Browsing by Author "Rabi, Doreen"

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    ACSC Indicator: testing reliability for hypertension
    (2017-06-26) Walker, Robin L; Ghali, William A; Chen, Guanmin; Khalsa, Tej K; Mangat, Birinder K; Campbell, Norm R C; Dixon, Elijah; Rabi, Doreen; Jette, Nathalie; Dhanoa, Robyn; Quan, Hude
    Abstract Background With high-quality community-based primary care, hospitalizations for ambulatory care sensitive conditions (ACSC) are considered avoidable. The purpose of this study was to test the inter-physician reliability of judgments of avoidable hospitalizations for one ACSC, uncomplicated hypertension, derived from medical chart review. Methods We applied the Canadian Institute for Health Information’s case definition to obtain a random sample of patients who had an ACSC hospitalization for uncomplicated hypertension in Calgary, Alberta. Medical chart review was conducted by three experienced internal medicine specialists. Implicit methods were used to judge avoidability of hospitalization using a validated 5-point scale. Results There was poor agreement among three physicians raters when judging the avoidability of 82 ACSC hospitalizations for uncomplicated hypertension (κ = 0.092). The κ also remained low when assessing agreement between raters 1 and 3 (κ = 0.092), but the κ was lower (less than chance agreement) for raters 1 and 2 (κ = -0.119) and raters 2 and 3 (κ = -0.008). When the 5-point scale was dichotomized, there was fair agreement among three raters (κ = 0.217). The proportion of ACSC hospitalizations for uncomplicated hypertension that were rated as avoidable was 32.9%, 6.1% and 26.8% for raters 1, 2, and 3, respectively. Conclusions This study found a low proportion of ACSC hospitalization were rated as avoidable, with poor to fair agreement of judgment between physician raters. This suggests that the validity and utility of this health indicator is questionable. It points to a need to abandon the use of ACSC entirely; or alternatively to work on the development of explicit criteria for judging avoidability of hospitalization for ACSC such as hypertension.
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    Administrative Coding of Type 1 and Type 2 Diabetes: Assessment of Validity and Implications of Coding Practices ob Outcome Evaluation
    (2013-10-01) Burs, Simona; Rabi, Doreen; Ghali, William
    Rationale: Administrative coding of diabetes mellitus is a difficult task. Objectives: to evaluate misclassification of diabetes status and type, examine contributors to classification uncertainty and explore how difficult cases are perceived by health professionals. Methods: A chart review was performed to validate coding of diabetes type in two data sources. The presence or absence of key clinical information and documentation deficiencies were evaluated. Health professionals were surveyed regarding classification of uncertain cases. Results: 1) Misclassification of diabetes status and type were higher in APPROACH (7.1% and 6.4%) than in ICD-10 (3.6% and 4.3%); 2) treatment with insulin was associated with classification uncertainty (Χ2=36.16; p<0.001); 3) documentation deficiencies were prevalent and were higher in the uncertain classification group (30% vs. 18%). Conclusions: This thesis highlights some elements related to diabetes misclassification. Clear documentation by physicians is required to improve administrative coding of diabetes. Improving administrative data quality may lead to improved outcomes. Keywords: administrative coding, diabetes mellitus, misclassification, insulin
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    East African Immigrant Women with Gestational Diabetes Mellitus: A Mixed-methods Evaluation of the Care Experience in a Vulnerable Population
    (2016) Siad, Fartoon; Rabi, Doreen; Santana, Maria; Butalia, Sonia
    Background: Low rates of post-partum diabetes screening continues to impact the health of immigrant women diagnosed with gestational diabetes and high-risk for the development of future diabetes. The objectives of this study were to explore the diabetes resources available in Calgary and the care experiences of immigrant women. Methods: An online survey was distributed to six health clinics and community organizations involved in the provision of diabetes services to immigrant women. Ten East African women with gestational diabetes were identified and interviewed. Interviews were transcribed verbatim and thematically analyzed. Conclusion: The findings of this thesis suggest that current approaches to diabetes education and care in East African women with GDM lack cultural relevance to this high-risk community and do not emphasize the need for ongoing post-partum screening. Diabetes prevention using innovative community-level interventions such as patient navigators and care that engages and empowers women as partners in health are needed. Key words: Gestational diabetes, immigrant women, East Africa, health education, care experience, diabetes, post-partum screening.
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    Evaluation of a Targeted Video for Transition from Pediatric To Adult Care For Patients with Type 1 Diabetes Mellitus
    (2016) Winston, Karin; Dewey, Deborah; Pacaud, Danièle; Rabi, Doreen; Hebert, Marilynne; Ho, Josephine
    Transition from pediatric to adult care is challenging for patients with complex, chronic illnesses such as type 1 diabetes mellitus. To optimize successful transition of care, providers put great efforts into preparing patients for the change. This thesis evaluated the use of videos for patient decision-making in general and one video in particular that was designed to facilitate transition of care. The scoping review demonstrated that there is a vast amount of published data, which show that videos are effective in helping patients make decisions. The focus group study affirmed that patients appreciate the incorporation of a video in their transition preparation. These participants also noted that the process of transition required then to deal with complex emotional ambiguity as well as navigate logistic challenges. Video resources, which may be particularly useful to prepare in youth and young adults for important junctions in care, are valuable tools that should continue to be developed and refined.
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    Exploring Novel Diabetes Surveillance Methods: A Comparison of Administrative, Laboratory and Pharmacy Data Case Definitions
    (2014-09-29) Khokhar, Bushra; Rabi, Doreen
    Rationale: There are several ways to potentially identify diabetes for the purpose of surveillance and hence it is crucial to understand the validity of these approaches. This thesis systematically reviewed population-based studies validating ICD-9 and ICD-10 codes reporting on sensitivity, specificity and PPV of case definitions. Data from THIN was used to study demographic differences of the populations being captured using different case definitions. Methods: Electronic databases were systematically searched for validation studies where an administrative case definition of diabetes was validated and test measures reported. The second sub-study used a large EMR to compare different case definitions of diabetes with respect to the number of cases identified and characteristics of each cohort. Conclusion: This thesis demonstrates that the validity of commonly used case definitions varies significantly. Whether using administrative or clinical data, this work illustrates the importance of using multiple data sources to effectively capture individuals with diabetes.
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    Hospitalizations for Uncomplicated Hypertension: An Ambulatory Care Sensitive Condition
    (2015-12-16) Walker, Robin; Quan, Hude; Ghali, William; Rabi, Doreen; Dixon, Elijah; Jette, Nathalie
    With high-quality community-based primary care, hospitalizations for ambulatory care sensitive conditions (ACSC) are considered avoidable. ACSC are promising healthcare quality indicators widely used internationally, potentially creating opportunity for health care system quality improvement. The overall aim of this thesis was to explore, assess and evaluate ACSC hospitalization as a healthcare quality indicator for one condition, uncomplicated hypertension. We conducted three studies to achieve the aim. Our first study explored ACSC hospitalization rates for uncomplicated hypertension, taking into account important patient characteristics among hypertensive patients. Using population-based data in four provinces we found that the rate of hospitalizations for uncomplicated hypertension has decreased over time, potentially indicating improvement in community care. We found geographic variations in the rate of hospitalizations, potentially signifying disparity among the provinces and those residing in rural versus urban regions. Our second study examined the association between ACSC hospitalizations for uncomplicated hypertension and previous primary care physician (PCP) utilization. Among this population-based cohort of hypertensive patients we found as the frequency of hypertension-related PCP visits increased the adjusted rate of ACSC hospitalizations also increased, even when stratified by demographic and clinical variables. This suggests that hospitalization for uncomplicated hypertension is not reduced with increasing frequency of PCP visits and may not be an appropriate indicator to measure and evaluate patients’ access to primary care. Our final study tested inter-physician reliability of judgments of avoidable hospitalizations for uncomplicated hypertension derived from medical chart review. We found a low proportion of ACSC hospitalizations were rated as avoidable, with poor agreement between physician raters. These findings point either to a need to abandon the use of the ACSC entirely; or alternatively a need to develop explicit criteria for judging avoidability. This research has provided crucial information for the interpretation of ACSC findings for uncomplicated hypertension. The results indicate that the use of this health quality indicator is questionable and may not provide information that is applicable for interventions to improve quality of primary care. At present, ACSC are most appropriately used as a starting point for assessing potential issues in the community which would then require further, more in-depth analysis.
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    Investigating the association between prenatal provider specialty and postpartum glucose testing in people with gestational diabetes: a retrospective analysis of a population-based Canadian cohort.
    (2024-07-03) Charlong, Kathleen Mackenzie; Metcalfe, Amy; Rabi, Doreen; Cuthbert, Colleen
    Background Gestational diabetes mellitus (GDM) increases future risk of type 2 diabetes and cardiovascular disease. Diabetes Canada guidelines recommend postpartum glucose tolerance testing for everyone with GDM, yet uptake is low. Most evidence of barriers to testing comes from international sources and may not be generalizable to the Canadian perinatal context. Canadian maternity care providers include general practitioners (GPs), obstetricians (OBs), and registered midwives (RMs), with care models that differ from each other and from international providers of the same titles. There is a need for Canadian population-based studies exploring systems-level factors associated with low postpartum screening uptake. Methods We used de-identified population-based data on all births in Alberta, Canada between 2017 and 2018. We identified prenatal care provider specialty, glucose testing incidence, and cohort demographics. The study outcomes were 1) reciept of the gold standard protocol: oral glucose tolerance test (OGTT) within 6 weeks to 6 months, and 2) any glucose test occurring within 6 weeks to 1 year postpartum. We used logistic regression, adjusted for clinically relevant covariates, to estimate an association between test uptake and provider specialty. Results From 105,691 births we identified a GDM cohort of 9,884 eligible births. Cohort proportions of each prenatal care provider were OB (58.6%), GP (38.5%), and RM (2.9%). Overall test incidence was low; 22.2% (95% CI: 21.4 – 23.1) received gold standard testing and 53.9% (95% CI: 52.9 – 54.9) received any testing. When compared to the OB group, people in the GP group were less likely to receive follow-up testing (ORGS= 0.86, 95% CI: 0.77 – 0.95; ORAny= 0.88, 95% CI: 0.81 – 0.96). Those with RM care were also less likely to receive follow-up testing (ORGS= 0.67, 95% CI: 0.46 – 0.96; ORAny= 0.88, 95% CI: 0.67 – 1.15) when compared to the OB group. Discussion The overall proportion of people receiving postpartum glucose testing was low, indicating that efforts to improve screening uptake should be targeted to all care providers.
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    Subjective social status and its associations with social vulnerabilities and health
    (2017) Tang, Karen; Ghali, William; Manns, Braden; Rabi, Doreen; Santana, Maria
    BACKGROUND: Subjective social status (SSS) is the perception of where one stands in a social hierarchy, distinct from one’s actual, objective position in this hierarchy. SSS may influence health through behavioral and psychosocial mechanisms. METHODS: We conducted three sub-studies to examine whether SSS affects risk of and outcomes in chronic disease, and to explore the role of health care access and experience of social vulnerabilities in the SSS-health pathway. RESULTS: We found that low SSS is associated with increased risk of 1) cardiovascular disease; 2) hospital readmissions and barriers to health care access; and 3) social vulnerabilities that affect health care access. Having high perceived status in the community appears to mitigate the experience of social vulnerabilities through the ability to mobilize social supports. CONCLUSION: Subjective social status has important associations with health and clinical outcomes. These findings have implications to the development of interventions that aim to reduce disparities.