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Hsu AT, Manuel DG, Spruin S, Bennett C, Taljaard M, Beach S, Sequeira Y, Talarico R, Chalifoux M, Kobewka D, Costa AP, Bronskill SE, Tanuseputro P. Predicting death in home care users: derivation and validation of the Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT). CMAJ 2021; 193:E997-E1005. [PMID: 34226263 PMCID: PMC8248571 DOI: 10.1503/cmaj.200022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND: Prognostication tools that report personalized mortality risk and survival could improve discussions about end-of-life and advance care planning. We sought to develop and validate a mortality risk model for older adults with diverse care needs in home care using self-reportable information — the Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT). METHODS: Using a derivation cohort that comprised adults living in Ontario, Canada, aged 50 years and older with at least 1 Resident Assessment Instrument for Home Care (RAI-HC) record between Jan. 1, 2007, and Dec. 31, 2012, we developed a mortality risk model. The primary outcome was mortality 6 months after a RAI-HC assessment. We used proportional hazards regression with robust standard errors to account for clustering by the individual. We validated this algorithm for a second cohort of users of home care who were assessed between Jan. 1 and Dec. 31, 2013. We used Kaplan–Meier survival curves to estimate the observed risk of death at 6 months for assessment of calibration and median survival. We constructed 61 risk groups based on incremental increases in the estimated median survival of about 3 weeks among adults at high risk and 3 months among adults at lower risk. RESULTS: The derivation and validation cohorts included 435 009 and 139 388 adults, respectively. We identified a total of 122 823 deaths within 6 months of a RAI-HC assessment in the derivation cohort. The mean predicted 6-month mortality risk was 10.8% (95% confidence interval [CI] 10.7%–10.8%) and ranged from 1.54% (95% CI 1.53%–1.54%) in the lowest to 98.1% (95% CI 98.1%–98.2%) in the highest risk group. Estimated median survival spanned from 28 days (11 to 84 d at the 25th and 75th percentiles) in the highest risk group to over 8 years (1925 to 3420 d) in the lowest risk group. The algorithm had a c-statistic of 0.753 (95% CI 0.750–0.756) in our validation cohort. INTERPRETATION: The RESPECT mortality risk prediction tool that makes use of readily available information can improve the identification of palliative and end-of-life care needs in a diverse older adult population receiving home care.
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Affiliation(s)
- Amy T Hsu
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont.
| | - Douglas G Manuel
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
| | - Sarah Spruin
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
| | - Carol Bennett
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
| | - Monica Taljaard
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
| | - Sarah Beach
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
| | - Yulric Sequeira
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
| | - Robert Talarico
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
| | - Mathieu Chalifoux
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
| | - Daniel Kobewka
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
| | - Andrew P Costa
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
| | - Susan E Bronskill
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
| | - Peter Tanuseputro
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
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Fisher S, Manuel DG, Hsu AT, Bennett C, Tuna M, Bader Eddeen A, Sequeira Y, Jessri M, Taljaard M, Anderson GM, Tanuseputro P. Development and validation of a predictive algorithm for risk of dementia in the community setting. J Epidemiol Community Health 2021; 75:843-853. [PMID: 34172513 PMCID: PMC8372383 DOI: 10.1136/jech-2020-214797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/30/2020] [Accepted: 11/04/2020] [Indexed: 12/23/2022]
Abstract
Background Most dementia algorithms are unsuitable for population-level assessment and planning as they are designed for use in the clinical setting. A predictive risk algorithm to estimate 5-year dementia risk in the community setting was developed. Methods The Dementia Population Risk Tool (DemPoRT) was derived using Ontario respondents to the Canadian Community Health Survey (survey years 2001 to 2012). Five-year incidence of physician-diagnosed dementia was ascertained by individual linkage to administrative healthcare databases and using a validated case ascertainment definition with follow-up to March 2017. Sex-specific proportional hazards regression models considering competing risk of death were developed using self-reported risk factors including information on socio-demographic characteristics, general and chronic health conditions, health behaviours and physical function. Results Among 75 460 respondents included in the combined derivation and validation cohorts, there were 8448 cases of incident dementia in 348 677 person-years of follow-up (5-year cumulative incidence, men: 0.044, 95% CI: 0.042 to 0.047; women: 0.057, 95% CI: 0.055 to 0.060). The final full models each include 90 df (65 main effects and 25 interactions) and 28 predictors (8 continuous). The DemPoRT algorithm is discriminating (C-statistic in validation data: men 0.83 (95% CI: 0.81 to 0.85); women 0.83 (95% CI: 0.81 to 0.85)) and well-calibrated in a wide range of subgroups including behavioural risk exposure categories, socio-demographic groups and by diabetes and hypertension status. Conclusions This algorithm will support the development and evaluation of population-level dementia prevention strategies, support decision-making for population health and can be used by individuals or their clinicians for individual risk assessment.
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Affiliation(s)
- Stacey Fisher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada .,Populations & Public Health, ICES, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Douglas G Manuel
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Populations & Public Health, ICES, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada.,Centre for Individualized Health, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Amy T Hsu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Populations & Public Health, ICES, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Centre for Individualized Health, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Carol Bennett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Populations & Public Health, ICES, Ottawa, Ontario, Canada
| | - Meltem Tuna
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Populations & Public Health, ICES, Ottawa, Ontario, Canada
| | - Anan Bader Eddeen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Populations & Public Health, ICES, Ottawa, Ontario, Canada
| | - Yulric Sequeira
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Mahsa Jessri
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Populations & Public Health, ICES, Ottawa, Ontario, Canada.,Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Geoffrey M Anderson
- Cardiovascular Research, ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Populations & Public Health, ICES, Ottawa, Ontario, Canada.,Centre for Individualized Health, Bruyere Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Yusuf W, Vyuha R, Bennett C, Sequeira Y, Maskerine C, Manuel DG. cchsflow: an open science approach to transform and combine population health surveys. Can J Public Health 2021; 112:714-721. [PMID: 33761108 PMCID: PMC7989714 DOI: 10.17269/s41997-020-00470-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
Setting The Canadian Community Health Survey (CCHS) is one of the world’s largest ongoing cross-sectional population health surveys, with over 130,000 respondents every two years or over 1.1 million respondents since its inception in 2001. While the survey remains relatively consistent over the years, there are differences between cycles that pose a challenge to analyze the survey over time. Intervention A program package called cchsflow was developed to transform and harmonize CCHS variables to consistent formats across multiple survey cycles. An open science approach was used to maintain transparency, reproducibility and collaboration. Outcomes The cchsflow R package uses CCHS survey data between 2001 and 2014. Worksheets were created that identify variables, their names in previous cycles, their category structure, and their final variable names. These worksheets were then used to recode variables in each CCHS cycle into consistently named and labelled variables. Following, survey cycles can be combined. The package was then added as a GitHub repository to encourage collaboration with other researchers. Implication The cchsflow package has been added to the Comprehensive R Archive Network (CRAN) and contains support for over 160 CCHS variables, generating a combined data set of over 1 million respondents. By implementing open science practices, cchsflow aims to minimize the amount of time needed to clean and prepare data for the many CCHS users across Canada.
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Affiliation(s)
- Warsame Yusuf
- Ottawa Hospital Research Institute, Civic Campus, ASB 2-012, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
| | - Rostyslav Vyuha
- Ottawa Hospital Research Institute, Civic Campus, ASB 2-012, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - Carol Bennett
- Ottawa Hospital Research Institute, Civic Campus, ASB 2-012, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - Yulric Sequeira
- Ottawa Hospital Research Institute, Civic Campus, ASB 2-012, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - Courtney Maskerine
- Ottawa Hospital Research Institute, Civic Campus, ASB 2-012, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Douglas G Manuel
- Ottawa Hospital Research Institute, Civic Campus, ASB 2-012, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.,ICES, Ottawa and Toronto, Ottawa, Ontario, Canada.,Statistics Canada, Ottawa, Ontario, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Paradis M, Stiell I, Atkinson KM, Guerinet J, Sequeira Y, Salter L, Forster AJ, Murphy MS, Wilson K. Acceptability of a Mobile Clinical Decision Tool Among Emergency Department Clinicians: Development and Evaluation of The Ottawa Rules App. JMIR Mhealth Uhealth 2018; 6:e10263. [PMID: 29891469 PMCID: PMC6018230 DOI: 10.2196/10263] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/06/2018] [Accepted: 04/06/2018] [Indexed: 01/15/2023] Open
Abstract
Background The Ottawa Ankle Rules, Ottawa Knee Rule, and Canadian C-Spine Rule—together known as The Ottawa Rules—are a set of internationally validated clinical decision rules developed to decrease unnecessary diagnostic imaging in the emergency department. In this study, we sought to develop and evaluate the use of a mobile app version of The Ottawa Rules. Objective The primary objective of this study was to determine acceptability of The Ottawa Rules app among emergency department clinicians. The secondary objective was to evaluate the effect of publicity efforts on uptake of The Ottawa Rules app. Methods The Ottawa Rules app was developed and publicly released for free on iOS and Android operating systems in April 2016. Local and national news and academic media coverage coincided with app release. This study was conducted at a large tertiary trauma care center in Ottawa, Canada. The study was advertised through posters and electronically by email. Emergency department clinicians were approached in person to enroll via in-app consent for a 1-month study during which time they were encouraged to use the app when evaluating patients with suspected knee, foot, or neck injuries. A 23-question survey was administered at the end of the study period via email to determine self-reported frequency, perceived ease of use of the app, and participant Technology Readiness Index scores. Results A total of 108 emergency department clinicians completed the study including 42 nurses, 33 residents, 20 attending physicians, and 13 medical students completing emergency department rotations. The median Technology Readiness Index for this group was 3.56, indicating a moderate degree of openness for technological adoption. The majority of survey respondents indicated favorable receptivity to the app including finding it helpful to applying the rules (73/108, 67.6%), that they would recommend the app to colleagues (81/108, 75.0%), and that they would continue using the app (73/108, 67.6%). Feedback from study participants highlighted a desire for access to more clinical decision rules and a higher degree of interactivity of the app. Between April 21, 2016, and June 1, 2017, The Ottawa Rules app was downloaded approximately 4000 times across 89 countries. Conclusions We have found The Ottawa Rules app to be an effective means to disseminate the Ottawa Ankle Rules, Ottawa Knee Rule, and Canadian C-Spine Rule among all levels of emergency department clinicians. We have been successful in monitoring uptake and access of the rules in the app as a result of our publicity efforts. Mobile technology can be leveraged to improve the accessibility of clinical decision tools to health professionals.
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Affiliation(s)
- Michelle Paradis
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ian Stiell
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Katherine M Atkinson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Public Health Sciences, Karolinska Institute, Karolinska, Sweden
| | - Julien Guerinet
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Yulric Sequeira
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Laura Salter
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Alan J Forster
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Malia Sq Murphy
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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