bluuebunny/crossref_metadata_2025_split huggingface dataset:
BC Data ScoutTM: A New Tool To Investigate Datasets For Health Research
Authors: Kesselring Sarah , Galo Jessica , Sanderson Kelly , Wong Shirley , Neuman Maureen , Mintha Jim , McGrail Kim 
Published: September 2018

IntroductionBC’s Ministry of Health (MOH) maintains many administrative databases with rich information and analytical potential. Researchers are keen to use these data for both discovery and applied research. Historically, limited views of data availability and populations therein have supported study feasibility. Therefore, we developed BC Data ScoutTM, a cohort browser.
Objectives and ApproachWe developed a cohort browser service to provide information to researchers planning a study using MOH data. The objective was to create a tool that is simple to use, provides quick results and is free to users to encourage its use. A better understanding of the data available can improve study quality and expand the user-base by giving researchers access to information not previously available during the planning stages. The tool will be evaluated by examining the number of requests received and a user satisfaction survey. Plans are in place to expand into additional data sources and extend query sophistication.
ResultsThe BC Data ScoutTM online tool provides cohort information in the form of highly aggregated, approximate results to researchers planning a study. It was developed by the MOH, the BC SUPPORT Unit and Population Data BC (PopData) and was launched in February 2018. The service is delivered by PopData. BC Data ScoutTM offers province-wide information for query, is accessible to a wide group of eligible researchers, and has data availability from the year 2000 onwards. Four types of MOH data are available for query: hospital data; physician data; pharmaceutical data; and demographics. In addition to determining study feasibility, the aggregate reports also help to further refine a full data access request and provide enough information to complete and strengthen a funding application.
Conclusion/ImplicationsBC Data ScoutTM will be beneficial for researchers planning to request data. This preliminary information may increase the chances of meaningful research studies to obtain funding, and the production of relevant, high-quality research results. BC will be among the first jurisdictions across Canada to offer this type of feasibility service.
Big data and human biosensors – birthweight as a biomonitor for air pollution levels. A population based study using routine data.
Authors: Dibben Chris , Clemens Tom 
Published: September 2018

IntroductionIn the natural sciences biomonitors, (organisms, such as pine needles, shells, lichen, that can provide quantitative information on the quality of their past and present environments) have been developed for environmental measurement. In recent year’s physiologists have started to explore if human tissue could also be used.
Objectives and ApproachThe costs of collecting and processing human tissues for biomonitoring, may be too prohibitive for its use in wide scale monitoring. In contrast if biomonitors could be identified within a routine data collection process that were part of standard medical recording a low cost, widely available large sample would be available to scientists. Pregnancy is known to be effected by air pollution, therefore we explore whether birthweight, recorded in maternity records, could be a biomonitor for air pollution.
ResultsWe use maternity records (~1 million births) in Scotland between 2000 and 2015. We modelled, at the individual mother level birthweight, controlling mother’s age, estimated household income, local area crime rates and area level of multiple deprivation. We then aggregate and calculate the averaged of the residuals for this model for all mothers within an intermediate datazones (small areas of around 4000 residents). These mean deviations were then compared with pollution modelled figures produced by AEA for the Scottish government averaged over the same spatial units and time period as the maternity data. "We find a relatively strong correlations (between -0.37 and -0.39) between our ‘biomonitor estimates’ of air pollution derived from the maternity records and the entirely separated modelled air pollution data."
Conclusion/ImplicationsAs far as we know this is the first study to demonstrate that it may be possible to use routine health data to derive ‘biomonitors’ information. Importantly if this method proves to be reliable it will be a relatively cheap method for collecting information that is actually personally monitoring.
Impact of a web-based clinical decision-support system on pulmonary embolism diagnoses
Authors: Haubrich Sydney , Ocampo Wrechelle , Babione Julie , Kaufman Jaime , Ghali William , Altabbaa Ghazwan 
Published: September 2018

IntroductionPulmonary embolism (PE) is a disease that offers a diagnostic challenge for physicians. Literature suggests a gap remains between PE diagnostic guidelines and adherence to such guidelines in practice. While computerized decision support systems (CDSS) for PE exist, evidence is lacking on their impact in clinical settings.
Objectives and ApproachThe objective is to evaluate the impact of a web-based PE-CDSS on physician adherence to diagnostic guidelines by collecting and linking chart review data, hospital administrative data, and PE-CDSS usage data from six months before and after the CDSS is deployed. This CDSS was integrated into an electronic medical record system and deployed at two inpatient hospital sites in early 2018. Pre- and post-intervention workups are assigned a score based on their adherence to PE diagnostic guidelines, then compared. Data from a third hospital site with no access to the PE-CDSS will be used as a control.
ResultsPreliminary results will be available by mid-2018. Based on previous research, the investigators expect to see increased provider adherence to diagnostic guidelines for PE in settings where the PE-CDSS was deployed.
Conclusion/ImplicationsImplementing a PE-CDSS may increase provider adherence to evidence-based diagnostic guidelines by providing supportive information about PE diagnosis and addressing uncertainties about clinical decision making. This could result in greater diagnostic accuracy for PE and improved outcomes for patients with suspected PE.
Examination of High-Cost Patients in Ontario
Authors: Homenauth Esha , Graves Erin , Ishiguro Lisa , Saskin Refik , Schull Michael , Wodchis Walter , Tanke Marit 
Published: September 2018

IntroductionIn Ontario, the top 5% of high-cost users account for 66% of health care costs. The heavy use of resources combined with perceived inefficiencies offer an imperative to target strategies to redesign care to better meet patient needs and increase value.
Objectives and ApproachAs part of a request submitted to the Applied Health Research Question (AHRQ) review team, the main objective of this study was to identify drivers of high health care use in Ontario in order to find better ways to improve the efficiency in healthcare delivery. Using data in fiscal year 2012/13, characteristics of the top 5% of high costs users were described, and further stratified by mental health status. Total spending by sector of care were also described. Data were linked including physician, hospital, medication and long term care databases for each patient.
ResultsIn the top 5% of high-cost users, there were 729,870 patients who accounted for $20,179,208,348 of total healthcare spending in 2012/13, with the highest percentage of spending observed among older adults aged 61-80 years old. Mental health high-cost patients accounted for 6.1% of these patients, of which 51.5% were female, had a low socio-economic status and an average age of 44 years. These patients had an average of 4.9 (SD=2.3) ICD chapters and used an average of 8.7 (SD=3.8) drugs. Using the health accounts methodology (ICHA), as described by the OECD and WHO, over 90% of healthcare costs among the top 5% of high-cost patients were from inpatient care, day surgery and clinic care, physician care, outpatients drugs and inpatient rehabilitation and complex/continuing care.
Conclusion/ImplicationsThis study provides a systematic description of the needs in a high cost patient group, and serves as a platform for international comparisons across healthcare systems to better understand gaps and identify targets for intervention. These cross-comparisons offer a tool to evaluate performance of healthcare systems and to prioritize policies.
Cultural and institutional barriers among data stewards regarding data access for research
Authors: Teng Jack , McGrail Kim 
Published: September 2018

IntroductionIn British Columbia, the rules and procedures that data stewards follow to adjudicate data access requests (DAR) vary considerably. These variations can lead to discrepancies in the speed at which DARs are processed. With complex DARs involving numerous data stewards and data sets, the request may take over a year
Objectives and ApproachOur main goal was to understand the institutional and cultural factors that influence data stewards when processing a DAR. We wished to see in particular if risk aversion was playing a role when making decisions about data access. We interviewed 24 people representing 21 organizations in British Columbia. Most were data stewards, but we also interviewed people processing the data requests and also privacy advisors.
ResultsWe found that organizations varied greatly in terms of their skills and expertise regarding the rules and procedures around processing DARs. In particular, data stewards noted that they experienced differences in interpreting legislation, resulting in disagreements when they were working with other data stewards. In terms of risk aversion, data stewards stated they wished to encourage research, but in some cases followed unclear rules. Nearly all noted that there is little guidance provided for the job of “data steward” and either no or very little training when taking on these positions.
Conclusion/ImplicationsWhile there may be stated governmental policies promoting that linked data be used for research, ultimately it is the data stewards approving DARs that will determine access to data. Understanding how and why they make those decisions will help better implement data access policies.
Medical Needs after Pediatric Traumatic Brain Injury: Probabilistic Linkage of State Claims Data with Trauma Center Data
Authors: Bennett Tellen , Sevick Carter , Cox-Martin Matthew , Gritz Mark , Okada Carol , Kahn Michael 
Published: September 2018

IntroductionTraumatic brain injury (TBI) causes enormous morbidity and mortality in both adults and children. Children who survive TBI may have significant disability. It is not known if patterns of outpatient claim use among TBI survivors can be used to estimate patient functional status.
Objectives and ApproachThe objectives of this study are to 1) link regional data sources to create a dataset containing information about the entire continuum of care for children with TBI and 2) identify patterns of outpatient medical needs that can serve as proxies for functional status. We probabilistically linked trauma registry and electronic medical record (EMR) data for children hospitalized after acute TBI at the two pediatric trauma centers in Colorado, Children’s Hospital Colorado (CHCO) and Denver Health (DH), with claims data from the Colorado All Payer Claims Database (APCD) (2009-2014). Probabilistic linkage was performed using LinkSolv (Strategic Matching, Inc., Morrisonville, NY).
ResultsOf 737 hospitalized children, 387 (53%) linked to records in the APCD. Among the children in the linked cohort (213 at CHCO and 174 at DH), the median age was 5 years (interquartile range [IQR] 2 to 13) and 264 (68%) were male. Most had either mild (Glasgow Coma Scale [GCS] 13-15, 51%) or severe (GCS <= 8, 36%) TBI. The 1-year hospital readmission rate among the 355 (92%) survivors was 52/355 (15%). Among the 248/355 (70%) who had a medication claim and the 316/355 (89%) who had an outpatient claim in the first year, respectively, the median number of medication claims was 6 (IQR 2 to 14) and the median number of outpatient claims was 5 (IQR 3 to 11).
Conclusion/ImplicationsWe will leverage the linked registry, EMR, and claims data by using unsupervised machine learning to identify patterns of outpatient care that can serve as proxies for functional status in children who survive TBI. Analyses are ongoing and will be completed by September 2018.
Does the family physicians’ characteristics affect Cervical Cancer Screening rates?
Authors: Sayed Sayeeda Amber , Naugler Christopher , Dickinson James 
Published: September 2018

IntroductionWhile the effectiveness of cervical cancer-screening (CCS) programs is well accepted, concern is growing regarding Family physicians (FP) poor adherence to CCS guidelines resulting in over and under screening. In Canada, it is a FP responsibility to ensure that the CCS is done as per guidelines and with appropriate follow-up.
Objectives and ApproachTo identify primary care physicians’ characteristics that are associated with over and under CCS for eligible women in Calgary, Alberta.
We accessed the Calgary Laboratory Services data for 1475 FPs practicing in Calgary and linked it with the Physicians database of College of Physicians and Surgeons Alberta database. We then matched FP’s gender, country and year of medical school graduation, years since medical school graduation, certification in family medicine and their clinic address with their CCS testing patterns. Using doctors as their own controls, we compared data from 2010-2016 to determine practice variations in CCS patterns subsequent to guideline changes.
ResultsWe analyzed approximately 2,400,000 Pap test requisitions (approx. 300,000 per year) to identify screening patterns from 2010-2016 of 1475 family practitioners practicing in Calgary. Our preliminary results identified significant variations in the test ordering patterns of FPs. Approx. half of the male FPs were not performing CCS tests on their eligible female patients. Female FPs ordered more CCS tests than their male counterparts. FP trained in North America, were ordering more pap tests than FPS trained elsewhere. Decreased CSS was also observed among FPs practicing in Northeast Calgary.
Conclusion/ImplicationsWe detected three CCS patterns: FPs who never perform CSS on eligible female patients; FPs who followed recommended guidelines for performing CCS tests and FPs who performed CCS tests, not following the guidelines. To ensure appropriate use of CSS, identifying intention-behavior relationships and innovative educational interventions for FPs are required.
Prescription Opioid Use and Concurrent Psychotropic Drug Use During Pregnancy: A Population-Based Retrospective Cohort Study Utilizing Linked Administrative Data
Authors: Singal Deepa , Chateau Dan , Dahl Matthew , Derksen Shelley , Katz Laurence , Ruth Chelsea , Hanlon-Dearman Ana , Brownell Marni 
Published: September 2018

IntroductionIt is important to investigate the use of prescription opioids during pregnancy to gain insight into the potential impact of maternal opioid exposure during pregnancy on children. We report the prevalence of prescription opioid use and concurrent psychotropic drug use in a large, Canadian population-based cohort of pregnant women.
Objectives and ApproachUsing population-level linked administrative data from a universal health care system, this study included all women with a live birth in Manitoba from 1996 to 2014. Dispensing of opioids was determined from prescription drug data. Patterns of prescription opioids dispensed to pregnant women were investigated by demographic characteristics, region of residence, and socioeconomic status. Concurrent psychotropic therapies were also measured. These data address limitations associated with re-call bias, cilitate longitudinal analaysis, and allow the investigation of rare outcomes, difficult to study using other data sources.
ResultsIn a large population level sample of pregnancies (N=245,784), 2.43% of pregnancies were exposed to 2+ dispensations of opioids. An additional 4.95% of pregnancies recorded at a single opioid dispensation. Compared to women who were not dispensed any opioid prescriptions, the proportion of opioid exposed pregnancies who were also prescribed anti-depressants (SSRI/SNRI) was sevenfold higher (22.5% vs 3.05%). The same pattern was found for anxiolytics (37.2% vs 1.5%) and antipsychotics (3.5% vs 0.34%).
Conclusion/ImplicationsThese data demonstrate high proportions of women were dispensed opioids during pregnancy. Further research should be done on the short term and long term effects of these medications on infants and children. Moreover, these results highlight the need for further investigation into the effects of exposure to multiple psychotropic drugs
In-Utero SSRI and SNRI Exposure and the Risk of Long Term Adverse Mental and Educational Outcomes in Children: A Population-Based Retrospective Cohort Study Utilizing Linked Administrative Data
Authors: Singal Deepa , Chateau Dan , Dahl Matthew , Katz Laurence , Ruth Chelsea , Wall-Wieler Elizabeth , Hanlon-Dearman Ana , Brownell Marni 
Published: September 2018

IntroductionFew studies are capable of investigating the impact of untreated maternal depression versus in-utero antidepressant exposure on long-term effects on children. Previous studies are limited by confounding by indication and are unable to follow children over time to accurately investigate long term outcomes present in childhood and adolescence.
Objectives and ApproachWe utilize linkable administrative data to facilitate longitudinal analysis to investigate mental and educational outcomes in children exposed to in utero antidepressants. Using population-level linked administrative data from a universal health system, this study included all mother-newborn dyads in Manitoba (born 1996 to 2009, with follow-up through 2014). High Dimensional Propensity Scores and inverse probability treatment weighting were used to address confounding by indication and disease severity.Cox Proportional Hazard Regression models were used to estimate risk of mood and anxiety disorder in children and educational outcomes.
ResultsAsymmetric trimming of the study cohort resulted in a total of 4998 mother-child dyads; 4159 children whose mothers did not use SSRIs/SNRIs during pregnancy and 839 children who were exposed to 2+ prescriptions in-utero. Use of SSRIs/SNRIs during pregnancy was not associated with an increased risk of mood/anxiety disorder in children HR 1.32 (95% CI 0.67 to 2.62). Initial results on the association between in-utero antidepressant use and early childhood development index (EDI) scores indicate no impact on school readiness (31.9% vs 29.3%), or scores on standardized tests of literacy and numeracy in Grade 3 (28.4% meeting expectation versus 31.4%) and in Grade 7 (68.8% versus 70.0%).
Conclusion/ImplicationsAdministrative data facilitate investigation into an important clinical concern. These data provide robust evidence demonstrating in a large population based sample, in utero exposure to serotonergic antidepressants compared with no exposure does not increase risk of the onset of mood and anxiety disorders and adverse educational outcomes in children .
Prenatal care of women who give birth to Children with Fetal Alcohol Spectrum Disorder in a universal health care system: A retrospective cohort study utilizing linkable administrative data
Authors: Singal Deepa , Brownell Marni , Wall-Wieler Elizabeth , Chateau Dan , Hanlon-Dearman Ana , Longestaffe Sally 
Published: September 2018

IntroductionFetal Alcohol Spectrum Disorder (FASD) is a significant public health concern. Prenatal care (PNC) settings are integral to preventing prenatal alcohol exposure as physicians delivering PNC services are in a unique position to reduce alcohol consumption during pregnancy. However, few studies have investigated PNC use among women who drink during
Objectives and ApproachAnalysis was conducted of women with children born in Manitoba between April 1, 1984 and Mach 31, 2012, with follow up till 2013 using linkable administrative and novel clinic data. Study group included women whose child(ren) were diagnosed with FASD from 1999 to 2012 (n=702) at a centralised FASD diagnostic clinic. Comparison group included women from the general population whose children who did not have an FASD diagnosis (n=2097), matched on the index child’s birthdate, postal code, and SES. Adequacy of PNC utilization was defined using the revised Graduated Index of Prenatal Care Utilization.
ResultsThis is the first population-based study to investigate rates of PNC usage of women who have given birth to children with FASD. Rates of inadequate PNC were higher among the study group (adjusted RR 2.47, 95% CI 2.08 to 2.94), as well as no PNC (adjusted RR 3.55, CI 2.42 to 5.22). Among the study group 63% accessed PNC, with 59% receiving intermediate, adequate, or intensive PNC.
Conclusion/ImplicationsResults represent opportunity for screening and brief intervention programs to be delivered in PNC health care settings, as well as outreach programs to facilitate the uptake of PNC among high risk women.
Linking First Nations data to administrative health data within Manitoba
Authors: Ramayanam Venkata Shravan , Star Leona 
Published: September 2018

IntroductionFirst Nation peoples (FNs) were unable to track their own health care trends due to limitations in datasets. The key linked file enables FNs to identify themselves within administrative datasets and work with Crown governments to bring equity in all services and departments to support FNs understanding of wellness.
Objectives and ApproachFirst Nations Health and Social Secretariat of Manitoba (FNHSSM) was established by 2013 resolution of Assembly of Manitoba Chiefs (AMC) and incorporated in 2014. FNHSSM leads and supports research according to FNs criteria approved by the Chiefs in Assembly. Information Sharing Agreements (ISA) have been developed with federal and provincial governments to mandate the processes for data linkage. The ISA allows Indian Status Register (ISR) data of Department of Indigenous Services Canada (DISC) to be transferred to FNHSSM to provide oversight, and link to Provincial Personal Health Information Numbers (PHINs) to create the de-identified, scrambled, and encrypted Key Linked file.
ResultsPrevious linkages were done in early 2000s with FNs approval and oversight. The 2018 linkage is the first time that ISAs have been formally developed. ISA-1 is between FNHSSM and Manitoba Health Seniors and Active Living (MHSAL) to create Key Linked file. ISA-2 is between FNHSSM, MHSAL and Manitoba Centre for Health Policy (MCHP) at University of Manitoba, to create the FNs Research File. This research file can only be accessed with application to and approval by the MFNs Health Information Research Governance Committee. This key linked file allows FNHSSM to prepare community health profiles specifically and only for each FN, to respect FNs Data Governance under Chief and Council. A regional report on Manitoba FNs will be created for all MFNs, FNHSSM and MHSAL.
Conclusion/ImplicationsLinking datasets helps to strengthen FNs data governance in re-building nations, recognizing FNs inherent right to self-determination. Linking files help to provide meaningful data to advocate for FNs rights and access to the resources and social determinants of health needed to achieve equity in Manitoba.