Biomedical subjects

Jack V Tu

Publications and source records attributed to Jack V Tu.

At least 91 records · Page 5Linked to original sources

PubMed2003

Trends in treatment and outcomes for acute stroke patients in Ontario, 1992-1998.

BACKGROUND: Several interventions have been shown to be of benefit to patients with stroke (hereafter referred to as stroke patients) in clinical trials, but the net effect of these interventions in the general stroke population has not been established. The purpose of this study was to evaluate temporal trends in the characteristics, treatments, and outcomes of acute stroke patients in the province of Ontario. METHODS: We conducted a population-based retrospective cohort study using linked administrative databases of all 91 419 patients discharged with a most-responsible diagnosis of acute stroke from acute care hospitals in Ontario from April 1, 1992, to March 31, 1999 (fiscal years 1992-1998). RESULTS: The average age and proportion of stroke patients with co-existing diseases increased over time. The proportion of elderly patients 65 years and older who received warfarin sodium (Coumadin) and statins increased during the study period (14.6% to 19.6% [P =.001] and 2.7% to 15.0% [P<.001], respectively). Declines in the median length of stay (11 to 8 days [P<.001]) and risk-adjusted in-hospital mortality (21.9% to 18.9% [P<.001]) were significant, but the 30-day mortality rates for acute stroke stayed relatively constant (19.7% to 19.0% [P =.18]). We found a moderate decline in risk-adjusted 1-year mortality (34.1% to 32.0% [P<.001]) and stroke readmission rates (12.1% to 9.9% [P =.001]). CONCLUSIONS: Improvements in the outcomes of stroke patients have occurred in Ontario during the 1990s, despite an increasing proportion of elderly stroke patients with multiple comorbidities. Increasing use of secondary prevention medications may explain this trend.

Acute Disease↗

PubMed2003

Geography and service supply do not explain socioeconomic gradients in angiography use after acute myocardial infarction.

BACKGROUND: Socioeconomic status appears to be an important predictor of coronary angiography use after acute myocardial infarction. One potential explanation for this is that patients with lower socioeconomic status live in neighbourhoods near nonteaching hospitals that have no catheterization capacity, few specialists and lower volumes of patients with acute myocardial infarction. This study was conducted to determine whether the impact of socioeconomic status on angiography use would be lessened by considering variations in the supply of services. METHODS: We examined payment claims for physician services, hospital discharge abstracts and vital status data for 47 036 patients with acute myocardial infarction admitted to hospitals in Ontario between April 1994 and March 1997. Neighbourhood income of each patient was obtained from Canada's 1996 census. Using multivariate hierarchical logistic regression and adjusting for baseline patient and physician factors, we examined the interaction among hospital and regional characteristics, socioeconomic status and angiography use in the first 90 days after admission to hospital for acute myocardial infarction. RESULTS: Within each hospital and geographic subgroup, crude rates of angiography rose progressively with increases in neighbourhood income. After adjusting for sociodemographic, clinical and physician characteristics, hospitals with on-site angiography capacity (adjusted odds ratio [OR] 1.88, 95% confidence interval [CI] 1.52-2.33), those with university affiliations (adjusted OR 1.60, 95% CI 1.27-2.01) and those closest to tertiary institutions (adjusted OR 1.57, 95% CI 1.32-1.87) were all associated with higher 90-day angiography use after acute myocardial infarction. However, the relative impact of socioeconomic status on 90-day angiography use was similar whether or not hospitals had on-site procedural capacity (interaction term p = 0.68), had university affiliations (interaction term p = 0.99), were near tertiary facilities (interaction term p = 0.67) or were in rural or urban regions (interaction term p = 0.90). INTERPRETATION: Socioeconomic status was as important a predictor of angiography use in hospitals with ready access to cardiac catheterization facilities as it was in those without. The socioeconomic gradient in the use of angiography after acute myocardial infarction cannot be explained by the distribution of specialists or tertiary hospitals.

Cardiac Care Facilities↗

PubMed2003

Developing risk-adjusted 30-day hospital mortality rates.

This article describes one risk-adjustment method useful for minimizing threats to internal validity that stem from the impact on the outcomes under investigation from patients' own characteristics and their associated risks. Mortality is the outcome used to illustrate the risk-adjustment approach. A two-step approach to outcomes research is suggested. The first step includes risk-adjusting outcomes for patient characteristics by developing standard mortality rates. In the second step these risk-adjusted standard rates can be used as dependent variables in outcomes analytic models. This article focuses on the first step. In the current study risk adjustment resulted in changes in both absolute values and rank ordering of hospital mortality rates compared to crude rates. This procedure is useful for developing risk-adjusted outcomes with administrative data similar to those used in this study.

Aged↗

PubMed2003

Use of interventional procedures for peripheral arterial occlusive disease in Ontario between 1991 and 1998: a population-based study.

PURPOSE: Although peripheral arterial occlusive disease (PAOD) is a public health issue in the elderly population, limited population-based data are available on use of interventional procedures in Canada. We describe trends in use of interventional procedures to treat PAOD in Ontario over the past decade. METHODS: A retrospective population-based cohort study was conducted for fiscal years 1991 to 1998 with Ontario administrative databases to identify all arterial bypass surgeries, angioplasty procedures, and amputations performed. RESULTS: A total of 19,332 bypass operations, 16,334 angioplasty procedures, and 17,534 amputations were identified. Population-based rates showed that angioplasty use peaked at about 110 per 100,000 at age 65 to 74 years, arterial bypass surgery use peaked at 129 per 100,000 at age 75 to 84 years, and amputation use peaked at 138 per 100,000 at age 85 years or older. All types of interventional procedures to treat PAOD were performed more frequently in men than in women. Age-adjusted and sex-adjusted rate of arterial bypass surgery decreased significantly, from 77 to 61 per 100,000 population aged 45 years or older (P =.0002, linear regression analysis), whereas rate for PTA increased significantly, from 59 to 75 per 100,000 population aged 45 years or older (P =.0005). The overall major amputation rate declined slightly over the study period, influenced by the decreased rate in patients aged 85 years or older. The revascularization rate in patients aged 85 years or older increased (P =.055). CONCLUSION: Reduced use of arterial bypass surgery and increased use of angioplasty procedures has occurred over the past decade and may reflect a change in the practice pattern of vascular surgeons in Ontario, who have become more conservative in treating localized disease and reserve surgical interventions for more severe forms of PAOD. The slight reduction in overall major amputation rate, driven by decreased rate in patients aged 85 years or older, may reflect a trend toward a more aggressive revascularization approach in this age group.

Age Distribution↗

PubMed2003

Outcome of revascularization procedures for peripheral arterial occlusive disease in Ontario between 1991 and 1998: a population-based study.

PURPOSE: We describe the outcome of revascularization procedures used to treat peripheral arterial occlusive disease (PAOD), using population-based administrative data. METHODS: A retrospective population-based cohort study utilizing administrative databases in Ontario, Canada, was conducted for fiscal years 1991 to 1998 to identify patients who underwent arterial bypass surgery and percutaneous transluminal angioplasty to treat PAOD. The Kaplan-Meier method was used to calculate cumulative survival rate and amputation-free survival rate. To analyze factors that affect these rates, multivariate analysis was performed with Cox proportional hazard models. RESULTS: Over the study period 15,824 patients underwent bypass operations and 11,548 underwent angioplasty. For patients who underwent bypass surgery, 5-year cumulative survival rate was 61.5% and major amputation-free survival rate was 83.4%, compared with 69% and 92.2%, respectively, for patients who underwent angioplasty. Male sex, older age, diabetes, and heart disease were associated with increased risk for death after revascularization procedures. Increased risk for major amputation after revascularization procedures was associated with male sex, older age, and diabetes, whereas hypertension was linked to decreased risk. CONCLUSION: To evaluate the long-term outcome of revascularization procedures for PAOD at the population level, survival and major amputation-free survival rates should be used, because they provide more clinically accepted estimates compared with the correlation between utilization rates for revascularization and amputation procedures, which have been used to describe outcome in previously published reports in the literature.

Amputation, Surgical↗

PubMed2003

Meta-analysis of the effects of endothelin receptor blockade on survival in experimental heart failure.

BACKGROUND: Although an initial study of endothelin receptor blockade reported positive findings, subsequent experiments and clinical trials in humans found little or no benefit. METHODS: We applied meta-analytic methods to assess the methodologic rigor of preclinical studies of endothelin blockade and to quantitatively evaluate the totality of evidence regarding the effect of endothelin receptor blockers in experimental heart failure. A total of 396 animals were assigned to control and 594 were assigned to experimental therapy in the pooled analysis. Of the 9 studies identified, no study reported a priori sample size justification. Although there was a tendency to increased mortality with early administration (relative risk 1.39, P=.15) and decreased mortality with late administration (relative risk 0.85, P=.6), in the overall analysis, there was no significant evidence of benefit or harm (relative risk 1.03, P=.9). Studies with a small sample size had estimated effects that tended to deviate further from the pooled estimate of all studies. CONCLUSIONS: Consideration of mortality effects in the totality of studies revealed no significant effect of endothelin antagonists in animal models of experimental heart failure. Given the potential for between-study variability, reliance on studies with small sample size may lead to unrealistic expectations when extrapolating preclinical experimental results to future research.

Animals↗

PubMed2003

Comparing hierarchical modeling with traditional logistic regression analysis among patients hospitalized with acute myocardial infarction: should we be analyzing cardiovascular outcomes data differently?

BACKGROUND: Data in health research are frequently structured hierarchically. For example, data may consist of patients treated by physicians who in turn practice in hospitals. Traditional statistical techniques ignore the possible correlation of outcomes within a given practice or hospital. Furthermore, imputing characteristics measured at higher levels of the hierarchy to the patient-level artificially inflates the amount of available information on the effect of higher-level characteristics on outcomes. METHODS: Conventional logistic regression models and multilevel logistic regression models were fit to a cross-sectional cohort of patients hospitalized with a diagnosis of acute myocardial infarction. The statistical significance of the effect of patient, physician, and hospital characteristics on patient outcomes was compared between the 2 modeling strategies. RESULTS: The 2 analytic strategies agreed well on the effect of patient characteristics on outcomes. According to the traditional analysis, teaching status was statistically significantly associated with 5 of the 9 outcomes, whereas the multilevel models did not find a statistically significant association between teaching status and any patient outcomes. Similarly, the traditional and multilevel models disagreed on the statistical significance of the effect of being treated at a revascularization hospital and 3 patient outcomes. CONCLUSIONS: In comparing the resultant models, we see that false inferences can be drawn by ignoring the structure of the data. Conventional logistic regression tended to increase the statistical significance for the effects of variables measured at the hospital-level compared to the level of significance indicated by the multilevel model.

Adult↗

PubMed2003

Impact of an acute myocardial infarction report card in Ontario, Canada.

OBJECTIVES: Acute myocardial infarction (AMI) 'report cards' are being developed using administrative databases in many jurisdictions, but little is known about their acceptance by and their usefulness to the medical community. The purpose of this study was to determine the impact of the publication of Cardiovascular Health and Services in Ontario: An ICES Atlas (Naylor CD, Slaughter P. (eds), 1999, Toronto: ICES), the first report featuring hospital-specific AMI performance measures to be published in Canada. DESIGN: We conducted a mail survey of physicians at Ontario hospitals to determine their views on the usefulness of various atlas performance measures for assessing and improving quality of care, the types of quality initiatives launched at their hospital in response to the atlas, and their views on the concept and limitations of reporting hospital-specific AMI mortality data. RESULTS: Respondents to the survey indicated that information on process of care measures such as post-infarction beta-blocker and angiotensin-converting enzyme (ACE) inhibitor use, and cardiac procedure waiting times were the most useful, and outcomes data (e.g. 30-day and 1-year risk-adjusted AMI mortality rates) the least useful of the multiple performance measures published in the atlas (P = 0.0385). Fifty-four percent of respondents reported launching one or more quality of care initiatives at their hospital in response to the atlas. The majority of respondents (65%) indicated that they support the public release of hospital-specific AMI mortality data, although many had concerns about potential miscoding in administrative databases and the adequacy of risk-adjustment methods. CONCLUSION: The publication of the first AMI report card in Canada stimulated quality of care initiatives at many Ontario hospitals. Inclusion of performance measures other than mortality in health care report cards may lead to greater acceptance and use by the medical community.

Attitude of Health Personnel↗

PubMed2003

Processes and outcomes of care for diabetic acute myocardial infarction patients in Ontario: do physicians undertreat?

OBJECTIVE: To compare the health service utilization and long-term outcomes of acute myocardial infarction (AMI) patients with and without diabetes in Ontario. RESEARCH DESIGN AND METHODS: We examined 25,697 patients from Ontario (6,052 and 19,645 patients with and without diabetes, respectively) who were hospitalized because of AMI between 1 April 1992 and 31 December 1993. Using linked administrative databases, we determined the use of invasive cardiac procedures at 1 year as well as the intensity of specialty follow-up care and use of evidence-based pharmacotherapies (among elderly individuals) within the first 90 days of hospital discharge. Outcomes examined included mortality and recurrent cardiac admissions at 30 days and 5 years post AMI. Multivariable analyses adjusted for sociodemographic and case-mix characteristics, attending physician specialty, and admitting hospital characteristics. RESULTS: Despite being at significantly higher risk for death at baseline, diabetic patients were less likely to be followed-up by a cardiologist (22.2 vs. 25.6%, P < 0.001), to receive myocardial revascularization (12.6 vs. 14.9%, P < 0.001), to receive beta-blockers (34.2 vs. 44.0%, P < 0.001), and to receive aspirin therapy (59.7 vs. 63.5%, P < 0.001) after AMI than their nondiabetic counterparts. Diabetes was an important independent predictor of 5-year morbidity (adjusted hazard ratio 1.52, 95% CI 1.45-1.59) and 5-year mortality outcomes (1.57, 1.50-1.63). Variations in processes of care were marginally associated with higher nonfatal complication rates for diabetic patients. CONCLUSIONS: When managing AMI patients with diabetes in Ontario, physician treatment aggressiveness does not correspond appropriately to the baseline risk of patients.

Aged↗

PubMed2003

CCORT/CCS quality indicators for acute myocardial infarction care.

BACKGROUND: Although quality indicators for the care of acute myocardial infarction (AMI) patients have been described for other countries, there are none specifically designed for the Canadian health care system. The authors' goal was to develop a set of Canadian quality indicators for AMI care. METHODS: A literature review identified existing quality indicators for AMI care. A list of potential indicators was assessed by a nine-member panel of clinicians from a variety of disciplines using a modified-Delphi panel process. After an initial round of rating the potential indicators, a series of indicators was identified for a second round of discussion at a national meeting. Further refinement of indicators occurred following a teleconference and review by external reviewers. RESULTS: To identify an AMI cohort, case definition criteria were developed, using a hospital discharge diagnosis for AMI of International Classification of Diseases-Ninth revision (ICD-9) code 410.x. Thirty-seven indicators for AMI care were established. Pharmacological process of care indicators included administration of acetylsalicylic acid, beta-blockers, angiotensin-converting enzyme inhibitors, thrombolytics and statins. Mortality and readmissions for AMI, unstable angina and congestive heart failure were recommended as outcome indicators. Nonpharmacological indicators included median length of stay in the emergency department, and median waiting times for cardiac catheterization, percutaneous coronary intervention and/or coronary artery bypass graft surgery. INTERPRETATION: A set of Canadian quality indicators for the care of AMI patients has been established. It is anticipated that these indicators will be useful to clinicians and researchers who want to measure and improve the quality of AMI patient care in Canada.

Ambulatory Care↗

PubMed2003

An overview of the methods and data used in the CCORT Canadian Cardiovascular Atlas project.

The Canadian Cardiovascular Atlas project, an initiative of the Canadian Cardiovascular Outcomes Research Team (CCORT), will be published as a series of 20 articles in future issues of the Canadian Journal of Cardiology. Through a wide range of data sources and analyses from a number of collaborators across Canada, the CCORT Atlas will provide a comprehensive overview of the current state of cardiac care and disease in Canada. Administrative data, clinical registries and community survey data will be analyzed at the provincial and health region levels. The purposes of this article are to 1) provide an overview of the data types and sources used in the Atlas project, 2) give a general description of the methods and analyses used to report Atlas data and 3) describe how Atlas maps were created and how they can be interpreted.

Canada↗

PubMed2003

Outcomes of acute myocardial infarction in Canada.

BACKGROUND: Little information is available on recent population-based trends in the outcomes of patients who have had an acute myocardial infarction (AMI) in Canada. METHODS: Data were analyzed from the Discharge Abstract Database and Hospital Morbidity Database of the Canadian Institute for Health Information. All new cases of AMI in Canada between fiscal 1997/98 and fiscal 1999/2000 of patients at least 20 years old were examined. Data were also analyzed from these databases for hospital readmissions for a second AMI, angina and congestive heart failure (CHF). RESULTS: There were 139,523 new AMI cases. The overall crude in-hospital AMI mortality rate in Canada was 12.3%. In-hospital mortality rate after an AMI was worse for women than for men in Canada (16.7% and 9.9%, respectively). The age- and sex-standardized in-hospital mortality rate varied from a low of 10.5% (95% CI 8.4% to 12.6%) in Prince Edward Island to a high of 13.1% (95% CI 12.8% to 13.5%) in Quebec. Among AMI survivors, 12.5% were readmitted within one year for angina, 7.7% for a second AMI and 7.5% for CHF. There were wide interregional differences in age- and sex-standardized mortality rates and one-year readmission rates. CONCLUSIONS: AMI is associated with a substantial acute mortality rate in Canada, especially in the elderly and female patients. Identifying the causes of interregional differences in patient outcomes should be a priority for future research.

Adult↗

PubMed2003

Hospitalization rates and length of stay for cardiovascular conditions in Canada, 1994 to 1999.

BACKGROUND: Cardiovascular diseases (CVDs) are a leading cause of hospitalization in Canada. An examination of recent trends in cardiovascular hospitalization rates across Canada is of considerable value and interest to health policy decision makers and administrators, clinicians and researchers. OBJECTIVES: To examine temporal trends and regional variation in hospitalization rates and length of stay for CVD conditions in Canada. METHODS: Hospital discharge data for fiscal years 1994/95 to 1999/2000 were used to identify all Canadians who were hospitalized with the most responsible diagnoses of acute myocardial infarction (AMI), congestive heart failure (CHF), angina and chest pain. Direct age- and sex-standardized hospitalization rates were calculated by province and health region. Length of stay (LOS) for episodes of hospital care were adjusted for age, sex and cardiac procedures using ordinary least squares regression. RESULTS: Overall, AMI, angina and chest pain hospitalization rates increased 6%, 8% and 11%, respectively, between fiscal years 1994/95 and 1999/2000 and decreased by 7% for CHF in Canada. There was wide regional variation in cardiovascular hospitalization rates in Canada, with the greatest variation seen in CHF, chest pain and angina, and the least seen in AMI. There was a modest downward trend in adjusted LOS between fiscal years 1994/95 and 1999/2000. In general, patients hospitalized in provinces in western Canada and Ontario had shorter LOS for all conditions when compared with those in Quebec and the eastern provinces. CONCLUSIONS: AMI, angina and chest pain hospitalization rates in Canada increased between fiscal years 1994/95 and 1999/2000, while CHF rates declined. There is considerable regional variation in the cardiovascular hospitalization rates across the country that may be amenable to further interventional strategies.

Adult↗

PubMed2003

Regional variations in cardiovascular mortality in Canada.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in Canada with wide, unexplained regional variations in heart disease mortality. However, no studies to date have explored the relationship between a number of health region characteristics and regional variation in heart disease mortality rates across Canada. INTRODUCTION: We studied the contribution of various traditional cardiac risk factors, social determinants of health and other community characteristics to regional variations in heart disease mortality rates across Canada. METHODS: Cardiovascular disease and ischemic heart disease (IHD) age-standardized mortality rates were obtained from Statistics Canada for three years - 1995 to 1997. Health region characteristics were taken from the 2000/2001 Canadian Community Health Survey, and the 1996 Canadian Census and the Labour Force Survey. Linear regression analyses and analyses of variance were employed to identify relationships between these health region characteristics and CVD and IHD mortality rates. RESULTS: Significant regional variations in CVD mortality rates per 100,000 population were observed. Newfoundland and Labrador had the highest CVD and IHD mortality rates, while Nunavut and the Northwest Territories had the lowest CVD and IHD mortality rates. Health region smoking and unemployment rates were identified as the most important factors associated with CVD and IHD mortality at the health region level. CONCLUSIONS: Significant regional variations in age-standardized CVD and IHD mortality were noted both at the provincial/territorial level and the health region level. Efforts to reduce CVD and IHD mortality in Canada require attention to both traditional risk factors (eg, smoking) and broader determinants of health (eg, unemployment rates).

Age Distribution↗

PubMed2003

Trends in cardiovascular drug utilization and drug expenditures in Canada between 1996 and 2001.

BACKGROUND: There is increasing interest in studying trends in drug utilization because drug costs are the fastest growing sector of the health care system. OBJECTIVES: To focus on the trends in the utilization of and expenditures for cardiovascular drugs in Canada by drug class and by province over a six-year period. METHODS: Data from the IMS Health Canada CompuScript Audit database were used for this study from the period of February 1996 to January 2002. Patterns of drug utilization and expenditures in Canada were described for cardiovascular drug classes, individual agents within classes and by provincial analyses. RESULTS: Substantial increases in both the utilization of and the expenditures for cardiovascular medications have occurred in Canada over the last six years. Newer medication classes such as angiotensin converting enzyme inhibitors and statins now comprise the majority of cardiovascular drugs prescribed, along with continued high use of diuretics. Increases in some drug classes, such as angiotensin converting enzyme inhibitors, statins and beta-blockers, appear to be based on trial evidence or guidelines. However, marketing may play a larger role in the increases in use of angiotensin receptor blockers and specific drugs, such as amlodipine besylate and atorvastatin, because their increased utilization cannot be explained by major clinical trial evidence and/or practice guidelines. CONCLUSIONS: Changes in patterns of cardiovascular drug utilization and expenditures in Canada may be associated with clinical trial evidence, clinical practice guidelines, policy changes and/or marketing initiatives.

Canada↗

PubMed2002

Hypertension guidelines in elderly patients: is anybody listening?

PURPOSE: Previous guidelines for the management of uncomplicated hypertension in elderly patients have recommended diuretic agents and then beta-blockers. We examined trends in the initial treatment choice for elderly people with hypertension and the effects of a government-sponsored program to publish and disseminate a simplified version of the national guidelines for the treatment of hypertension to all physicians in Ontario, Canada. SUBJECTS AND METHODS: Linked administrative databases containing information on the more than 1.2 million elderly residents in Ontario were used. Time series analysis was performed to determine prescribing trends from 1993 to 1998 for patients who began antihypertensive medication for the treatment of hypertension and to examine the effects of the simplified guidelines that were distributed in July of 1995. RESULTS: Diuretic agents were the most commonly prescribed medications, with annual rates from 35% to 38% (P = 0.59) throughout the study. Beta-blocker prescribing rose from 12% to 16% (P <0.01), whereas angiotensin-converting enzyme (ACE) inhibitor prescribing rose from 27% to 32% (P <0.01). Prescriptions for calcium channel blockers dropped significantly, from 23% to 14% (P <0.01). However, the publication and dissemination of the Ontario hypertension guidelines had no statistically significant effects on the proportion of patients who began treatment with a diuretic agent (P = 0.55), beta-blocker, (P = 0.32), ACE inhibitor (P = 0.09), or calcium channel blocker (P = 0.07). CONCLUSION: The dissemination of simplified practice guidelines for hypertension did not have notable effects on prescribing patterns in Ontario.

Adrenergic beta-Antagonists↗

PubMed2002

A multicenter study of the coding accuracy of hospital discharge administrative data for patients admitted to cardiac care units in Ontario.

BACKGROUND: Cardiac health services researchers frequently use cohorts derived from administrative hospital discharge abstract data to study the outcomes and treatment of coronary artery disease. However, relatively limited data exist on the accuracy of the coding of cardiac diagnoses in discharge abstract data. The goal of this study was to examine the accuracy of the coding of acute myocardial infarction and other cardiac diagnoses in the Canadian Institute of Health Information hospital discharge abstracts. METHODS: Patients admitted to 58 cardiac care units (CCUs) in Ontario that participated in the Fastrak II Acute Coronary Syndromes registry were linked to CIHI hospital discharge abstracts. The most responsible diagnosis at hospital discharge in the administrative data was compared with the CCU discharge diagnosis in the clinical registry. RESULTS: A total of 58,816 CCU patients were linked to hospital discharge abstract data. The specificity, sensitivity, and positive predictive value of a most responsible diagnosis of acute myocardial infarction were 92.8%, 88.8%, and 88.5%, respectively. The specificity of CIHI diagnosis codes for arrhythmia, congestive heart failure, unstable angina, and chest pain not yet diagnosed were all at least 93.9%. However, the sensitivity of these CIHI diagnosis codes was no greater than 60.7%. Furthermore, the positive predictive values were no larger than 80.8%. CONCLUSION: Myocardial infarction is generally accurately coded in Ontario hospital discharge abstract data. However, other cardiac diagnoses are less reliably coded in discharge abstract data.

Aged↗

PubMed2002

Factoring socioeconomic status into cardiac performance profiling for hospitals: does it matter?

BACKGROUND: Critics of "scorecard medicine" often highlight the incompleteness of risk-adjustment methods used when accounting for baseline patient differences. Although socioeconomic status is a highly important determinant of adverse outcome for patients admitted to the hospital with acute myocardial infarction, it has not been used in most risk-adjustment models for cardiovascular report cards. OBJECTIVES: To determine the incremental impact of socioeconomic status adjustments on age, sex, and illness severity for hospital-specific 30-day mortality rates after acute myocardial infarction. METHODS: The authors compared the absolute and relative hospital-specific 30-day acute myocardial infarction mortality rates in 169 hospitals throughout Ontario between April 1, 1994 and March 31, 1997. Patient socioeconomic status was characterized by median neighborhood income using postal codes and 1996 Canadian census data. They examined two risk-adjustment models: the first adjusted for age, sex, and illness severity (standard), whereas the second adjusted for age, sex, illness severity, and median neighborhood income level (socioeconomic status). RESULTS: There was an extremely strong correlation between 'standard' and 'socioeconomic status' risk-adjusted mortality rates (r = 0.99). Absolute differences in 30-day risk-adjusted mortality rates between the socioeconomic status and standard risk-adjustment models were small (median, 0.1%; 25th-75th percentile, 0.1-0.2). The agreement in the quintile rankings of hospitals between the socioeconomic status and standard risk-adjustment models was high (weighted kappa = 0.93). CONCLUSION: Despite its importance as a determinant of patient outcomes, the effect of socioeconomic status on hospital-specific mortality rates over and above standard risk-adjustment methods for acute myocardial infarction hospital profiling in Ontario was negligible.

Age Factors↗