Using linked data to tackle the big questions for health services policy and planning: When do linked datasets really add value?

Transcription

1 Using linked data to tackle the big questions for health services policy and planning: When do linked datasets really add value? Professor David Preen Chair in Public Health School of Population and Global Health The University of Western Australia

2 National data linkage landscape

3 WA Data Linkage System Established 1995 One of the first whole-population systems worldwide Covers >5 million individuals (1966 current) Includes >50 datasets (health & social sector linkages) Genealogical linkage (dating back to1940) Best-practice privacy Extensively used outputs to date Missed links <0.11%

4 WA Data Linkage System

5 Current linked data research initiatives Medication safety & pharmacoepidemiology Cancer services and outcomes Chronic disease management Obstetric service use and female reproductive health Adherence to clinical guidelines Health of disadvantaged populations - older Australians - ex-prisoners - migrants - socioeconomic disadvantage - remote populations

6 Selected examples of data linkage projects - Regular GP visitation - Psychostimulant use for ADHD - Age-related macular degeneration

7 Chronic Diseases & Primary Care Project Study population and data: Linked hospital, death, PBS, MBS and Electoral Roll data >300,000 seniors 65+yr in Investigated a number of chronic disease areas - Diabetes, asthma & COPD, heart failure, seizure disorders, Analyses adjusted for age, sex, race, SES, remoteness, comorbidity, disease severity, admission type, length of stay etc Study focus: GP Visitation and Ambulatory Care Sensitive Conditions Protective effects of GP intensity & periodicity on disease progression

8 Calculating Regularity of GP contact Subsequent GP visits 1 st GP contact End of Year Number of days between services R 1 (1 Variance ( Days)) Score between 0 and 1

9 GP regularity and Asthma & COPD Mortality Hospitalisation Einarsdottir K, Preen D, Holman CDJ, Emery J. Journal of General Internal Medicine 2011; 26(10):

10 Other conditions (mortality) Epilepsy Ischemic heart disease Einarsdottir K, Preen D, Holman CDJ, Emery J. Medical Care 2010; 48(5):

11 Relative Risk Ratio Adjusted Likelihood of increased regularity and frequency for EPC exposed compared to unexposed Low Medium High Highest Regularity Quintile Regularity Frequency Unexposed Lowest Quintile Gibson D, Moorin RE, Preen DB, Emery J, Holman CDJ. Australian Health Review 2011; 35:

12 Preen D, Calver J, Sanfilippo FM, Bulsara M. Western Australian Department of Health, 2005; pp ISBN Linked data sets: Prescriber notification Medication dispensing Hospitalisation Death

13 Number of WA children (per 1,000 child-population) by age and gender using stimulant medication to treat ADHD Children (per 1,000 child population) Males Females All patients 1 in every 18 boys within WA Age (years) P<0.001, significantly different from prevalence of treatment in females for the same age. 9,664 children (prevalence: 2.4% of WA Child population) Preen DB, Calver J, Bulsara M, Sanfilippo FM, Holman CDJ. ANZ J Pub Health 2007; 31(2):

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15 /Stimulant-Regulatory-Scheme

16 Rate per 1,000 population by gender Number of patients in the ADHD Cohort by gender ( ) Girls Boys Women Men Department of Health, (2015), Western Australian Stimulant Regulatory Scheme 2014 Annual Report, Pharmaceutical Services Branch, Public Health and Clinical Services Division, Department of Health, Western Australia 0 Number and proportion of patients in the ADHD cohort with a nominated co-prescriber ( ) Year Table 37 Average daily notified dose in DXE for patients in the ADHD cohort by gender ( ) % 5.1% 5.2%

17 Background Clinical trials for macular degeneration show small increases in risk of these events Small samples; n<400 Different control groups Data WA outpatient eye clinics ( ) Hospital ( ) Mortality ( )

18 Design: Retrospective, matched multiple-comparison cohort study Patients (n=3862): 1680 VEGF-inhibitor treated patients 1783 matched untreated community members 399 photodynamic therapy patients

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20 Thankyou