Maternal disability and newborn discharge to child protection in Ontario, Canada

Objectives One in 8 pregnancies are to women with disabilities. These mothers can face additional social, structural, and health-related challenges, and negative health care provider assumptions about their parenting capacity. We aimed to examine rates of newborn discharge to child protection comparing newborns of mothers with and without a disability. Method We are conducting a population-based cohort study in Ontario, Canada using linked administrative health data. The cohort includes all women in Ontario with a live birth between 2003 and 2020. Diagnostic algorithms were applied to health care encounters prior to pregnancy to identify maternal disability. We will use modified Poisson regression to estimate the relative risk of discharge to child protection immediately after the birth hospital stay, comparing newborns of women with physical, sensory, developmental, and multiple disabilities to those without disabilities. Models will be adjusted for socio-demographic factors, antenatal care receipt, and maternal mental illness and substance use disorders. Results The study cohort includes of over 1.4 million newborns delivered to women with physical disabilities (n=120,014), sensory disabilities (n=39,892), developmental disabilities (n=2,182), multiple disabilities (n=8,428), and no known disability (n=1,269,633). Analyses are ongoing and results will be concluded by the conference date. Conclusion Early infancy is a critical period for breastfeeding and maternal-infant bonding. Findings will inform the development of tailored services and resources for supporting women with disabilities in antenatal care and after birth by identifying those most at-risk of child protection intervention, thus potentially reducing maternal-newborn separations

Development of a Concept Dictionary to Standardize Definitions and Classifications While Working With a Common Repository of Linked Administrative Data

Introduction Supporting standardized approaches to common tasks is an important component of quality research using linked administrative data. Standard concept definitions and classifications are vital for ensuring accuracy and consistency in definitions between projects, and improving efficiency and quality. Other leading organizations have published online standard definitions of concepts and classifications. Objectives and Approach We developed a comprehensive concept dictionary using a standardized definition template of key components including data sources, codes, scale or range of values, validation details, limitations, SAS code and formats, related concepts, and MeSH terms. A web-based application (built on the Microsoft SharePoint platform) was developed to offer the latest web content authoring capabilities, and advanced search mechanisms enabling the user to search concepts by MeSH terms and key words. It also allowed for navigating concepts through category navigation including clickable categories and sub-categories. Entries will be reviewed annually to ensure the content remains up-to-date. Results To date, ten concepts, with accompanying codes, have been published on the concept dictionary with another ten currently undergoing editorial review. These concepts span a variety of topics such as injuries, mental health and addictions-related outpatient services, and annual physical exams. New concepts written by content experts and reviewed by an editorial committee will be added on an on-going basis; thirty concepts are currently under development. Conclusion/Implications Development of a concept dictionary provides standardized definitions, algorithms and codes to ensure consistency and quality of research and analysis across multiple projects. Future aims include expansion of the internal organizational site to an external site through collaboration with key stakeholders

Depression and mental health visits to physicians--a prospective records-based study

Previous studies of access to care for depression have been based on cross-sectional surveys of self-reported use of mental health service use. As the recall of use may be differentially biased by mood states, inferences about how well persons with depression are accessing services in comparison to other groups may be misleading. Accordingly, we estimated the magnitude of the depression-use associations in relation to key covariates based on prospective records of mental health visits to physicians. The sample, N=23,063, of persons 12 years and older, was drawn from the 1996/97 Ontario Health Survey and linked to their administrative mental health care records 24 months forward in time. We found that depression-use associations were in the expected direction but similar in magnitude to associations for gender and education unlike previous self-reported use surveys. Female gender was positively related to the use of a primary care physician but negatively related to seeing a psychiatrist as opposed to a primary care physician. Those who had attained higher levels of education were more likely to be seen by physicians than those with lower education levels. The meaning behind these findings bears further study as it may have implications for primary care reform and the design of future studies of access.Mental health services utilization Depression Recall bias Prospective studies Canada

Health service utilization in immigrants with multiple sclerosis.

BackgroundAccess to neurology specialty care can influence outcomes in individuals with multiple sclerosis (MS), but may vary based on patient sociodemographic characteristics, including immigration status.ObjectiveTo compare health services utilization in the year of MS diagnosis, one year before diagnosis and two years after diagnosis in immigrants versus long-term residents in Ontario, Canada.MethodsWe identified incident cases of MS among adults aged 20-65 years by applying a validated algorithm to health administrative data in Ontario, Canada, a region with universal health insurance and comprehensive coverage. We separately assessed hospitalizations, emergency department (ED) visits, outpatient neurology visits, other outpatient specialty visits, and primary care visits. We compared rates of health service use in immigrants versus long-term residents using negative binomial regression models with generalized estimating equations adjusted for age, sex, socioeconomic status, urban/rural residence, MS diagnosis calendar year, and comorbidity burden.ResultsFrom 2003 to 2014, there were 13,028 incident MS cases in Ontario, of whom 1,070 (8.2%) were immigrants. As compared to long-term residents, rates of hospitalization were similar (Adjusted rate ratio (ARR) 0.86; 95% CI: 0.73-1.01) in immigrants the year before MS diagnosis, but outpatient neurology visits (ARR 0.93; 95% CI: 0.87-0.99) were slightly less frequent. However, immigrants had higher rates of hospitalization during the diagnosis year (ARR 1.20, 95% CI: 1.04-1.39), and had greater use of outpatient neurology (ARR 1.17, 95% CI: 1.12-1.23) but fewer ED visits (ARR 0.86; 95% CI: 0.78-0.96). In the first post-diagnosis year, immigrants continued to have greater numbers of outpatient neurology visits (ARR 1.16; 95% CI: 1.10-1.23), but had fewer hospitalizations (ARR 0.79; 95% CI: 0.67-0.94).ConclusionsOverall, our findings were reassuring concerning health services access for immigrants with MS in Ontario, a publicly funded health care system. However, immigrants were more likely to be hospitalized despite greater use of outpatient neurology care in the year of MS diagnosis. Reasons for this may include more severe disease presentation or lack of social support among immigrants and warrant further investigation

Thirty-day readmission after medical-surgical hospitalization for people who experience imprisonment in Ontario, Canada: A retrospective cohort study.

We aimed to compare 30-day readmission after medical-surgical hospitalization for people who experience imprisonment and matched people in the general population in Ontario, Canada. We used linked population-based correctional and health administrative data. Of people released from Ontario prisons in 2010, we identified those with at least one medical or surgical hospitalization between 2005 and 2015 while they were in prison or within 6 months after release. For those with multiple eligible hospitalizations, we randomly selected one hospitalization. We stratified people by whether they were in prison or recently released from prison at the time of hospital discharge. We matched each person with a person in the general population based on age, sex, hospitalization case mix group, and hospital discharge year. Our primary outcome was 30-day hospital readmission. We included 262 hospitalizations for people in prison and 1,268 hospitalizations for people recently released from prison. Readmission rates were 7.7% (95%CI 4.4-10.9) for people in prison and 6.9% (95%CI 5.5-8.3) for people recently released from prison. Compared with matched people in the general population, the unadjusted HR was 0.72 (95%CI 0.41-1.27) for people in prison and 0.78 (95%CI 0.60-1.02) for people recently released from prison. Adjusted for baseline morbidity and social status, hospitalization characteristics, and post-discharge health care use, the HR for 30-day readmission was 0.74 (95%CI 0.40-1.37) for people in prison and 0.48 (95%CI 0.36-0.63) for people recently released from prison. In conclusion, people recently released from prison had relatively low rates of readmission. Research is needed to elucidate reasons for lower readmission to ensure care quality and access

Primary care utilization in people who experience imprisonment in Ontario, Canada: a retrospective cohort study

Abstract Background Access to primary care is an important determinant of health, and data are sparse on primary care utilization for people who experience imprisonment. We aimed to describe primary care utilization for persons released from prison, and to compare utilization with the general population. Methods We linked correctional data for all persons released from provincial prison in Ontario, Canada in 2010 with health administrative data. We matched each person by age and sex with four general population controls. We compared primary care utilization rates using generalized estimating equations. We adjusted rate ratios for aggregated diagnosis groups, to explore this association independent of comorbidity. We examined the proportion of people using primary care using chi squared tests and time to first primary care visit post-release using the Kaplan-Meier method. Results Compared to the general population controls, the prison release group had significantly increased relative rates of primary care utilization: at 6.1 (95% CI 5.9-6.2) in prison, 3.7 (95% CI 3.6-3.8) in the week post-release and between 2.4 and 2.6 in the two years after prison release. All rate ratios remained significantly increased after adjusting for comorbidity. In the month after release, however, 66.3% of women and 75.5% of men did not access primary care. Conclusions Primary care utilization is high in prison and post-release for people who experience imprisonment in Ontario, Canada. Increased use is only partly explained by comorbidity. The majority of people do not access primary care in the month after prison release. Future research should identify reasons for increased use and interventions to improve care access for persons who are not accessing care post-release

Health care utilization for persons released from provincial prison in Ontario in 2010 (N = 48,861) and general population controls (N = 195,444), by health care type and period relative to time in prison^*.

<p>Health care utilization for persons released from provincial prison in Ontario in 2010 (N = 48,861) and general population controls (N = 195,444), by health care type and period relative to time in prison^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0201592#t003fn001" target="_blank">*</a>}.</p

Rate ratio* of health care utilization of persons released from provincial correctional facilities in Ontario in 2010 (N = 48,861) and age- and sex-matched general population controls (N = 195,444), by health care type and period relative to time in prison† *Adjusted for neighbourhood income quintile and rurality.

<p>†Or the corresponding dates for general population controls.</p