Data that makes a difference in quality improvements in primary health care: approaches through a pan-Canadian voluntary electronic medical record source.

Primary Health Care (PHC) is the most common health care experienced by Canadians and is an important source of chronic disease prevention and management; however, PHC providers say they have little information about their patient populations, especially groups of patients with multiple conditions. The Canadian Institute for Health Information in collaboration with 50 PHC providers examined the ability to extract and use a subset of PHC EMR data from four disparate environments in an agreed and privacy sensitive manner. Findings describing the feasibility of clinician engagement, EMR data extraction, EMR content standards and data utility gaps, information system requirements, and systemic enablers and barriers are described in this paper. Ability to collect and use discrete and standardized clinical and administrative information is fundamental to improving practice efficiency, optimal use of information, and patient quality of care. Improving quality of EMR data captured at the point of service will considerably enable our ability to measure and understand PHC across Canada; promote dialogue to identify priority information needs; and support health system information uses for clinical program and health system management, research, and population surveillance.

Recent Trends in Hospitalizations for Cardiovascular Disease, Stroke, and Vascular Cognitive Impairment in Canada.

BACKGROUND: We analyzed hospitalization rates for a broad set of cardiovascular diseases, stroke, and vascular cognitive impairment (VCI) between 2007 and 2016 in Canada to characterize population-level trends and demographic and provincial/territorial variation in inpatient health care utilization. METHODS: Record-level administrative hospitalization data from April 1, 2007 to March 31, 2017 for individuals aged 0-105 years were obtained from the Canadian Institute for Health Information Discharge Abstract Database. Data were available for all provinces and territories, except Quebec. Using the International Classification of Diseases (10th Revision, Canada) diagnostic coding standards, we identified disease categories related to cardiovascular disease, stroke, or VCI. Hospitalizations, crude and standardized, for age and sex (direct method) were calculated using the 2011 Census as the standard population. RESULTS: Between 2007 and 2016, percent decreases in standardized hospitalization rates were relatively small for heart failure and stroke (-2.4% and -4.7%, respectively), whereas those for coronary artery and vascular disease and heart rhythm disorders were moderate (-27.4% and -16.8%, respectively). Percent increases were relatively small for congenital heart disease (+7.2%) and moderate for acquired valvular heart disease (+31.1%) and VCI (+23.4%). There were notable age- and sex-specific differences along with provincial/territorial variation. CONCLUSIONS: Between 2007 and 2016, there was an overall decrease in standardized hospitalization rates for coronary artery and vascular disease, heart failure, heart rhythm disorders, and stroke, and an increase in hospitalization rates for structural heart disease (congenital heart disease and acquired valvular heart disease) and VCI in Canada.

COVID-19 Pandemic: Global Impact and Potential Implications for Cardiovascular Disease in Canada.

BACKGROUND: The literature indicates that cardiovascular disease (CVD; including stroke), older age, and availability of health care resources affect COVID-19 case fatality rates (CFRs). The cumulative effect of COVID-19 CFRs in global CVD populations and the extrapolated effect on access to health care services in the CVD population in Canada are not fully known. In this study we explored the relationships of factors that might affect COVID-19 CFRs and estimated the potential indirect effects of COVID-19 on Canadian health care resources. METHODS: Country-level epidemiological data were analyzed to study the correlation, main effect, and interaction between COVID-19 CFRs and: (1) the proportion of the population with CVD; (2) the proportion of the population 65 years of age or older; and (3) the availability of essential health services as defined by the World Health Organization Universal Health Coverage index. For indirect implications on health care resources, estimates of the volume of postponed coronary artery bypass grafting, percutaneous coronary intervention, and valve surgeries in Ontario were calculated. RESULTS: Positive correlations were found between COVID-19 CFRs and: (1) the proportion of the population with CVD (ρ = 0.40; P = 0.001); (2) the proportion of the population 65 years of age or older (ρ = 0.43; P = 0.0005); and (3) Universal Health Coverage index (ρ = 0.27; P = 0.03). For every 1% increase in the proportion of the population 65 years of age or older or proportion of the population with CVD, the COVID-19 CFR was 9% and 19% higher, respectively. Approximately 1252 procedures would be postponed monthly in Ontario because of current public health measures. CONCLUSIONS: Countries with more prevalent CVD reported higher COVID-19 CFRs. Strain on health care resources is likely in Canada.

CONTEXTE: La littérature indique que les maladies cardiovasculaires (MCV, incluant les accidents vasculaires cérébraux), l'âge avancé et la facilité d'accès aux ressources de soins de santé ont une incidence sur les taux de létalité (TL) des cas de COVID-19. L'effet cumulatif du TL de la COVID-19 dans l'ensemble de la population atteinte de MCV et l'impact anticipé sur l'accès aux services de santé dans la population atteinte de MCV au Canada ne sont pas entièrement connus. Cette étude a exploré les liens entre les facteurs pouvant influencer le TL des cas de COVID-19 et a estimé le potentiel impact indirect de la COVID-19 sur les ressources de soins de santé au Canada. MÉTHODES: Les données épidémiologiques à l'échelle du pays ont été analysées pour étudier la corrélation, l'effet principal et l'interaction entre le TL de laCOVID-19 et : 1) la proportion de la population souffrant de MCV, 2) la proportion de la population ≥ 65 ans, et 3) l'accessibilité des services de santé essentiels tels que définis par l'indice de couverture sanitaire universelle (CSU) de l'Organisation Mondiale de la Santé. Pour les implications indirectes concernant les ressources de santé, des estimations du volume d'opération de pontages coronariens, d'interventions coronariennes percutanées et de chirurgies valvulaires reportées en Ontario ont été calculées. RÉSULTATS: Des corrélations positives ont été trouvées entre le TL de la COVID-19 et 1) la proportion de la population souffrant de MCV (ρ= 0,40, P = 0,001), 2) la proportion de la population ≥ 65 ans (ρ= 0,43, P = 0,0005), et 3) l'indice CSU (ρ= 0,27, P = 0,03). Pour chaque augmentation de 1 % de la proportion de la population ≥ 65 ans ou de la proportion de la population souffrant de MCV, le TL de la COVID-19 était respectivement supérieur de 9 % et 19 %. Environ 1 252 interventions seraient reportées chaque mois en Ontario en raison des mesures de santé publique actuelles. CONCLUSIONS: Les pays où les MCV sont plus répandues ont signalé un TL de la COVID-19 plus élevé. Il est probable que les ressources de soins de santé soient soumises à de fortes contraintes au Canada.