RESUMEN
Predictive risk models using general practice (GP) data to predict the risk of hospitalisation have the potential to identify patients for targeted care. Effective use can help deliver significant reductions in the incidence of hospitalisation, particularly for patients with chronic conditions, the highest consumers of hospital resources. There are currently no published validated risk models for the Australian context using GP data to predict hospitalisation. In addition, published models for other contexts typically rely on a patient's history of prior hospitalisations, a field not commonly available in GP information systems, as a predictor. We present a predictive risk model developed for use by GPs to assist in targeting coordinated healthcare to patients most in need. The algorithm was developed and validated using a retrospective primary care cohort, linked to records of hospitalisation in Victoria, Australia, to predict the risk of hospitalisation within one year. Predictors employed include demographics, prescription history, pathology results and disease diagnoses. Prior hospitalisation information was not employed as a predictor. Our model shows good performance and has been implemented within primary care practices participating in Health Care Homes, an Australian Government initiative being trialled for providing ongoing comprehensive care for patients with chronic and complex conditions.
Asunto(s)
Hospitalización/estadística & datos numéricos , Afecciones Crónicas Múltiples/epidemiología , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Algoritmos , Australia/epidemiología , Medicina General/estadística & datos numéricos , Humanos , PacientesRESUMEN
OBJECTIVES: To investigate whether General Practice Management Plans (GPMPs), Team Care Arrangements (TCAs) and reviews of these improve the management and outcomes of patients with diabetes when supported by cdmNet, a web-based chronic disease management system; and to investigate adherence to the annual cycle of care (ACOC), as recommended in diabetes guidelines. DESIGN, PARTICIPANTS AND SETTING: A before-and-after study to analyse prospectively collected data on 577 patients with type 1 or 2 diabetes mellitus who were managed with a GPMP created using cdmNet between June 2008 and November 2012. MAIN OUTCOME MEASURES: Completion of the clinical tests in the ACOC (process outcome) and values of six of these clinical measurements (clinical outcomes). RESULTS: Significant improvements were seen after creation of a GPMP in the proportion of ACOC clinical tests completed (57.9% v 74.8%, P < 0.001), total cholesterol level (P < 0.01), low-density lipoprotein (LDL) cholesterol level (P < 0.001) and body mass index (BMI) (P < 0.01). Patients using GPMPs and TCAs also improved their glycated haemoglobin (HbA1c) level (P < 0.05). Patients followed up with irregular reviews had significant improvements in the proportion of ACOC clinical tests completed (59.2% v 77.6%, P < 0.001), total cholesterol level (P < 0.05), and BMI (P < 0.01), but patients with regular reviews had greater improvements in the proportion of ACOC clinical tests completed (58.9% v 85.0%, P < 0.001), HbA(1c) level (57.7 v 53.0 mmol/mol, P < 0.05), total cholesterol level (4.8 v 4.5 mmol/L, P < 0.05), LDL cholesterol level (2.8 v 2.4 mmol/L, P < 0.01) and diastolic blood pressure (76.0 v 74.0 mmHg, P < 0.05). CONCLUSION: There were significant improvements in process and clinical outcomes for patients on a GPMP or a GPMP and TCA, particularly when these were followed up by regular reviews. Patients using cdmNet were four times more likely to have their GPMP or TCA followed up through regular reviews than the national average.
Asunto(s)
Diabetes Mellitus/terapia , Medicina General/organización & administración , Planificación de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/organización & administración , Pautas de la Práctica en Medicina/organización & administración , Australia , Diabetes Mellitus/prevención & control , Femenino , Adhesión a Directriz/estadística & datos numéricos , Humanos , Hipoglucemiantes/uso terapéutico , Masculino , Visita a Consultorio Médico/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud , Cooperación del Paciente/estadística & datos numéricos , Educación del Paciente como Asunto , Estudios ProspectivosRESUMEN
BACKGROUND: Lymph node yield (LNY) is a measure of quality of care and a strong prognostic factor for outcome from colorectal cancer (CRC). The main aims of this study were to determine LNY across multiple Australian centres and the clinico-pathologic factors that influence yield. METHODS: Analysis of data from prospective CRC databases at 11 Australian centres between January 1988 and May 2008 was undertaken utilizing the linkage and analysis resources of BioGrid Australia. The LNY depending on different clinico-pathologic patient characteristics was evaluated. RESULTS: In total, 10,082 cases (54.1% men, 45.9% women) were identified. Median LNY was 12 (range 0-174). LNY increased significantly (P < 0.001) over time, from a mean of 8.5 in 1988 to 13 in 2008. LNY also varied significantly between surgical centres. Female gender, younger age, right-sided disease, higher T and N stage, specific operation types and absence of preoperative radiotherapy were all significantly associated with higher LNY. CONCLUSIONS: While varying across centres, the median LNYs in Australia are acceptable and have improved significantly over recent years. Multiple clinico-pathologic factors significantly influence the number of nodes retrieved.
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Neoplasias Colorrectales/secundario , Escisión del Ganglio Linfático/métodos , Ganglios Linfáticos/patología , Garantía de la Calidad de Atención de Salud , Abdomen , Anciano , Neoplasias Colorrectales/cirugía , Femenino , Estudios de Seguimiento , Humanos , Ganglios Linfáticos/cirugía , Masculino , Estadificación de Neoplasias , Estudios ProspectivosRESUMEN
BioGrid Australia is a federated data linkage and integration infrastructure that uses the Internet to enable patient specific information to be utilized for research in a privacy protected manner, from multiple databases of various data types (e.g. clinical, treatment, genomic, image, histopathology and outcome), from a range of diseases (oncological, neurological, endocrine and respiratory) and across more than 20 health services, universities and medical research institutes. BioGrid has demonstrated an ability to facilitate powerful research into the causation of human disease and the prediction of disease and treatment outcomes. BioGrid has successfully implemented technology and processes that allow researchers to efficiently extract data from multiple sources, without compromising data security and privacy. This article reviews BioGrid's first seven years and how it has overcome 9 of its top 10 challenges.
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Investigación Biomédica/métodos , Biología Computacional/métodos , Conducta Cooperativa , Recolección de Datos/normas , Bases de Datos Factuales/normas , Academias e Institutos , Australia , Seguridad Computacional , Recolección de Datos/métodos , Recolección de Datos/tendencias , Humanos , PrivacidadRESUMEN
AIM: The aims of this study were to calculate theoretical cost savings of oxaliplatin dose rounding in colorectal cancer (CRC), and to assess clinician attitudes to chemotherapy dose rounding. METHODS: Data were obtained from a prospective data repository (BioGrid Australia) from four hospitals regarding the use of oxaliplatin, given at a standard dose of 85 mg/m(2). We examined potential cost savings for patients with a body surface area (BSA) between 1.77 m(2) and 1.94 m(2), resulting in a calculated dose up to 10% above 150 mg (a 100 mg and 50 mg vial). The attitudes of oncologists at these hospitals toward minor dose reductions were assessed. RESULTS: From January 2003 to June 2008, of 676 patients with Stages III or IV CRC, 227 (33.58%) received oxaliplatin. Overall 66 patients (29%) had a calculated BSA between 1.77 m(2) and 1.94 m(2). The potential cost saving for these hospitals in one year, if oxaliplatin doses were rounded down to 150 mg, is $AU51,898. Extrapolated to the Australian population, estimated savings are over $AU2.5 million per year. Three of nine (33.3%) oncologists were comfortable with an initial dose reduction of up to 10% in the adjuvant disease setting, and seven of nine (77.8%) in the setting of metastatic disease. CONCLUSION: Minor dose reductions for CRC to accommodate vial sizes would lead to significant cost savings. Oncologists are more comfortable with minor dose reductions when treatment is given in a palliative setting.
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Antineoplásicos/administración & dosificación , Antineoplásicos/economía , Neoplasias Colorrectales/tratamiento farmacológico , Conocimientos, Actitudes y Práctica en Salud , Compuestos Organoplatinos/administración & dosificación , Compuestos Organoplatinos/economía , Neoplasias Colorrectales/economía , Ahorro de Costo/economía , Costos de la Atención en Salud , Humanos , Oncología Médica/economía , OxaliplatinoRESUMEN
This chapter gives an educational overview of: * The clinical research lifecycle * Sources of research data * The need for contextual data standardization to retain meaning * Information management principles for sustainable data * Data linkage technologies used to support collaborative research aimed at improving health outcomes * Making use of identifiers in health.
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Investigación Biomédica , Gestión de la Información , Confidencialidad , Recolección de Datos , Gestión de la Información/ética , Sistemas de Información/organización & administración , Informática Médica , Evaluación de Resultado en la Atención de Salud , Systematized Nomenclature of MedicineRESUMEN
BACKGROUND: Collecting data regarding treatment and outcomes of patients with cancer, for both audit and research purposes, is a common but challenging goal. Modern technology promises greater ease and sophistication for data collection, linkage and analysis, but many traditional challenges remain. METHOD: Here we relate our experience of an initiative aimed at multicentre colorectal cancer data collection, that is, in collaboration with the Colorectal Surgical Society Australia and New Zealand, moving towards a national initiative. RESULTS: Initiated from a single site in Melbourne, using a range of data collection and linkage processes, and optimizing the use of modern technology, we have now implemented and sustained comprehensive and multidisciplinary data collection across multiple Victorian and interstate institutions. Specific challenges related to ethics and privacy, data accuracy and completeness and data ownership have been addressed and many lessons have been learnt. Multicentre audit and research queries can now be conducted with confidence that privacy, security and intellectual property issues are addressed. Research output, including many studies that were not previously possible, has informed a broad range of topics relevant to colorectal cancer. CONCLUSION: Multicentre and comprehensive data collection for colorectal cancer is achievable and sustainable and promises great benefit as an audit and research tool. Similar initiatives could be established for other tumour types.
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Neoplasias Colorrectales , Bases de Datos como Asunto , Australia , Humanos , Informática Médica , Modelos Biológicos , Biología Molecular , Programas Nacionales de SaludRESUMEN
In 2005 a major collaboration in Melbourne, Australia successfully implemented a major medical informatics infrastructure. The convergence of life sciences, healthcare, and information technology is now driving research into the fundamentals of disease causation and toward tailoring individualized treatment. The Molecular Medicine Informatics Model (MMIM) is a 'virtual' research repository of clinical, laboratory and genetic data sets. Integrated data, physically located within independent hospital and research organisations can be searched and queried seamlessly via a federated data integrator. Researchers must gain authorisation to access data, and obtain permission from the data owners before the data can be accessed. The legal and ethical issues surrounding the use of this health data have been addressed so data complies with privacy requirements. The MMIM platform also record links individual cases across multiple institutions and multiple clinical specialties. Significant research outcomes in epilepsy and colorectal cancer have already been enabled by the MMIM research platform. The infrastructure of MMIM enables discovery research to be accessible via the Web with security, intellectual property and privacy addressed.
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Bases de Datos Factuales , Informática Médica , Biología Molecular , Humanos , Registro Médico Coordinado , Sistemas de Registros Médicos Computarizados , Integración de SistemasRESUMEN
In 2005, a major collaboration in Melbourne Australia successfully completed implementing a major medical informatics infrastructure - this is now being used for discovery research and has won significant expansion funding for 2006 - 2009. The convergence of life sciences, healthcare, and information technology is now driving research into the fundamentals of disease causation. Key to enabling this is collating data in sufficient numbers of patients to ensure studies are adequately powered. The Molecular Medicine Informatics Model (MMIM) is a 'virtual' research repository of clinical, laboratory and genetic data sets. Integrated data, physically located within independent hospital and research organisations can be searched and queried seamlessly via a federated data integrator. Researchers must gain authorisation to access data, and inform/obtain permission from the data owners, before the data can be accessed. The legal and ethical issues surrounding the use of this health data have been addressed so data complies with privacy requirements. The MMIM platform has also solved the issue of record linking individual cases and integrating data sources across multiple institutions and multiple clinical specialties. Significant research outcomes already enabled by the MMIM research platform include epilepsy seizure analyses for responders / non responders to therapy; sensitivity of faecal occult blood testing for asymptomatic colorectal cancer and advanced adenomas over a 25-year experience in colorectal cancer screening; subsite-specific colorectal cancer in diabetic and non diabetic patients; and the influence of language spoken on colorectal cancer diagnosis, management and outcomes. Ultimately the infrastructure of MMIM enables discovery research to be accessible via the Web with security, intellectual property and privacy addressed.