Data Then and Now. What do your Numbers Mean?
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1 Data Then and Now What do your Numbers Mean? Jennifer Payne, PhD Epidemiologist, DCPNS DCPNS Workshop 29 April 2011
2 Objectives become familiar with the National Diabetes Surveillance System understand how DCPNS provides practitioners with data to support individual care understand how the DCPNS Registry can support care improvements provincially
3 Outline Now: focus on National Diabetes Surveillance System Then: understand development of DCPNS Registry Back to Now: understand how the current Registry supports care individually understand how the DCPNS Registry can support care improvements provincially
4 Now : National Diabetes Surveillance System
5 National Diabetes Surveillance System (NDSS) developed to provide improved data about diabetes network of regionally distributed diabetes surveillance systems that compile administrative health care data Hospital admissions Practitioner billings aggregate anonymous data to Health Canada for national analyses data: pres
6 National Diabetes Surveillance System (NDSS) Reports on : Prevalence Incidence Comorbidity (e.g., hypertension) Health services utilization (e.g., hospital admissions)
7
8 Section I - Burden Prevalence Incidence Mortality Table of Contents Section II - Comorbidity e.g., Cardiovascular Disease Hypertension Section III Health Care Utilization e.g., hospital admission length of stay in hospital family practitioner visits
9 Crude and Age-Sex Standardized Diabetes Prevalence for the Population Aged 20+ in Nova Scotia and the DHAs 2008/09 Source: Nova Scotia Diabetes Statistics Report 2011 (DCPNS) in press
10 Crude Diabetes Prevalence for the Population Aged 20+ in Nova Scotia and the DHAs 2008/09 Source: Nova Scotia Diabetes Statistics Report 2011 (DCPNS) in press
11 Trend in Crude and Standardized Diabetes Incidence Rates (per 1000) for the Population Aged 20+ in Nova Scotia, 2004/05 to 2008/09 Source: Nova Scotia Diabetes Statistics Report 2011 (DCPNS) in press
12 $!!"!#,!"!# +!"!# Crude HTN Rates for the Population Aged 20+, with/without Diabetes (DM), in Nova Scotia by Age Group and Sex, 2008/09 )35+&6738+&-)6/&!"#$%&'()&*+,%&-./& *!"!# )!"!# (!"!# '!"!# &!"!# %!"!# $!"!# 4#-#54# 4#-#60#54# 7#-#54# 7#-#60#54#!"!# %!-&,# '!-',# (!-(,# )!-),# *!-*,# +!.# /0123# 01%&2"3#4& Source: Nova Scotia Diabetes Statistics Report 2011 (DCPNS) in press
13 Comparison of Measures of Diabetes Burden, Comorbidity, and Health Services Utilization by DHA Relative to Nova Scotia, 2008/09 Source: Nova Scotia Diabetes Statistics Report 2011 (DCPNS) in press
14 Then & Now : The DCPNS Registry
15 DCPNS Registry Evolution: Disease-based registry (via DCs): 1992: pediatric cases (<19yrs) 1994: adults DC Visit-based registry 2002: visits 2011: > 80,000 people 5000 new cases/yr; 50,000 visits/yr Longitudinal Analysis!
16 69,298 living
17 DCPNS Registry Individual Data Diabetes Centres: acts as clinical information system use to monitor care of individuals over time Reports: Monthly stats (DCs) Clinical Indicator Report (monitoring/evaluation) Physician/Nurse Practitioner Report Family Physician/Nurse Practitioner-Patient List
18 DCPNS Registry Group data Monitoring/Evaluation: acts as surveillance system monitor burden across province over time monitor disease management across province and over time can be used for evaluating change pre/post implementation of intervention/program
19 District Diabetes Report
20 Cumulative District B Cases (all DM/PreDM types), 2005/06 to 2009/10 Existing Registry Cases New Registry Cases 6,000 Frequency 4,500 3,000 1, , , ,590 4,915 5, /06 N=4, /07 N=4, /08 N=4, /09 N=5, /10 N=5,460
21 5-Year Trends in Type of DM/PreDM for Cases at Selected DCs, 1995/96 to 2009/10 PreDM tripled over the last 15 years
22 Characteristics of Adult ( 19 yrs) Types 1 & 2 DM Follow-Up Cases in District A, 2009 Characteristic District A NS % male / % female 52 / / 50 Mean age (yrs) as of 31-Dec % with body mass index > 30 (i.e., obese) Mean duration of DM in years % of DM treatment type apple Diet / exercise only apple Oral agent (OA) only apple Insulin only apple Insulin / OA combined % 33%
23 Adult ( 19 yrs) Types 1 & 2 DM Follow-Up Cases within Management Targets, District D, 2009 District D NS 100% 80% Percentage 60% 40% 20% 44% 47% 43% 44% 69% 71% 79% 82% 52% 44% 0% A1C < 7.0% BP < 130/80 LDL-C < 2.5 Absence of a documented eye or foot exam does not mean that the exam was not performed; it may have been performed but just not recorded. Eye exam in last 12 mos Foot exam in last 12 mos
24 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% A1C in Adult ( 19 yrs) Types 1 & 2 DM Follow-Up Cases, by Age Group and Sex, District B, Total Total 8.5% % < 7% Females Males
25 Surveillance vs Clinical Data Surveillance data (PHAC-NDSS) Population-based Crude estimates Basic subgroups: person (age, sex), place, time meant for high-level comparisons Clinical data (DCPNS-Registry) Patient/client-centric Very specific, rich data Meant for drilling down to individual level Capacity for detailed evaluation of care
26 With and eye to the future Registry: Monitor burden Evaluate care: Self-care System: link to health services data Evaluate interventions Manage care: use of DCs, specialists Care pathways/referrals Opportunity: Model for chronic disease: burden and management
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