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Rosella LC, Hurst M, O'Neill M, Pagalan L, Diemert L, Kornas K, Hong A, Fisher S, Manuel DG. A study protocol for a predictive model to assess population-based avoidable hospitalization risk: Avoidable Hospitalization Population Risk Prediction Tool (AvHPoRT). Diagn Progn Res 2024; 8:2. [PMID: 38317268 PMCID: PMC10845544 DOI: 10.1186/s41512-024-00165-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 01/15/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Avoidable hospitalizations are considered preventable given effective and timely primary care management and are an important indicator of health system performance. The ability to predict avoidable hospitalizations at the population level represents a significant advantage for health system decision-makers that could facilitate proactive intervention for ambulatory care-sensitive conditions (ACSCs). The aim of this study is to develop and validate the Avoidable Hospitalization Population Risk Tool (AvHPoRT) that will predict the 5-year risk of first avoidable hospitalization for seven ACSCs using self-reported, routinely collected population health survey data. METHODS AND ANALYSIS The derivation cohort will consist of respondents to the first 3 cycles (2000/01, 2003/04, 2005/06) of the Canadian Community Health Survey (CCHS) who are 18-74 years of age at survey administration and a hold-out data set will be used for external validation. Outcome information on avoidable hospitalizations for 5 years following the CCHS interview will be assessed through data linkage to the Discharge Abstract Database (1999/2000-2017/2018) for an estimated sample size of 394,600. Candidate predictor variables will include demographic characteristics, socioeconomic status, self-perceived health measures, health behaviors, chronic conditions, and area-based measures. Sex-specific algorithms will be developed using Weibull accelerated failure time survival models. The model will be validated both using split set cross-validation and external temporal validation split using cycles 2000-2006 compared to 2007-2012. We will assess measures of overall predictive performance (Nagelkerke R2), calibration (calibration plots), and discrimination (Harrell's concordance statistic). Development of the model will be informed by the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) statement. ETHICS AND DISSEMINATION This study was approved by the University of Toronto Research Ethics Board. The predictive algorithm and findings from this work will be disseminated at scientific meetings and in peer-reviewed publications.
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Affiliation(s)
- Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building 6th Floor, Toronto, ON, M5T 3M7, Canada.
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.
- Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- ICES, Toronto, ON, M4N 3M5, Canada.
| | - Mackenzie Hurst
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building 6th Floor, Toronto, ON, M5T 3M7, Canada
- ICES, Toronto, ON, M4N 3M5, Canada
| | - Meghan O'Neill
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building 6th Floor, Toronto, ON, M5T 3M7, Canada
| | - Lief Pagalan
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building 6th Floor, Toronto, ON, M5T 3M7, Canada
| | - Lori Diemert
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building 6th Floor, Toronto, ON, M5T 3M7, Canada
| | - Kathy Kornas
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building 6th Floor, Toronto, ON, M5T 3M7, Canada
| | - Andy Hong
- PEAK Urban Research Programme, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Department of City & Metropolitan Planning, University of Utah, Salt Lake City, UT, USA
- The George Institute for Global Health, Newtown, NSW, Australia
| | - Stacey Fisher
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building 6th Floor, Toronto, ON, M5T 3M7, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Douglas G Manuel
- Ottawa Hospital Research Institute, Ottawa, Canada
- Statistics Canada, Ottawa, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
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Anderson LN, Alvarez E, Incze T, Tarride JE, Kwan M, Mbuagbaw L. Motivational interviewing to promote healthy behaviors for obesity prevention in young adults (MOTIVATE): a pilot randomized controlled trial protocol. Pilot Feasibility Stud 2023; 9:156. [PMID: 37679845 PMCID: PMC10483727 DOI: 10.1186/s40814-023-01385-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Obesity is a chronic disease and is an established risk factor for other chronic diseases and mortality. Young adulthood is a period when people may be highly amenable to healthy behavior change, develop lifelong healthy behaviors, and when primary prevention of obesity may be feasible. Interventions in early adulthood have the potential for primary or primordial prevention (i.e., preventing risk factors before disease onset). The primary objective of this study is to determine the feasibility of a 6-month behavioral and educational intervention to promote healthy behaviors for obesity prevention among young adults. METHODS This is the study protocol for a pilot randomized controlled trial. Young adults (age 18-29) attending McMaster University, Hamilton, Canada, will be recruited and randomized to either the intervention or control. The intervention will include individual motivational interviewing sessions (online or in-person) with a trained interviewer plus educational materials (based on Canada's food guide and physical activity recommendations). The control group will receive educational materials only. The primary feasibility outcomes that will be evaluated as part of this pilot study include enrollment, retention (≥ 80%), data completion (≥ 80% of weights measured, and surveys completed), and participant satisfaction. Secondary clinical outcomes will include body mass index (BMI) change from baseline to 6 months, physical activity, nutrition risk, health-related quality of life mental health, and economic outcomes. Outcomes will be measured remotely using activity trackers, and online questionnaires at baseline and every 2 months. Risk stratification will be applied at baseline to identify participants at high risk of obesity (e.g., due to family or personal history). Exit questionnaires will collect data on how participants felt about the study and cost analysis will be conducted. DISCUSSION Our pilot randomized controlled trial will evaluate the feasibility of an obesity prevention intervention in early adulthood and will inform future larger studies for obesity prevention. The results of this study have the potential to directly contribute to the primary prevention of several types of cancer by testing an intervention that could be scalable to public health, post-secondary education, or primary care settings. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT05264740 . Registered on March 3, 2022.
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Affiliation(s)
- Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada.
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, ON, Canada.
- Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada.
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada
- Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada
| | - Taylor Incze
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada
- Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare, Hamilton, Canada
| | - Matthew Kwan
- Department of Child and Youth Studies, Brock University, St. Catharines, ON, Canada
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Department of Anaesthesia, McMaster University, Hamilton, ON, Canada
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Geda NR, Feng CX, Yu Y. Examining the association between work stress, life stress and obesity among working adult population in Canada: findings from a nationally representative data. Arch Public Health 2022; 80:97. [PMID: 35351179 PMCID: PMC8966340 DOI: 10.1186/s13690-022-00865-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 03/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background Obesity is a priority public health concern in Canada and other parts of the world. The study primarily aims at assessing the role of self-perceived work and life stress on obesity among working adults in Canada. Methods The study was conducted based on a total of 104,636 Canadian adults aged 18 and above, extracted from the 2017–2018 Canadian Community Health Survey (CCHS) data. We used a mixed-effect logistic regression model to determine the possible association between two stress variables and obesity, controlling for other variables in the model. The random effect term accounts for the correlation among the observations from the same health region. Results A total of 63,815 adult respondents (aged 18 and above) who were working during the 12 months prior to the survey were studied. Of those, 18.7% were obese based on their self-reported BMI > =30.0 kg/m2. More than two-thirds of the respondents reported that their stress level is a bit stressful to extremely stressful. The results of multivariable mixed-effect logistic regression showed that the odds of obesity were 1.432 times (95% CI: 1.248–1.644) among those who reported extremely work-related stress, compared to those who had no work-related stress. Perceived life stress was not significantly associated with obesity risk among working adult population, after adjusting other factors. Conclusion The study concluded that obesity among Canadian adults is 18.7% of the working adult population being obese. Given the reported high prevalence of stress and its effect on obesity, the findings suggested improving social support systems, individual/group counseling, and health education focusing on work environments to prevent and manage stressors and drivers to make significant program impacts. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00865-8.
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Affiliation(s)
- Nigatu Regassa Geda
- Center for Population Studies, College of Development Studies, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Cindy Xin Feng
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Yamei Yu
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Rosella LC, O'Neill M, Fisher S, Hurst M, Diemert L, Kornas K, Hong A, Manuel DG. A study protocol for a predictive algorithm to assess population-based premature mortality risk: Premature Mortality Population Risk Tool (PreMPoRT). Diagn Progn Res 2020; 4:18. [PMID: 33292834 PMCID: PMC7640636 DOI: 10.1186/s41512-020-00086-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 09/24/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Premature mortality is an important population health indicator used to assess health system functioning and to identify areas in need of health system intervention. Predicting the future incidence of premature mortality in the population can facilitate initiatives that promote equitable health policies and effective delivery of public health services. This study protocol proposes the development and validation of the Premature Mortality Risk Prediction Tool (PreMPoRT) that will predict the incidence of premature mortality using large population-based community health surveys and multivariable modeling approaches. METHODS PreMPoRT will be developed and validated using various training, validation, and test data sets generated from the six cycles of the Canadian Community Health Survey (CCHS) linked to the Canadian Vital Statistics Database from 2000 to 2017. Population-level risk factor information on demographic characteristics, health behaviors, area level measures, and other health-related factors will be used to develop PreMPoRT and to predict the incidence of premature mortality, defined as death prior to age 75, over a 5-year period. Sex-specific Weibull accelerated failure time models will be developed using a Canadian provincial derivation cohort consisting of approximately 500,000 individuals, with approximately equal proportion of males and females, and about 12,000 events of premature mortality. External validation will be performed using separate linked files (CCHS cycles 2007-2008, 2009-2010, and 2011-2012) from the development cohort (CCHS cycles 2000-2001, 2003-2004, and 2005-2006) to check the robustness of the prediction model. Measures of overall predictive performance (e.g., Nagelkerke's R2), calibration (e.g., calibration plots), and discrimination (e.g., Harrell's concordance statistic) will be assessed, including calibration within defined subgroups of importance to knowledge users and policymakers. DISCUSSION Using routinely collected risk factor information, we anticipate that PreMPoRT will produce population-based estimates of premature mortality and will be used to inform population strategies for prevention.
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Affiliation(s)
- Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, 155 College St, 6th floor, Toronto, Ontario, M5T 3M7, Canada.
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, Ontario, M5G 1V2, Canada.
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada.
| | - Meghan O'Neill
- Dalla Lana School of Public Health, University of Toronto, 155 College St, 6th floor, Toronto, Ontario, M5T 3M7, Canada
| | - Stacey Fisher
- Dalla Lana School of Public Health, University of Toronto, 155 College St, 6th floor, Toronto, Ontario, M5T 3M7, Canada
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, Ontario, M5G 1V2, Canada
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada
| | - Mackenzie Hurst
- Dalla Lana School of Public Health, University of Toronto, 155 College St, 6th floor, Toronto, Ontario, M5T 3M7, Canada
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada
| | - Lori Diemert
- Dalla Lana School of Public Health, University of Toronto, 155 College St, 6th floor, Toronto, Ontario, M5T 3M7, Canada
| | - Kathy Kornas
- Dalla Lana School of Public Health, University of Toronto, 155 College St, 6th floor, Toronto, Ontario, M5T 3M7, Canada
| | - Andy Hong
- University of Oxford, The George Institute for Global Health, Nuffield Department of Women's & Reproductive Health, Hayes House, 75 George Street, Oxford, OX1 2BQ, UK
| | - Douglas G Manuel
- Ottawa Hospital Research Institute, Ottawa, Canada
- Statistics Canada, Ottawa, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
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Ng R, Sutradhar R, Kornas K, Wodchis WP, Sarkar J, Fransoo R, Rosella LC. Development and Validation of the Chronic Disease Population Risk Tool (CDPoRT) to Predict Incidence of Adult Chronic Disease. JAMA Netw Open 2020; 3:e204669. [PMID: 32496565 PMCID: PMC7273197 DOI: 10.1001/jamanetworkopen.2020.4669] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Predicting chronic disease incidence for the population provides a comprehensive picture to health policy makers of their jurisdictions' overall future chronic disease burden. However, no population-based risk algorithm exists for estimating the risk of first major chronic disease. OBJECTIVE To develop and validate the Chronic Disease Population Risk Tool (CDPoRT), a population risk algorithm that predicts the 10-year incidence of the first major chronic disease in the adult population. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, CDPoRT was developed and validated with 6 cycles of the Canadian Community Health Survey, linked to administrative data from January 2000 to December 2014. Development and internal validation (bootstrap and split sample) of CDPoRT occurred in Ontario, Canada, from June 2018 to April 2019 followed by external validation in Manitoba from May 2019 to July 2019. The study cohorts included 133 991 adults (≥20 years) representative of the Ontario and Manitoba populations who did not have a history of major chronic disease. EXPOSURES Predictors were routinely collected risk factors from the Canadian Community Health Survey, such as sociodemographic factors (eg, age), modifiable lifestyle risk factors (ie, alcohol consumption, cigarette smoking, unhealthy diet, and physical inactivity), and other health-related factors (eg, body mass index). MAIN OUTCOMES AND MEASURES Six major chronic diseases were considered, as follows: congestive heart failure, chronic obstructive pulmonary disease, diabetes, myocardial infarction, lung cancer, and stroke. Sex-specific CDPoRT algorithms were developed with a Weibull model. Model performance was evaluated with measures of overall predictive performance (eg, Brier score), discrimination (eg, Harrell C index), and calibration (eg, calibration curves). RESULTS The Ontario cohort (n = 118 747) was younger (mean [SD] age, 45.6 [16.1] vs 46.3 [16.4] years), had more immigrants (23 808 [20.0%] vs 1417 [10.7%]), and had a lower mean (SD) body mass index (26.9 [5.1] vs 27.7 [5.4]) than the Manitoba cohort (n = 13 244). During development, the full and parsimonious CDPoRT models had similar Brier scores (women, 0.087; men, 0.091), Harrell C index values (women, 0.779; men, 0.783), and calibration curves. A simple version consisting of cigarette smoking, age, and body mass index performed slightly worse than the other versions (eg, Brier score for women, 0.088; for men, 0.092). Internal validation showed consistent performance across models, and CDPoRT performed well during external validation. For example, the female parsimonious version had C index values for bootstrap, split sample, and external validation of 0.778, 0.776, and 0.752, respectively. CONCLUSIONS AND RELEVANCE In this study, CDPoRT provided accurate, population-based risk estimates for the first major chronic disease.
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Affiliation(s)
- Ryan Ng
- Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, Toronto, Ontario, Canada
| | | | - Kathy Kornas
- Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, Toronto, Ontario, Canada
| | - Walter P. Wodchis
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Trillium Health Partners’ Institute for Better Health, Mississauga, Ontario, Canada
| | - Joykrishna Sarkar
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Randall Fransoo
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura C. Rosella
- Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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O'Neill M, Kornas K, Rosella L. The future burden of obesity in Canada: a modelling study. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2019; 110:768-778. [PMID: 31429040 PMCID: PMC6900264 DOI: 10.17269/s41997-019-00251-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/16/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We applied the validated Obesity Population Risk Tool (OPoRT) to estimate the future burden of obesity in Canada using baseline risk factors attained through routinely collected survey data. METHODS OPoRT was developed using logistic regression with sex-specific generalized estimating equations to predict the 10-year prevalence of obesity (outcome BMI ≥ 30.0) among adults 18 and older. The algorithm includes 17 predictive factors, including socio-demographic and health behavioural characteristics. OPoRT demonstrated excellent discrimination (C-statistic ≥ 0.89) and achieved calibration. We applied OPoRT to Canadian Community Health Survey (2013/14) data to predict the future prevalence of obesity in Canada for a variety of population subgroups. RESULTS The predicted burden of obesity grew from 261 cases per 1000 in 2013/14 to 326 cases per 1000 in 2023/24 corresponding to a total of 8.54 million individuals with obesity. The burden is expected to be higher among males (347 cases per 1000) than females (305 cases per 1000). Individuals aged 35-49 had the highest predicted burden of obesity (374 cases per 1000) and the largest number of predicted cases (2.42 million), while individuals in the ≥ 65 age group had the lowest predicted burden (236 cases per 1000). The number of individuals with obesity per 1000 is highest among those severely food insecure (452 cases per 1000), compared with food secure individuals (324 cases per 1000). CONCLUSIONS OPoRT can be used to estimate the future population burden of obesity, to identify priority subgroups at an elevated risk. Burden estimates should be reflected in approaches to curb the future burden of obesity.
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Affiliation(s)
- Meghan O'Neill
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building 6th Floor, Suite 600, Toronto, ON, M5T 3M7, Canada
| | - Kathy Kornas
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building 6th Floor, Suite 600, Toronto, ON, M5T 3M7, Canada
| | - Laura Rosella
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building 6th Floor, Suite 600, Toronto, ON, M5T 3M7, Canada.
- Institute for Clinical Evaluative Sciences, Room 424, 155 College Street, Toronto, ON, Canada.
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada.
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Sutradhar R, Rostami M, Barbera L. Patient-Reported Symptoms Improve Performance of Risk Prediction Models for Emergency Department Visits Among Patients With Cancer: A Population-Wide Study in Ontario Using Administrative Data. J Pain Symptom Manage 2019; 58:745-755. [PMID: 31319103 DOI: 10.1016/j.jpainsymman.2019.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/03/2019] [Accepted: 07/08/2019] [Indexed: 01/08/2023]
Abstract
CONTEXT Prior work shows measurements of symptom severity using the Edmonton Symptom Assessment System (ESAS) which are associated with emergency department (ED) visits in patients with cancer; however, it is not known if symptom severity improves the ability to predict ED visits. OBJECTIVES To determine whether information on symptom severity improves the ability to predict ED visits among patients with cancer. METHODS This was a population-based study of patients who were diagnosed with cancer and had at least one ESAS assessment completed between 2007 and 2015 in Ontario, Canada. After splitting the cohort into training and test sets, two ED visit risk prediction models using logistic regression were developed on the training cohort, one without ESAS and one with ESAS. The predictive performance of each risk model was assessed on the test cohort and compared with respect to area under the curve and calibration. RESULTS The full cohort consisted of 212,615 unique patients with a total of 1,267,294 ESAS assessments. The risk prediction model including ESAS was superior in sensitivity, specificity, accuracy, and discrimination. The area under the curve was 73.7% under the model with ESAS, whereas it was 70.1% under the model without ESAS. The model with ESAS was also better calibrated. This improvement in calibration was particularly noticeable among patients in the higher deciles of predicted risk. CONCLUSION This study demonstrates the importance of incorporating symptom measurements when developing an ED visit risk calculator for patients with cancer. Improved predictive models for ED visits using measurements of symptom severity may serve as an important clinical tool to prompt timely interventions by the cancer care team before an ED visit is necessary.
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Affiliation(s)
- Rinku Sutradhar
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario.
| | - Mehdi Rostami
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Barbera
- ICES, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
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Ng R, Sutradhar R, Wodchis WP, Rosella LC. Chronic Disease Population Risk Tool (CDPoRT): a study protocol for a prediction model that assesses population-based chronic disease incidence. Diagn Progn Res 2018; 2:19. [PMID: 31093567 PMCID: PMC6460781 DOI: 10.1186/s41512-018-0042-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/17/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Population-based risk prediction tools exist for individual chronic diseases. From a population health perspective, studying chronic diseases together provides a comprehensive view of the burden of disease in the population. Thus, public health officials and health policymakers would benefit from a prediction tool that measures the incidence of chronic diseases compositely. This study protocol proposes the development and validation of the Chronic Disease Population Risk Tool (CDPoRT) that will predict the incidence of six chronic diseases in the population setting using multivariable modeling techniques. METHODS CDPoRT will be built using population-based responses to the first six cycles of the Canadian Community Health Survey linked to health administrative data in Ontario and Manitoba from 2000 to 2014. Predictors including modifiable lifestyle risk factors (i.e., alcohol consumption, cigarette smoking, diet, and physical activity) will be used to predict time-to-chronic disease incidence (i.e., congestive heart failure, chronic obstructive pulmonary disease, diabetes, lung cancer, myocardial infarction, and stroke including transient ischemic heart attack). Sex-specific Royston-Parmar models will be used for model development and validation with death free of chronic disease as a competing risk. CDPoRT will be developed using an Ontario derivation cohort consisting of 47,960 females and 38,267 males with 7035 and 6220 chronic disease events, respectively. The model will be validated using split-sample validation using an Ontario validation cohort consisting of 20,325 females and 16,627 males with 2972 and 2658 chronic disease events, respectively. The model will be externally validated in the Manitoba validation cohort (i.e., geographic validation) expected to consist of 11,800 females and 9700 males with 1650 and 1550 chronic disease events, respectively. Measures of overall predictive accuracy (e.g., Nagelkerke's R 2), discrimination (e.g., Harrell's concordance statistic), and calibration (e.g., calibration plots) will be used to assess predictive performance. DISCUSSION To the extent of our knowledge, CDPoRT will be the first population-based regression prediction model that will predict the incidence of multiple chronic diseases simultaneously at the population level.
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Affiliation(s)
- Ryan Ng
- Dalla Lana School of Public Health, University of Toronto, 155 College St, 6th floor, Toronto, Ontario M5T 3M7 Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario M4N 3M5 Canada
| | - Walter P. Wodchis
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario M4N 3M5 Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M6 Canada
- Institute for Better Health, Trillium Health Partners, 100 Queensway West – Clinical Administrative Building, 6th floor, Mississauga, Ontario L5B 1B8 Canada
| | - Laura C. Rosella
- Dalla Lana School of Public Health, University of Toronto, 155 College St, 6th floor, Toronto, Ontario M5T 3M7 Canada
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario M4N 3M5 Canada
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