Linking cohort data with administrative health data to develop a new hypertension prediction model to aid precision health approach

Introduction Hypertension is a common medical condition, affecting 1 in 5 Canadians, and is a major risk factor for heart attack, stroke, and kidney disease. Predicting the risk of developing incident hypertension may help to inform targeted preventive strategies. Objectives and Approach Identification of major risk factors and incorporation into a multivariable model for risk stratification may help to identify individuals who are at highest risk for developing incident hypertension and would potentially benefit most from intervention. The goal of the proposed research is to develop a robust hypertension prediction model for the general population using the Alberta Tomorrow Project (ATP) cohort data linked with Alberta’s administrative health data. ATP is Alberta's largest population health cohort, contains baseline data on socio-demographic characteristic, personal and family history of disease, medication use, lifestyle and health behavior, environmental exposures, physical measures and bio samples. Results Alberta’s administrative health data additionally provides information on health care utilization, enrollment, drugs, physician services, and hospital services. A prediction model for hypertension will be developed using logistic regression where information on candidate variables for the model will be gathered from ATP data and outcome (incident hypertension) will be ascertained from administrative health data (physicians/practitioner claim data and hospital discharge abstract data). Lacking follow-up information in current ATP data has laid the foundation of linking the two data sources through an anonymous unique person identifier (e.g. PHN) that will eventually provide follow-up information on ATP participants who are free of hypertension at baseline developed the disease as well as information on other potential variables. Conclusion/Implications The proposed prediction model will help to identify individuals at highest risk for developing hypertension and those who may benefit most from targeted healthy behavioral interventions and/or treatment. Such identification of high risk people may help prevent hypertension as well as the continuing costly cycle of managing hypertension and its complications

Co-designing person-centred quality indicator implementation for primary care in Alberta: a consensus study

Abstract Background We aimed to contribute to developing practical guidance for implementing person-centred quality indicators (PC-QIs) for primary care in Alberta, Canada. As a first step in this process, we conducted stakeholder-guided prioritization of PC-QIs and implementation strategies. Stakeholder engagement is necessary to ensure PC-QI implementation is adapted to the context and local needs. Methods We used an adapted nominal group technique (NGT) consensus process. Panelists were presented with 26 PC-QIs, and implementation strategies. Both PC-QIs and strategies were identified from our extensive previous engagement of patients, caregivers, healthcare providers, and quality improvement leaders. The NGT objectives were to: 1. Prioritize PC-QIs and implementation strategies; and 2. Facilitate the participation of diverse primary care stakeholders in Alberta, including patients, healthcare providers, and quality improvement staff. Panelists participated in three rounds of activities. In the first, panelists individually ranked and commented on the PC-QIs and strategies. The summarized results were discussed in the second-round face-to-face group meeting. For the last round, panelists provided their final individual rankings, informed by the group discussion. Finally, we conducted an evaluation of the consensus process from the panelists’ perspectives. Results Eleven primary care providers, patient partners, and quality improvement staff from across Alberta participated. The panelists prioritized the following PC-QIs: ‘Patient and caregiver involvement in decisions about their care and treatment’; ‘Trusting relationship with healthcare provider’; ‘Health information technology to support person-centred care’; ‘Co-designing care in partnership with communities’; and ‘Overall experience’. Implementation strategies prioritized included: ‘Develop partnerships’; ‘Obtain quality improvement resources’; ‘Needs assessment (stakeholders are engaged about their needs/priorities for person-centred measurement)’; ‘Align measurement efforts’; and ‘Engage champions’. Our evaluation suggests that panelists felt that the process was valuable for planning the implementation and obtaining feedback, that their input was valued, and that most would continue to collaborate with other stakeholders to implement the PC-QIs. Conclusions Our study demonstrates the value of co-design and participatory approaches for engaging stakeholders in adapting PC-QI implementation for the primary care context in Alberta, Canada. Collaboration with stakeholders can promote buy-in for ongoing engagement and ensure implementation will lead to meaningful improvements that matter to patients and providers.Plain English summary Person-centred care (PCC) is a model of care where patient needs and preferences are included in decisions about care and treatment. To improve PCC in primary care in Alberta, Canada, we plan to use person-centred quality indicators (PC-QIs). Using PC-QIs involves surveying patients about their care experiences and using this information to make improvements. For example, if 20% of patients do not feel they are getting enough information, the clinic may create a checklist for the providers so information is not missed. We engaged a panel of 11 people, including patients, family doctors, and staff who support quality improvement in clinics across the province to decide together which PC-QIs primary care clinics in Alberta should use. We also asked the panel to decide the most important strategies that would make using the PC-QIs more successful. The panel chose PC-QIs related to: patient and caregiver involvement in decisions about care and treatment, a trusting relationship with the healthcare provider, having health information technology to support PCC, partnering with communities in healthcare, and the patient’s overall experience. The most important strategies were: developing partnerships among people working in primary care in Alberta, discussing their needs and common efforts for improving PCC, engaging “champions,” and securing funding that would be needed. Finally, we asked the panelists to share their experiences with participating in this process. Panelists found the process useful and that their input was valued. Most panelists would also like to continue to work together to put the PC-QIs into practice

Additional file 1 of Co-designing person-centred quality indicator implementation for primary care in Alberta: a consensus study

Additional file 1. The table provided shows where each implementation strategy is mapped to one or more broad strategy from the Consolidated Framework for Implementation Research (CFIR) - Expert Recommendations for Implementing Change (ERIC) Strategy Matching Tool

Characteristics of Participants in a Longitudinal Cohort of Pregnant Women in Alberta, Canada.

<p>Characteristics of Participants in a Longitudinal Cohort of Pregnant Women in Alberta, Canada.</p

Distribution of Plasma Vitamin D Metabolites in the First and Second Trimesters of Pregnancy in a Longitudinal Cohort of Pregnant Women and Their Infants in Alberta, Canada.

<p>Distribution of Plasma Vitamin D Metabolites in the First and Second Trimesters of Pregnancy in a Longitudinal Cohort of Pregnant Women and Their Infants in Alberta, Canada.</p

Scatter plot of plasma 3-epi-25(OH)D₃ and 25(OH)D₃ in pregnant women during second trimester of pregnancy in a longitudinal cohort of pregnant women and their infants in Alberta, Canada (n = 537).

<p>Pearson correlation coefficient showed a significant correlation between 25(OH)D₃ and 3-epi-25(OH)D₃ (r = 0.69, P<0.001).</p

Absolute concentrations of (A) plasma 25(OH)D, and (B) plasma 3-epi-25(OH)D₃ versus maternal vitamin D intake (IU/day) in a longitudinal cohort of pregnant women and their infants in Alberta, Canada.

<p>Black horizontal lines in each box represent medians; edges of each box represent 25^th and 75^th percentiles; the lines extending from each box represent 1.5 times the interquartile range; outliers are shown as stars.</p

Distribution of Reported Dietary Vitamin D Intake (IU/day) in the First, Second, and Third Trimesters of Pregnancy in a Longitudinal Cohort of Pregnant Women and Their Infants in Alberta, Canada.

<p>Distribution of Reported Dietary Vitamin D Intake (IU/day) in the First, Second, and Third Trimesters of Pregnancy in a Longitudinal Cohort of Pregnant Women and Their Infants in Alberta, Canada.</p