Browsing by Author "Eastwood, Catherine"

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    Exploring the differences in ICD and hospital morbidity data collection features across countries: an international survey
    (2021-04-07) Otero Varela, Lucia; Doktorchik, Chelsea; Wiebe, Natalie; Quan, Hude; Eastwood, Catherine
    Abstract Background The International Classification of Diseases (ICD) is the reference standard for reporting diseases and health conditions globally. Variations in ICD use and data collection across countries can hinder meaningful comparisons of morbidity data. Thus, we aimed to characterize ICD and hospital morbidity data collection features worldwide. Methods An online questionnaire was created to poll the World Health Organization (WHO) member countries that were using ICD. The survey included questions focused on ICD meta-features and hospital data collection systems, and was distributed via SurveyMonkey using purposive and snowball sampling. Accordingly, senior representatives from organizations specialized in the topic, such as WHO Collaborating Centers, and other experts in ICD coding were invited to fill out the survey and forward the questionnaire to their peers. Answers were collated by country, analyzed, and presented in a narrative form with descriptive analysis. Results Responses from 47 participants were collected, representing 26 different countries using ICD. Results indicated worldwide disparities in the ICD meta-features regarding the maximum allowable coding fields for diagnosis, the definition of main condition, and the mandatory type of data fields in the hospital morbidity database. Accordingly, the most frequently reported answers were “reason for admission” as main condition definition (n = 14), having 31 or more diagnostic fields available (n = 12), and “Diagnoses” (n = 26) and “Patient demographics” (n = 25) for mandatory data fields. Discrepancies in data collection systems occurred between but also within countries, thereby revealing a lack of standardization both at the international and national level. Additionally, some countries reported specific data collection features, including the use or misuse of ICD coding, the national standards for coding or lack thereof, and the electronic abstracting systems utilized in hospitals. Conclusions Harmonizing ICD coding standards/guidelines should be a common goal to enhance international comparisons of health data. The current international status of ICD data collection highlights the need for the promotion of ICD and the adoption of the newest version, ICD-11. Furthermore, it will encourage further research on how to improve and standardize ICD coding.
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    The Identification of Clinically Relevant Readmission Risk Factors in Previously Hospitalized Albertan Heart Failure (HF) Patients: A Modified Delphi Process
    (2022-04) Wiebe, Natalie Kristen; Quan, Hude; Leung, Alexander; Eastwood, Catherine; Howlett, Jonathan; Aggarwal, Sandeep
    Introduction: Heart failure (HF) is a leading national cause of hospitalization. Canadians hospitalized with HF have a 20% 30-day readmission rate. Readmission risk prediction (RRP) helps providers plan follow-up patient care, decreasing readmission risk. Current RRP models have low predictive ability. There is poor consensus on variables to include in RRP models. RRP models often use clinician-derived variables. However, including patient perspectives encourages the integration of sociodemographic and healthcare utilization variables in RRP models. To our knowledge, there are no previously published works on clinician/ non-clinician derived variables for an RRP. The aim was to formulate a list of variables deemed necessary for inclusion in an RRP model by both clinicians and non-clinicians. Methods: An in-depth literature review revealed variables associated with readmission risk in HF patients. A modified Delphi process was used as the consensus-reaching method. A survey was administered to 13 panelists for a total of 3 rounds. Panelists included clinicians who varied in clinical expertise, profession, and years of practice. Also included were patients with HF and their caregivers. Results were summarized using medians, interquartile range (IQR) and narrative synthesis. Results: A total 61 of 99 original variables reached consensus for association with readmission risk in HF patients. Variables were grouped into 6 domains. The domains with the lowest consensus were Clinical Features and Treatment. Comorbidities and Sociodemographic reached high levels of consensus. Within the systematic reviews, of the 19 variables not reaching agreement on association with readmission risk, 10 reached consensus in the Delphi. The five variables that were heavily reported in the literature and reached high % consensus in the Delphi were: “follow-up with a multi-disciplinary team”, “elevated BNP” ,“elevated Creatinine”, “ACE-I” and “ARB” prescriptions upon discharge. Conclusion: The combination of clinicians and non-clinicians using a Delphi method to establish variables associated with readmission risk in HF patients proved to be productive. A final list of 61 variables has been proposed for inclusion in RRP models. These variables may be able to be abstracted from the electronic medical record (EMR) and will be included in an RRP model in the province of Alberta using local EMR systems.