Suchergebnisse

ObjectiveTo describe clinical pathways and use of the bundled care funding model, where a patient's treatment and payment is assigned to a group of providers, among individuals who underwent a total joint arthroplasty (TJA) in Ontario. The request for this work was submitted by the Rehabilitative Care Alliance through the Applied Health Research Question (AHRQ) program.
ApproachAdults with TJA from April 1st 2018 to March 31st 2022 were included. Demographics, surgical characteristics, inclusion in bundled care, and use of health services were defined using administrative health data. Results were stratified by location of surgery (bilateral or unilateral hip, knee, or shoulder TJA).
ResultsAmong 152,135 individuals with TJA during the study period, 71,996 individuals (47.3%) received services through a bundled care approach. Rate of bundled care use was highest among individuals with unilateral knee TJA (52.5% in bundled care), and the lowest among individuals with shoulder TJA (13.4% in bundled care). In fiscal year 2018, 33% of TJA patients used bundled care, in fiscal year 2019, over 50% of TJA patients used bundled care and 55% of TJA patients used bundled care by 2021. Most individuals used bundled care following an inpatient surgery (88.9% of individuals following a unilateral knee TJA) as opposed to a same day surgery (11.1% with a unilateral knee TJA).
ConclusionThe purpose of bundled care service delivery is to provide integrated healthcare delivery and therefore improved patient experience and outcomes. Understanding bundled care use may improve healthcare planning and assessment of health services.

ObjectivesAn Applied Health Research Question request from Peel Public Health was investigated, to provide a comprehensive overview of injury patterns and healthcare utilization, among cyclists and pedestrians in the Peel Region of Ontario.
ApproachEmergency department visits and hospitalizations across the Peel region were analyzed from 2018 to 2022, and categorized by collision type (pedestrian, cyclist motor vehicle collision (MVC), and cyclist non-MVC). Data was segmented quarterly and annually, and further stratified by residence status, sex, and age, by linking individuals to other administrative health databases. Additionally, 30-day mortality outcomes were evaluated. To contextualize incidence rates with population demographics, Public Health Data Zone and Census Subdivision data were also utilized.
ResultsFor ambulatory visits, a substantial majority of Peel residents received treatment within the region, evidenced by 4,483 cyclist visits (55%) and 1,338 pedestrian visits (50%). However, a noteworthy portion of Peel residents — 188 cyclists (45%) and 182 pedestrians (46%) — received treatment outside the region. Hospitalization patterns echoed these visits. Overall, non-MVCs accounted for a large proportion of cycling incidents, particularly among females, stressing the need for targeted safety measures. Still, survival rates post-incident were notable, with a 100% survival rate for cyclists after ambulatory visits. Pedestrian survival rates were similarly high.
ConclusionThis study provided valuable insights into patterns of pedestrian and cyclist injuries among Peel residents, revealing considerable cross-regional healthcare utilization.
ImplicationsFindings will be utilized by the Region of Peel and partner organizations, to enhance local road safety initiatives and service delivery for vulnerable road users.

ObjectivesPeople with intellectual and developmental disabilities (IDD) have been disproportionately impacted by COVID-19, a population more likely to experience poor health outcomes. An Applied Health Research Question (AHRQ) request through ICES led to an investigation that monitored COVID-19 related infections and outcomes in adults with and without IDD.
ApproachThe ICES-AHRQ team approved a request from the Ministry of Children, Community and Social Services (MCCSS), to determine the proportion of adults with IDD tested and confirmed positive for COVID-19. The scientists also explored if positive IDD cases experienced similar health outcomes to the general population. The open cohort was derived by linking those with a COVID-19 test in Ontario Laboratories Information System, from January 2020 to December 2021, to supplemented positive case data and administrative health databases. An algorithm was used to define IDD by a series of inpatient hospitalizations, emergency department and/or physician visits, with IDD diagnostic codes.
ResultsSimilar rates of testing and positivity were observed for those with (46%; 6%) and without IDD (43%; 5%). However, adults with IDD confirmed positive for COVID-19 were mostly male (62% vs 49%), aged 18-29 (40% vs 27%), had medical conditions associated with frailty (15% vs 4%), and from the lowest neighborhood income quintile (27% vs 23%), compared to the non-IDD population, respectively. Cumulatively, deaths and hospitalizations following a COVID-19 diagnosis were two-times more likely in the IDD population, while comparable rates of intensive care unit (ICU) admissions were reported. Particularly, adults with IDD aged 18-54 experienced higher rates of hospitalizations (48% vs 30%), ICU admissions (56% vs 36%), and deaths (26% vs 6%), compared to the same age group in those without IDD.
Conclusion/ImplicationsReal-time administrative health data and analytics were used to support Ontario's COVID-19 response in those with IDD. To inform decision making and policy actions related to immediate testing strategies, MCCSS used such findings to increase the availability of testing for adults with IDD, who may face multiple barriers.

Objectives/ApproachWe linked the Ontario Social Assistance (OSA) Benefit Unit file from the Ministry of Children, Community and Social Services to provincial health administrative datasets housed at ICES to examine the impact of COVID-19 on Mental Health and Addictions (MHA) service use among OSA recipients.
Those receiving OSA benefits for February 2020 were matched to Ontario residents not receiving benefits based on age (±1 year), sex, income, expected resource utilization, and area of residence (N=771,891 matched pairs). We computed rates of MHA-related emergency department (ED) visits and hospitalizations in the 16-month period before (November 2018-February 2020) and after (March 2020-June 2021) pandemic onset.
ResultsMHA-related ED visit rates were much greater among OSA recipients (8.82 per 1,000 person-months) compared with matched controls (1.83 per 1,000 person-months) in the post-COVID period (Relative Rate [RR]=4.82; 95% Confidence Interval [95%CI] 4.75-4.89). Comparatively, MHA-related ED visit rates were also greater among OSA recipients (9.85 per 1,000 person-months) compared with controls (2.38 per 1,000 person-months) during the pre-COVID period (RR=4.13; 95%CI 4.08-4.18). The pre-COVID and post-COVID period RRs comparing OSA recipients and matched controls were significantly different (p<0.001). Results were consistent when examining MHA-related hospitalizations.
Conclusions/ImplicationsWhile MHA-related ED visits and hospitalizations rates were significantly higher in OSA recipients than matched controls in both time periods, this difference increased following the onset of COVID-19. Increased reliance on hospital-based MHA services post-COVID represents the greater ongoing need for, and/or reduced access to, MHA-related ambulatory care for OSA recipients during the pandemic.

ObjectivesThe Rehabilitative Care Alliance issued an Applied Health Research Question request to collect information regarding healthcare and rehabilitation use among COVID-19 positive individuals. The objective of this project is to determine the association between length of stay (LOS) in acute care and the number of rehabilitation services used post COVID-19 diagnosis.
ApproachHospital and rehabilitation service use was identified among individuals diagnosed with COVID-19, using administrative health data. Admission into acute care within 30 days post COVID-19 diagnosis was recorded. Use of inpatient, physiatry and home-care rehabilitative services were collected until March 31st 2021. Outpatient rehabilitation reporting is not mandatory and was not included. Marginalization was evaluated using the Ontario Marginalization Index factor scores. The association between LOS in acute care and number of rehabilitation categories used was assessed using a negative binomial model, stratified by with or without a stay in the ICU and controlling for age, sex, comorbidities and long-term care residence.
ResultsOf 181,139 individuals diagnosed with COVID-19 prior to December 31st 2020, 5% were hospitalized. Of those hospitalized 2.3% then entered rehabilitation compared to 0.06% who were not hospitalized post COVID-19 infection. Rehabilitation users had higher residential instability (mean=0.45 vs -0.01 in the overall cohort), dependency (mean=-0.02 vs -0.27) and material deprivation (mean=0.37 vs 0.19) but similar ethnic diversity (mean=0.87 vs 0.90) compared to the full cohort. LOS in acute care was associated with a 3.3% increased risk of using additional rehabilitation services for individuals without a stay in the ICU (RR 1.033, 95% CI: 1.011 to 1.055; p=0.0036), and a 3.7% increased risk for individuals with a stay in the ICU (RR 1.037, 95% CI: 1.025 to 1.048; p<.0001).
ConclusionsPost COVID-19 diagnosis, a larger proportion of rehabilitation service users were hospitalized compared to all COVID-19+ individuals. Additionally, LOS in acute care was associated with the use of more rehabilitation care categories following a COVID-19 diagnosis, and the association was stronger for more severe cases requiring an ICU stay.

ObjectivesEquitable vaccine distribution was essential in supporting Ontario's COVID-19 response, particularly for persons with intellectual and developmental disabilities (IDD), who have been disproportionately impacted by the pandemic. An Applied Health Research Question (AHRQ) request through ICES, sought to report on COVID-19 vaccination uptake in adults with and without IDD.
ApproachTo examine the proportion of adults with IDD vaccinated for COVID-19, a request from the Ministry of Children, Community and Social Services (MCCSS) was approved by the ICES-AHRQ team. A secondary goal was to explore if vaccinated individuals with IDD experienced similar levels of protection from COVID-19 infection, to the general population. The open cohort was derived by linking vaccination events reported in Ontario COVID-19 Vaccine Data, between December 2020 to December 2021, to several administrative health databases. An algorithm was used to define IDD by a series of inpatient hospitalizations, emergency department and/or physician visits, with IDD diagnostic codes.
ResultsThe proportion who received at least two doses was similar between both groups (82% (IDD); 83% (non-IDD)). However, despite emerging evidence suggesting that high-risk populations should receive a third dose, a lower proportion of people with IDD (25%), compared to the general population without IDD (30%), had done so. The IDD subpopulation is generally younger, and partially explained the third dose findings when examined by age. Withal, adults with IDD vaccinated with at least two doses were mostly male (62% vs 48%), 18-29 years of age (44% vs 17%), and from the lowest neighborhood income quintile (26% vs 18%), compared to the non-IDD population, respectively. Cumulatively, adults with IDD had comparable rates of confirmed breakthrough case infections following vaccination (17%), to those without IDD (19%).
Conclusion/ImplicationsAdministrative health data and analytics through the ICES-AHRQ program were used in responding to COVID-19, and providing public health guidance, for those with IDD. To inform decision making and policy actions related to immediate vaccination strategies, MCCSS used such findings to target vaccination efforts in specific IDD subpopulations, across Ontario.

ObjectivesTo understand changes in prescription patterns over time, and support dental and oral health program planning, Toronto Public Health issued an AHRQ request to collect information on physician-prescribed medications following an oral health-related incident.
ApproachAn algorithm was created to identify oral health-related incidents among children and youth aged up to 17 years old in Ontario and Toronto during fiscal years 2013 to 2022. The algorithm used provincial data on physician visits, emergency department visits, inpatient hospitalizations, or day surgeries to define 'dental-related incidents'. Physician-prescribed medications (e.g., chlorhexidine, opioids, benzodiazepines, antibiotics, NSAIDs and others) within seven days of a dental-related incident were recorded using Ontario Drug Benefit Claims and the Narcotics Monitoring System.
ResultsOf 522,674 dental-related incidents in Ontario between 1 April 2013 and 31 March 2023, 9.2% had physician-prescribed medications (versus 8.6% of 90,810 dental-related incidents in Toronto). The proportion of incidents with prescriptions increased from 6.4% in 2013 to 10.7% in 2022 in Ontario, and from 5.9% to 10.3% in Toronto. The most prescribed medication was antibiotics, followed by immediate-release combination medications and non-long-acting medications.
Conclusions/ImplicationsOver the 10-year period examined, an increasing proportion of dental-related incidents had physician-prescribed medications, which may be attributed to the implementation of Ontario's pharmacare program (OHIP+) in 2018. Early access to routine and preventative dental care could become more accessible as part of Canada's new federal dental program. Results from this AHRQ will inform better resource allocation in dental and oral health program planning, potentially reducing avoidable healthcare costs.

IntroductionThe Applied Health Research Question (AHRQ) portfolio is an initiative funded by the Ontario Ministry of Health and Long-Term Care, leveraging the linked data and the scientific expertise at ICES to answer questions from Knowledge Users that have a direct impact on healthcare policy, planning or practice.
Objectives and ApproachA request from Casey House, a specialty HIV hospital located in Toronto, ON, was reviewed and approved by the ICES AHRQ Team to evaluate patient healthcare utilization and costs. The purpose was to support the design of programs and services, improve transitions from healthcare settings to community services, and inform continuous quality improvement initiatives. Using inpatient records, hospital admissions to Casey House were identified in fiscal years 2009-2014. Inpatient, emergency, outpatient and home care visits were characterized before and after admission. Using the Ontario Drug Benefit Claims, antiretroviral (ARV) prescription fills were examined 7 days post discharge.
ResultsBetween April 1, 2009 and March 31, 2015, 268 HIV patients had one or more hospital admissions to Casey House. The majority of Casey House patients had an Aggregated Diagnosis Group (ADG) ≥ 10 (79%) or Resource Utilization Band (RUB) = 5 (78%), indicating a high co-morbidity burden. Rate of emergency department usage declined from 4.61 to 2.46 per person-year, before and after Casey House admission (p < 0.0001). Conversely, home care visits increased from 24.29 to 35.63 per person-year and family physician visits increased from 18.33 to 22.59 per person-year before and after Casey House admission (both p < 0.0001). Interestingly, 89% did not fill an ARV prescription within 7 days of Casey House discharge, however 76% followed up with an outpatient HIV visit within 30 days.
Conclusion/ImplicationsHealthcare utilization differed before and after admission to Casey House. Follow-up post-discharge warrants further examination to increase ARV prescription fills. Data from this AHRQ has facilitated future policy and programming changes. Results have been disseminated throughout the Toronto HIV research community to generate discussion on quality improvement in this population.

Objective/ApproachThe Black Health Equity Working Group's Applied Health Research Question aimed to compare cancer screening rates and surgical wait times between community health centre (CHC) clients based on race-related data and non-CHC clients.
CHC client data was categorized by self-identified racial groups, with Black self-identification compared to non-Black racialized, White, and missing racial self-identification, and non-CHC clients. Health card numbers were encrypted to link individuals to the Primary Care Population dataset for breast, cervical, and colorectal cancer screening rates. Surgical wait time indicators, such as the number of patients undergoing surgery and average wait times for initial consultation and completed surgeries, were derived from the Wait Time Information System. Assessments were conducted semi-annually from fiscal year 2018 to 2021.
ResultsFollowing the onset of COVID-19, CHC clients self-identifying as Black experienced the most significant decrease (6.8%) in colorectal screenings compared to other groups. Mammogram screenings remained consistently higher for CHC clients self-identifying as Black pre- and post-pandemic. Average cervical cancer screening rates were approximately 8% higher among CHC clients compared to non-CHC clients, irrespective of racial self-identification. However, due to small sample sizes and missing data among self-identified racial groups, trends in surgical wait times for both CHC and non-CHC clients were unstable.
Conclusion/ImplicationsTailored interventions targeting Black CHC clients can enhance cancer screening rates, particularly colorectal screenings. The analysis of CHC data offers valuable insights into race-based disparities in health outcomes. Improved data completeness is essential for accurately assessing health outcome variations among different racial groups.

ObjectiveIn response to the COVID-19 pandemic, Sunnybrook Health Sciences Centre launched the first virtual emergency department (VED) in Toronto, Ontario. The objective of this pilot project was to leverage linked administrative data to describe the healthcare utilization of VED patients compared to matched patients who attended an ED in person.
ApproachEvaluation of the VED program was supported by the ICES Applied Health Research Question Program, which is funded by the Ontario Ministry of Health to answer questions directly related to Ontario healthcare policy, planning, or practice. VED visit records from December 2020 to May 2021 were linked with Ontario administrative data. VED patients with low acuity complaints were matched 1:1 with in-person ED comparators according to visit date, presenting complaint, and a propensity score that incorporated age, sex, comorbidities, and other important potential confounders. The primary outcomes were healthcare utilization within 7 days and all-cause mortality within 30 days.
ResultsOf the 609 eligible patients discharged from the VED, 600 (98.5%) were successfully matched to a comparator. Mean (SD) age was 43.0 (21.1) and 64.1% were female. In-person ED revisits and hospitalizations were similar for VED and comparator patients at 72 hours (ED: 12.1% vs. 11.3%; Δ 0.8%, 95%: -2.8, 4.5%; hospitalization: 1.2% vs. 1.5%; Δ 0.3%, 95%: -0.7, 1.4%,) and 7 days (ED: 16.1% vs. 14.4%; Δ 1.7, 95%: -2.4, 5.7%; hospitalization: 1.7% vs. 1.8%; Δ 0.2%, 95%: -0.1, 1.4%) following the index visit. The number of patients visiting a primary care provider within 7 days was also similar between groups (36.7% vs. 32.4%; Δ 4.3, 95%: -1.1, 9.8%). No patients died within 30 days.
Conclusion/ImplicationsVED patients and their matched comparators had similar healthcare utilization in the 7 days following their index ED visit. Methodology from this study will inform a province-wide evaluation of VED programs across Ontario.

ICES upholds a strong reputation for generating high-quality evidence to inform policy and practice through its collaborations with a broad range of health system stakeholders including government policymakers and healthcare providers including clinicians. Supported by the Ontario Ministry of Health and Ministry of Long-Term Care, the ICES Applied Health Research Question (AHRQ) Program leverages the data holdings and, scientific and clinical expertise to generate evidence tailored to the information needs of requestors. This paper outlines the approach, process, strengths, challenges and the resulting influence and impact to the healthcare landscape in Ontario.

ObjectiveTo provide an update on the key characteristics, refinements to project flow, and future opportunities for a program providing customized research evidence to health system policymakers and providers.
ApproachWith a goal to inform health system decision making, the program answers research questions posed by health system requestors that can be answered with linked, population-based administrative data. Now in its 10th year of operation, the program has been refined over time to improve efficiency, usefulness of research products, and requestor satisfaction. Satisfaction surveys and individual-level engagements with requestors are used to collect feedback on the needs of an increasingly diverse group of requests.
ResultsWith 508 requests, 82 Data Sharing Agreements, and 257 unique requestors since its inception, the program informs governmental decision making, evaluates intervention effectiveness, and aids grassroots organizations' planning for services. Notable updates to the program include, inserting multiple opportunities for connection between the program and requestors through the project life cycle to understand goals and needs; assigning staff scientists to shepherd projects and promote efficiency; training coordinators to review privacy impact assessments; and (soon) accepting a broader range of projects to include data beyond the health sector e.g. education.
ConclusionThis program continues to improve and is an exemplar of sustainable approaches to supporting health system requestors with evidence from administrative data in program evaluation, planning and policy change.
ImplicationsBeing responsive to requestor needs has allowed the program to attract an increasingly diverse range of requesters who can obtain impactful and timely research evidence.