The suicide rate in Alberta is consistently above the Canadian average. Health care use profiles of those who die by suicide in Alberta are currently unknown.
Death records were selected for people aged 25 to 64 with suicide coded as the underlying cause of death from April 1, 2003 to March 31, 2006. The death records were linked to administrative records pertaining to physician visits, emergency department visits, inpatient hospital separations, and community mental health visits. The control group was the Alberta population aged 25 to 64 who did not die by suicide. Frequency estimates were produced to determine the characteristics of the study population. Odds ratios relating to demographics, exposure to health care services, and case-control status were estimated with logistic regression.
Almost 90% of suicides had a health service in the year before their death. Suicides averaged 16.6 visits per person, compared with 7.7 visits for non-suicides. Much of the health service use among people who died by suicide appears to have been driven by mental disorders.
Information about health service delivery to those who die by suicide can guide prevention and intervention efforts.
To determine the test characteristics of diagnostic codes within a medical service claims database for deep vein thrombosis (DVT) and pulmonary embolism (PE).
The Regie de l' Assurance Maladie du Québec (RAMQ) administers the health insurance program in Québec, Canada. RAMQ claims data were obtained for subjects with objectively diagnosed DVT with or without PE who were participants in the Venous Thrombosis Outcomes (VETO) Study from April 2001 to July 2002. Using the date of DVT and PE diagnosis in the VETO record as the reference standard, the proportion of subjects correctly classified by RAMQ diagnostic codes was determined for the exact date of DVT and PE occurrence and for four expanded time windows around this date.
In all, 355 VETO patients were included, 301 with DVT alone and 54 with DVT and PE. Overall, 97% of VETO cases had a RAMQ diagnostic code for DVT and 82% of VETO cases with PE had a RAMQ diagnostic code for PE. Sensitivity for DVT and PE was 52% (95% confidence interval (CI), 47-57) and 35% (95% CI, 23-49), respectively for the exact date of diagnosis, and 87% (95% CI, 83-90) and 78% (95% CI, 64-88), respectively for a 60-day window around this date. As all VETO participants had DVT, specificity for the diagnosis of DVT could not be determined.
Diagnostic codes within a medical service claims database are relatively sensitive indicators for DVT and PE, and use of claims data for VTE research purposes can be considered.
To develop and validate the accuracy of a predictive model to identify adult asthmatics from administrative health care databases.
An existing electronic medical record project in Montreal, Quebec.
One thousand four hundred and thirty-one patients with confirmed asthma status were identified from primary care physician's electronic medical record.
Therapeutic indication of asthma in an electronic prescription and/or confirmed asthma from an automated problem list were used as the gold standard. Five groups of asthma-specific markers were identified from administrative health care databases to estimate the probability of the presence of asthma. Cross-validation evaluated the diagnostic ability of each predictive model using 50 percent of sample.
The best performance in discriminating between the patients with asthma and those without it included indicators from medical service and prescription claims databases. The best-fitting algorithm had a sensitivity of 70 percent, a specificity of 94 percent, and positive predictive value of 65 percent. The prescriptions claims-specific algorithm demonstrated a nearly equal performance to the model with medical services and prescription claims combined.
Our algorithm using asthma-specific markers from administrative claims databases provided moderate sensitivity and high specificity.
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Genetic test results may be available to greater numbers of people through genetic screening projects and other means. The effects of widespread genetic testing and notification of genetic test results, particularly added costs through increased physician utilization, have not been clearly established.
A primary care-based cohort of 20,306 participants (Hemochromatosis and Iron Overload Study, Ontario site) were tested for the C282Y and H63D mutations of the HFE gene and for abnormal serum ferritin (SF) and transferrin saturation levels. The primary outcome variable was the total number of physician claims per patient after genetic test notification by mail. Multiple Poisson regression was used to adjust for age, sex, baseline SF, diagnoses of arthritis, diabetes, heart failure and impotence, self-rated health, and the number of claims during the 12 months before notification of results. The reference group had no HFE mutations (wild type) and normal transferrin saturation/SF values.
Participants with an ambiguous hemochromatosis gene test and normal iron levels had statistically significantly higher average physician utilization of 3.0%. Participants with HFE mutations (excluding C282Y homozygotes) and elevated iron values showed a 6% increase in physician utilization.
The health effects, if any, of increased utilization in heterozygotes or those with mild ferritin elevations are unknown but are unlikely to be large at the population level. Ambiguous genetic test results are associated with increased physician service use and should be considered when assessing the complete societal costs of widespread genetic testing.
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The incidence and prognosis of whiplash injury from motor vehicle collisions may be related to eligibility for compensation for pain and suffering. On January 1, 1995, the tort-compensation system for traffic injuries, which included payments for pain and suffering, in Saskatchewan, Canada, was changed to a no-fault system, which did not include such payments. To determine whether this change was associated with a decrease in claims and improved recovery after whiplash injury, we studied a population-based cohort of persons who filed insurance claims for traffic injuries between July 1, 1994, and December 31, 1995.
Of 9006 potentially eligible claimants, 7462 (83 percent) met our criteria for whiplash injury. The six-month cumulative incidence of claims was 417 per 100,000 persons in the last six months of the tort system, as compared with 302 and 296 per 100,000, respectively, in the first and second six-month periods of the no-fault system. The incidence of claims was higher for women than for men in each period; the incidence decreased by 43 percent for men and by 15 percent for women between the tort period and the two no-fault periods combined. The median time from the date of injury to the closure of a claim decreased from 433 days (95 percent confidence interval, 409 to 457) to 194 days (95 percent confidence interval, 182 to 206) and 203 days (95 percent confidence interval, 193 to 213), respectively. The intensity of neck pain, the level of physical functioning, and the presence or absence of depressive symptoms were strongly associated with the time to claim closure in both systems.
The elimination of compensation for pain and suffering is associated with a decreased incidence and improved prognosis of whiplash injury.
Comment In: N Engl J Med. 2000 Oct 12;343(15):1118-9; author reply 112011032514
Comment In: N Engl J Med. 2000 Oct 12;343(15):1119-2011032517
Comment In: N Engl J Med. 2000 Oct 12;343(15):1119; author reply 112011032516
Comment In: N Engl J Med. 2000 Apr 20;342(16):1211-310770990
Comment In: N Engl J Med. 2000 Oct 12;343(15):1119; author reply 112011032515