oral presentation at ispor portugal 2016 lbacelar-nicolau
TRANSCRIPT
HELPING DECISION-MAKERS VISUALIZE INEQUITIES IN HEALTH IMPACT ASSESSMENT: LINKED ELECTRONIC RECORDS, MORTALITY AND REGIONAL DISPARITIES IN PORTUGAL
Disclosures: Nothing to disclose. Funded partially by FCT, QREN, COMPETE (HMSP-ICT/0013/2011)
Leonor Bacelar Nicolau 1, 2, Teresa Rodrigues 1, Elisabete Fernandes 1, Mariana Lobo 3, Cláudia Fernandes Nisa 3, Vanessa Azzone 5, Armando Teixeira-Pinto 4,
Francisco Rocha-Gonçalves 3, Luís Filipe R Azevedo 3, Alberto Freitas 3, Altamiro Costa-Pereira 3, Sharon-Lise Normand 5, José Pereira Miguel 1, 2
1 Faculdade de Medicina da Universidade de Lisboa 2 ISAMB 3 Faculdade de Medicina da Universidade
do Porto & CINTESIS 4 University of Sydney 5 Harvard Medical School
http://www.cuteheart.med.up.pt
http://www.cuteheart.med.up.pt
Disclosures: Nothing to disclose. Funded by FCT, QREN, COMPETE (HMSP-ICT/0013/2011)
For further information, please contact: [email protected]
Helping Decision-Makers visualize Inequities in Health Impact Assessment: Linked Electronic Records, Mortality and Regional Disparities in Portugal
Leonor Bacelar Nicolau 1, 2, Teresa Rodrigues 1, Elisabete Fernandes 1, Mariana Lobo 3, Cláudia Fernandes Nisa 3, Vanessa Azzone 5, Armando Teixeira-Pinto 4, Francisco Rocha-Gonçalves 3, Luís Filipe R Azevedo 3, Alberto Freitas 3, Altamiro Costa-Pereira 3, Sharon-Lise Normand 5, José Pereira Miguel 1, 2
1 Faculdade de Medicina da Universidade de Lisboa 2 ISAMB 3 Faculdade de Medicina da Universidade do Porto & CINTESIS 4 University of Sydney 5 Harvard Medical School
Acknowledgments
″ CUTEHeart Team for all the hard work and team support
″ FCT & Harvard Medical Program for their support
″ SPMS & ACSS for Data that made this research possible
http://www.cuteheart.med.up.pt
Disclosures: Nothing to disclose. Funded by FCT, QREN, COMPETE (HMSP-ICT/0013/2011)
For further information, please contact: [email protected]
Helping Decision-Makers visualize Inequities in Health Impact Assessment: Linked Electronic Records, Mortality and Regional Disparities in Portugal
Leonor Bacelar Nicolau 1, 2, Teresa Rodrigues 1, Elisabete Fernandes 1, Mariana Lobo 3, Cláudia Fernandes Nisa 3, Vanessa Azzone 5, Armando Teixeira-Pinto 4, Francisco Rocha-Gonçalves 3, Luís Filipe R Azevedo 3, Alberto Freitas 3, Altamiro Costa-Pereira 3, Sharon-Lise Normand 5, José Pereira Miguel 1, 2
1 Faculdade de Medicina da Universidade de Lisboa 2 ISAMB 3 Faculdade de Medicina da Universidade do Porto & CINTESIS 4 University of Sydney 5 Harvard Medical School
Context
″ CUTEHeart Project: includes research on how Health Impact Assessment (HIA) and Health Technology Assessment (HTA) could learn from one another
″ HIA: combination of procedures, methods and tools by which a policy may be judged as to its potential health effects on a population, and the distribution of these effects within that population
″ Equity concern: feature that could be added value to HTA
http://www.cuteheart.med.up.pt
Disclosures: Nothing to disclose. Funded by FCT, QREN, COMPETE (HMSP-ICT/0013/2011)
For further information, please contact: [email protected]
Helping Decision-Makers visualize Inequities in Health Impact Assessment: Linked Electronic Records, Mortality and Regional Disparities in Portugal
Leonor Bacelar Nicolau 1, 2, Teresa Rodrigues 1, Elisabete Fernandes 1, Mariana Lobo 3, Cláudia Fernandes Nisa 3, Vanessa Azzone 5, Armando Teixeira-Pinto 4, Francisco Rocha-Gonçalves 3, Luís Filipe R Azevedo 3, Alberto Freitas 3, Altamiro Costa-Pereira 3, Sharon-Lise Normand 5, José Pereira Miguel 1, 2
1 Faculdade de Medicina da Universidade de Lisboa 2 ISAMB 3 Faculdade de Medicina da Universidade do Porto & CINTESIS 4 University of Sydney 5 Harvard Medical School
Aims
″ Show how multivariate methods outputs visualization may help decision-makers identify inequities through 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.
http://www.cuteheart.med.up.pt
Disclosures: Nothing to disclose. Funded by FCT, QREN, COMPETE (HMSP-ICT/0013/2011)
For further information, please contact: [email protected]
Helping Decision-Makers visualize Inequities in Health Impact Assessment: Linked Electronic Records, Mortality and Regional Disparities in Portugal
Leonor Bacelar Nicolau 1, 2, Teresa Rodrigues 1, Elisabete Fernandes 1, Mariana Lobo 3, Cláudia Fernandes Nisa 3, Vanessa Azzone 5, Armando Teixeira-Pinto 4, Francisco Rocha-Gonçalves 3, Luís Filipe R Azevedo 3, Alberto Freitas 3, Altamiro Costa-Pereira 3, Sharon-Lise Normand 5, José Pereira Miguel 1, 2
1 Faculdade de Medicina da Universidade de Lisboa 2 ISAMB 3 Faculdade de Medicina da Universidade do Porto & CINTESIS 4 University of Sydney 5 Harvard Medical School
Data
″ Sample
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
″ Variables
Mortality outcome at December 31 2013
4 PC health indicators (registered or not) - 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 Fonte:SPMS/ACSS
http://www.cuteheart.med.up.pt
Disclosures: Nothing to disclose. Funded by FCT, QREN, COMPETE (HMSP-ICT/0013/2011)
For further information, please contact: [email protected]
Helping Decision-Makers visualize Inequities in Health Impact Assessment: Linked Electronic Records, Mortality and Regional Disparities in Portugal
Leonor Bacelar Nicolau 1, 2, Teresa Rodrigues 1, Elisabete Fernandes 1, Mariana Lobo 3, Cláudia Fernandes Nisa 3, Vanessa Azzone 5, Armando Teixeira-Pinto 4, Francisco Rocha-Gonçalves 3, Luís Filipe R Azevedo 3, Alberto Freitas 3, Altamiro Costa-Pereira 3, Sharon-Lise Normand 5, José Pereira Miguel 1, 2
1 Faculdade de Medicina da Universidade de Lisboa 2 ISAMB 3 Faculdade de Medicina da Universidade do Porto & CINTESIS 4 University of Sydney 5 Harvard Medical School
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)
http://www.cuteheart.med.up.pt
Disclosures: Nothing to disclose. Funded by FCT, QREN, COMPETE (HMSP-ICT/0013/2011)
For further information, please contact: [email protected]
Helping Decision-Makers visualize Inequities in Health Impact Assessment: Linked Electronic Records, Mortality and Regional Disparities in Portugal
Leonor Bacelar Nicolau 1, 2, Teresa Rodrigues 1, Elisabete Fernandes 1, Mariana Lobo 3, Cláudia Fernandes Nisa 3, Vanessa Azzone 5, Armando Teixeira-Pinto 4, Francisco Rocha-Gonçalves 3, Luís Filipe R Azevedo 3, Alberto Freitas 3, Altamiro Costa-Pereira 3, Sharon-Lise Normand 5, José Pereira Miguel 1, 2
1 Faculdade de Medicina da Universidade de Lisboa 2 ISAMB 3 Faculdade de Medicina da Universidade do Porto & CINTESIS 4 University of Sydney 5 Harvard Medical School
Registration of each health indicator by region
″ Algarve and LVT have the highest no-registration percentages for every indicator
″ Norte, usually followed by Algarve and Centro, have the lowest percentages
http://www.cuteheart.med.up.pt
Disclosures: Nothing to disclose. Funded by FCT, QREN, COMPETE (HMSP-ICT/0013/2011)
For further information, please contact: [email protected]
Helping Decision-Makers visualize Inequities in Health Impact Assessment: Linked Electronic Records, Mortality and Regional Disparities in Portugal
Leonor Bacelar Nicolau 1, 2, Teresa Rodrigues 1, Elisabete Fernandes 1, Mariana Lobo 3, Cláudia Fernandes Nisa 3, Vanessa Azzone 5, Armando Teixeira-Pinto 4, Francisco Rocha-Gonçalves 3, Luís Filipe R Azevedo 3, Alberto Freitas 3, Altamiro Costa-Pereira 3, Sharon-Lise Normand 5, José Pereira Miguel 1, 2
1 Faculdade de Medicina da Universidade de Lisboa 2 ISAMB 3 Faculdade de Medicina da Universidade do Porto & CINTESIS 4 University of Sydney 5 Harvard Medical School
Association between Mortality and No registration of health indicators by Region -OR (1)(2)
″ 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
http://www.cuteheart.med.up.pt
Disclosures: Nothing to disclose. Funded by FCT, QREN, COMPETE (HMSP-ICT/0013/2011)
For further information, please contact: [email protected]
Helping Decision-Makers visualize Inequities in Health Impact Assessment: Linked Electronic Records, Mortality and Regional Disparities in Portugal
Leonor Bacelar Nicolau 1, 2, Teresa Rodrigues 1, Elisabete Fernandes 1, Mariana Lobo 3, Cláudia Fernandes Nisa 3, Vanessa Azzone 5, Armando Teixeira-Pinto 4, Francisco Rocha-Gonçalves 3, Luís Filipe R Azevedo 3, Alberto Freitas 3, Altamiro Costa-Pereira 3, Sharon-Lise Normand 5, José Pereira Miguel 1, 2
1 Faculdade de Medicina da Universidade de Lisboa 2 ISAMB 3 Faculdade de Medicina da Universidade do Porto & CINTESIS 4 University of Sydney 5 Harvard Medical School
Multiple Correspondence Analysis Factorial Plan 1-2
″ MCA summarizes previous findings with a clear visual graphical aid
″ Dimension 1: registration axis
″ Dimension 2: outcome axis
http://www.cuteheart.med.up.pt
Disclosures: Nothing to disclose. Funded by FCT, QREN, COMPETE (HMSP-ICT/0013/2011)
For further information, please contact: [email protected]
Helping Decision-Makers visualize Inequities in Health Impact Assessment: Linked Electronic Records, Mortality and Regional Disparities in Portugal
Leonor Bacelar Nicolau 1, 2, Teresa Rodrigues 1, Elisabete Fernandes 1, Mariana Lobo 3, Cláudia Fernandes Nisa 3, Vanessa Azzone 5, Armando Teixeira-Pinto 4, Francisco Rocha-Gonçalves 3, Luís Filipe R Azevedo 3, Alberto Freitas 3, Altamiro Costa-Pereira 3, Sharon-Lise Normand 5, José Pereira Miguel 1, 2
1 Faculdade de Medicina da Universidade de Lisboa 2 ISAMB 3 Faculdade de Medicina da Universidade do Porto & CINTESIS 4 University of Sydney 5 Harvard Medical School
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.