Birtwhistle Richard, Green Michael E, Frymire Eliot, Dahrouge Simone, Whitehead Marlo, Khan Shahriar, Greiver Michelle, Glazier Richard H
Affiliations: Department of Family Medicine and Public Health Sciences (Birtwhistle, Green, Frymire, Whitehead, Khan), Queen's University, Kingston, Ont.; Department of Family and Community Medicine (Greiver, Glazier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Dahrouge), University of Ottawa, Ottawa, Ont.; Canadian Primary Care Sentinel Surveillance Network (Birtwhistle, Green, Greiver), Kingston, Ont.; Institute for Clinical Evaluative Sciences (Birtwhistle, Green, Frymire, Dahrouge, Whitehead, Khan, Greiver, Glazier), Toronto, Ont.; North York General Hospital (Greiver), North York, Ont.; Department of Family and Community Medicine (Glazier), St. Michael's Hospital, Toronto, Ont.
CMAJ Open. 2017 Jul 11;5(3):E557-E564. doi: 10.9778/cmajo.20170017.
The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) collects extensive data on primary care patients but it currently does not gather reliable information on outcomes in other settings. The objectives of this study were to link electronic medical record (EMR) data from Ontario patients in the CPCSSN with administrative data from the Institute for Clinical Evaluative Sciences (ICES), to assess the representativeness of the CPCSSN population, and to identify people with diabetes in the CPCSSN data and describe their emergency department (ED) visits and hospital admissions over a 2-year period (2010-2012) by HbA1c level.
We conducted a cross-sectional study linking 2014 Ontario CPCSSN data with ICES administrative data and a retrospective cohort study using the 2014 data extraction linked with data from the Ontario health care registry, hospital discharge abstracts and a database of emergency department visits. Demographics of CPCSSN patients were compared with those of the Ontario population. Patients with a CPCSSN diagnosis of diabetes were compared by HbA1c category for ED visits, hospital admissions and diagnosis of diabetes-related complications.
The linkage rate was 99%. We identified 12 358 patients with diabetes, 2356 of whom were missing data on HbAIc, for a final sample of 10 002. Patients with diabetes had a mean age of 64 years. Those with a higher HbA1c were younger, more likely to be male, had a lower income, had more comorbidities and were more likely to live in rural or suburban areas than patients with a lower HbA1c. Over the study period 31.8% of patients had 1 or more ED visits and 13.7% had a hospital admission for a diabetes-related complication. Patients with HbA1c greater than 8 had significantly more hospital admissions, ED visits and diabetes-related complications than patients with a lower HbA1c .
The linkage between EMR and administrative data was successful. In this study population, higher HbA1c values were associated with increased ED visits and hospital admissions, with an increasing gradient as HbA1c increased from less than 7% to greater than 8%.
加拿大初级保健哨点监测网络（CPCSSN）收集了大量关于初级保健患者的数据，但目前尚未收集其他环境下可靠的结局信息。本研究的目的是将CPCSSN中安大略省患者的电子病历（EMR）数据与临床评估科学研究所（ICES）的行政数据相链接，评估CPCSSN人群的代表性，并在CPCSSN数据中识别糖尿病患者，并按糖化血红蛋白（HbA1c）水平描述他们在2年期间（2010 - 2012年）的急诊科就诊和住院情况。
我们进行了一项横断面研究，将2014年安大略省CPCSSN数据与ICES行政数据相链接，并进行了一项回顾性队列研究，使用2014年的数据提取结果与安大略省医疗保健登记处、医院出院摘要和急诊科就诊数据库的数据相链接。将CPCSSN患者的人口统计学特征与安大略省人群的特征进行比较。对CPCSSN诊断为糖尿病的患者，按HbA1c类别比较急诊科就诊、住院情况以及糖尿病相关并发症的诊断情况。
链接率为99%。我们识别出12358例糖尿病患者，其中2356例缺失HbA1c数据，最终样本为10002例。糖尿病患者的平均年龄为64岁。与HbA1c水平较低的患者相比，HbA1c水平较高的患者更年轻、男性比例更高、收入更低、合并症更多，且更有可能居住在农村或郊区。在研究期间，31.8%的患者有1次或更多次急诊科就诊，13.7%的患者因糖尿病相关并发症住院。HbA1c大于8的患者比HbA1c水平较低的患者有更多的住院、急诊科就诊和糖尿病相关并发症。
电子病历与行政数据的链接是成功的。在本研究人群中，较高的HbA1c值与急诊科就诊和住院次数增加相关，随着HbA1c从低于7%增加到大于8%，呈递增梯度。
