Presentation on theme: "Proof of Concept Collaboration #1"— Presentation transcript:
1 Proof of Concept Collaboration #1 Using Cross-jurisdictional Data Linkage to Investigate Cross-Border Hospital UsePresented by Katrina SpilsburyCentre for Population Health Research, Curtin University
2 Why Cross-jurisdictional Linkage of Health Data? Accurate data for longitudinal studiesPeople who move frequently or die interstateSeasonal or out of state workersIncrease statistical power to research rare diseases or health outcomesEvaluate state-based variations in hospital care
3 Is cross-border hospital use really an issue? DarwinNTQLDNSWQLDBrisbaneWABrisbaneSANSW& ACTPerthSydneyAdelaideVICMelbourneHobart= HospitalTASSource: Australian Bureau of Statistics
4 PoC #1 – Aims Epidemiological Technical / Logistical Cross-border hospital use – size of the issue?Can cross-jurisdictional linkage refine estimates of hospital-related mortality?Technical / LogisticalData handling and cleaning issuesStandardisation of dataWhat can be improved or streamlined?
5 PoC #1 – Data WA, NSW, QLD & SA participating jurisdictions Five years of data – July 2004 to June 2009Hospital recordsPublic and private hospital in-patient (WA, NSW and QLD)Public hospital in-patient (SA)Death records – WA, NSW, QLD & SA
6 Data Separation Principle State Data Linkage Units& Data CustodiansCentre for Data LinkageResearcherKeysKey Name DobAAA Joe Blow 1930BBB May Wind 1980Year Clinical info2003 Poorly2005 Very poorly2006 Died2002 1st child2004 TwinsKeys Names DOBKeysXXXAAABBBYYYName Dob KeyJoe BlowMay WindNSWKey Year Clinical infoBroken armPoorlyVery poorlyDiedst childTwinsTripletsExhaustionKeysClinical InfoKeysClinical InfoKeys Names DOBSAKey Name DobXXX Joe Blow 1930YYY May Wind 1980Year Clinical info2000 Broken arm2007 Triplets2008 ExhaustionKeys
7 Data cleaning Reformatting file types Renaming and recoding variables Applying exclusion criteriaFunding duplicates, cancelled procedures, boarders, organ procurements, healthy newbornsRecords missing age, sex, principal diagnosis or separation modeNon-Australian postcodes of residence.1.4 million out of 38 million hospital recordsexcluded
8 Excluded episodes of care (hospital records) Data cleaning by stateExcluded episodes of care (hospital records)NSWWAQLDSATotal excludedPotential funding duplicate records – one kept31,3459,35896420,903Missing age at admission842Missing sex or intersex19936211Missing principal diagnosis28,738Newborn3, boarder, organ procurement care types604,12836,473427,79522,0421,090,438Non-hospital facility (rehab, nursing, hospices)149,41613,4471,879164,742Non-medical hospital encounter (Z76)1,8994,1371,4967608,292Cancelled procedures (Z53)1,609351,644Missing, unknown or overseas postcodes84,8888,41230,7883,267127,355Separation date < admission date or missing125Total excluded903,18949,025482,92528,9151,443,290
9 Coding variation between states NSWWAQLDSAN%Day case chemotherapy (Z51.1)Public hospital26,78411.5150,82653.5180,89136.063,606100Private hospital206,69388.5131,01146.5321,81264.0-Day case renal dialysis (Z49.1)Elective1,606,25891.557,3164.7Emergency12,5810.72900.02Not assigned136,4947.8729,1041,159,71995.3313,774100.0Single delivery (O80)25,79830.40.01,8662.72,1552.56,4729.557,02967.123,98359,52187.711,205ED deaths recorded as in-patientYesNo
10 PoC #1 – Findings Acute care hospital stays Multi-episodes of care (records) bought togetherSA – Public Hospitals onlyNSWWAQLDSATotalN%All Hospital stays8,723,87946.22,799,64614.85,919,02531.41,427,7807.618,870,330All Individuals3,660,99147.91,094,30314.32,286,44930.0608,9218.07,650,664Public Hospital Stays In-hospital deaths95,7351.819,1771.240,9291.420,073175,91330 day deaths30,7336,4091.112,0477,9221.366,324
11 Hospital Stays by Travellers Jurisdiction of hospital stay 223,262 (3.0%) individuals who had 352,969 (1.9%) hospital stays as travellerResidenceJurisdiction of hospital stayNSWWAQLDSATotal-3,111131,1495,986140,2463,5502,5361,2607,34665,5062,6121,60669,7243,7981,1952,9647,957VIC59,9672,71612,1319,59484,408TAS2,2694181,8503694,906NT1,8901,5933,8628,62715,972ACT20,8711891,12822222,410157,851 (1.81%)11,834 (0.42%)155,620 (2.63%)27,664 (1.94%)352,969 (1.87%)
12 Residence of Travellers Jurisdiction of residence
13 Hospital Stays by Movers Jurisdiction of post-move residence There were 48,575 (0.6%) individuals with 59,387 hospital stays recorded as moversPre-moveresidenceJurisdiction of post-move residenceNSWWAQLDSATotal-3,71919,5491,83225,1002,8543,9881,1688,01012,8353,1431,52017,4981,5681,1731,9174,658VIC9702165912862,063TAS105359415249NT154220299257930ACT700341252087919,186 (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 receiving hospital Over 11,000 acute care hospital transfers across state borders of the four jurisdictions were identifiedJurisdictionof sending hospitalJurisdiction of receiving hospitalNSWWAQLDSATotal -128,1141,3169,44227- 2665125881,278299243311,584288,1641,34011,116
16 Cross-border hospital transfers Jurisdiction of sending hospital
17 Conclusion Cross-border hospital use SA & QLD receive highest proportions of patients from elsewhereMining / tourism regions in QLD & WA have high numbers of moversCross-jurisdictionally linked data is complex!Very large filesTakes time to understandLocal knowledge and input essentialCentralised approach to data and metadata?
18 PoC #1 - ContributorsCentre for Data Linkage (WA)Anna Ferrante, James Boyd, Sean Randall & Jacqui BauerQueenslandBen Wilkinson, Trisha Johnston & Ann Harrington– QLD HealthJulie Hall and Erica Findlay – QLD Births Deaths Marriages,PHRN Program OfficeMerran Smith, Felicity Flack, Angela Young, Nathalie Wray,Emma Fuller & Tony WoollacottOthersVicky Stagg - University of Calgary, CanadaJames Harrison – Flinders UniversityBruce Armstrong – University of SydneyNeville Board – ACSQHCRobyn Munro & Alan Finlayson – NS, ScotlandSanja Lujic – University of Western SydneyResearch team (WA)Katrina Spilsbury & Janine Alan – Centre for Population Health Research, Curtin UniversityDi Rosman – WA HealthNew South WalesLee Taylor, Kim Lim, Baohui Yang and Zoran Bolevich– NSW Ministry of HealthSouth AustraliaAlmond Sparrow and Stacy Vasquez – SA NT Data LinkPaul Basso, Tina Hardin & Tomi Adejoro – SA HealthHelen Paues – SA Births Deaths and MarriagesDarren Shaw – PromadisWestern AustraliaJessica Lee, Alex Godfrey, Paul Stevens & Carol Garfield - WA HealthBrett Burns – WA Births, Deaths & Marriages,This project was jointly supported by the Australian Government’s National Collaborative Research Infrastructure Strategy and the Western Australian Department of Commerce
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