poster presented at ispor vienna 2016 lbacelar-nicolau
TRANSCRIPT
Multiple Correspondence Analysis Factorial Plan 1-2
Registration of each health indicator by region Association between Mortality
and No registration of health indicators by Region (1)(2)
HELPING DECISION-MAKERS VISUALIZE INEQUITIES IN HEALTH IMPACT ASSESSMENT: LINKED ELECTRONIC RECORDS, MORTALITY AND REGIONAL DISPARITIES IN PORTUGAL
Bacelar-Nicolau L Rodrigues T Fernandes E Lobo MF Nisa C Azzone V Teixeira-Pinto A Rocha-Gonçalves F Azevedo LF Freitas A Normand SL Costa-Pereira A Pereira Miguel J
Methods
″ Show how multivariate methods outputs visualization may help decision-makers identify inequities through health impact assessment (HIA)
″ Show how a policy promoting quality of linked Electronic Health Records (EHR) regarding Acute Myocardial Infarction (AMI) patients may be associated to mortality and regional inequities.
″ Data Adults (>=20 years) admitted in Portuguese NHS Hospitals with AMI diagnosis during the 2nd semester 2012, followed regularly in NHS Primary Care (PC) during 2013
Source: SPMS/ACSS
″ Variables • Mortality outcome at December 31 2013
• 4 PC registered indicators - Blood Pressure, Cholesterol, Triglycerides, Waist Circumference, Body Mass Index (BMI)
• 5 regions - Norte, Centro, LVT, Alentejo, Algarve
• Adjustment variables - sex, age, AMI hospital readmissions during the 2nd semester 2012, surgery during hospital admission, mean admission duration>6 days, hospital diagnosis>=6
″ Statistical Procedures • Qui-Square and Fisher Exact tests
• Logistic Regressions simple and stratified by region, estimating crude and adjusted ORs (and 95%CI)
• Multivariate Correspondence Analysis (MCA)
Aims Findings
″ Algarve and LVT have the highest no-registration percentages for every indicator. Norte, usually followed by Algarve and Centro, have the lowest percentages.
″ Globally, patients followed regularly in PC, but without registered information for all health indicators, are more than twice as likely to be deceased, than patients with information registered (OR>2.0).
″ Mortality is more associated with no records for: Cholesterol, Triglycerides (OR>13.0) and Blood pressure (OR>3) in Norte; BMI in Alentejo (OR near7); Cholesterol and Triglycerides (3.17 and 4.41) in Centro.
″ MCA summarizes previous findings with a clear visual graphical aid.
Main Conclusions
″ Disparities between regions are found regarding Electronic Health Records of AMI patients, but also concerning association patterns of mortality and registration of these health indicators.
″ Complex multivariate methodologies generate visual outputs easily interpreted by decision-makers, exposing regional inequities regarding mortality and PC recording policies and pinpointing where action priorities may lay.
Disclosures: Nothing to disclose. Funded by FCT, QREN, COMPETE (HMSP-ICT/0013/2011). Acknowledgments: SPMS/ACSS for kindly making available the data that made this research possible
CUTEheart Comparative Use of Technologies for Coronary Heart Disease Harvard Medical School – Portugal Program
http://www.cuteheart.med.up.pt
ISPOR 19th Annual European Congress 2016 Vienna, Austria