Suchergebnisse

IMPORTANCE: Over the past decade, reducing 30-day readmission rates has been emphasized in the United States (including via the implementation of the Hospital Readmissions Reduction Program) but not Canada. OBJECTIVE: To examine changes that occurred from April 1, 2005, to December 31, 2015, in the United States and Canada for hospitalization length of stay and 30-day readmission rates of patients with heart failure. DESIGN, SETTING, AND PARTICIPANTS: This cohort study included patients admitted with a primary diagnosis of heart failure to Canadian and US hospitals between April 1, 2005, and December 31, 2015, using International Classification of Diseases, Ninth Revision code 428.xx and Tenth Revision code I50. The study examined secular trends in length of stay and readmissions in both countries and tested for changes after implementation of the Hospital Readmissions Reduction Program using segmented regression models and the association between length of stay and readmissions using patient-level and hospital-level multivariable logistic regression models. Data analysis was completed from February 2018 to August 2018. MAIN OUTCOMES AND MEASURES: Thirty-day readmissions. RESULTS: Between 2005 and 2015, mean length of stay declined marginally in Canadian hospitals (from a mean [SD] of 7.5 [5.7] to 7.3 [5.6] days; P < .001) but remained stable in US hospitals (mean [SD], 4.9 [3.7] days to 4.9 [3.5] days). Thirty-day readmission rates declined similarly in Canada (from 4088 of 20 758 patients [19.7%] to 3823 of 21 733 patients [17.6%] for all-cause readmissions; P < .001; and from 1743 of 20 758 patients [8.4%] to 1490 of 21 733 patients [6.9%] for heart failure–specific readmissions; P < .001) and the United States (from 21.2% to 18.5% for all-cause readmissions; from 7.6% to 5.7% for heart failure–specific readmissions; both P < .001). There were small but statistically significant positive correlations between length of stay and 30-day readmissions in both Canada (odds ratio, 1.01 [95% CI, ...

IntroductionAntipsychotic medications form the cornerstone of schizophrenia treatment. However, only a minority of patients adhere to their initial antipsychotic regimen. It's expected that Long-Acting Injectable (LAI) antipsychotics improves patient adherence to treatment, however previous research comparing the use of first generation LAI's against oral antipsychotics reported results that were inconclusive.
Objectives and ApproachExplore the effectiveness of the use of LAI's in the delivery of mental health services in Alberta.
Using linked data from AHS Analytics:

Physician claims
National Ambulatory Care Reporting System (NACRS),
Discharge Abstract database (DAD)
Pharmacy Information Network (PIN)
Alberta Provincial Registry data


Define a cohort of patients on antipsychotic medications.
Explore and contrast outcomes related to the use of LAIs against other antipsychotic medication types. Specifically using linked data to define:

Treatment Adherence
Utilization of LAI vs. other medication
Demographic differences
Outcomes pre- and post-LAI treatment


ResultsA patient cohort was established containing only cases from April 1, 2013 to March 31, 2015. Additional data was used to perform a two year washout and a one year follow-up.
Case and medication definitions were determined by a team of psychiatric clinicians. Patient comorbidity information was extracted using previously validated methods.
Overall, 6349 incident cases were identified.
Preliminary analysis indicate:

Overall patient cohort is older than expected
Use of additional medication types is correlated with greater health services utilization after diagnosis
Patients on only oral medications appear to have lower treatment adherence
Males seem to have higher treatment adherence than females
No significant differences were found between patients with rural vs. urban postal codes

Conclusion/ImplicationsWe faced significant challenges when defining cases, medication use and outcomes. However, the linkage of a large number of data sources gives us powerful and multi-faceted insight into the use of antipsychotic medication use in Alberta. Future work will include work on definition validations and deeper analysis of outcomes.

INTRODUCTION: Sleep-time blood pressure correlates more strongly with adverse cardiovascular events than does daytime blood pressure. The BedMed trial evaluates whether bedtime antihypertensive administration, as compared with conventional morning use, reduces major adverse cardiovascular events. METHODS AND ANALYSIS: Design Prospective randomised, open-label, blinded end-point trial. Participants Hypertensive primary care patients using blood pressure lowering medication and free from glaucoma. Setting Community primary care providers in 5 Canadian provinces (British Columbia, Alberta, Saskatchewan, Manitoba and Ontario) are mailing invitations to their eligible patients. Social media campaigns (Google, Facebook) are additionally running in the same provinces. Intervention Consenting participants are allocated via central randomisation to bedtime vs morning use of all antihypertensives. Follow-up (1) Telephone or email questionnaire at 1 week, 6 weeks, 6 months and every 6 months thereafter, and (2) accessing linked governmental healthcare databases tracking hospital and community medical services. Primary outcome Composite of all-cause death, or hospitalisation for myocardial infarction/acute-coronary syndrome, stroke or congestive heart failure. Secondary outcomes Each primary outcome element on its own, all-cause hospitalisation or emergency department visit, long-term care admission, non-vertebral fracture, new glaucoma diagnosis, 18-month cognitive decline from baseline (via Short Blessed Test). Select other outcomes Self-reported nocturia burden at 6 weeks and 6 months (no, minor or major burden), 1-year self-reported overall health score (EQ-5D-5L), self-reported falls, total cost of care (acute and community over study duration) and mean sleep-time systolic blood pressure after 6 months (via 24-hour monitor in a subset of 302 sequential participants). Primary outcome analysis Cox proportional hazards survival analysis. Sample size The trial will continue until a projected 254 primary outcome events have ...