The REFINEMENT Glossary of Terms: An International Terminology for Mental Health Systems Assessment.

Comparing mental health systems across countries is difficult because of the lack of an agreed upon terminology covering services and related financing issues. Within the European Union project REFINEMENT, international mental health care experts applied an innovative mixed "top-down" and "bottom-up" approach following a multistep design thinking strategy to compile a glossary on mental health systems, using local services as pilots. The final REFINEMENT glossary consisted of 432 terms related to service provision, service utilisation, quality of care and financing. The aim of this study was to describe the iterative process and methodology of developing this glossary.

Real-world experience with anti-PD-1/PD-L1 monotherapy in patients with non-small cell lung cancer : A retrospective Austrian multicenter study.

OBJECTIVE: As real-world data regarding immunotherapy for non-small cell lung cancer are lacking for Austria, we conducted a retrospective study in six hospitals to present data from real-world practice. METHODS: Patients with metastatic non-small cell lung cancer were stratified into two groups, either patients with first-line pembrolizumab monotherapy (cohort 1) or patients with second-line nivolumab, pembrolizumab or atezolizumab monotherapy (cohort 2). Primary outcome measures were objective response rate and overall survival. A matched-pair analysis was performed to compare overall survival to patients from the Tyrolean Lung Cancer Project as a historical control group. RESULTS: In total, 89 patients were identified, 42 patients in cohort 1 and 47 patients in cohort 2. The objective response rates were 43.3% and 31.4%, respectively. The median overall survival was 17.0 months (95% CI 11.7-21.5 months) in cohort 1 and 18.7 months (95% CI 9.5-23.4 months) in cohort 2. Treatment-related adverse events grades 3 and 4 were reported in 11.2% of patients. The matched-pair analysis showed a median overall survival of 15.2 months (95% CI 7.6-20.4 months) for first-line pembrolizumab monotherapy compared to 9.8 months (95% CI 7.8-11.6 months) for the historical control (p = 0.43). In cohort 2, a median overall survival of 20.3 months (95% CI 6.9-26.2 months) for second-line immunotherapy compared to 5.4 months (95% CI 3.2-11.7 months) for the historical control (p = 0.18) was shown. CONCLUSION: The results are comparable with other real-world studies and, when matched to historical controls, support the improvement in outcomes made possible by these agents.

Improving Information About Private Consultants Through Data Linkage.

In Austria, there is no single source of truth holding information about all physicians and their medical practice. Therefore, different sources have to be combined to accumulate detailed information about doctors, identify data errors and increase overall data quality. The aim of this project is to link two datasets from vastly different origins utilizing reproduceable and mostly automatic procedures in contrast to manually acquired links in the past. As there is no global identifier, names and addresses of the doctors were used instead. Because of different spellings and typos of names and addresses within and in between the datasets, direct comparison does not lead to satisfactory results. Therefore, probabilistic matching with string metrics was applied. The utilized methods significantly improve the linkage and allow to match about 80 % of the private consultants in both datasets.

Health Care Atlases: Informing the General Public About the Situation of the Austrian Health Care System.

There is a great number of complex data concerning the Austrian Health Care System. The goal was to process this data and present it to the general public on an easily accessible information platform. The platform focuses on data about the burden of disease of the Austrian Population, the available medical care and the services provided by the physicians. Due to the vast differences in the underlying source data, the methods used for the data acquisition range from statistical linkage over web scraping to aggregating data on the reimbursed services. The results are published on a website and are mainly displayed with interactive graphics. Overall, these dynamic and interactive websites provide a good overview of the situation of the Austrian Health Care System and presents the information in an intuitive and comprehensible manner. Furthermore, the information given in the atlases can contribute to the health care planning in order to identify distinctive service provision in Austria.

Using national electronic health care registries for comparing the risk of psychiatric re-hospitalisation in six European countries: Opportunities and limitations.

Psychiatric re-hospitalisation rates have been of longstanding interest as health care quality metric for planners and policy makers, but are criticized for not being comparable across hospitals and countries due to measurement unclarities. The objectives of the present study were to explore the interoperability of national electronic routine health care registries of six European countries (Austria, Finland, Italy, Norway, Romania, Slovenia) and, by using variables found to be comparable, to calculate and compare re-hospitalisation rates and the associated risk factors. A "Methods Toolkit" was developed for exploring the interoperability of registry data and protocol led pilot studies were carried out. Problems encountered in this process are described. Using restricted but comparable data sets, up to twofold differences in psychiatric re-hospitalisation rates were found between countries for both a 30- and 365-day follow-up period. Cumulative incidence curves revealed noteworthy additional differences. Health system characteristics are discussed as potential causes for the differences. Multi-level logistic regression analyses showed that younger age and a diagnosis of schizophrenia/mania/bipolar disorder consistently increased the probability of psychiatric re-hospitalisation across countries. It is concluded that the advantage of having large unselected study populations of national electronic health care registries needs to be balanced against the considerable efforts to examine the interoperability of databases in cross-country comparisons.

Guidance for a causal comparative effectiveness analysis emulating a target trial based on big real world evidence: when to start statin treatment.

Aim: The aim of this project is to describe a causal (counterfactual) approach for analyzing when to start statin treatment to prevent cardiovascular disease using real-world evidence. Methods: We use directed acyclic graphs to operationalize and visualize the causal research question considering selection bias, potential time-independent and time-dependent confounding. We provide a study protocol following the 'target trial' approach and describe the data structure needed for the causal assessment. Conclusion: The study protocol can be applied to real-world data, in general. However, the structure and quality of the database play an essential role for the validity of the results, and database-specific potential for bias needs to be explicitly considered.

Secondary Use of Claims Data from the Austrian Health Insurance System with i2b2: A Pilot Study.

BACKGROUND: In conformity with increasing international efforts to reuse routine health data for scientific purposes, the Main Association of Austrian Social Security Organisations provides pseudonymized claims data of the Austrian health care system for clinical research. OBJECTIVES: We aimed to examine, whether an integration of the corresponding database into i2b2 would be possible and provide benefits. METHODS: We applied docker-based software containers and data transformations to set up the system. To assess the benefits of i2b2 we plan to reenact the task of cohort formation of an earlier research project. RESULTS: The claims database was successfully integrated into i2b2. The docker-based installation approach will be published as git repository. The assessment of i2b2's benefits is currently work in progress and will be presented at the conference. CONCLUSIONS: Docker enables a flexible, reproducible, and resource-efficient installation of i2b2 within the restricted environment implied by our highly secured target system. First preliminary tests indicated several potential benefits of i2b2 compared to the methods applied during the earlier research project.