1. Institute for Clinical Evaluative Sciences HEALTH ANALYTICS FOR INFORMED DECISION MAKING: HEALTH SYSTEM USE SUMMIT Concurrent Track #2, February 11, 2016 Analytical Tools, Methodologies and Algorithms that Transform Data into Usable Information Michael Schull, Institute for Clinical Evaluative Sciences

2. Institute for Clinical Evaluative Sciences 2 Derived chronic conditions People & Geography Special Collections* Registries (cancer, stoke, cardiac, POGO, BORN) Federal immigration register (Ontario portion) EMR Data First Nation Metis HIV clinics Developmental Disabilities (using linked data) Diabetes Hypertension COPD CHF AMI Asthma IBD Health Service Visits Physician claims ~In patient hospital discharge abstracts ~Emergency and ambulatory care Prescription drug claims (> age 64) Home care claims Rehab Claims Long-term care claims Provider/ Facilities Physicians Hospitals Complex care Long-term care homes Home care Real-time (IKN) HOBIC ICD ICES CORE Data Repository: De-sensitized and Linkable Unique algorithm based on Ontario health card number Linked data set Project Specific Research data People in Ontario eligible for health care since 1985 Unique individual IKN used for linking across all data sets Demographics Deaths Census ~CIHI via MOHLTC *Special governance 2

3. 3

4. 4

5. Persons with dementia (including Alzheimer’s disease) are identified based on the following algorithm: –1 hospitalization record from Discharge Abstract Database; –OR 3 physician claim records at least 30 days apart in a 2-year period from OHIP; –OR 1 related prescription drug reimbursement record from Ontario Drug Benefit plan. Algorithm was validated by comparison with primary care EMR data housed at ICES (EMRALD) Jaakkimainen RL, Bronskill SE, Tierney M, Herrmann N, Green D, Young J, Ivers N, Tu K. Identification of physician- diagnosed Alzheimer’s disease in population-based administrative data: a validation study using family physicians’ electronic medical records. Submitted to Journal of Alzheimer’s Disease, January 2016. New derived disease cohort: dementia 5

6. Study 1 (Trajectory, Newly-identified) Community-dwelling persons with newly-identified dementia & matched control group Rate of all personal and homemaking home care visits in Ontario, by fiscal year (Note: Number of individuals surviving and remaining in the community decreases each year.) Dementia patients in Ontario: time trajectory of personal and homemaking home care services 6

7. 7 Currently 350+ family physicians 40+ clinics >500,000 patients Average duration on EMR 4.5 years, min 2 yrs - max 25 yrs Electronic Medical Record Administrative data Linked Database EMRALD: primary care EMR data

8. 8 EMRALD practice reports for family physicians

9. Institute for Clinical Evaluative Sciences 9 Thank You