare providers. Under the universal coverage system, having fee-for-services covering all citizens in South Korea, HIRA contains comprehensive and rich information pertaining to healthcare services such as treatments, pharmaceuticals, procedures, and diagnoses for almost 50 million beneficiaries. This corpus of HIRA data, which constitutes a large repository of data in the healthcare sector, has enormous potential to create value in several ways: enhancing the efficiency of the healthcare delivery system without compromising quality of care; adding supporting evidence for a given intervention; and providing the information needed to prevent (or monitor) adverse events. In order to actualize this potential, HIRA data need to actively be utilized for research. Thus understanding this data would greatly enhance this potential. We introduce HIRA data as an important source for health research and provide guidelines for researchers who are currently utilizing HIRA, or interested in doing so, to answer their research questions. We present the characteristics and structure of HIRA data. We discuss strengths and limitations that should be considered in conducting research with HIRA data and suggest strategies for optimal utilization of HIRA data by reviewing published research using HIRA data.

Using Predicted Therapy Visits in the Medicare Home Health Prospective Payment System

A criticism of Medicare’s home health prospective payment system is its partial reliance on cost-based reimbursement of therapy services provided by home health agencies (HHAs) to Medicare fee-for-service (FFS) beneficiaries, potentially overincentivizing the provision of therapy services. Using Medicare FFS home health claims and assessment data, we estimated a model to predict therapy use as a proxy for clinical need and replace actual therapy use with the prediction in the home health payment system. We estimated a $1.178 billion (95% confidence interval, $1.171-$1.184) decrease in home health payments relative to levels under the current system. The majority of the decrease was due to the model predicting fewer high therapy episodes than actually occurred. It may therefore be more appropriate to predict both therapy and nontherapy use, requiring an overhaul of the current system.

An Overview of Useful Data and Analyzing Techniques for Improved Multivariate Diagnostics and Prognostics in Condition-Based Maintenance

The reliability of production machines gains in importance in today’s optimized and highly productive business environments. Unexpected machine breakdowns do not only lead to loss of production time and production outages but also to diminishing customer satisfaction due to deterioration in quality and declining availability of products. The condition-based maintenance (CBM) strategy aims at preventing these machine breakdowns through real-time monitoring of machine conditions. Sensor data are collected and analyzed using diagnostic and prognostic approaches to identify the type of fault and the remaining useful life. Identifying the reasons and time of breakdowns fosters improved planning of maintenance and spare parts demand, leading to higher machine reliability. In general, machine sensor data are regarded as a useful source of information to assess the machine’s operating condition. However, in some specific cases, the machine sensors lack the ability to correctly represent the health of the machine or the specific component under consideration. Therefore, additional information by further available data is required to improve diagnostic and prognostic techniques for more accurate and precise analysis. Current research focuses on the analysis of sensor data for condition-based maintenance, while other data like the operating history and environment temperature have only been considered to a limited extend so far. Hence, this paper gives an overview on potential data for machine health assessment and remaining useful life prediction in condition-based maintenance. Furthermore, corresponding approaches and techniques for fault diagnostics and prognostics are presented targeting the analysis of individual data sources as well as of multivariate settings featuring multiple integrated data sources.

Disaster Impact on Impoverished Area of US: An Inter-Professional Mixed Method Study.

Using an ethnographic mixed-methods approach, an inter-collaborative team conducted face-to-face interviews with (N=12) Appalachian residents about their disaster experience, documented observations and visual assessment of need on an observation tool, and used photography depicting structural and environmental conditions. A Health and Emergency Preparedness Assessment Survey Tool was used to collect demographic, health, housing, environment, and disaster readiness assessment data. Community stakeholders facilitated purposeful sampling through coordination of scheduled home visits. Triangulation of all data sources provided evidence that the community had unique coping strategies related to faith and spirituality, cultural values and heritage, and social support to manage antecedent circumstances, risk, and protective factors during times of adversity that, in turn, enhanced resilience up to 12 months post-disaster. The community was found to have an innate capacity to persevere and utilize resources to manage and transcend adversity and restore equilibrium, which reflected components of resilience that deserve greater recognition and appreciation. Resilience is a foundational concept for disaster science. A model of resilience for the rural Appalachia community was developed to visually depict the encompassing element of community-based interventions that may enhance coping strategies, mitigate risk factors, integrate protective factors, and strengthen access. Community-based interventions are recommended to strengthen resilience, yielding improved outcomes of adaptation, health and wellness, and disaster readiness. Banks LH , Davenport LA , Hayes MH , McArthur MA , Toro SN , King CE , Vazirani HM . Disaster impact on impoverished area of US: an inter-professional mixed method study. Prehosp Disaster Med. 2016;31(6):583-592.

Sexual orientation and sexual assault victimization among US college students

Sexual victimization continues to be a problem on college campuses across the United States. Research on risk focuses on victimization of heterosexual women while that of sexual minority students is under-studied. The current study uses National College Health Assessment data to examine the relationship between sexual identity and four measures of self-reported sexual victimization. Several victimization correlates identified in prior research are included in analyses. Logistic regression results show that gay men and bisexual men and women were more likely compared to heterosexuals to report all four victimization types, and unsure students are more likely to report three types. However, lesbian students are no more likely than heterosexual students to report any sexual victimization. Also, transgendered students were more likely compared to female students to report three victimization types.

A novel dietary improvement strategy: examining the potential impact of community-supported agriculture membership.

To investigate the use of community-supported agriculture (CSA) as an employer-based health promotion intervention. Quasi-experimental study using a convenience sample of employees at three employers. Participants and controls from three Minnesota employers completed baseline and follow-up health assessments and surveys about their experiences with CSA. A total of 324 participants purchased a CSA share and were eligible for study inclusion. Study participants were matched by age, sex, employer and occupation to a non-randomized control group of individuals who did not purchase a CSA share but completed health assessments during the same time frame as the study participants. The majority of participants were female, white, middle-aged and highly educated. The most common reason for purchasing a CSA share was a desire for fresh food, and the majority of participants were satisfied with their experience. Participants reported a significant increase in the number of vegetables present in the household and the frequency of family meals. The frequency of eating out decreased significantly, especially at fast-food restaurants. Participants also reported an increase in the amount and variety of produce consumed. However, health assessment data did not show significant changes in dietary intake, health status or BMI. CSA participation was associated with improvement in some aspects of the household environment and dietary behaviours. Further research is needed to determine whether employer-based CSA interventions may also lead to improvements in dietary intake and health.

Precautionary Behavior and Violent Victimization: Do Safer Drinking Strategies Reduce Risk?

This study was undertaken to test if precautionary drinking behaviors can be associated with reduced risk of violent victimization. Some studies have shown that these behaviors (e.g. limiting alcohol intake, eating before or during drinking, and having friends close by) reduce the negative consequences of drinking, but very few have focused on criminal victimization. National College Health Assessment data from 20121 were utilized to examine the association between precautionary drinking behavior and violent victimization (physical assault or verbal threat), controlling for demographic and risky lifestyle factors. Regression analyses found that precautionary drinking behavior reduced the odds of victimization only among men who frequently drink. In this same group being “single” increased risk. Other variables were consistent predictors: drug use, multiple sex partners, mental health disorder, and first year student status. Binge drinking and having a disability were also frequent predictors. Finally, Black women but not men were more likely to be victimized. These results suggest that the risky or protective nature of types of drinking behaviors is gendered and taking precautions is especially important for men who drink frequently.

Sexual violence, weight perception, and eating disorder indicators in college females

ABSTRACTObjective: To examine the relationships between sexual violence experiences, inaccurate body weight perceptions, and the presence of eating disorder (ED) indicators in a sample of female US college students. Participants: Participants were 6,090 college females 25 years of age and younger. Methods: A secondary analysis of National College Health Assessment data gathered annually at one institution from 2004 to 2013 was utilized. A model predicting ED indicators was tested using logistic regression analyses with multiple categorical variables representing severity of sexual violence, accuracy of body weight perception, and an interaction between the two. Results: Sexual violence and inaccurate body weight perception significantly predicted ED indicators; sexual violence was the strongest predictor of purging behavior, whereas inaccurate body weight perception was best predicted by underweight status. Conclusions: Findings provide support to the relationship between purging behavior and severity of sexual violence and also to the link between inaccurate body weight perception and being underweight.

Eradication Rates of Helicobacter pylori in Korea Over the Past 10 years and Correlation of the Amount of Antibiotics Use: Nationwide Survey.

The efficacy of proton-pump inhibitor-amoxicillin-clarithromycin therapy for H. pylori eradication has decreased over time. We assessed the trend of H. pylori eradication rates over the last 10 years and the relationship between the eradication rates and the amount of macrolide antibiotic use in a country with a high prevalence of H. pylori infection. This vast nationwide multicenter study was conducted with 34,139 adults treated for H. pylori infection from January 2001 to December 2010. The defined daily dose per km(2) (DSD) of macrolide antibiotics was calculated (n = 141,019) using the Health Insurance Review & Assessment data base from 2008 to 2010 in the two cities which had the lowest (Jeju city) or highest (Chuncheon city) eradication rate. The eradication rates of proton-pump inhibitor-amoxicillin-clarithromycin therapy ranged 84.9-87.5% from 2001 to 2007, and those of 2008 to 2010 ranged 80.0-81.4% with a decreasing trend (p < 0.0001). The decreasing trend of eradication rates for the overall first-line therapy was observed only in three of the seven geographic areas in Korea (p < 0.0001). The DSD of macrolide antibiotics was significantly higher in Jeju than Cheunchon city (0.85 vs 0.52, p < 0.0001). H. pylori eradication rates with clarithromycin-containing triple therapy in Korea showed a decreasing trend over the past 10 years, although the trend varied among geographic areas. This difference may be associated with the amount of macrolide antibiotic use.

Development and Assessment of Ash Mortality Models in Relation to Emerald Ash Borer Infestation

Emerald ash borer is a pest of North American ash that has caused significant mortality within its introduced range. The timeline for tree mortality, once infested by emerald ash borer, is variable for individual trees, with a small proportion surviving infestation. Using tree health assessments and signs of emerald ash borer infestation, researchers developed decision models to predict the probability of mortality. Two resulting models performed well at correctly predicting mortality (&gt;83% correct) and significantly separating probability of mortality for those trees. Both models used diameter at breast height (DBH) and presence of bark splits, with one including percent crown dieback and the other including vigor rating (overall tree health assessment). A third model had reduced correct prediction of mortality, but was still potentially an effective model. Other tested models had shortcomings in prediction of mortality or in separation of probabilities of mortality. Using variables from three potential decision models, the year of mortality was modeled. However, specific year prediction was not as effective. Because of a wide range of external factors, prediction of a specific year of mortality may not be appropriate. Using DBH and rapid health and infestation assessment data, the authors were able to correctly predict ash mortality within a three-year period for the majority of trees within this study. Management strategies that use these models for developing hierarchical removal programs for infested ash may distribute financial and environmental costs over multiple years as opposed to mass removal of street and park trees.

PHP88 - Real World data for Health and Technology assessment in Brazil: an unmet need

PHP88 - Real World data for Health and Technology assessment in Brazil: an unmet need

From the April Issue of JAMDA

From the April Issue of JAMDA

Diabetes and Cardiovascular Disease Risk in Cambodian Refugees.

To determine rates of diabetes, hypertension, and hyperlipidemia in Cambodian refugees, and to assess the proportion whose conditions are satisfactorily managed in comparison to the general population. Self-report and laboratory/physical health assessment data obtained from a household probability sample of U.S.-residing Cambodian refugees (N=331) in 2010-2011 were compared to a probability sample of the adult U.S. population (N=6,360) from the 2009-2010 National Health and Nutrition Examination Survey. Prevalence of diabetes, hypertension and hyperlipidemia in Cambodian refugees greatly exceeded rates found in the age- and gender-adjusted U.S. Cambodian refugees with diagnosed hypertension or hyperlipidemia were less likely than their counterparts in the general U.S. population to have blood pressure and total cholesterol within recommended levels. Increased attention should be paid to prevention and management of diabetes and cardiovascular disease risk factors in the Cambodian refugee community. Research is needed to determine whether this pattern extends to other refugee groups.

The Comparison of the Minimum Data Set for Elderly Health in Selected Countries.

Introduction:Ongoing increase in the elderly population in many developed countries has drawn attention to health of this age group. Recording adequate and relevant data for the elderly is considered as the basis for future planning for this segment of society. So this study was conducted to compare minimum data about elderly health in selected countries.Methods:This review study was conducted through Internet and library studies. Key words were extracted from search engines and data bases including Google, Yahoo, Google Scholar, PubMed, ProQuest and Iranian National Medical Digital Library. Inclusion criteria included English language with no time limits. All articles, research projects, theses, guidelines and progress reports were retrieved from the United States, Sweden, Japan and Iran and reviewed. Also, websites of organizations responsible for elderly health in selected countries were visited and their documents were reviewed. Results from this search were provided narratively and finally were presented within comparison tables.Findings:The findings of this study showed that elderly data in the selected countries are collected around four axis including minimum demographic data, medical histories, health assessment and financial data of elderly health.Discussion and Conclusion:Given the importance of the minimum data set of elderly health for future planning, the use of experiences of leading countries in elderly health seems necessary; however, localization of it according to the country’s needs is inevitable.