Suchergebnisse

ObjectivesElectronic Health Record (EHR) data have created unique opportunities for research. However, these data are: not curated, siloed and poorly integrated. We describe linkage of EHR data from an entire health service with government datasets to establish a linked geographic cohort within the Australian National Centre for Healthy Ageing (NCHA).
ApproachResearch suitable EHR items were identified from Peninsula Health (NCHA partner) data systems based on: published research, availability and quality. Items underwent end-user Delphi processes to identify core research items (consensus=70%). Approvals were obtained from the Australian Institute of Health and Welfare (AIHW) for linkage with: Medicare, medication dispensings, Aged Care and death registry data through the AIHW spine, created using identifiers from the Medicare Consumer Directory (MCD); and from the Centre for Victorian Data Linkage for linkage to state-wide hospital data. Identifiers for local residents aged ≥60 years who attended Peninsula Health were submitted for probabilistic data linkage.
ResultsDelphi participants included 10 researchers from 8 fields/departments and 13 clinicians from 11 clinical areas. To date 7 of the 11 datasets have been reviewed. N=107 potentially suitable data items were identified and 96 gained consensus for inclusion in the core dataset. Of the 49,767 Health Service users (episodes: Jan 2010-Dec May 2021) submitted for linkage, 98.4% were successfully linked to the MCD (Median age 72.2 years, 52.2% female, 1.8% regional residence). An additional 172,290 individuals living within the geographic region but not contained within the EHR dataset were identified in the MCD for linkage to the government datasets. Linkage accuracy was impacted by inaccurate/incomplete address fields (~30%) and lack of adherence to naming conventions within the EHR data.
ConclusionLinking with EHR data is complex. Having an established EHR research dataset will improve the feasibility of data linkage and potential for future expansion of linkages within the NCHA. Once merged, the data will be used to underpin a range of research activities related to ageing and dementia.

Background Administrative data are used extensively for research purposes, but there remains limited information on the quality of these data for identifying comorbidities related to stroke. Objective To compare the prevalence of comorbidities of stroke identified using International Classification Diseases, Australian Modification (ICD-10-AM) or Anatomical Therapeutic Chemical codes, with those from (i) self-reported data and (ii) published studies. Method The cohort included patients with stroke or transient ischaemic attack admitted to hospitals (2012–2016; Victoria and Queensland) in the Australian Stroke Clinical Registry (N = 26,111). Data were linked with hospital and pharmaceutical datasets to ascertain comorbidities using published algorithms. The sensitivity, specificity, and positive predictive value of these comorbidities were compared with survey responses from 623 patients (reference standard). An indirect comparison was also performed with clinical data from published stroke studies. Results The sensitivity of hospital ICD-10-AM data was poor for most comorbidities, except for diabetes (93.0%). Specificity was excellent for all comorbidities (87–96%), except for hypertension (70.5%). Compared to published stroke studies (3 clinical trials and 1 incidence study), the prevalence of diabetes and atrial fibrillation in our cohort was similar using ICD-10-AM codes, but lower for dyslipidaemia and anxiety/depression. Whereas in the pharmaceutical dispensing data, the sensitivity was excellent for dyslipidaemia (94%) and modest for anxiety/depression (77%). In the pharmaceutical data, specificity was modest for hypertension (78%) and anxiety or depression (76%), but specificity was poor for dyslipidaemia (19%) and heart disease (46%). Conclusion Variation was observed in the reporting of comorbidities of stroke in administrative data, and consideration of multiple sources of data may be necessary for research. Further work is needed to improve coding and clinical documentation for reporting of comorbidities in administrative data.

ObjectivesData linkage can provide sufficient breadth and size of data, to draw reliable estimates of effectiveness, at a population level using real-world data. We compared differences in survival and hospital presentations following stroke or transient ischaemic attack (TIA), based on whether a Medicare funded chronic disease management plan was claimed.
ApproachA population-based, comparative effectiveness study of Victorian and Queensland Australian Stroke Clinical Registrants (January 2012-June 2015), using the emulated target trial approach, was performed. Chronic disease management items were identified from Medicare claims in the 6-18 months post-stroke (exposure period). Data on covariates for model adjustment were obtained from hospital, pharmacy and aged care datasets. Outcomes at 19-30 months post-stroke were determined using the national death registry and state hospital data. Cox regression, adjusted using propensity score methods with inverse probability treatment weights was used to determine the effect of receipt of chronic disease management claims on outcomes.
ResultsOf 28,775 AuSCR registrants, 27,435 (95.3%) were linked across the Medicare, pharmacy and hospital datasets. Following exclusions, 11,574 registrants from 42 hospitals (42% female, median age 70 years, 27% TIA) were eligible for the study. Overall, 45% of participants received chronic disease management during the exposure period. After propensity score weighting, there was excellent balance between groups across 35 baseline variables (standardised differences <0.1). Receipt of chronic disease management (vs non-receipt) was associated with a 30% reduced hazard of death (adjusted Hazard Ratio [aHR]: 0.70, 95%CI: 0.57, 0.87) but a 17% increase in hospital presentations (aHR: 1.17, 95%CI: 1.12, 1.23). Variation was observed between planned (aHR: 1.21, 95%CI: 1.10, 1.33) and unplanned (aHR: 1.15, 95%CI: 1.07, 1.23) presentations.
ConclusionWe provide an evaluation of the effectiveness of Medicare funded chronic disease management within "real world" healthcare provision, thereby demonstrating the value of linked population data in health services research. Further work is underway to examine causal mechanisms.

Introduction and PurposeChronic Disease Management (CDM) plans are used by general practitioners to manage chronic diseases such as stroke. However, there is limited evidence that being on these plans improve adherence to secondary prevention medications after stroke. We aimed to assess the association of the duration on a CDM plan in improving adherence to secondary prevention medications following stroke.
MethodsAustralian survivors of stroke or transient ischaemic attack were participants from the STAND FIRM trial. Patients were individually linked with claims for CDM plans from Medicare and dispensings of secondary prevention medications from the Pharmaceutical Benefits Scheme. We estimated (1) duration on a CDM plan based on the timing and Medicare items claimed and (2) the proportion of days that patients would have been covered by these medications (PDC), while accounting for deaths and instances of over-supply. Dosage for each quantity of medication was determined by the regularity in which patients returned for a refill. Logistic regression was used to evaluate factors associated with ≥80% adherence, up to 3 years after stroke, for each of antihypertensive, antithrombotic and lipid-modifying drugs.
ResultsThe median PDC for 563 patients (median age 70yrs; 36% female) ranged from 92% to 95% among the three classes of medications. Approximately 27% did not take up a CDM plan, 33% were on plans for <1.5 years and 40% for 1.5-3 years. Duration on a CDM plan (quintiles) was associated with adherence for antihypertensive (Odds Ratio (OR) 1.18, 95% confidence interval (95%CI) 1.00-1.40, p=0.029) and antithrombotic medications (OR 1.22, 95%CI 1.03-1.46, p=0.024), but not for lipid-lowering medications.
ConclusionPeople on a CDM plan for longer had better adherence to antihypertensive and antithrombotic medications in the long-term after stroke. Use and ongoing reviews of CDM plans should be encouraged to improve adherence to secondary prevention medications after stroke.