Tracking emergency response actions during COVID-19 leads to development of an innovative public health evaluation tool.

SETTING: Early in the pandemic, KFL&A Public Health needed a way to capture, organize, and display COVID-19-related events to be accountable for and evaluate our actions. INTERVENTION: We used accessible software (Microsoft Office 365 suite, Microsoft PowerBI) to develop a data collection and visualization system. The Canadian Institute for Health Information (CIHI) developed a timeline and categorization approach for provincial and national COVID-related interventions, which was used to develop a regional version for local events using similar categories. We collected and displayed qualitative data alongside epidemiological data that allowed users to display different timelines of actions and outcomes and evaluate our response. OUTCOMES: In developing the timeline, we took stock of the information and data we wanted to collect, sort, and display locally. Next, we collected information on response actions, case and contact tracing, and staffing changes in a database that we displayed on a timeline. We included CIHI's data set to provide insight into pandemic response across all jurisdictions. IMPLICATIONS: Our timeline tool has many advantages for public health authorities beyond responding to a rapidly evolving emergency. By collecting information on events as they occur, decisions and actions are documented that may otherwise be overlooked. This enables decision-makers to visualize the impact of public health actions on health outcomes over time. The tool is completely customizable and scalable depending on the project scope and we plan to apply this method to other public health programming. Finally, we include lessons learned from quickly developing these tools in a real-time pandemic setting, both locally at KFL&A Public Health and nationally at CIHI.

RéSUMé: LIEU: Au début de la pandémie, le Bureau de santé de Kingston, Frontenac, Lennox et Addington (KFL&A) avait besoin d'un moyen de saisir, d'organiser et de présenter les événements liés à la COVID-19 pour pouvoir en rendre compte et évaluer ses actions. INTERVENTION: Nous avons utilisé des logiciels accessibles (Microsoft Office 365, Microsoft PowerBI) pour mettre au point un système de collecte et de visualisation de données. L'Institut canadien d'information sur la santé (ICIS) a créé un fil d'actualité et une approche de catégorisation pour les interventions provinciales et nationales liées à la COVID; nous avons créé une version régionale de ces outils pour présenter les événements locaux, en utilisant des catégories semblables. Nous avons collecté et affiché des données qualitatives en plus des données épidémiologiques, ce qui a permis aux utilisateurs d'afficher les mesures prises et leurs résultats sur différentes périodes et d'évaluer leurs interventions. RéSULTATS: Pour créer ce fil d'actualité, nous avons fait l'inventaire des informations et des données que nous voulions collecter, trier et présenter localement. Ensuite, nous avons réuni des informations sur les mesures d'intervention, les enquêtes sur les cas, la recherche de contacts et les changements de personnel dans une base de données, et nous les avons présentées dans un fil d'actualité. Nous avons inclus le jeu de données de l'ICIS pour apporter un éclairage sur la lutte contre la pandémie dans toutes les administrations du pays. CONSéQUENCES: Notre fil d'actualité présente de nombreux avantages pour les autorités de santé publique, en plus de la possibilité de réagir à une situation urgence qui évolue rapidement. En collectant des informations sur les événements à mesure qu'ils se produisent, il est possible de documenter des décisions et des mesures qui risquent d'être oubliées sinon. Cela permet aux décideurs de visualiser dans le temps l'effet des mesures de santé publique sur les résultats cliniques. L'outil est entièrement personnalisable et évolutif, selon la portée du projet, et nous avons l'intention de l'appliquer à d'autres programmes de santé publique. Enfin, nous présentons les leçons de la mise au point rapide d'un tel outil pendant une pandémie en temps réel, tant à l'échelle locale (à la Santé publique de KFL&A) qu'à l'échelle nationale (à l'ICIS).

COVID-19 Vaccine Uptake in Southeastern Ontario, Canada: Monitoring and Addressing Health Inequities.

CONTEXT: Implementation of a population-based COVID-19 vaccine strategy, with a tailored approach to reduce inequities in 2-dose coverage, by a mid-sized local public health agency in southeastern Ontario, Canada. PROGRAM: Coverage maps and crude and age-standardized coverage rates by material and social deprivation, urban/rural status, and sex were calculated biweekly and reviewed by local public health planners. In collaboration with community partners, the results guided targeted strategies to enhance uptake for marginalized populations. EVALUATION: The largest gaps in vaccine coverage were for those living in more materially deprived areas and rural residents-coverage was lower by 10.9% (95% confidence interval: -11.8 to -10.0) and 9.3% (95% confidence interval: -10.4 to -8.1) for these groups compared with living in less deprived areas and urban residents, respectively. The gaps for all health equity indicators decreased statistically significantly over time. Targeted strategies included expanding clinic operating hours and availability of walk-in appointments, mobile clinics targeted to marginalized populations, leveraging primary care partners to provide pop-up clinics in rural and materially and socially deprived areas, and collaborating with multiple partners to coordinate communication efforts, especially in rural areas. DISCUSSION: The scale and scope of monitoring and improving local vaccine uptake are unprecedented. Regular review of health equity indicators provided critical situational awareness for decision makers, allowing partners to align and tailor strategies locally and in collaboration with one another. Health care providers and pharmacies/pharmacists are key partners who require innovative support to increase uptake in marginalized groups. Continued engagement of other community partners such as schools, municipalities, and local service groups is also crucial. A "hyper local" approach is needed along with commitment from partners in all sectors and at all levels to reduce barriers to vaccination that lie further upstream for marginalized groups.

Prevalence of toddler, child and adolescent overweight and obesity derived from primary care electronic medical records: an observational study.

BACKGROUND: Population monitoring and surveillance of objectively measured child weight data in Canada is limited to national surveys with poor regional applicability, and no healthy weight data are available for children less than 2 years of age. We aimed to determine the prevalence of childhood overweight and obesity using objective measures derived from primary care electronic medical records. METHODS: Observational data included all height and weight records for children less than 20 years of age, between 2004 and 2013, from 3 Ontario primary care research networks. We calculated body mass index (BMI)-for-age and weight-for-length using the World Health Organization Growth Standards and Reference to assign growth status indicator categories by age group. Descriptive data and prevalence estimates were generated for 2013. We also compared weight-for-length for children less than 2 years of age with a corresponding billing code for known well-child visits. RESULTS: Our study included 8261 children with a corresponding growth status indicator, a sample close to 4 times larger than the national survey sample. In 2013, 28.4% of children aged 5-19 years, and 6% of children aged 0-5 years, were categorized as overweight or obese. Between 2008 and 2013, the total number of 18-month well baby visit billing codes was 1152; 6.9% of this group were categorized as overweight or obese; 19.2% were categorized as having risk of overweight. INTERPRETATION: Primary care electronic medical records show good potential for ongoing population monitoring of overweight and obesity, particularly for very young children for whom early intervention is likely to show the greatest positive health impact.

Utility of linking primary care electronic medical records with Canadian census data to study the determinants of chronic disease: an example based on socioeconomic status and obesity.

BACKGROUND: Electronic medical records (EMRs) used in primary care contain a breadth of data that can be used in public health research. Patient data from EMRs could be linked with other data sources, such as a postal code linkage with Census data, to obtain additional information on environmental determinants of health. While promising, successful linkages between primary care EMRs with geographic measures is limited due to ethics review board concerns. This study tested the feasibility of extracting full postal code from primary care EMRs and linking this with area-level measures of the environment to demonstrate how such a linkage could be used to examine the determinants of disease. The association between obesity and area-level deprivation was used as an example to illustrate inequalities of obesity in adults. METHODS: The analysis included EMRs of 7153 patients aged 20 years and older who visited a single, primary care site in 2011. Extracted patient information included demographics (date of birth, sex, postal code) and weight status (height, weight). Information extraction and management procedures were designed to mitigate the risk of individual re-identification when extracting full postal code from source EMRs. Based on patients' postal codes, area-based deprivation indexes were created using the smallest area unit used in Canadian censuses. Descriptive statistics and socioeconomic disparity summary measures of linked census and adult patients were calculated. RESULTS: The data extraction of full postal code met technological requirements for rendering health information extracted from local EMRs into anonymized data. The prevalence of obesity was 31.6 %. There was variation of obesity between deprivation quintiles; adults in the most deprived areas were 35 % more likely to be obese compared with adults in the least deprived areas (Chi-Square = 20.24(1), p < 0.0001). Maps depicting spatial representation of regional deprivation and obesity were created to highlight high risk areas. CONCLUSIONS: An area based socio-economic measure was linked with EMR-derived objective measures of height and weight to show a positive association between area-level deprivation and obesity. The linked dataset demonstrates a promising model for assessing health disparities and ecological factors associated with the development of chronic diseases with far reaching implications for informing public health and primary health care interventions and services.

Adult obesity prevalence in primary care users: An exploration using Canadian Primary Care Sentinel Surveillance Network (CPCSSN) data.

OBJECTIVES: This research examines the feasibility of using electronic medical records within the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) for obesity surveillance in Canada by assessing obesity trends over time and comparing BMI distribution estimates from CPCSSN to those obtained from nationally representative surveys. METHODS: Data from 2003-2012 on patients 18 years and older (n = 216,075) were extracted from the CPCSSN database. Patient information included demographics (age and sex) and anthropometric measures (height, weight, body mass index (BMI), waist circumference, and waist-to-hip ratio). Standard descriptive statistics were used to characterize the sample, including, as appropriate, means, proportions and medians. The BMI distribution of the CPCSSN population was compared to estimates from the Canadian Community Health Survey (CCHS) and the Canadian Health Measures Survey (CHMS) for the years: 2004, 2007-2009 and 2009-2011. RESULTS: The estimated prevalence of obesity increased from 17.9% in 2003 to 30.8% in 2012. Obesity class I, II and III prevalence estimates from CPCSSN in 2009-2011 (18.0%, 95% CI: 17.8-18; 7.4%, 95% CI: 7.3-7.6; 4.2%, 95% CI: 4.1-4.3 respectively) were greater than those from the most recent (2009- 2011) cycle of the CHMS (16.2%, 95% CI: 14-18.7; 6.3%, 95% CI: 4.6-8.5; 3.7%, 95% CI: 2.8-4.8 respectively), however these differences were not statistically significant. CONCLUSION: The data from CPCSSN present a unique opportunity for longitudinal obesity surveillance among primary care users in Canada, and offer prevalence estimates similar to those obtained from nationally representative survey data.

Data discipline in electronic medical records: Improving smoking status documentation with a standardized intake tool and process.

OBJECTIVE: To evaluate the transformation in smoking status documentation after implementing a standardized intake tool as part of a primary care smoking cessation program. DESIGN: A before-and-after evaluation of smoking status documentation was conducted following implementation of a smoking assessment tool. To evaluate the effect of the intervention, the Canadian Primary Care Sentinel Surveillance Network was used to extract aggregate smoking data on the study cohort. SETTING: Academic primary care clinic in Kingston, Ont. PARTICIPANTS: A total of 7312 primary care patients. INTERVENTIONS: As the first phase in a primary care smoking cessation program, a standardized intake tool was developed as part of a vital signs screening process. MAIN OUTCOME MEASURES: Documented smoking status of patients before implementation of the intake tool and documented smoking status of patients in the 6 months after its implementation. RESULTS: Following the implementation of the standardized intake tool, there was a 55% (P < .001; 95% CI 0.53 to 0.56) increase in the proportion of patients with a completed smoking status; more than 1100 former smokers were identified and the documented smoking rate in this cohort increased from 4.4% to 16.2%. CONCLUSION: This study shows that the implementation of an intake tool, integrated into existing clinical operational structures, is an effective way to standardize clinical documentation and promotes the optimization of electronic medical records.