Administrative data provide vital research evidence for maximizing health-system performance and outcomes

Variations in Patterns of Care of Rectal Cancer Patients in South Australia According to Sociodemographic Characteristics:A Registry Study

Objective. To explore variations in patterns of care over three decades for a subgroup of rectal cancer patients in South Australia according to sociodemographic characteristics. Methods. This study evaluated three decades of retrospective data from the South Australian Clinical Cancer Registry. A total of 4,131 patients diagnosed with rectal cancer between 1982 and 2015 and treated in South Australian public hospitals were included. Study outcomes were age at diagnosis, area of primary residence, cancer stage, and primary treatment (surgery, chemotherapy, or radiotherapy). Results. There was a significantly lower likelihood of conventional therapy for the elderly. Adjusted odds of receiving surgery or radiotherapy decreased by 70% and those of receiving chemotherapy by 90% in the 80+ age group, compared to the 50–59 age group. No significant variation was detected according to area-level socioeconomic status or remoteness. Conclusion. Socioeconomic factors showed little impact on the receipt of therapies for rectal cancer patients in South Australia. Variation in treatment by age, irrespective of disease stage or period of diagnosis, requires further investigation.

Validation and adaptation of the Charlson Comorbidity Index using administrative data from the Colombian health system: retrospective cohort study

OBJECTIVE

To validate the Charlson Comorbidity Index (CCI) for the Colombian population using administrative databases from the health insurance system.

DESIGN

Retrospective cohort study.

SETTING

Database reports of events related to services that insurers provided (Health Promoter Enterprises, EPS in Spanish) in the Colombian health system, which covered 22.19 million residents in 2016.

PARTICIPANTS

The study cohort comprised 3 849 849 patients aged 18 years and up admitted to the Colombian hospitals between 1 January and 31 December 2016.

PRIMARY OUTCOME

The study aimed to gauge the CCI's predictive value for mortality by comparing the calibration and discrimination of three different versions of the index, with mortality information obtained from death certificates, including date of death and diagnoses associated with cause of death. Follow-up was conducted for at least 1 year.

RESULTS

Altogether, 46 429 patients died within 1 year (1.21%). Discriminatory power in predicting 1-year mortality was calculated for three versions of the ICC. In the original CCI model, the area under the Receiver operating characteristic (ROC) curve was 0.906 (95% CI (0.906 to 0.907), p<0.001). In the version for Colombia, it was 0.908 (95% CI (0.908 to 0.909), p<0.001) and for the new model it was 0.909 (95% CI (0.908 to 0.910), p<0.001).

CONCLUSIONS

Adapting the CCI based on the 14 predictive variables of the new model resulted in an adequate predictive value for 1-year mortality in patients who were hospitalised for all causes. These findings support the use of the modified CCI in the Colombian population.