Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, 2021
Background: Migraine is costly to governments. Despite significant burden, Canada lacks populatio... more Background: Migraine is costly to governments. Despite significant burden, Canada lacks population data regarding migraine prevalence, resource and medication utilization. We sought to characterize the demographics, health resource utilization, and medication use in an adult migraine cohort in Alberta. Methods: Migraine cohort: previously validated case definition of migraine (ICD 10 + dispensation of abortive and/or preventative migraine drug (04/2010-03/2016). Patients over 18 years, followed three years from index date [first dispensation of migraine medication]. Health resource utilization (HRU) assessed by emergency department (ED) visits, hospital admission and physician claims. Medication assessed province-wide dispensation database linkage. Patient demographics and Charlson Comorbidity Index (CCI) included. Results: Over 5 years: 53,333 migraine cases identified (mean age 40.5 years, 79% female). Common comorbidities: hypertension, COPD, diabetes mellitus, cancer, cerebrovas...
Acute myocardial infarction with ST-segment elevation (STEMI) remains a major global public healt... more Acute myocardial infarction with ST-segment elevation (STEMI) remains a major global public health issue. Despite advances in therapy, patients remain at risk for death, repeat myocardial infarction (MI) shock and heart failure (HF). Novel markers that predict those at risk are needed. We studied 903 STEMI patients in The Assessment of Pexelizumab in Acute Myocardial Infarction trial (which enrolled STEMI patients presenting < 6 hrs of symptom onset who were to undergo primary PCI) in a case-control design (cases selected based on the trial’s primary composite outcome - death, shock or HF - and matched on age, gender and infarct location to controls). NT-proBNP (pg/ml) was measured at randomization and 24 hrs. Outcomes (individually and the composite) of death, shock, and HF at 90 days were examined by quartiles of NT-proBNP. A CART model was used to categorize adjusted risk. NT-proBNP was higher in patients who had events. Patients with higher NT-proBNP levels at baseline (media...
1 (1.2%) and 3 (3.5%) PMP patients, respectively. After TAVR procedure the degree of mitral regur... more 1 (1.2%) and 3 (3.5%) PMP patients, respectively. After TAVR procedure the degree of mitral regurgitation decreased by at least 1-degree in all patients with moderate-severe insufficiency and half-pressure time decreased by 89.76±6.6 msec (p=0.015), with no changes in mean gradients (p=0.20). Valve embolization occurred in 6 patients (6.7%), all of them with a distance shorter than 7 mm between the PMP and the aortic annulus as assessed by MDCT (p<0.001). Risk of embolization was neither influenced by the use of transapical approach nor balloon/self-expandable devices. Distance between PMP and Aortic annulus Conclusions: MDCT helped to determine that TAVR could be performed in patients with PMP presenting a distance from PMP to aortic annulus larger than 7-mm with extremely low risk of valve embolization. In patients with shorter distance, the use of transapical vs. transfemoral approach or self-vs. balloonexpandable devices did not reduce this risk. After TAVR, mean transmitral gradients were comparable but a significant decrease in half-pressure time and rate of moderate-severe mitral regurgitation were found.
Introduction: Increasing pressures on the health care system, particularly in emergency departmen... more Introduction: Increasing pressures on the health care system, particularly in emergency departments (EDs), make it critical to understand changing ED case-mix, patient demographics and care needs, and resource utilization. Our objective is to assess Alberta (AB) ED volumes, utilization and case mix, stratified by ED type. This knowledge will help identify opportunities for system change and quality improvement. Methods: Data from Alberta Health Services administrative databases, including the National Ambulatory Care Reporting System, ED Admission/Discharge/Transfer data, and Comprehensive Ambulatory Care Classification System codes, were linked for all ED visits from 2010-17. Data were stratified by seven facility categories: tertiary referral (TR), regional referral (RR), community<5,000 inpatient discharges (CL), community>600 inpatient discharges (CM), community <600 inpatient discharges (CS), community ambulatory care (CA), and free-standing EDs (FS). Results: We analy...
Cooperation among supply chain members, both horizontally and vertically, has become the norm in ... more Cooperation among supply chain members, both horizontally and vertically, has become the norm in practice. Unlike traditional supply chains with members competing to reduce their individual costs, the overall cost of the entire supply chain is minimized in a cooperative supply chain. The savings from cooperation may be shared among the members, while a lower average cost and a lower cost variation is materialized for individual members. The problem is formulated as an integrated flow network and expanded to multi-period and multi-product, with the possibility of holding inventories in a multi-stage, multi-member cooperative supply chain. Simulation results indicate an approximately 26% reduction in total costs of the supply chain, utilizing this formulation over competitive setups. In a multiperiod chain, members may hold an inventory or use an inventory policy. As the holding costs increase, the problem decomposes into a single period (just-in-time) again. The disturbing bullwhip effect disappears in cooperative supply chains.
Rationale: Even though idiopathic pulmonary fibrosis (IPF) is a disease with high morbidity and m... more Rationale: Even though idiopathic pulmonary fibrosis (IPF) is a disease with high morbidity and mortality and no cure, palliative care is rarely implemented, leading to high symptom burden and unmet care needs. In 2012, we implemented a multidisciplinary collaborative (MDC) care model linking clinic and community multidisciplinary teams to provide an early integrated palliative approach, focusing on early symptom management and advance care planning. Objectives: To evaluate the differences in resource use and associated costs of end-of-life care between patients with IPF who received early integrated palliative care and patients with IPF who received conventional treatment. Methods: Using administrative health data, we identified all patients in the Province of Alberta, Canada, who presented to a hospital with an IPF diagnosis between January 1, 2012, and December 31, 2018, and died within this time frame. We compared three groups of patients: those who received MDC care (our clinic patients), specialist care (SC; respirologist), or non-specialist care (NSC; no contact with a respiratory clinic). The primary outcomes were healthcare resource use and costs in the year before death. Results: Of 2,768 patients across the three study groups, in the last year of life, MDC patients were more than three times as likely as SC patients to have received antifibrotic therapies (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.8-5.2), almost twice as likely to have received pulmonary rehabilitation (OR, 1.9; 95% CI, 1.1-3.4), and 36% more likely to have received opiates (OR, 1.4; 95% CI, 0.8-2.3). The median total healthcare costs in the last 3 months of life were approximately C$7,700 lower for MDC patients than for those receiving SC, driven primarily by fewer hospitalizations and emergency department visits. MDC patients were also less likely to die in the hospital (44.9% MDC vs. 64.9% SC vs. 66.8% NSC; P , 0.001) and had the highest rates of no hospitalization in the last year of life. Conclusions: An integrated palliative approach in IPF is associated with improvements in the quality of end-of-life care and reduction in costs. Transformation of care models is required to deliver palliative care for patients with IPF. MDC teams within such models can address the high burden of unmet needs for symptom management, advance care planning, and community support in this complex population.
Introduction: Asthma is a chronic condition and exacerbations are a common reason for emergency d... more Introduction: Asthma is a chronic condition and exacerbations are a common reason for emergency department (ED) presentations across Canada. The objective of this study was to characterize and describe acute asthma presentations over a five-year period. Methods: Administrative health data for Alberta from 2011-2015 was obtained from the National Ambulatory Care Reporting System (NACRS) for all adult (>17 years) acute asthma (ICD-10-CA: J45) ED presentations. All presentations to an Alberta ED with a primary or secondary diagnosis of acute asthma were eligible for inclusion. Presentations with a Canadian Triage and Acuity Scale (CTAS) score of 1 were excluded. Data from NACRS were linked with a provincial diagnostic imaging database. Data are reported as means and standard deviation (SD), medians and interquartile range (IQR) or proportions, as appropriate. Results: From 2011-2015, a total of 51,269 (~10,000/year) acute asthma presentations were made by 34,481 patients (~0.3 prese...
Introduction: Most acute asthma presentations to the emergency department (ED) are uncomplicated ... more Introduction: Most acute asthma presentations to the emergency department (ED) are uncomplicated and do not require chest radiographs (CXR). Evidence suggests that the proportion of acute asthma patients receiving CXRs in the ED is high and varies substantially within and across sites and studies. This study explored CXR ordering and variation in acute asthma presentations to Alberta’s EDs. Methods: Administrative health data for Alberta was obtained from the National Ambulatory Care Reporting System (NACRS) for all adult (>17 years) acute asthma (ICD-10-CA: J45) ED visits from 2011-2015. Patients with a primary or secondary diagnosis of asthma were included, provided they had a Canadian Triage and Acuity Scale score of 2-5. NACRS data were linked with Alberta Health Services’ (AHS) diagnostic imaging database. Preliminary analysis on variation in imaging at the zone, ED site, and physician level was completed using SAS (v.9.4). Physicians who saw less than an average of 10 asthm...
Introduction: Headaches are a common emergency department (ED) presentation. Evidence demonstrate... more Introduction: Headaches are a common emergency department (ED) presentation. Evidence demonstrates that computed tomography (CT) imaging varies significantly within and across sites. This study explored CT ordering and variation among headache presentations across Alberta EDs. Methods: Administrative health data for Alberta were obtained from the National Ambulatory Care Reporting System (NACRS) for all adult (>17 years) headache (ICD-10-CA: G44, G43, R51) ED visits from 2011-2015. Patients with a primary or secondary diagnosis code of headache were included. Exclusions were: sites without CT scanners, Canadian Triage and Acuity Scale score of 1, patients with trauma or external mechanism of injury (e.g., ICD-10-CA S,T,V,W,X,Y), or enhanced/contrast CTs. NACRS data were linked with Alberta Health Services’ (AHS) diagnostic imaging data. Preliminary analysis on imaging variation at the zone, ED site, and physician level was completed using SAS (v.9.4). Physicians who saw less than...
Introduction: Headaches are a common emergency department (ED) presentation. The objective of thi... more Introduction: Headaches are a common emergency department (ED) presentation. The objective of this study was to characterize headache presentations in Alberta over a five-year period and explore the proportion of patients with potentially severe pathology. Methods: Administrative health data for Alberta (years 2011-2015) were obtained from the National Ambulatory Care Reporting System (NACRS) for all adult (>17 years) headache presentations (ICD-10-CA: G43, G44, R51). Patients with a primary or secondary diagnosis code of headache were eligible for inclusion in the study. Exclusions were made using the following criteria: 1) sites without computed tomography (CT) scanners; 2) presentations with a Canadian Triage and Acuity Scale (CTAS) score of 1; 3) patients with trauma or external mechanism of injury (e.g., ICD-10-CA codes S,T,V,W,X,Y); and 4) presentations receiving an enhanced/contrast CT (head). NACRS data were linked with a provincial diagnostic imaging data. Data are repor...
BACKGROUND: Currently, International Classification of Disease, version 10 (ICD-10) codes are use... more BACKGROUND: Currently, International Classification of Disease, version 10 (ICD-10) codes are used to identify comorbidities in administrative healthcare databases. Although not readily available in all jurisdictions, case definitions typically use physician billing claims data. We linked administrative data to a regional ST-elevation myocardial infarction (STEMI) registry to determine the accuracy of several alternative case definitions to identify the presence of cardiovascular comorbidities, using the registry as gold standard. METHODS/RESULTS: Vital Heart Response (VHR) is a comprehensive registry of 3049 consecutive STEMI patients (2006 and 2011) within a defined health region (Edmonton, Alberta). Clinical information in VHR was acquired via chart review by a dedicated research organization (EPICORE). Using unique patient identifiers, the registry data were linked to the inpatient discharge abstract database (DAD) and the outpatient (ACCR e 2010; NACRS >2010) databases. The DAD includes most responsible diagnosis and up to 24 other diagnoses (all acute care hospitalizations) while the outpatient databases include up to 10 diagnoses for all visit to ERs or hospital-based clinics. Both DAD and ACCS used the Canadian enhancement of ICD-10 (ICD-10-CA) during the study time period.
Aims: Adenosine triphosphate sensitive potassium (K ATP) channel activity is cardioprotective dur... more Aims: Adenosine triphosphate sensitive potassium (K ATP) channel activity is cardioprotective during ischaemia. One of the purported mechanisms for sulphonylurea adverse effects is through inhibition of these channels. The purpose of this study is to examine whether patients using K ATP channel inhibitors at the time of an acute coronary syndrome are at greater risk of death or heart failure (HF) than those not exposed. Methods: Using linked administrative databases we identified all adults who had an acute coronary syndrome between April 2002 and October 2006 (n = 21 023).
BACKGROUND: Almost 10% of patients seen in the emergency department for atrial fibrillation die w... more BACKGROUND: Almost 10% of patients seen in the emergency department for atrial fibrillation die within a year of the visit. We sought to assess predictors of mortality in a real-world, older population of atrial fibrillation patients who were discharged from the emergency department, and to determine care strategies associated with mortality. METHODS: We performed a retrospective cohort analysis of all patients age Ն 65 with a primary emergency department diagnosis of atrial fibrillation, seen in all non-paediatric emergency departments in the province of Ontario, Canada between April 2007 and March 2010. Patients admitted to hospital were excluded, and only the index (first) emergency department visit was assessed. We evaluated the effect of post-discharge outpatient care and medications, emergency department cardioversion, and site volumes of atrial fibrillation patients on the adjusted hazard of death within 90 days of the index visit. Patients were censored on return to an emergency department. RESULTS: Among 12,772 qualifying index emergency department visits, there were 417 (3.3%; 95% CI 3.0% to 3.6%) deaths within 90 days of the visit. Patients with no follow-up care had an increased hazard of death (HR 2.27, pϽ0.001), relative to those who saw a family doctor, as did patients prescribed a calcium-channel blocker (HR 1.55, pϭ0.004), relative to a beta-blocker. A filled warfarin prescription was associated with a lower hazard of death (HR 0.70, pϭ0.02). Neither site volumes of atrial fibrillation patients (HR 0.66; pϭ0.10) nor cardioversion (HR 0.69; pϭ0.15) were associated with 90-day mortality. CONCLUSION: Among older atrial fibrillation patients seen in and discharged from the emergency department in the province of Ontario, lack of follow-up care had the greatest association with subsequent mortality. If more of these patients are to be discharged from emergency departments in future, the focus must go beyond emergency department care itself, to ensuring ongoing care subsequent to the emergency visit.
ABSTRACTImportanceWith the emergence of more transmissible SARS-CoV-2 variants of concern (VOC), ... more ABSTRACTImportanceWith the emergence of more transmissible SARS-CoV-2 variants of concern (VOC), there is an urgent need for evidence about disease severity and the health care impacts of VOC in North America, particularly since a substantial proportion of the population have declined vaccination thus far.ObjectiveTo examine 30-day outcomes in Canadians infected with SARS-CoV-2 in the first year of the pandemic and to compare event rates in those with VOC versus wild-type infection.DesignRetrospective cohort study using linked healthcare administrative datasets.SettingAlberta and Ontario, the two Canadian provinces that experienced the largest third wave in the spring of 2021.ParticipantsAll individuals with a positive SARS-CoV-2 reverse transcriptase polymerase chain reaction swab from March 1, 2020 until March 31, 2021, with genomic confirmation of VOC screen-positive tests during February and March 2021 (wave 3).Exposure of InterestVOC versus wild type SARS-CoV-2Main Outcomes and...
Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, 2021
Background: Migraine is costly to governments. Despite significant burden, Canada lacks populatio... more Background: Migraine is costly to governments. Despite significant burden, Canada lacks population data regarding migraine prevalence, resource and medication utilization. We sought to characterize the demographics, health resource utilization, and medication use in an adult migraine cohort in Alberta. Methods: Migraine cohort: previously validated case definition of migraine (ICD 10 + dispensation of abortive and/or preventative migraine drug (04/2010-03/2016). Patients over 18 years, followed three years from index date [first dispensation of migraine medication]. Health resource utilization (HRU) assessed by emergency department (ED) visits, hospital admission and physician claims. Medication assessed province-wide dispensation database linkage. Patient demographics and Charlson Comorbidity Index (CCI) included. Results: Over 5 years: 53,333 migraine cases identified (mean age 40.5 years, 79% female). Common comorbidities: hypertension, COPD, diabetes mellitus, cancer, cerebrovas...
Acute myocardial infarction with ST-segment elevation (STEMI) remains a major global public healt... more Acute myocardial infarction with ST-segment elevation (STEMI) remains a major global public health issue. Despite advances in therapy, patients remain at risk for death, repeat myocardial infarction (MI) shock and heart failure (HF). Novel markers that predict those at risk are needed. We studied 903 STEMI patients in The Assessment of Pexelizumab in Acute Myocardial Infarction trial (which enrolled STEMI patients presenting < 6 hrs of symptom onset who were to undergo primary PCI) in a case-control design (cases selected based on the trial’s primary composite outcome - death, shock or HF - and matched on age, gender and infarct location to controls). NT-proBNP (pg/ml) was measured at randomization and 24 hrs. Outcomes (individually and the composite) of death, shock, and HF at 90 days were examined by quartiles of NT-proBNP. A CART model was used to categorize adjusted risk. NT-proBNP was higher in patients who had events. Patients with higher NT-proBNP levels at baseline (media...
1 (1.2%) and 3 (3.5%) PMP patients, respectively. After TAVR procedure the degree of mitral regur... more 1 (1.2%) and 3 (3.5%) PMP patients, respectively. After TAVR procedure the degree of mitral regurgitation decreased by at least 1-degree in all patients with moderate-severe insufficiency and half-pressure time decreased by 89.76±6.6 msec (p=0.015), with no changes in mean gradients (p=0.20). Valve embolization occurred in 6 patients (6.7%), all of them with a distance shorter than 7 mm between the PMP and the aortic annulus as assessed by MDCT (p<0.001). Risk of embolization was neither influenced by the use of transapical approach nor balloon/self-expandable devices. Distance between PMP and Aortic annulus Conclusions: MDCT helped to determine that TAVR could be performed in patients with PMP presenting a distance from PMP to aortic annulus larger than 7-mm with extremely low risk of valve embolization. In patients with shorter distance, the use of transapical vs. transfemoral approach or self-vs. balloonexpandable devices did not reduce this risk. After TAVR, mean transmitral gradients were comparable but a significant decrease in half-pressure time and rate of moderate-severe mitral regurgitation were found.
Introduction: Increasing pressures on the health care system, particularly in emergency departmen... more Introduction: Increasing pressures on the health care system, particularly in emergency departments (EDs), make it critical to understand changing ED case-mix, patient demographics and care needs, and resource utilization. Our objective is to assess Alberta (AB) ED volumes, utilization and case mix, stratified by ED type. This knowledge will help identify opportunities for system change and quality improvement. Methods: Data from Alberta Health Services administrative databases, including the National Ambulatory Care Reporting System, ED Admission/Discharge/Transfer data, and Comprehensive Ambulatory Care Classification System codes, were linked for all ED visits from 2010-17. Data were stratified by seven facility categories: tertiary referral (TR), regional referral (RR), community<5,000 inpatient discharges (CL), community>600 inpatient discharges (CM), community <600 inpatient discharges (CS), community ambulatory care (CA), and free-standing EDs (FS). Results: We analy...
Cooperation among supply chain members, both horizontally and vertically, has become the norm in ... more Cooperation among supply chain members, both horizontally and vertically, has become the norm in practice. Unlike traditional supply chains with members competing to reduce their individual costs, the overall cost of the entire supply chain is minimized in a cooperative supply chain. The savings from cooperation may be shared among the members, while a lower average cost and a lower cost variation is materialized for individual members. The problem is formulated as an integrated flow network and expanded to multi-period and multi-product, with the possibility of holding inventories in a multi-stage, multi-member cooperative supply chain. Simulation results indicate an approximately 26% reduction in total costs of the supply chain, utilizing this formulation over competitive setups. In a multiperiod chain, members may hold an inventory or use an inventory policy. As the holding costs increase, the problem decomposes into a single period (just-in-time) again. The disturbing bullwhip effect disappears in cooperative supply chains.
Rationale: Even though idiopathic pulmonary fibrosis (IPF) is a disease with high morbidity and m... more Rationale: Even though idiopathic pulmonary fibrosis (IPF) is a disease with high morbidity and mortality and no cure, palliative care is rarely implemented, leading to high symptom burden and unmet care needs. In 2012, we implemented a multidisciplinary collaborative (MDC) care model linking clinic and community multidisciplinary teams to provide an early integrated palliative approach, focusing on early symptom management and advance care planning. Objectives: To evaluate the differences in resource use and associated costs of end-of-life care between patients with IPF who received early integrated palliative care and patients with IPF who received conventional treatment. Methods: Using administrative health data, we identified all patients in the Province of Alberta, Canada, who presented to a hospital with an IPF diagnosis between January 1, 2012, and December 31, 2018, and died within this time frame. We compared three groups of patients: those who received MDC care (our clinic patients), specialist care (SC; respirologist), or non-specialist care (NSC; no contact with a respiratory clinic). The primary outcomes were healthcare resource use and costs in the year before death. Results: Of 2,768 patients across the three study groups, in the last year of life, MDC patients were more than three times as likely as SC patients to have received antifibrotic therapies (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.8-5.2), almost twice as likely to have received pulmonary rehabilitation (OR, 1.9; 95% CI, 1.1-3.4), and 36% more likely to have received opiates (OR, 1.4; 95% CI, 0.8-2.3). The median total healthcare costs in the last 3 months of life were approximately C$7,700 lower for MDC patients than for those receiving SC, driven primarily by fewer hospitalizations and emergency department visits. MDC patients were also less likely to die in the hospital (44.9% MDC vs. 64.9% SC vs. 66.8% NSC; P , 0.001) and had the highest rates of no hospitalization in the last year of life. Conclusions: An integrated palliative approach in IPF is associated with improvements in the quality of end-of-life care and reduction in costs. Transformation of care models is required to deliver palliative care for patients with IPF. MDC teams within such models can address the high burden of unmet needs for symptom management, advance care planning, and community support in this complex population.
Introduction: Asthma is a chronic condition and exacerbations are a common reason for emergency d... more Introduction: Asthma is a chronic condition and exacerbations are a common reason for emergency department (ED) presentations across Canada. The objective of this study was to characterize and describe acute asthma presentations over a five-year period. Methods: Administrative health data for Alberta from 2011-2015 was obtained from the National Ambulatory Care Reporting System (NACRS) for all adult (>17 years) acute asthma (ICD-10-CA: J45) ED presentations. All presentations to an Alberta ED with a primary or secondary diagnosis of acute asthma were eligible for inclusion. Presentations with a Canadian Triage and Acuity Scale (CTAS) score of 1 were excluded. Data from NACRS were linked with a provincial diagnostic imaging database. Data are reported as means and standard deviation (SD), medians and interquartile range (IQR) or proportions, as appropriate. Results: From 2011-2015, a total of 51,269 (~10,000/year) acute asthma presentations were made by 34,481 patients (~0.3 prese...
Introduction: Most acute asthma presentations to the emergency department (ED) are uncomplicated ... more Introduction: Most acute asthma presentations to the emergency department (ED) are uncomplicated and do not require chest radiographs (CXR). Evidence suggests that the proportion of acute asthma patients receiving CXRs in the ED is high and varies substantially within and across sites and studies. This study explored CXR ordering and variation in acute asthma presentations to Alberta’s EDs. Methods: Administrative health data for Alberta was obtained from the National Ambulatory Care Reporting System (NACRS) for all adult (>17 years) acute asthma (ICD-10-CA: J45) ED visits from 2011-2015. Patients with a primary or secondary diagnosis of asthma were included, provided they had a Canadian Triage and Acuity Scale score of 2-5. NACRS data were linked with Alberta Health Services’ (AHS) diagnostic imaging database. Preliminary analysis on variation in imaging at the zone, ED site, and physician level was completed using SAS (v.9.4). Physicians who saw less than an average of 10 asthm...
Introduction: Headaches are a common emergency department (ED) presentation. Evidence demonstrate... more Introduction: Headaches are a common emergency department (ED) presentation. Evidence demonstrates that computed tomography (CT) imaging varies significantly within and across sites. This study explored CT ordering and variation among headache presentations across Alberta EDs. Methods: Administrative health data for Alberta were obtained from the National Ambulatory Care Reporting System (NACRS) for all adult (>17 years) headache (ICD-10-CA: G44, G43, R51) ED visits from 2011-2015. Patients with a primary or secondary diagnosis code of headache were included. Exclusions were: sites without CT scanners, Canadian Triage and Acuity Scale score of 1, patients with trauma or external mechanism of injury (e.g., ICD-10-CA S,T,V,W,X,Y), or enhanced/contrast CTs. NACRS data were linked with Alberta Health Services’ (AHS) diagnostic imaging data. Preliminary analysis on imaging variation at the zone, ED site, and physician level was completed using SAS (v.9.4). Physicians who saw less than...
Introduction: Headaches are a common emergency department (ED) presentation. The objective of thi... more Introduction: Headaches are a common emergency department (ED) presentation. The objective of this study was to characterize headache presentations in Alberta over a five-year period and explore the proportion of patients with potentially severe pathology. Methods: Administrative health data for Alberta (years 2011-2015) were obtained from the National Ambulatory Care Reporting System (NACRS) for all adult (>17 years) headache presentations (ICD-10-CA: G43, G44, R51). Patients with a primary or secondary diagnosis code of headache were eligible for inclusion in the study. Exclusions were made using the following criteria: 1) sites without computed tomography (CT) scanners; 2) presentations with a Canadian Triage and Acuity Scale (CTAS) score of 1; 3) patients with trauma or external mechanism of injury (e.g., ICD-10-CA codes S,T,V,W,X,Y); and 4) presentations receiving an enhanced/contrast CT (head). NACRS data were linked with a provincial diagnostic imaging data. Data are repor...
BACKGROUND: Currently, International Classification of Disease, version 10 (ICD-10) codes are use... more BACKGROUND: Currently, International Classification of Disease, version 10 (ICD-10) codes are used to identify comorbidities in administrative healthcare databases. Although not readily available in all jurisdictions, case definitions typically use physician billing claims data. We linked administrative data to a regional ST-elevation myocardial infarction (STEMI) registry to determine the accuracy of several alternative case definitions to identify the presence of cardiovascular comorbidities, using the registry as gold standard. METHODS/RESULTS: Vital Heart Response (VHR) is a comprehensive registry of 3049 consecutive STEMI patients (2006 and 2011) within a defined health region (Edmonton, Alberta). Clinical information in VHR was acquired via chart review by a dedicated research organization (EPICORE). Using unique patient identifiers, the registry data were linked to the inpatient discharge abstract database (DAD) and the outpatient (ACCR e 2010; NACRS >2010) databases. The DAD includes most responsible diagnosis and up to 24 other diagnoses (all acute care hospitalizations) while the outpatient databases include up to 10 diagnoses for all visit to ERs or hospital-based clinics. Both DAD and ACCS used the Canadian enhancement of ICD-10 (ICD-10-CA) during the study time period.
Aims: Adenosine triphosphate sensitive potassium (K ATP) channel activity is cardioprotective dur... more Aims: Adenosine triphosphate sensitive potassium (K ATP) channel activity is cardioprotective during ischaemia. One of the purported mechanisms for sulphonylurea adverse effects is through inhibition of these channels. The purpose of this study is to examine whether patients using K ATP channel inhibitors at the time of an acute coronary syndrome are at greater risk of death or heart failure (HF) than those not exposed. Methods: Using linked administrative databases we identified all adults who had an acute coronary syndrome between April 2002 and October 2006 (n = 21 023).
BACKGROUND: Almost 10% of patients seen in the emergency department for atrial fibrillation die w... more BACKGROUND: Almost 10% of patients seen in the emergency department for atrial fibrillation die within a year of the visit. We sought to assess predictors of mortality in a real-world, older population of atrial fibrillation patients who were discharged from the emergency department, and to determine care strategies associated with mortality. METHODS: We performed a retrospective cohort analysis of all patients age Ն 65 with a primary emergency department diagnosis of atrial fibrillation, seen in all non-paediatric emergency departments in the province of Ontario, Canada between April 2007 and March 2010. Patients admitted to hospital were excluded, and only the index (first) emergency department visit was assessed. We evaluated the effect of post-discharge outpatient care and medications, emergency department cardioversion, and site volumes of atrial fibrillation patients on the adjusted hazard of death within 90 days of the index visit. Patients were censored on return to an emergency department. RESULTS: Among 12,772 qualifying index emergency department visits, there were 417 (3.3%; 95% CI 3.0% to 3.6%) deaths within 90 days of the visit. Patients with no follow-up care had an increased hazard of death (HR 2.27, pϽ0.001), relative to those who saw a family doctor, as did patients prescribed a calcium-channel blocker (HR 1.55, pϭ0.004), relative to a beta-blocker. A filled warfarin prescription was associated with a lower hazard of death (HR 0.70, pϭ0.02). Neither site volumes of atrial fibrillation patients (HR 0.66; pϭ0.10) nor cardioversion (HR 0.69; pϭ0.15) were associated with 90-day mortality. CONCLUSION: Among older atrial fibrillation patients seen in and discharged from the emergency department in the province of Ontario, lack of follow-up care had the greatest association with subsequent mortality. If more of these patients are to be discharged from emergency departments in future, the focus must go beyond emergency department care itself, to ensuring ongoing care subsequent to the emergency visit.
ABSTRACTImportanceWith the emergence of more transmissible SARS-CoV-2 variants of concern (VOC), ... more ABSTRACTImportanceWith the emergence of more transmissible SARS-CoV-2 variants of concern (VOC), there is an urgent need for evidence about disease severity and the health care impacts of VOC in North America, particularly since a substantial proportion of the population have declined vaccination thus far.ObjectiveTo examine 30-day outcomes in Canadians infected with SARS-CoV-2 in the first year of the pandemic and to compare event rates in those with VOC versus wild-type infection.DesignRetrospective cohort study using linked healthcare administrative datasets.SettingAlberta and Ontario, the two Canadian provinces that experienced the largest third wave in the spring of 2021.ParticipantsAll individuals with a positive SARS-CoV-2 reverse transcriptase polymerase chain reaction swab from March 1, 2020 until March 31, 2021, with genomic confirmation of VOC screen-positive tests during February and March 2021 (wave 3).Exposure of InterestVOC versus wild type SARS-CoV-2Main Outcomes and...
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Papers by J. Bakal