Chronic Lung Diseases, Coronary Artery Disease, Diabete Mellitus, Heart Failure, Kidney Disease
Conditions
Keywords
Clinical Information System
Brief summary
This is a retrospective, observational study using routinely collected information collected by Alberta Health Services. The study will identify patients with chronic disease, defined by one or more of the following conditions; diabetes mellitus, heart failure, coronary artery disease, chronic kidney disease, or chronic lung disease. Adult residents of Alberta with a chronic disease of interest present upon hospital admission and who survive to hospital discharge will be included in the study cohort. The primary outcome will be the composite of hospital readmission or death within 30 days of discharge. Secondary outcomes will include components of the composite, length of stay, patient experiences related to their hospital to home transition of care, and processes of care. Multi-level interrupted time series analysis will be used to compare outcomes before versus after implementation of the Connect Care CIS.
Detailed description
The design of the protocol is a multiple-baseline interrupted time series (ITS) analysis to assess effects of the CIS on patient outcomes with five pre-specified NCDs (diabetes mellitus, coronary artery disease, heart failure, chronic kidney disease, and chronic lung disease) before versus after implementation at each cluster of sites, accounting for pre-existing trends in outcomes and correlation between different time points and sites. The primary outcome will be unplanned hospital readmission and death within 30 days of discharge. Secondary outcomes will include readmission and death as individual outcomes, length of hospital stay, processes of care, and measures of patient experience with care transitions. The study uses retrospective administrative, clinical, and patient experience data collected between 2019 and 2024, covering periods before and after clinical information system implementation at each site. All observations will be recorded prior to study initiation and will be analyzed retrospectively within a multiple baseline interrupted time series framework.
Interventions
OTHERClinical Information System (CIS) / Connect Care Implementation
The intervention (exposure) is the implementation of the Connect Care Clinical Information System (CIS) across Alberta Health Services (AHS) acute-care facilities. Connect Care integrates comprehensive electronic health records, clinician communication tools, pharmacy dispensing data, laboratory and diagnostic imaging results, standardized medication reconciliation, and electronic discharge summaries. It supports coordination across hospital, specialty, and primary care settings and includes a patient-facing portal allowing access to personal health information. The CIS rollout occurred at multiple sites with staggered launch dates and represents one of the largest Epic deployments.
Sponsors
University of Calgary
Study design
Observational model
OTHER
Time perspective
OTHER
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults aged 18 years or older at the time of hospital admission. * Residents of Alberta eligible to receive acute-care services in AHS facilities. * Hospitalized for any cause during the study period (5 years pre-implementation and 2 years post-implementation of the CIS). * Meet the validated case definition for one or more of the five key NCDs (diabetes mellitus, chronic kidney disease, coronary artery disease, heart failure, or chronic lung disease) based on ICD codes, laboratory measures, or pharmacy records during standardized lookback periods (up to 5 years for diagnoses; up to 1 year for labs/pharmacy). * Have a qualifying date for the NCD(s) that occurs prior to or during the index hospital admission. * Eligible for inclusion in the primary and patient experience outcomes if they survive to hospital discharge. * May enter multiple sub-cohorts if more than one NCD is present.
Exclusion criteria
* Individuals younger than 18 years at the time of hospital admission. * Non-residents of Alberta or individuals not eligible for care within AHS facilities. * Hospitalizations that end in death (excluded from analyses of the primary outcome and patient experience measures). * Patients without evidence of any of the five key NCDs during the lookback period or at the index hospital admission. * Admissions outside the study period or admissions for which necessary administrative, laboratory, or pharmacy data are unavailable.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| All-cause unplanned hospital readmission or death within 30 days after hospital discharge | Within 30 days after hospital discharge | This primary outcome captures whether a patient experiences either (1) the unplanned hospital readmission for any cause or (2) death from any cause within 30 days following discharge from an acute-care hospitalization. The outcome is restricted to patients who survived to hospital discharge. Analyses will also be stratified by the presence of each of the five key NCDs (diabetes, CKD, CAD, heart failure, chronic lung disease) and by multimorbidity (two or more of the NCDs). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Acute care admission frequency | Monthly intervals across the 7-year follow-up (5 years pre-implementation, 2 years post-implementation | Number of acute-care hospital admissions occurring during monthly intervals. |
| Length of stay in hospital | From hospital admission date to date of discharge or switch to alternate level of care, up to a maximum of 30 days | Duration of index hospitalization in days, excluding days coded as alternate level of care (occupying a hospital bed but no longer needing acute care while waiting for a transfer to a more suitable setting like long-term care, rehab, or home support), measured from admission to discharge, including multi-facility episodes. |
| 30-day all-cause mortality | Within 30 days after each discharge. | Death from any cause within 30 days after hospital discharge, assessed independently from readmission. |
| 30-day all-cause readmission | Within 30 days after each discharge. | Any acute-care readmission occurring within 30 days after discharge, analyzed separately from mortality. |
| Emergency department visits within 30 days of discharge | Within 30 days after each discharge. | Count of emergency department visits within 30 days following discharge. |
| Outpatient physician follow-up within 30 days | Within 30 days after each discharge. | Completion of a primary care or specialist outpatient visit within 30 days after discharge (restricted to patients who survived to discharge). |
| Medication dispensation within 120 days of discharge | Within 120 days after discharge. | ACE-I/ARB/ARNI prescription dispensed within 120 days for patients with heart failure, CAD, or CKD with ACR \>30 mg/mmol.Statin prescription dispensed within 120 days for patients with ASCVD, diabetes (age \>40 years), or CKD (age \>50 years). |
| Outpatient laboratory testing within 30 days of discharge | Within 30 days after each discharge. | Completion of recommended outpatient laboratory testing during the early post-discharge period (restricted to patients who survived to discharge). |
| Multi-question composite score of Information Understanding When Leaving the Hospital from the Canadian Patient Experiences Survey on Inpatient Care | Survey completed up to12 weeks following discharge among a 10% random sample of patients discharged. | Composite score based on three questions related to Information Understanding When Leaving the Hospital |
Countries
Canada
Contacts
CONTACTNusrat S Shommu, PhD
PRINCIPAL_INVESTIGATORMatthew T James, MD, PhD
University of Calgary
Outcome results
None listed