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Ehrenstein V, Hellfritzsch M, Kahlert J, Langan SM, Urushihara H, Marinac-Dabic D, Lund JL, Sørensen HT, Benchimol EI. Validation of algorithms in studies based on routinely collected health data: general principles. Am J Epidemiol 2024; 193:1612-1624. [PMID: 38754870 DOI: 10.1093/aje/kwae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/21/2024] [Accepted: 05/14/2024] [Indexed: 05/18/2024] Open
Abstract
Clinicians, researchers, regulators, and other decision-makers increasingly rely on evidence from real-world data (RWD), including data routinely accumulating in health and administrative databases. RWD studies often rely on algorithms to operationalize variable definitions. An algorithm is a combination of codes or concepts used to identify persons with a specific health condition or characteristic. Establishing the validity of algorithms is a prerequisite for generating valid study findings that can ultimately inform evidence-based health care. In this paper, we aim to systematize terminology, methods, and practical considerations relevant to the conduct of validation studies of RWD-based algorithms. We discuss measures of algorithm accuracy, gold/reference standards, study size, prioritization of accuracy measures, algorithm portability, and implications for interpretation. Information bias is common in epidemiologic studies, underscoring the importance of transparency in decisions regarding choice and prioritizing measures of algorithm validity. The validity of an algorithm should be judged in the context of a data source, and one size does not fit all. Prioritizing validity measures within a given data source depends on the role of a given variable in the analysis (eligibility criterion, exposure, outcome, or covariate). Validation work should be part of routine maintenance of RWD sources. This article is part of a Special Collection on Pharmacoepidemiology.
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Affiliation(s)
- Vera Ehrenstein
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Maja Hellfritzsch
- Research Unit of Clinical Pharmacology, Pharmacy, and Environmental Medicine, University of Southern Denmark, 5230 Odense M, Denmark
- Department of Cardiology, Gødstrup Hospital, 7400 Herning, Denmark
| | - Johnny Kahlert
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Sinéad M Langan
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Hisashi Urushihara
- Division of Drug Development and Regulatory Science, Faculty of Pharmacy, Keio University, Tokyo 105-8512, Japan
| | - Danica Marinac-Dabic
- Office of Clinical Evidence and Analysis, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD 20993, United States
| | - Jennifer L Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Eric I Benchimol
- Division of Gastroenterology, Hepatology and Nutrition and Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada
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Liu PPS, Chang HR, Hsu JY, Huang HK, Loh CH, Yeh JI. Association between holiday and weekend admissions and mortality outcomes among patients with acute myocardial infarction receiving percutaneous coronary intervention in Taiwan. Sci Rep 2024; 14:8892. [PMID: 38632335 PMCID: PMC11023946 DOI: 10.1038/s41598-024-59571-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 04/12/2024] [Indexed: 04/19/2024] Open
Abstract
There is a lack of studies that concurrently differentiate the effect of the holiday season from the weekend effect on mortality risk in patients with acute myocardial infarction (AMI). We evaluated the mortality risk among patients admitted with AMI who underwent percutaneous coronary intervention, using data from the Taiwan National Health Insurance Research Database. Adult AMI patients admitted during January and February between 2013 and 2020 were enrolled and classified into the holiday season (using the Chinese New Year holiday seasons as an indicator) (n = 1729), weekend (n = 4725), and weekday (n = 14,583) groups according to the first day of admission. A multivariable logistic regression model was used to assess the risk. With the weekday group or the weekend group as the reference, the holiday season group did not have increased risks of in-hospital mortality (adjusted odds ratio [aOR] 1.15; 95% confidence intervals [CI] 0.93-1.42 or aOR 1.23; 95% CI 0.96-1.56) and 7-day mortality (aOR 1.20; 95% CI 0.90-1.58 or aOR 1.24; 95% CI 0.90-1.70). Stratified and subgroup analyses showed similar trends. We conclude that holiday season-initiated admissions were not associated with higher mortality risks in AMI admission cases than weekday or weekend admissions.
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Affiliation(s)
- Peter Pin-Sung Liu
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
- Center for Healthy Longevity, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Huai-Ren Chang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Cardiology, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Jin-Yi Hsu
- Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Huei-Kai Huang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung Yang Rd., Hualien, 97002, Taiwan
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ching-Hui Loh
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
- Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Jih-I Yeh
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
- School of Medicine, Tzu Chi University, Hualien, Taiwan.
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung Yang Rd., Hualien, 97002, Taiwan.
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Ferreira AR, Gonçalves-Pinho M, Simões MR, Freitas A, Fernandes L. Dementia-related agitation: a 6-year nationwide characterization and analysis of hospitalization outcomes. Aging Ment Health 2023; 27:380-388. [PMID: 35466829 DOI: 10.1080/13607863.2022.2065663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To characterize all hospitalizations held in mainland Portugal (2010-2015) with dementia-related agitation based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding, and to investigate whether there is a relationship between agitation and hospitalization outcomes. METHODS A retrospective observational study was conducted using an administrative dataset containing data from all mainland Portuguese public hospitals. Only hospitalization episodes for patients aged over 65 years who have received a dementia diagnosis ascertained by an ICD-9-CM code of dementia with behavioral disturbance (294.11 and 294.21) and dementia without behavioral disturbance (294.10 and 294.20) were selected. Episodes were further grouped according to the presence of an agitation code. For each episode, demographic data and hospitalization outcomes, including length of stay (LoS), in-hospital mortality, discharge destination and all-cause hospital readmissions, were sourced from the dataset. Comparative analyses were performed and multivariable logistic methods were used to estimate the adjusted associations between agitation (exposure) and outcomes. RESULTS Overall, 53,156 episodes were selected, of which 6,586 had an agitation code. These were mostly related to male, younger inpatients (mean 81.19 vs. 83.29 years, p < 0.001), had a higher comorbidity burden, stayed longer at the hospital (median 9.00 vs. 8.00 days, p < 0.001) and frequently ended being transferred to another facility with inpatient care. Agitation was shown to independently increase LoS (aOR = 1.385; 95%CI:1.314-1.461), but not the risk of a fatal outcome (aOR = 0.648; 95%CI:0.600-0.700). CONCLUSION These results support the importance of detecting and managing agitation early on admission, since its prompt management may prevent lengthy disruptive hospitalizations.
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Affiliation(s)
- Ana Rita Ferreira
- Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Manuel Gonçalves-Pinho
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Mário R Simões
- University of Coimbra, CINEICC, PsyAssessmentLab, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
| | - Alberto Freitas
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Lia Fernandes
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal.,Psychiatry Service, Centro Hospitalar Universitário de São João, Porto, Portugal
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Krefting J, Sen P, David-Rus D, Güldener U, Hawe JS, Cassese S, von Scheidt M, Schunkert H. Use of big data from health insurance for assessment of cardiovascular outcomes. Front Artif Intell 2023; 6:1155404. [PMID: 37207237 PMCID: PMC10188985 DOI: 10.3389/frai.2023.1155404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/13/2023] [Indexed: 05/21/2023] Open
Abstract
Outcome research that supports guideline recommendations for primary and secondary preventions largely depends on the data obtained from clinical trials or selected hospital populations. The exponentially growing amount of real-world medical data could enable fundamental improvements in cardiovascular disease (CVD) prediction, prevention, and care. In this review we summarize how data from health insurance claims (HIC) may improve our understanding of current health provision and identify challenges of patient care by implementing the perspective of patients (providing data and contributing to society), physicians (identifying at-risk patients, optimizing diagnosis and therapy), health insurers (preventive education and economic aspects), and policy makers (data-driven legislation). HIC data has the potential to inform relevant aspects of the healthcare systems. Although HIC data inherit limitations, large sample sizes and long-term follow-up provides enormous predictive power. Herein, we highlight the benefits and limitations of HIC data and provide examples from the cardiovascular field, i.e. how HIC data is supporting healthcare, focusing on the demographical and epidemiological differences, pharmacotherapy, healthcare utilization, cost-effectiveness and outcomes of different treatments. As an outlook we discuss the potential of using HIC-based big data and modern artificial intelligence (AI) algorithms to guide patient education and care, which could lead to the development of a learning healthcare system and support a medically relevant legislation in the future.
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Affiliation(s)
- Johannes Krefting
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research e.V. (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- *Correspondence: Johannes Krefting
| | - Partho Sen
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Diana David-Rus
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Ulrich Güldener
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Johann S. Hawe
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Salvatore Cassese
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research e.V. (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Moritz von Scheidt
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research e.V. (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research e.V. (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- Heribert Schunkert
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Liu Y, Xiao S, Yin X, Gao P, Wu J, Xiong S, Hockham C, Hone T, Wu JHY, Pearson SA, Neal B, Tian M. Nation-Wide Routinely Collected Health Datasets in China: A Scoping Review. Public Health Rev 2022; 43:1605025. [PMID: 36211230 PMCID: PMC9532513 DOI: 10.3389/phrs.2022.1605025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/12/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives: The potential for using routinely collected data for medical research in China remains unclear. We sought to conduct a scoping review to systematically characterise nation-wide routinely collected datasets in China that may be of value for clinical research. Methods: We searched public databases and the websites of government agencies, and non-government organizations. We included nation-wide routinely collected databases related to communicable diseases, non-communicable diseases, injuries, and maternal and child health. Database characteristics, including disease area, data custodianship, data volume, frequency of update and accessibility were extracted and summarised. Results: There were 70 databases identified, of which 46 related to communicable diseases, 20 to non-communicable diseases, 1 to injury and 3 to maternal and child health. The data volume varied from below 1000 to over 100,000 records. Over half (64%) of the databases were accessible for medical research mostly comprising communicable diseases. Conclusion: There are large quantities of routinely collected data in China. Challenges to using such data in medical research remain with various accessibility. The potential of routinely collected data may also be applicable to other low- and middle-income countries.
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Affiliation(s)
- Yishu Liu
- George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Shaoming Xiao
- The George Institute for Global Health, Health Science Centre, Peking University, Beijing, China
| | - Xuejun Yin
- George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Pei Gao
- School of Public Health, Health Science Center, Peking University, Beijing, China
| | - Jing Wu
- National Center for Chronic and Non-Communicable Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shangzhi Xiong
- George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Carinna Hockham
- The George Institute for Global Health, UK, London, United Kingdom
| | - Thomas Hone
- School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Jason H. Y. Wu
- George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Sallie Anne Pearson
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Bruce Neal
- George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
- School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Maoyi Tian
- George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
- School of Public Health, Harbin Medical University, Harbin, China
- *Correspondence: Maoyi Tian,
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Kor PPK, Kwan RYC, Cheung DSK, Lai C. The utilization of a nurse-led clinic by older people with cognitive complaints: Do they follow our advice? Int J Nurs Pract 2022; 28:e13096. [PMID: 36003029 DOI: 10.1111/ijn.13096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 06/08/2022] [Accepted: 07/23/2022] [Indexed: 12/01/2022]
Abstract
AIM Cognitive assessment services were found to be beneficial to older people with cognitive complaints but information is limited on adherence to the recommendations provided. This study aimed to identify predictors of clients' adherence to nursing recommendations after attending a community-based nurse-led cognitive assessment service in Hong Kong. METHODS A cross-sectional design was adopted. We analysed a dataset routinely collected from clients attending the services between January 2012 and January 2018. Multiple regression analyses were conducted to identify predictors (demographics, functional health status and cognitive performance) of the clients' adherence. Their satisfaction with the services was also examined. RESULTS Two hundred and twenty-three clients attended the clinic. Of the 133 who completed the telephone follow-up at the 6 months postconsultation, 44.1% did not adhere to the recommendations. Clients with a higher Clinical Dementia Rating (OR = 4.17), lower Clock Drawing Test score (OR = 1.13) and lower education level (OR = 0.91) were found to be less likely to adhere to the nursing recommendations. Ninety-six percent (190/198) were satisfied with the overall services. CONCLUSION Cognitive assessment services in nurse-led clinics could provide a self-referred service for older people with cognitive complaints. However, low adherence to nursing recommendations was found among clients with poorer cognitive functions and lower education levels.
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Affiliation(s)
- Patrick Pui-Kin Kor
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | | | | | - Claudia Lai
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, SAR, China
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Wang CH, Ou SF, Tseng YT. Long-term impact of certain coexisting extrahepatic unisystem and multisystem manifestations on trends in incidence of liver cirrhosis in treatment-naïve patients with chronic hepatitis C: A nested case-control study. Medicine (Baltimore) 2022; 101:e29697. [PMID: 35866797 PMCID: PMC9302331 DOI: 10.1097/md.0000000000029697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Diabetes mellitus (DM) was found to be more common in hepatitis C virus (HCV)-related cirrhotic males. However, the association between DM, or other extrahepatic manifestations (EHMs), and liver cirrhosis is still undetermined. We used a large-scale long-term study to analyze the cirrhosis risk of treatment-naïve HCV patients with EHMs as compared to those without. In this retrospective nested case-control study, we identified 11 872 treatment-naïve patients with chronic HCV between 2001 and 2013 from Taiwan National Health Insurance Research Database and divided them into patients with (cases) and without cirrhosis (controls). All patients were followed up from the index month (exact month of diagnosis) to the end of 2013, death, or study outcome, whichever occurred first. The cases and controls were 1:6 propensity score matched for age, sex, and exact month of diagnosis; finally, 8078 patients (1154 with and 6924 without cirrhosis) were included in the analysis. The presence of coexisting EHMs and a new diagnosis of cirrhosis was analyzed. Adjusted hazard ratios (HRs) and cumulative incidence for cirrhosis were calculated in conditional Cox regression models after propensity score matching. Patients with high-cirrhosis-risk EHMs, such as DM (HR: 1.72, 95% CI: 1.51-1.96, P < .001), HCD (HR: 1.45, 95% CI: 1.27-1.67, P < .007), CKD (HR: 1.21, 95% CI: 1.05-1.38, P < .001), hyperlipidemia (HR: 0.53, 95% CI: 0.46-0.60, P < .001), lichen planus (HR: 2.71, 95% CI: 1.56-4.72, P < .001), and palpable purpura (HR: 2.67, 95% CI: 2.13-3.35, P < .001) exhibited significantly higher risk of liver cirrhosis than those without. Cumulative incidence (P < .001) of liver cirrhosis by pairwise comparisons of multiple high-cirrhosis-risk EHMs, and that of lichen planus was the highest. Our study provided direct estimates of specific HCV-associated EHM time trends of cirrhosis risk, with an upward trend in incidence. Lichen planus was at the top of the list of single-EHM comparisons, and the maximum combination of certain EHMs was the greatest risk factor across a different array of multi-EHM comparisons for liver cirrhosis development.
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Affiliation(s)
- Chun-Hsiang Wang
- Department of Hepatogastroenterology, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan
- Department of Optometry, Chung Hwa Medical University, Tainan, Taiwan
| | - Shih-Fang Ou
- Department of Hepatogastroenterology, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan
| | - Yuan-Tsung Tseng
- Committee of Medical Research, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan
- * Correspondence: Yuan-Tsung Tseng, MS, Committee of Medical Research, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Taiwan (e-mail: )
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Zellweger NM, Hylander Møller M, Ellekjær KL, Jonsson AB, Bruun Svan K, Siegemund M, Perner A. Use of crystalloids and colloids in Europe per year from 2010 to 2019: Protocol for an international descriptive study. Acta Anaesthesiol Scand 2021; 65:1514-1517. [PMID: 34310693 DOI: 10.1111/aas.13955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/16/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Intravenous (IV) fluids are widely used in everyday clinical practice. In the last two decades, several trials and clinical practice guidelines have been published on the use of different types and dosages of IV fluid. This may have led to a change in clinical practice. Thus, we aim to describe the use of IV crystalloids and colloids in Europe over a 10-year period. METHODS AND ANALYSIS We will collect national or regional data on the use of IV crystalloids and colloids in European hospitals through companies and/or federal medical agencies that provide pharmaceutical data concerning the type and amount of fluids used from January 1st, 2010 to December 31st, 2019. We will use run charts to describe time trends in the use of fluids. CONCLUSION This study will provide insight into the use of IV fluids in Europe between 2010 and 2019. It will enable the observation of changes over time and among the different European countries and regions. This will provide information on the extent to which landmark trials and clinical practice guidelines on fluids have affected clinical practice in Europe regarding the use of IV fluids.
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Affiliation(s)
- Núria M. Zellweger
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Department of Intensive Care Department of Clinical Research University Hospital Basel Basel Switzerland
| | - Morten Hylander Møller
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Karen Louise Ellekjær
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Andreas Bender Jonsson
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Department of Anaesthesiology Herlev‐Gentofte Hospital Hellerup Denmark
| | - Kathrine Bruun Svan
- Clinical Pharmaceutical Services Rigshospitalet The Capital Regional Pharmacy Herlev Denmark
| | - Martin Siegemund
- Department of Intensive Care Department of Clinical Research University Hospital Basel Basel Switzerland
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
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Doetsch JN, Dias V, Indredavik MS, Reittu J, Devold RK, Teixeira R, Kajantie E, Barros H. Record linkage of population-based cohort data from minors with national register data: a scoping review and comparative legal analysis of four European countries. OPEN RESEARCH EUROPE 2021; 1:58. [PMID: 37645179 PMCID: PMC10445839 DOI: 10.12688/openreseurope.13689.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 08/31/2023]
Abstract
Background: The GDPR was implemented to build an overarching framework for personal data protection across the EU/EEA. Linkage of data directly collected from cohort participants, potentially serving as a prominent tool for health research, must respect data protection rules and privacy rights. Our objective was to investigate law possibilities of linking cohort data of minors with routinely collected education and health data comparing EU/EEA member states. Methods: A legal comparative analysis and scoping review was conducted of openly accessible published laws and regulations in EUR-Lex and national law databases on GDPR's implementation in Portugal, Finland, Norway, and the Netherlands and its connected national regulations purposing record linkage for health research that have been implemented up until April 30, 2021. Results: The GDPR does not ensure total uniformity in data protection legislation across member states offering flexibility for national legislation. Exceptions to process personal data, e.g., public interest and scientific research, must be laid down in EU/EEA or national law. Differences in national interpretation caused obstacles in cross-national research and record linkage: Portugal requires written consent and ethical approval; Finland allows linkage mostly without consent through the national Social and Health Data Permit Authority; Norway when based on regional ethics committee's approval and adequate information technology safeguarding confidentiality; the Netherlands mainly bases linkage on the opt-out system and Data Protection Impact Assessment. Conclusions: Though the GDPR is the most important legal framework, national legislation execution matters most when linking cohort data with routinely collected health and education data. As national interpretation varies, legal intervention balancing individual right to informational self-determination and public good is gravely needed for health research. More harmonization across EU/EEA could be helpful but should not be detrimental in those member states which already opened a leeway for registries and research for the public good without explicit consent.
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Affiliation(s)
- Julia Nadine Doetsch
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, 4050-600, Portugal
- EPIUnit, Instituto de Saúde Pública da, Universidade do Porto (ISPUP), Porto, 4050-600, Portugal
| | - Vasco Dias
- INESC TEC -Institute for Systems and Computer Engineering, Technology and Science, Campus da Faculdade de Engenharia da Universidade do Porto, Porto, 4050-091, Portugal
| | - Marit S. Indredavik
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU – Norwegian University of Science and Technology, Trondheim, NO-7491, Norway
| | - Jarkko Reittu
- Finnish Institute for Health and Welfare, Legal Services, Helsinki, Finland
- University of Helsinki, Faculty of Law, Helsinki, Finland
| | - Randi Kallar Devold
- Faculty of Medicine and Health Sciences, NTNU – Norwegian University of Science and Technology, Trondheim, NO-7491, Norway
| | - Raquel Teixeira
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, 4050-600, Portugal
- EPIUnit, Instituto de Saúde Pública da, Universidade do Porto (ISPUP), Porto, 4050-600, Portugal
| | - Eero Kajantie
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU – Norwegian University of Science and Technology, Trondheim, NO-7491, Norway
- Finnish Institute for Health and Welfare, Population Health Unit, Helsinki and Oulu, Finland
- PEDEGO Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Children’s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Henrique Barros
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, 4050-600, Portugal
- EPIUnit, Instituto de Saúde Pública da, Universidade do Porto (ISPUP), Porto, 4050-600, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal
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Brooks JD, Arneja J, Fu L, Saxena FE, Tu K, Pinzaru VB, Anagnostou E, Nylen K, Saunders NR, Lu H, McLaughlin J, Bronskill SE. Assessing the validity of administrative health data for the identification of children and youth with autism spectrum disorder in Ontario. Autism Res 2021; 14:1037-1045. [PMID: 33694293 PMCID: PMC8252648 DOI: 10.1002/aur.2491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/10/2021] [Indexed: 12/28/2022]
Abstract
Population‐level identification of children and youth with ASD is essential for surveillance and planning for required services. The objective of this study was to develop and validate an algorithm for the identification of children and youth with ASD using administrative health data. In this retrospective validation study, we linked an electronic medical record (EMR)‐based reference standard, consisting 10,000 individuals aged 1–24 years, including 112 confirmed ASD cases to Ontario administrative health data, for the testing of multiple case‐finding algorithms. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and corresponding 95% confidence intervals (CI) were calculated for each algorithm. The optimal algorithm was validated in three external cohorts representing family practice, education, and specialized clinical settings. The optimal algorithm included an ASD diagnostic code for a single hospital discharge or emergency department visit or outpatient surgery, or three ASD physician billing codes in 3 years. This algorithm's sensitivity was 50.0% (95%CI 40.7–88.7%), specificity 99.6% (99.4–99.7), PPV 56.6% (46.8–66.3), and NPV 99.4% (99.3–99.6). The results of this study illustrate limitations and need for cautious interpretation when using administrative health data alone for the identification of children and youth with ASD. Lay Summary We tested algorithms (set of rules) to identify young people with ASD using routinely collected administrative health data. Even the best algorithm misses more than half of those in Ontario with ASD. To understand this better, we tested how well the algorithm worked in different settings (family practice, education, and specialized clinics). The identification of individuals with ASD at a population level is essential for planning for support services and the allocation of resources. Autism Res 2021, 14: 1037–1045. © 2021 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals LLC.
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Affiliation(s)
- Jennifer D Brooks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jasleen Arneja
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Longdi Fu
- ICES, G1 06, Toronto, Ontario, Canada
| | | | - Karen Tu
- North York General Hospital, Toronto Western Hospital Family Health Team-University Health Network, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Evdokia Anagnostou
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Kirk Nylen
- Ontario Brain Institute, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Natasha R Saunders
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, G1 06, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hong Lu
- ICES, G1 06, Toronto, Ontario, Canada
| | - John McLaughlin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Susan E Bronskill
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, G1 06, Toronto, Ontario, Canada
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11
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A retrospective cohort study evaluating correlates of deep tissue infections among patients enrolled in opioid agonist treatment using administrative data in Ontario, Canada. PLoS One 2020; 15:e0232191. [PMID: 32330184 PMCID: PMC7182261 DOI: 10.1371/journal.pone.0232191] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/08/2020] [Indexed: 12/12/2022] Open
Abstract
Objective The objective of this study was to evaluate the relationship between individual characteristics and deep tissue infections in patients enrolled in opioid agonist treatment in Ontario, Canada. Methods A retrospective cohort study was conducted on patients in opioid agonist treatment between January 1, 2011, and December 31, 2015 in Ontario, Canada. Patients were identified using data from the Ontario Health Insurance Plan Database, and the Ontario Drug Benefit Plan Database. We identified other study variables including all-cause mortality using data from the Registered Persons Database. Encrypted patient identifiers were used to link across databases. Logistic regression models were used to measure potential correlates of deep tissue infections. Results An increase in the incidence of deep tissue infections was observed between 2011 and 2016 for patients on opioid agonist treatment. Additionally, age, sex, positive HIV diagnosis, and all-cause mortality was correlated with deep tissue infection in our study population. Conclusion The study indicates factors that are associated with deep tissue infections in the opioid use disorder population and can be used to identify opportunities to reduce the incidence of new infections.
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12
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Guldberg-Møller J, Cordtz RL, Kristensen LE, Dreyer L. Incidence and time trends of joint surgery in patients with psoriatic arthritis: a register-based time series and cohort study from Denmark. Ann Rheum Dis 2019; 78:1517-1523. [PMID: 31300461 DOI: 10.1136/annrheumdis-2019-215313] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/26/2019] [Accepted: 06/29/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate time-trends and cumulative incidence of joint surgery among patients with psoriatic arthritis (PsA) compared with the general population. METHODS In this nationwide register-based cohort study, The Danish National Patient Registry was used to identify incident PsA patients. The 5-year incidence rates (IR) and incidence rate ratios (IRR) of joint surgery were calculated in four calendar-period defined cohorts. Each patient was matched with ten non-PsA individuals from the general population cohort (GPC). The cumulative incidences of any joint and joint-sacrificing surgery, respectively, were estimated using the Aalen-Johansen method. RESULTS From 1996 to 2017, 11 960 PsA patients (mean age 50 years; 57% female) were registered. The IRR of any joint surgery was twice as high for PsA patients compared with GPCs across all calendar periods. Among patients with PsA, 2, 10 and 29% required joint surgery at 5, 10 and 15 years after diagnosis. The risk of surgery in PsA patients diagnosed at 18-40 years was higher (22%) than in GPC 60+ year old (20%) after 15 years of follow-up. CONCLUSIONS The use of joint surgery among PsA patients remained around twofold higher from 1996 to 2012 compared with GPC. After 15 years of follow-up, nearly 30% of the PsA patients had received any surgery, and even a person diagnosed with PsA at the age of 18-40 years had a higher risk of surgery than GPCs of 60+ year old. Thus, the high surgical rates represent an unmet need in the current treatment of PsA.
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Affiliation(s)
- Jørgen Guldberg-Møller
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, The Parker Institute, Frederiksberg, Denmark .,Department of Rheumatology, Slagelse Sygehus, Slagelse, Denmark
| | - Rene Lindholm Cordtz
- Center for Rheumatology and Spine Diseases - Gentofte, Rigshospitalet, Hellerup, Denmark
| | | | - Lene Dreyer
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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13
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Wegner J. Data, data, data…. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2018; 50:215-216. [PMID: 30581227 PMCID: PMC6296448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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14
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Kreuger AL, Middelburg RA, Beckers EAM, de Vooght KMK, Zwaginga JJ, Kerkhoffs JLH, van der Bom JG. The identification of cases of major hemorrhage during hospitalization in patients with acute leukemia using routinely recorded healthcare data. PLoS One 2018; 13:e0200655. [PMID: 30110326 PMCID: PMC6093651 DOI: 10.1371/journal.pone.0200655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/30/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Electronic health care data offers the opportunity to study rare events, although detecting these events in large datasets remains difficult. We aimed to develop a model to identify leukemia patients with major hemorrhages within routinely recorded health records. METHODS The model was developed using routinely recorded health records of a cohort of leukemia patients admitted to an academic hospital in the Netherlands between June 2011 and December 2015. Major hemorrhage was assessed by chart review. The model comprised CT-brain, hemoglobin drop, and transfusion need within 24 hours for which the best discriminating cut off values were taken. External validation was performed within a cohort of two other academic hospitals. RESULTS The derivation cohort consisted of 255 patients, 10,638 hospitalization days, of which chart review was performed for 353 days. The incidence of major hemorrhage was 0.22 per 100 days in hospital. The model consisted of CT-brain (yes/no), hemoglobin drop of ≥0.8 g/dl and transfusion of ≥6 units. The C-statistic was 0.988 (CI 0.981-0.995). In the external validation cohort of 436 patients (19,188 days), the incidence of major hemorrhage was 0.46 per 100 hospitalization days and the C-statistic was 0.975 (CI 0.970-0.980). Presence of at least one indicator had a sensitivity of 100% (CI 95.8-100) and a specificity of 90.7% (CI 90.2-91.1). The number of days to screen to find one case decreased from 217.4 to 23.6. INTERPRETATION A model based on information on CT-brain, hemoglobin drop and need of transfusions can accurately identify cases of major hemorrhage within routinely recorded health records.
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Affiliation(s)
- Aukje L. Kreuger
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rutger A. Middelburg
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik A. M. Beckers
- Department of Hematology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Karen M. K. de Vooght
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jaap Jan Zwaginga
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
- Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
| | - Jean-Louis H. Kerkhoffs
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
- Department of Hematology, Haga Hospital, Den Haag, the Netherlands
| | - Johanna G. van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- * E-mail:
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Tuttle C, Reeves M, Zhong Hu TC, Keates AK, Brady S, Maguire G, Stewart S. Pattern and Outcome of Heart Failure-Related Hospitalization Over 5 Years in a Remote Australian Population: A Retrospective Administrative Data Cohort of 617 Indigenous and non-Indigenous Cases. J Card Fail 2017; 23:729-738. [PMID: 28627404 DOI: 10.1016/j.cardfail.2017.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 05/25/2017] [Accepted: 06/08/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of this work was to understand the pattern and outcomes for heart failure (HF)-related hospitalization among Indigenous and non-Indigenous patients living in Central Australia. METHODS AND RESULTS A retrospective analysis of administrative data for patients presenting with a primary or secondary diagnosis of HF to Central Australia's Alice Springs Hospital during 2008-2012 was performed. The population rate of admission and subsequent outcomes (including mortality and readmission) during the 5-year study period were examined. A total of 617 patients, aged 55.8 ± 17.5 years and 302 (49%) female constituted the study cohort. The 446 Indigenous patients (72%) were significantly younger (50.8 ± 15.9 vs 68.7 ± 14.9; P < .001) and clinically more complex compared with the non-Indigenous patients. Annual prevalence of any HF hospitalization was markedly higher in the Indigenous population (1.9%, 95% CI 1.7-2.1) compared with the non-Indigenous population (0.5%, 95% CI 0.4-0.6); the greatest difference being for women. Overall, non-Indigenous patients had poorer outcomes and were significantly more likely to die (P < .0001), but this was largely driven by age differences. Alternatively, Indigenous patients were significantly more likely to have a higher number of hospitalizations, although indigeneity was not a predictor for 30- or 365-day rehospitalization from the index admission. CONCLUSION The pattern of HF among Indigenous Australians in Central Australia is characterized by a younger population with more clinically complex cases and greater health care utilization.
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Affiliation(s)
- Camilla Tuttle
- Baker IDI Heart and Diabetes Institute, Alice Springs, Northern Territory, Australia; Mary MacKillop Institute for Health Research, Melbourne, Victoria, Australia
| | - Matthew Reeves
- Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Ta-Chi Zhong Hu
- Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Ashley K Keates
- Mary MacKillop Institute for Health Research, Melbourne, Victoria, Australia
| | - Stephen Brady
- Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Graeme Maguire
- Baker IDI Heart and Diabetes Institute, Alice Springs, Northern Territory, Australia; Cairns Clinical School, School of Medicine, James Cook University, Cairns, Queensland, Australia
| | - Simon Stewart
- Baker IDI Heart and Diabetes Institute, Alice Springs, Northern Territory, Australia; Mary MacKillop Institute for Health Research, Melbourne, Victoria, Australia.
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Corraini P, Olsen M, Pedersen L, Dekkers OM, Vandenbroucke JP. Effect modification, interaction and mediation: an overview of theoretical insights for clinical investigators. Clin Epidemiol 2017; 9:331-338. [PMID: 28652815 PMCID: PMC5476432 DOI: 10.2147/clep.s129728] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We revisited the three interrelated epidemiological concepts of effect modification, interaction and mediation for clinical investigators and examined their applicability when using research databases. The standard methods that are available to assess interaction, effect modification and mediation are explained and exemplified. For each concept, we first give a simple “best-case” example from a randomized controlled trial, followed by a structurally similar example from an observational study using research databases. Our explanation of the examples is based on recent theoretical developments and insights in the context of large health care databases. Terminology is sometimes ambiguous for what constitutes effect modification and interaction. The strong assumptions underlying the assessment of interaction, and particularly mediation, require clinicians and epidemiologists to take extra care when conducting observational studies in the context of health care databases. These strong assumptions may limit the applicability of interaction and mediation assessments, at least until the biases and limitations of these assessments when using large research databases are clarified.
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Affiliation(s)
- Priscila Corraini
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Olsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.,Leiden University Medical Center, Leiden, the Netherlands
| | - Jan P Vandenbroucke
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.,Leiden University Medical Center, Leiden, the Netherlands.,Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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