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Proof of Concept Collaboration #1 Using Cross-jurisdictional Data Linkage to Investigate Cross-Border Hospital Use Presented by Katrina Spilsbury Centre.

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Presentation on theme: "Proof of Concept Collaboration #1 Using Cross-jurisdictional Data Linkage to Investigate Cross-Border Hospital Use Presented by Katrina Spilsbury Centre."— Presentation transcript:

1 Proof of Concept Collaboration #1 Using Cross-jurisdictional Data Linkage to Investigate Cross-Border Hospital Use Presented by Katrina Spilsbury Centre for Population Health Research, Curtin University

2 Why Cross-jurisdictional Linkage of Health Data?  Accurate data for longitudinal studies o People who move frequently or die interstate o Seasonal or out of state workers  Increase statistical power to research rare diseases or health outcomes  Evaluate state-based variations in hospital care

3 Is cross-border hospital use really an issue? Sydney Brisbane Perth Melbourne Adelaide Hobart Darwin Brisbane = Hospital Source: Australian Bureau of Statistics WA SA NT QLD NSW & ACT TAS VIC

4 PoC #1 – Aims  Epidemiological o Cross-border hospital use – size of the issue? o Can cross-jurisdictional linkage refine estimates of hospital- related mortality?  Technical / Logistical o Data handling and cleaning issues o Standardisation of data o What can be improved or streamlined?

5 PoC #1 – Data  WA, NSW, QLD & SA participating jurisdictions  Five years of data – July 2004 to June 2009  Hospital records o Public and private hospital in-patient (WA, NSW and QLD) o Public hospital in-patient (SA)  Death records – WA, NSW, QLD & SA

6 Data Separation Principle State Data Linkage Units & Data Custodians Centre for Data Linkage Researcher NameDobKey Joe Blow1930001 May Wind1980002 KeyYearClinical info 0012000Broken arm 0012003Poorly 0012005Very poorly 0012006Died 00220021 st child 0022004Twins 0022007Triplets 0022008Exhaustion KeysClinical Info KeysClinical Info SA NSW Key NameDob AAAJoe Blow1930 BBBMay Wind1980 Keys Names DOB Keys Key NameDob XXXJoe Blow1930 YYYMay Wind1980 YearClinical info 2000Broken arm 2007Triplets 2008Exhaustion YearClinical info 2003Poorly 2005Very poorly 2006Died 20021 st child 2004Twins Keys XXX AAA BBB YYY

7 Data cleaning  Reformatting file types  Renaming and recoding variables  Applying exclusion criteria o Funding duplicates, cancelled procedures, boarders, organ procurements, healthy newborns o Records missing age, sex, principal diagnosis or separation mode o Non-Australian postcodes of residence. 1.4 million out of 38 million hospital records excluded

8 Data cleaning by state Excluded episodes of care (hospital records)NSWWAQLDSA Total excluded Potential funding duplicate records – one kept31,34509,35896420,903 Missing age at admission842000 Missing sex or intersex199363211 Missing principal diagnosis28,738000 Newborn 3, boarder, organ procurement care types604,12836,473427,79522,0421,090,438 Non-hospital facility (rehab, nursing, hospices)149,416013,4471,879164,742 Non-medical hospital encounter (Z76)1,8994,1371,4967608,292 Cancelled procedures (Z53)1,60903501,644 Missing, unknown or overseas postcodes84,8888,41230,7883,267127,355 Separation date < admission date or missing125000 Total excluded903,18949,025482,92528,9151,443,290

9 Coding variation between states NSWWAQLDSA N%N%N%N% Day case chemotherapy (Z51.1) Public hospital26,78411.5150,82653.5180,89136.063,606100 Private hospital206,69388.5131,01146.5321,81264.0- Day case renal dialysis (Z49.1) Elective1,606,25891.50057,3164.700 Emergency12,5810.7002900.0200 Not assigned136,4947.8729,1041001,159,71995.3313,774100.0 Single delivery (O80) Elective 25,79830.400.01,8662.700.0 Emergency 2,1552.500.06,4729.500.0 Not assigned 57,02967.123,983100.059,52187.711,205100.0 ED deaths recorded as in-patient YesNo

10 PoC #1 – Findings  Acute care hospital stays o Multi-episodes of care (records) bought together o SA – Public Hospitals only NSWWAQLDSATotal N%N%N%N% All Hospital stays 8,723,87946.22,799,64614.85,919,02531.41,427,7807.618,870,330 All Individuals 3,660,99147.91,094,30314.32,286,44930.0608,9218.07,650,664 Public Hospital Stays In-hospital deaths 95,7351.819,1771.240,9291.420,0731.4175,913 30 day deaths 30,7331.46,4091.112,0471.17,9221.366,324

11 Residence Jurisdiction of hospital stay NSWWAQLDSATotal NSW -3,111131,1495,986140,246 WA 3,550-2,5361,2607,346 QLD 65,5062,612-1,60669,724 SA 3,7981,1952,964-7,957 VIC 59,9672,71612,1319,59484,408 TAS 2,2694181,8503694,906 NT 1,8901,5933,8628,62715,972 ACT 20,8711891,12822222,410 Total 157,851 (1.81%)11,834 (0.42%)155,620 (2.63%)27,664 (1.94%)352,969 (1.87%) Hospital Stays by Travellers 223,262 (3.0%) individuals who had 352,969 (1.9%) hospital stays as traveller

12 Residence of Travellers Jurisdiction of residence

13 Hospital Stays by Movers There were 48,575 (0.6%) individuals with 59,387 hospital stays recorded as movers Pre-move residence Jurisdiction of post-move residence NSWWAQLDSATotal NSW -3,71919,5491,83225,100 WA 2,854-3,9881,1688,010 QLD 12,8353,143-1,52017,498 SA 1,5681,1731,917-4,658 VIC 9702165912862,063 TAS 105359415249 NT 154220299257930 ACT 7003412520879 Total 19,186 (0.22%)8,540 (0.31%)26,563 (0.45%)5,098 (0.36%)59,387 (0.31%)

14 Residence of Movers Jurisdiction pre-move Note: By definition a mover had at least 2 hospital stays over a 5 year period

15 Cross-border hospital transfers Jurisdiction of sending hospital Jurisdiction of receiving hospital NSWWAQLDSATotal NSW -128,1141,3169,442 WA 27- 261265 QLD 12588- 121,278 SA 299824 -331 Total1,584288,1641,34011,116 Over 11,000 acute care hospital transfers across state borders of the four jurisdictions were identified

16 Cross-border hospital transfers Jurisdiction of sending hospital

17 Conclusion  Cross-border hospital use o SA & QLD receive highest proportions of patients from elsewhere o Mining / tourism regions in QLD & WA have high numbers of movers  Cross-jurisdictionally linked data is complex! o Very large files o Takes time to understand o Local knowledge and input essential o Centralised approach to data and metadata?

18 PoC #1 - Contributors This project was jointly supported by the Australian Government’s National Collaborative Research Infrastructure Strategy and the Western Australian Department of Commerce Research team (WA) Katrina Spilsbury & Janine Alan – Centre for Population Health Research, Curtin University Di Rosman – WA Health New South Wales Lee Taylor, Kim Lim, Baohui Yang and Zoran Bolevich– NSW Ministry of Health South Australia Almond Sparrow and Stacy Vasquez – SA NT Data Link Paul Basso, Tina Hardin & Tomi Adejoro – SA Health Helen Paues – SA Births Deaths and Marriages Darren Shaw – Promadis Western Australia Jessica Lee, Alex Godfrey, Paul Stevens & Carol Garfield - WA Health Brett Burns – WA Births, Deaths & Marriages, Centre for Data Linkage (WA) Anna Ferrante, James Boyd, Sean Randall & Jacqui Bauer Queensland Ben Wilkinson, Trisha Johnston & Ann Harrington– QLD Health Julie Hall and Erica Findlay – QLD Births Deaths Marriages, PHRN Program Office Merran Smith, Felicity Flack, Angela Young, Nathalie Wray, Emma Fuller & Tony Woollacott Others Vicky Stagg - University of Calgary, Canada James Harrison – Flinders University Bruce Armstrong – University of Sydney Neville Board – ACSQHC Robyn Munro & Alan Finlayson – NS, Scotland Sanja Lujic – University of Western Sydney

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