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Accuracy of Canadian health administrative databases in identifying patients with rheumatoid arthritis: a validation study using the medical records of rheumatologists.

https://arctichealth.org/en/permalink/ahliterature114676
Source
Arthritis Care Res (Hoboken). 2013 Oct;65(10):1582-91
Publication Type
Article
Date
Oct-2013
Author
Jessica Widdifield
Sasha Bernatsky
J Michael Paterson
Karen Tu
Ryan Ng
J Carter Thorne
Janet E Pope
Claire Bombardier
Author Affiliation
University of Toronto, Toronto, Ontario, Canada.
Source
Arthritis Care Res (Hoboken). 2013 Oct;65(10):1582-91
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Algorithms
Arthritis, Rheumatoid - diagnosis - epidemiology
Data Mining - statistics & numerical data
Databases, Factual - statistics & numerical data
Drug Prescriptions - statistics & numerical data
Fees and Charges - statistics & numerical data
Female
Hospitalization - statistics & numerical data
Humans
Male
Medical Records Systems, Computerized - statistics & numerical data
Middle Aged
Ontario - epidemiology
Reproducibility of Results
Retrospective Studies
Rheumatology - statistics & numerical data
Single-Payer System - statistics & numerical data
Abstract
Health administrative data can be a valuable tool for disease surveillance and research. Few studies have rigorously evaluated the accuracy of administrative databases for identifying rheumatoid arthritis (RA) patients. Our aim was to validate administrative data algorithms to identify RA patients in Ontario, Canada.
We performed a retrospective review of a random sample of 450 patients from 18 rheumatology clinics. Using rheumatologist-reported diagnosis as the reference standard, we tested and validated different combinations of physician billing, hospitalization, and pharmacy data.
One hundred forty-nine rheumatology patients were classified as having RA and 301 were classified as not having RA based on our reference standard definition (study RA prevalence 33%). Overall, algorithms that included physician billings had excellent sensitivity (range 94-100%). Specificity and positive predictive value (PPV) were modest to excellent and increased when algorithms included multiple physician claims or specialist claims. The addition of RA medications did not significantly improve algorithm performance. The algorithm of "(1 hospitalization RA code ever) OR (3 physician RA diagnosis codes [claims] with =1 by a specialist in a 2-year period)" had a sensitivity of 97%, specificity of 85%, PPV of 76%, and negative predictive value of 98%. Most RA patients (84%) had an RA diagnosis code present in the administrative data within ±1 year of a rheumatologist's documented diagnosis date.
We demonstrated that administrative data can be used to identify RA patients with a high degree of accuracy. RA diagnosis date and disease duration are fairly well estimated from administrative data in jurisdictions of universal health care insurance.
PubMed ID
23592598 View in PubMed
Less detail

Early management of newly diagnosed rheumatoid arthritis by Canadian rheumatologists: a national, multicenter, retrospective cohort.

https://arctichealth.org/en/permalink/ahliterature131696
Source
J Rheumatol. 2011 Nov;38(11):2342-5
Publication Type
Article
Date
Nov-2011
Author
Ruben Tavares
Janet E Pope
Jean-Luc Tremblay
Carter Thorne
Vivian P Bykerk
Juris Lazovskis
Kenneth L N Blocka
Mary J Bell
Diane Lacaille
Carol A Hitchon
Avril A Fitzgerald
Wesley K Fidler
Arthur A M Bookman
James M Henderson
Dianne P Mosher
Dalton E Sholter
Majed Khraishi
Boulos Haraoui
Hong Chen
Xiuying Li
Andreas Laupacis
Gilles Boire
George Tomlinson
Claire Bombardier
Author Affiliation
McMaster University, Hamilton, Canada. ruben.tavares@sympatico.ca
Source
J Rheumatol. 2011 Nov;38(11):2342-5
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Adult
Antirheumatic Agents - therapeutic use
Canada - epidemiology
Cohort Studies
Disability Evaluation
Disease Management
Drug Therapy, Combination
Female
Humans
Male
Middle Aged
Outcome Assessment (Health Care)
Physician's Practice Patterns
Retrospective Studies
Rheumatic Fever - diagnosis - drug therapy - epidemiology
Severity of Illness Index
Treatment Outcome
Abstract
To describe early rheumatologic management for newly diagnosed rheumatoid arthritis (RA) in Canada.
A retrospective cohort of 339 randomly selected patients with RA diagnosed from 2001-2003 from 18 rheumatology practices was audited between 2005-2007.
The most frequent initial disease-modifying antirheumatic drugs (DMARD) included hydroxychloroquine (55.5%) and methotrexate (40.1%). Initial therapy with multiple DMARD (15.6%) or single DMARD and corticosteroid combinations (30.7%) was infrequent. Formal assessment measures were noted infrequently, including the Health Assessment Questionnaire (34.6%) and Disease Activity Score for 28 joints (8.9%).
Initial pharmacotherapy is consistent with guidelines from the period. The infrequent reporting of multiple DMARD combinations and formal assessment measures has implications for current clinical management and warrants contemporary reassessment.
Notes
Comment In: J Rheumatol. 2011 Nov;38(11):2287-922045932
PubMed ID
21885485 View in PubMed
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Effectiveness and safety of etanercept in patients with psoriatic arthritis in a Canadian clinical practice setting: the REPArE trial.

https://arctichealth.org/en/permalink/ahliterature134507
Source
J Rheumatol. 2011 Jul;38(7):1355-62
Publication Type
Article
Date
Jul-2011
Author
Dafna D Gladman
Claire Bombardier
Carter Thorne
Boulos Haraoui
Majed Khraishi
Proton Rahman
William Bensen
Jerry Syrotuik
Melanie Poulin-Costello
Author Affiliation
Toronto Western Hospital (University of Toronto) and University Health Network, Toronto, Ontario, Canada. dafna.gladman@utoronto.ca
Source
J Rheumatol. 2011 Jul;38(7):1355-62
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Adult
Antirheumatic Agents - adverse effects - therapeutic use
Arthritis, Psoriatic - drug therapy - physiopathology
Canada
Disability Evaluation
Efficiency - physiology
Fatigue - epidemiology - physiopathology
Female
Health status
Humans
Immunoglobulin G - adverse effects - therapeutic use
Incidence
Interviews as Topic
Longitudinal Studies
Male
Middle Aged
Receptors, Tumor Necrosis Factor - therapeutic use
Treatment Outcome
Tumor Necrosis Factor-alpha - antagonists & inhibitors
Abstract
To describe the longterm effectiveness and safety of etanercept in Canadian patients with psoriatic arthritis (PsA), treated over 24 months in clinical practice.
Patients with active PsA (= 3 tender and = 3 swollen joints) were recruited from 22 centers. Etanercept was administered at 50 mg/week subcutaneously. In addition to clinical assessment of skin and joint disease, conducted at baseline and at Months 6, 12, 18, and 24, regular patient interviews were conducted by telephone. Patient responses related to health status, disability, and work productivity were scored using the patient global assessment tool, the Health Assessment Questionnaire (HAQ), the Health and Labour Questionnaire (HLQ), and the Fatigue Severity Scale.
Out of 110 patients, 71 (65%) maintained etanercept treatment through the end of our study. All clinical measures of disease severity, including joint tenderness/pain, joint swelling, and Psoriasis Area and Severity Index score, improved significantly between baseline and Month 6 of etanercept treatment and remained constant thereafter. By the end of our study, 79% of patients achieved a Psoriatic Arthritis Response Criteria response, and 56% of patients achieved a 0.5-point improvement on HAQ, indicating clinically significant improvement in disability; 14% of patients finished our study free of disability (HAQ = 0). Patients' work productivity and fatigue improved significantly in parallel with these clinical and functional improvements.
Continuous treatment with etanercept over 2 years in a clinical setting improved clinical symptoms of PsA while reducing fatigue, improving work productivity, and ameliorating or eliminating disability.
PubMed ID
21572156 View in PubMed
Less detail

The epidemiology of rheumatoid arthritis in Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature104423
Source
Arthritis Rheumatol. 2014 Apr;66(4):786-93
Publication Type
Article
Date
Apr-2014
Author
Jessica Widdifield
J Michael Paterson
Sasha Bernatsky
Karen Tu
George Tomlinson
Bindee Kuriya
J Carter Thorne
Claire Bombardier
Author Affiliation
University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Source
Arthritis Rheumatol. 2014 Apr;66(4):786-93
Date
Apr-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Arthritis, Rheumatoid - epidemiology
Databases, Factual
Female
Humans
Incidence
Male
Middle Aged
Ontario - epidemiology
Prevalence
Abstract
Epidemiologic assessments of sufficiently large populations are required in order to obtain robust estimates of disease prevalence and incidence, particularly when exploring the influence of various factors (age, sex, calendar time). We undertook this study to describe the epidemiology of rheumatoid arthritis (RA) over the past 15 years.
We used the Ontario Rheumatoid Arthritis administrative Database (ORAD), a validated population-based research database of all Ontarians with RA. The ORAD records were linked with census data to calculate crude and age and sex-standardized prevalence and incidence rates from 1996 to 2010. Vital statistics were used to estimate annual all-cause mortality during the study period.
As of 2010, there were 97,499 Ontarians with RA, corresponding to a cumulative prevalence of 0.9%. Age and sex-standardized RA prevalence increased steadily over time from 473 (95% confidence interval [95% CI] 469-478) per 100,000 population (0.49%) in 1996 to 784 (95% CI 779-789) per 100,000 population (0.9%) in 2010. Age and sex-standardized incidence per 100,000 population ranged from 62 (95% CI 60-63) in 1996 to 54 (95% CI 52-55) in 2010. All-cause mortality decreased by a relative 21.4% since 1996.
Over a 15-year period, we observed an increase in RA prevalence over time. This rise may be attributed to the increasing time to ascertain cases (which may have been latent in the population during earlier years of the study), increasing survival, and/or an increase in the aging background population. Incidence appears to be stable.
PubMed ID
24757131 View in PubMed
Less detail

Quality care in seniors with new-onset rheumatoid arthritis: a Canadian perspective.

https://arctichealth.org/en/permalink/ahliterature141136
Source
Arthritis Care Res (Hoboken). 2011 Jan;63(1):53-7
Publication Type
Article
Date
Jan-2011
Author
Jessica Widdifield
Sasha Bernatsky
J Michael Paterson
J Carter Thorne
Alfred Cividino
Janet Pope
Nadia Gunraj
Claire Bombardier
Author Affiliation
University of Toronto, Toronto, Ontario, Canada.
Source
Arthritis Care Res (Hoboken). 2011 Jan;63(1):53-7
Date
Jan-2011
Language
English
Publication Type
Article
Keywords
Age of Onset
Aged
Aged, 80 and over
Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - epidemiology - therapy
Cohort Studies
Female
Humans
Male
Ontario - epidemiology
Quality of Health Care - standards - trends
Abstract
To estimate the percentage of seniors with rheumatoid arthritis (RA) receiving disease-modifying antirheumatic drugs (DMARDs) within the first year of diagnosis.
We assembled an incident RA cohort from Ontario physician billing data for 1997-2006. We used a standard algorithm to identify 24,942 seniors with RA based on = 2 billing codes = 60 days apart but within 5 years. Drug exposures were obtained from pharmacy claims data. We followed subjects for 1 year, assessing if they had been exposed (defined as = 1 prescription) to 1 or more DMARDs within the first year of RA diagnosis. We assessed secular trends and differences for subjects who had received rheumatology care (defined as = 1 rheumatology encounter) versus those who had not.
In total, only 39% of the 24,942 seniors with new-onset RA identified over 1997-2006 were exposed to DMARD therapy within 1 year of diagnosis. This increased from 30% in 1997 to 53% in 2006. Patients whose care involved a rheumatologist were more likely to be exposed to DMARDs than those who had no rheumatology care. In 2006, 67% of subjects receiving rheumatology care were exposed to DMARDs versus 21% of those with no rheumatology care.
Improvements in RA care have occurred, but more efforts are needed. Subjects receiving rheumatology care are much more likely to receive DMARDs as compared to those with no rheumatology care. This emphasizes the key role of rheumatologists.
PubMed ID
20806274 View in PubMed
Less detail

The rising burden of rheumatoid arthritis surpasses rheumatology supply in Ontario.

https://arctichealth.org/en/permalink/ahliterature105073
Source
Can J Public Health. 2013 Nov-Dec;104(7):e450-5
Publication Type
Article
Author
Jessica Widdifield
J Michael Paterson
Sasha Bernatsky
Karen Tu
J Carter Thorne
Vandana Ahluwalia
Noah Ivers
Debra Butt
R Liisa Jaakkimainen
George Tomlinson
Claire Bombardier
Author Affiliation
University of Toronto. jessica.widdifield@utoronto.ca.
Source
Can J Public Health. 2013 Nov-Dec;104(7):e450-5
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Arthritis, Rheumatoid - epidemiology
Cost of Illness
Databases, Factual
Female
Humans
Incidence
Male
Middle Aged
Ontario - epidemiology
Physicians - supply & distribution
Prevalence
Rheumatology - manpower
Young Adult
Abstract
Accurate data on the burden of rheumatoid arthritis (RA) are scarce, but critical in helping health care providers and decision makers to optimize clinical and public health strategies for disease management. We quantified the burden of RA in Ontario from 1996 to 2010 by age, sex and health planning region.
We used the Ontario Rheumatoid Arthritis administrative Database (ORAD), a validated population-based cohort of all Ontarians with RA, to estimate the crude prevalence and incidence of RA among men and women, and by age group from 1996 to 2010. Burden by area of patient residence and rheumatology supply also were determined.
The number of RA patients increased over time, from 42,734 Ontarians (0.5%) in 1996 to 97,499 (0.9%) in 2010. On average 5,830 new RA patients were diagnosed each year. In 2010, the burden was higher among females (1.3%) than males (0.5%) and increased with age, with almost half of all RA patients aged 65 years and older. The burden was higher in northern communities (1.0%) than in southern urban areas (0.7%). During the study period, the number of rheumatologists practicing in Ontario remained unchanged (approximately 160).
Over a 15-year period, the number of RA patients more than doubled with no concomitant increase in the number of practicing rheumatologists. We observed considerable regional variation in burden, with the highest rates observed in the north. Our findings highlight the need for regional approaches to the planning and delivery of RA care in order to manage the growing burden.
PubMed ID
24495819 View in PubMed
Less detail

Time to disease-modifying antirheumatic drug treatment in rheumatoid arthritis and its predictors: a national, multicenter, retrospective cohort.

https://arctichealth.org/en/permalink/ahliterature121575
Source
J Rheumatol. 2012 Nov;39(11):2088-97
Publication Type
Article
Date
Nov-2012
Author
Ruben Tavares
Janet E Pope
Jean-Luc Tremblay
Carter Thorne
Vivian P Bykerk
Juris Lazovskis
Kenneth L N Blocka
Mary J Bell
Diane Lacaille
Carol A Hitchon
Avril A Fitzgerald
Wesley K Fidler
Arthur A M Bookman
James M Henderson
Dianne P Mosher
Dalton E Sholter
Majed Khraishi
Boulos Haraoui
Hong Chen
Xiuying Li
Andreas Laupacis
Gilles Boire
George Tomlinson
Claire Bombardier
Author Affiliation
McMaster University, Hamilton, ON, Canada. ruben.tavares@sympatico.ca
Source
J Rheumatol. 2012 Nov;39(11):2088-97
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Adult
Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - drug therapy - epidemiology
Canada
Cohort Studies
Comorbidity
Disease Management
Female
Fibromyalgia - epidemiology
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Osteoarthritis - epidemiology
Retrospective Studies
Time Factors
Abstract
To determine the proportion of patients with rheumatoid arthritis (RA) under rheumatologic care treated with disease-modifying antirheumatic drugs (DMARD) within 6 months from symptom onset and the components of time to treatment and its predictors.
A historical inception cohort of 339 patients with RA randomly selected from 18 rheumatology practices was audited. The proportion that initiated DMARD treatment within 6 months from symptom onset was estimated using Kaplan-Meier analysis. Time to each component of the care pathway was estimated. Multivariable modeling was used to determine predictors of early treatment using 12 preselected variables available in the clinical charts. Bootstrapping was used to validate the model.
Within 6 months from symptom onset, 41% (95% CI 36%-46%) of patients were treated with DMARD. The median time to treatment was 8.4 (interquartile range 3.8-24) months. Events preceding rheumatology referral accounted for 78.1% of the time to treatment. The most prominent predictor of increased time to treatment was a concomitant musculoskeletal condition, such as osteoarthritis or fibromyalgia. The significance of other variables was less consistent across the models investigated. Included variables accounted for 0.69 ± 0.03 of the variability in the model.
Fewer than 50% of patients with RA are treated with DMARD within 6 months from symptom onset. Time to referral to rheumatology represents the greatest component delay to treatment. Concomitant musculoskeletal condition was the most prominent predictor of delayed initiation of DMARD. Implications of these and other findings warrant further investigation.
Notes
Comment In: J Rheumatol. 2012 Nov;39(11):2059-6123118276
PubMed ID
22896027 View in PubMed
Less detail

7 records – page 1 of 1.