Assessing the burden of hospitalized and community-care heart failure in Canada.

BACKGROUND: The surveillance of heart failure (HF) is currently conducted using either survey or hospital data, which have many limitations. Because Canada is collecting medical information in administrative health data, the present study seeks to propose methods for the national surveillance of HF using linked population-based data. METHODS: Linked administrative data from 5 Canadian provinces were analyzed to estimate prevalence, incidence, and mortality rates for persons with HF between 1996/1997 and 2008/2009 using 2 case definitions: (1) 1 hospitalization with an HF diagnosis in any field (H_Any) and (2) 1 hospitalization in any field or at least 2 physician claims within a 1-year period (H_Any_2P). One hospitalization with an HF diagnosis code in the most responsible diagnosis field (H_MR) was also compared. Rates were calculated for individuals aged ≥ 40 years. RESULTS: In 2008/2009, combining the 5 provinces (approximately 82% of Canada's total population), both age-standardized HF prevalence and incidence were underestimated by 39% and 33%, respectively, with H_Any when compared with H_Any_2P. Mortality was higher in patients with H_MR compared with H_Any. The degree of underestimation varied by province and by age, with older age groups presenting the largest differences. Prevalence estimates were stable over the years, especially for the H_Any_2P case definition. CONCLUSIONS: The prevalence and incidence of HF using inpatient data alone likely underestimates the population rates by at least 33%. The addition of physician claims data is likely to provide a more inclusive estimate of the burden of HF in Canada.

Surveillance of ischemic heart disease should include physician billing claims: population-based evidence from administrative health data across seven Canadian provinces.

BACKGROUND: Canadian provinces and territories routinely collect health information for administrative purposes. This study used Canadian medical and hospital administrative data for population-based surveillance of diagnosed ischemic heart disease (IHD). METHODS: Hospital discharge abstracts and physician billing claims data from seven provinces were analyzed to estimate prevalence and incidence of IHD using three validated algorithms: a) one hospital discharge abstract with an IHD diagnosis or procedure code (1H); b) 1H or at least three physician claims within a one-year period (1H3P) and c) 1H or at least two physician claims within a one-year period (1H2P). Crude and age-standardized prevalence and incidence rates were calculated for Canadian adults aged 20 +. RESULTS: IHD prevalence and incidence varied by province, were consistently higher among males than females, and increased with age. Prevalence and incidence were lower using the 1H method compared to using the 1H2P or 1H3P methods in all provinces studied for all age groups. For instance, in 2006/07, crude prevalence by province ranged from 3.4%-5.5% (1H), from 4.9%-7.7% (1H3P) and from 6.0%-9.2% (1H2P). Similarly, crude incidence by province ranged from 3.7-5.9 per 1,000 (1H), from 5.0-6.9 per 1,000 (1H3P) and from 6.1-7.9 per 1,000 (1H2P). CONCLUSIONS: Study findings show that incidence and prevalence of diagnosed IHD will be underestimated by as much as 50% using inpatient data alone. The addition of physician claims data are needed to better assess the burden of IHD in Canada.

The impact of a multidisciplinary, holistic approach to management of patients diagnosed with multiple chemical sensitivity on health care utilization costs: an observational study.

OBJECTIVE: The aim of this study was to look at the impact of a multidisciplinary approach to treatment of individuals with multiple chemical sensitivity (MCS) and to present preliminary results which compare health care utilization pre- and postmanagement of individuals with MCS. STUDY DESIGN: The design for this study was that for a cohort study. SETTINGS/LOCATION: The setting for this study was the Nova Scotia Environmental Health Centre (NSEHC; Fall River, Nova Scotia, Canada). PATIENTS AND METHODS: Following ethical approval, individuals who had filled a detailed-symptoms questionnaire and had agreed to participate in research activities were linked to their medical insurance records, using encrypted numbers and a blind procedure for confidentiality. Diagnosis by the NSEHC; physicians followed the consensus criteria for multiple chemical sensitivity (MCS). A total of 563 patients formed 3 cohorts (145 in 1998; 181 in 1999; and 237 in 2000). RESULTS: Physicians' visits by general practitioner and by specialists, emergency and hospital separations, and associated costs showed a relative decrease in the years following the consultation at the NSEHC. The overall yearly decline in consultations between the years before the initial consultation until 2002, for each cohort, was: 9.1% for the 1998 cohort; 8% for the 1999 cohort; and 10.6% for the 2000 cohort; compared with 1.3% for the overall Nova Scotia population. Relative to the provincial utilization costs, the standardized average yearly decrease in utilization costs for the 3 cohorts combined was 8.7%, or a total savings of $77,440. The 1998 cohort showed a sustained decrease up to 2002, reaching a level similar to the overall Nova Scotia population. Those with high symptom scores had the highest reduction in mean physician visits (31% for the 1998 cohort) in the following years. CONCLUSIONS: Presented in this paper are the preliminary results of the health care utilization costs in the management of individuals with MCS. Despite the limitations of our study design, the initial findings from this study are encouraging and warrant further exploration. These results indicate a possible impact on the long-term health care utilization from the NSEHC's management strategies, although a further controlled study, with a longer follow-up, may be necessary to confirm these findings.

Impact of guidelines on health care use for the management of dyslipidemia in two Canadian provinces, Alberta and Nova Scotia, from 1990 to 2001.

BACKGROUND: Guidelines for the treatment of hyperlipidemia aim at improving the management of people at a higher risk of developing cardiovascular disease. OBJECTIVES: To study the potential impact of hyperlipidemia guidelines on health care use in two Canadian provinces with different levels of hyperlipidemia. METHODS: Trends in physician billing were obtained from Alberta between 1990 and 2000 and from Nova Scotia between 1994 to 2001 using the 272 primary diagnostic code for hyperlipidemia. Record linkage between a 272 code and a prescription in the subsequent six months was made through the Pharmacare database (which automatically registers all individuals 65 years of age and over). Data were also linked between the 1995 Nova Scotia Health Survey and the Pharmacare data. RESULTS: Trends in hyperlipidemia codes were similar in Alberta and Nova Scotia by sex and age, with acceleration in the final years of the study. Approximately 5% of the adult population had a diagnosis of hyperlipidemia. Less than 60% of people aged 65 years and over with a 272 code filled an antilipemic prescription in the subsequent six months. Using the National Cholesterol Education Program Adult Treatment Panel III classification and the 1995 Nova Scotia Health Survey, less than 10% of the participants aged 65 years and over had a corresponding diagnostic code of 272, while more than half could be classified as having hyperlipidemia. In 1995, approximately one-half of people at high risk, with a 272 code in the subsequent five years, had a prescription for antilipemic drugs. CONCLUSIONS: Despite some limitations, these data show a discrepancy between guideline development and practice, leaving a high number of at-risk individuals undiagnosed and untreated. Mechanisms need to be put in place to ensure better classification and follow-up of people with hyperlipidemia at risk for cardiovascular disease.