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Southern DA, James MT, Wilton SB, DeKoning L, Quan H, Knudtson ML, Ghali WA. Expanding the impact of a longstanding Canadian cardiac registry through data linkage: challenges and opportunities. Int J Popul Data Sci 2018; 3:441. [PMID: 32935018 PMCID: PMC7299492 DOI: 10.23889/ijpds.v3i3.441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) began as a province-wide inception cohort of all adult Alberta residents undergoing cardiac catheterization for ischemic heart disease. Strengths of the APPROACH initiative include the prospective collection of detailed clinical, procedural, and treatment information, measured at point-of-care. While this aspect of APPROACH provides data users with several advantages over use of typical administrative data, the ability to link APPROACH with data from multiple other sources has provided several unique opportunities to measure cardiovascular care and outcomes. As of June 2018, clinical information has been collected by APPROACH on over 240,000 adult Alberta residents. Linkage of this rich clinical data to administrative health data (eg. Vital statistics, hospitalizations, ambulatory events, prescription medications), secondary use clinical data (e.g. laboratory, ECG, rehabilitation, EMR, imaging) and other data sources (eg. Geospatial, crime data, meteorological) allows better study of the determinants of a patient's health trajectory. This paper describes applied examples of work that has leveraged the potential of linking several datasets with the APPROACH registry.
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Affiliation(s)
- Danielle A Southern
- Department of Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
| | - Matthew T James
- Department of Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
- Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
| | - Stephen B Wilton
- Libin Cardiovascular Institute of Alberta, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
| | - Lawrence DeKoning
- Department of Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
- Calgary Laboratory Services, 3535 Research Road NW, Calgary, AB, T2L 2K8
- Department of Paediatrics, Alberta Children's Hospital, 2888 Shaganappi Tr NW, Calgary, Alberta, T3B 6A8, Canada
| | - Hude Quan
- Department of Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
| | - Merril L Knudtson
- Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
| | - William A Ghali
- Department of Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
- Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
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Patel AB, Quan H, Welsh RC, Deckert-Sookram J, Tymchak W, Sookram S, Surdhar I, Kaul P. Validity and utility of ICD-10 administrative health data for identifying ST- and non-ST-elevation myocardial infarction based on physician chart review. CMAJ Open 2015; 3:E413-8. [PMID: 27570759 PMCID: PMC4987155 DOI: 10.9778/cmajo.20150060] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Health care administrative databases are useful for assessing the population-level burden of disease and examining issues related to access, costs and quality of care. In these databases, the diagnoses and procedures are coded with the use of the World Health Organization International Classification of Diseases (ICD). We examined the validity of 2 ICD-10 coding definitions for categorizing patients with acute myocardial infarction (MI) as having ST-elevation MI (STEMI) or non-ST-elevation MI (non-STEMI). METHODS Charts of patients with acute MI discharged between April and June 2007 from 3 hospitals in Edmonton, were reviewed to define the acute MI subtype (i.e., STEMI v. non-STEMI). The agreement between clinician chart review and STEMI/non-STEMI classification based on the standard (ICD-10 I21.x) and the supplementary electrocardiogram (ECG) codes (R94.3x) was determined. We assessed the effect of these alternative definitions on in-hospital mortality estimates by applying them to the data for all patients with acute MI admitted to hospital in the province from April 2007 to March 2010. RESULTS Of the 297 patients, 49.2% were identified as having STEMI based on chart review, 44.4% using the standard definition, and 44.1% using the ECG definition. Both the standard and ECG definitions provided high agreement (92% for STEMI and 100% for non-STEMI) with the chart review classification. In the larger population-level cohort (n = 15 148), use of the standard definition or the ECG definition did not affect in-hospital mortality estimates for patients with STEMI and those with non-STEMI. INTERPRETATION The standard definition appears equivalent to the definition using supplementary ECG codes to subcategorize patients with acute MI as having STEMI or non-STEMI. These findings may be relevant for the development of later versions of ICD codes.
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Affiliation(s)
- Alka B Patel
- Department of Community Health Sciences (Patel, Quan), University of Calgary, Calgary, Alta. Faculty of Medicine & Dentistry University of Alberta (Welsh, Deckert-Sookram, Tymchak, Sookram, Surdhar, Kaul), Edmonton, Alta
| | - Hude Quan
- Department of Community Health Sciences (Patel, Quan), University of Calgary, Calgary, Alta. Faculty of Medicine & Dentistry University of Alberta (Welsh, Deckert-Sookram, Tymchak, Sookram, Surdhar, Kaul), Edmonton, Alta
| | - Robert C Welsh
- Department of Community Health Sciences (Patel, Quan), University of Calgary, Calgary, Alta. Faculty of Medicine & Dentistry University of Alberta (Welsh, Deckert-Sookram, Tymchak, Sookram, Surdhar, Kaul), Edmonton, Alta
| | - Jessica Deckert-Sookram
- Department of Community Health Sciences (Patel, Quan), University of Calgary, Calgary, Alta. Faculty of Medicine & Dentistry University of Alberta (Welsh, Deckert-Sookram, Tymchak, Sookram, Surdhar, Kaul), Edmonton, Alta
| | - Wayne Tymchak
- Department of Community Health Sciences (Patel, Quan), University of Calgary, Calgary, Alta. Faculty of Medicine & Dentistry University of Alberta (Welsh, Deckert-Sookram, Tymchak, Sookram, Surdhar, Kaul), Edmonton, Alta
| | - Sunil Sookram
- Department of Community Health Sciences (Patel, Quan), University of Calgary, Calgary, Alta. Faculty of Medicine & Dentistry University of Alberta (Welsh, Deckert-Sookram, Tymchak, Sookram, Surdhar, Kaul), Edmonton, Alta
| | - Ian Surdhar
- Department of Community Health Sciences (Patel, Quan), University of Calgary, Calgary, Alta. Faculty of Medicine & Dentistry University of Alberta (Welsh, Deckert-Sookram, Tymchak, Sookram, Surdhar, Kaul), Edmonton, Alta
| | - Padma Kaul
- Department of Community Health Sciences (Patel, Quan), University of Calgary, Calgary, Alta. Faculty of Medicine & Dentistry University of Alberta (Welsh, Deckert-Sookram, Tymchak, Sookram, Surdhar, Kaul), Edmonton, Alta
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Beck CA, Southern DA, Saitz R, Knudtson ML, Ghali WA. Alcohol and drug use disorders among patients with myocardial infarction: associations with disparities in care and mortality. PLoS One 2013; 8:e66551. [PMID: 24039695 PMCID: PMC3770618 DOI: 10.1371/journal.pone.0066551] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 05/10/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Because alcohol and drug use disorders (SUDs) can influence quality of care, we compared patients with and without SUDs on frequency of catheterization, revascularization, and in-hospital mortality after acute myocardial infarction (AMI). METHODS This study employed hospital discharge data identifying all adult AMI admissions (ICD-9-CM code 410) between April 1996 and December 2001. Patients were classified as having an SUD if they had alcohol and/or drug (not nicotine) abuse or dependence using a validated ICD-9-CM coding definition. Catheterization and revascularization data were obtained by linkage with a clinically-detailed cardiac registry. Analyses (controlling for comorbidities and disease severity) compared patients with and without SUDs for post-MI catheterization, revascularization, and in-hospital mortality. RESULTS Of 7,876 AMI unique patient admissions, 2.6% had an SUD. In adjusted analyses mortality was significantly higher among those with an SUD (odds ratio (OR) 2.02; 95%CI: 1.10-3.69), while there was a trend toward lower catheterization rates among those with an SUD (OR 0.75; 95%CI: 0.55-1.01). Among the subset of AMI admissions who underwent catheterization, the adjusted hazard ratio for one-year revascularization was 0.85 (95%CI: 0.65-1.11) with an SUD compared to without. CONCLUSIONS Alcohol and drug use disorders are associated with significantly higher in-hospital mortality following AMI in adults of all ages, and may also be associated with decreased access to catheterization and revascularization. This higher mortality in the face of poorer access to procedures suggests that these individuals may be under-treated following AMI. Targeted efforts are required to explore the interplay of patient and provider factors that underlie this finding.
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Affiliation(s)
- Cynthia A. Beck
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
- Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| | - Danielle A. Southern
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Richard Saitz
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | | | - William A. Ghali
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
- Institute for Public Health (IPH), University of Calgary, Calgary, Alberta, Canada
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