Validation of an Algorithm to Detect Multiple Sclerosis Cases in Administrative Health Databases in Piedmont (Italy): An Application to the Estimate of Prevalence by Age and Urbanization Level

2021 ◽  
Vol 55 (2) ◽  
pp. 119-125
Author(s):  
Roberto Gnavi ◽  
Roberta Picariello ◽  
Paolo Emilio Alboini ◽  
Paola Cavalla ◽  
Maria Federica Grasso ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Hospital Discharges ◽  
Term Care ◽  
Urbanization Level ◽  
Capture Recapture ◽  
And Gender ◽  
Administrative Health Databases ◽  
Gender Specific ◽  
Different Sources

<b><i>Introduction:</i></b> Italy is considered a high-risk country for multiple sclerosis (MS). Exploiting electronic health archives (EHAs) is highly useful to continuously monitoring the prevalence of the disease, as well as the care delivered to patients and its outcomes. The aim of this study was to validate an EHA-based algorithm to identify MS patients, suitable for epidemiological purposes, and to estimate MS prevalence in Piedmont (North Italy). <b><i>Methods:</i></b> MS cases were identified, in the period between January 1, 2012 and December 31, 2017, linking data from 4 different sources: hospital discharges, drug prescriptions, exemptions from co-payment to health care, and long-term care facilities. Sensitivity of the algorithm was tested through record linkage with a cohort of 656 neurologist-confirmed MS cases; specificity was tested with a cohort of 2,966,293 residents presumably not affected by MS. Undercount was estimated by a capture-recapture method. We calculated crude, and age- and gender-specific prevalence. We also calculated age-adjusted prevalence by level of urbanization of the municipality of residence. <b><i>Results:</i></b> On December 31, 2017, the algorithm identified 8,850 MS cases. Sensitivity was 95.9%, specificity was 99.97%, and the estimated completeness of ascertainment was 91.9%. The overall prevalence, adjusted for undercount, was 152 per 100,000 among men and 286 among women; it increased with increasing age and reached its peak value in the 45- to 54-year class, followed by a progressive reduction. The age-adjusted prevalence of residents in cities was 15% higher than in those living in the countryside. <b><i>Discussion/Conclusion:</i></b> We validated an algorithm based on EHAs to identify cases of MS for epidemiological use. The prevalence of MS, adjusted for undercount, was among the highest in Italy. We also found that the prevalence was higher in highly urbanized areas.

scholarly journals Intersectionality: Mapping Critical Relations for Quality in Long-Term Care Research

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 39-39
Author(s):  
Katie Aubrecht ◽  
Ivy Bourgeault ◽  
Tamara Daly
Keyword(s):  
Long Term Care ◽  
Term Care ◽  
Social Divisions ◽  
Care Workers ◽  
Power Differentials ◽  
Care Relationships ◽  
And Gender ◽  
Relations Of Power ◽  
Status Of Care

Abstract Intersectionality is a useful method (Lutz, 2015) for interdisciplinary long-term care (LTC) research to advance a more critical understanding of how experiences of quality are shaped by mutually reproducing social divisions, identities and relations of power that shape LTC. This paper discusses insights from the “Mapping Care Relationships” stream of the Seniors – Adding Life to Years (SALTY) project, a pan-Canadian program of research examining clinical, social and policy perspectives on quality in LTC. “Mapping Care Relationships” mapped how promising approaches to care relationships are organized and experienced in LTC. From January 2018-August 2019 our team of nine researchers conducted rapid ethnographies in eight nursing homes, two in each of four provinces across Canada. We purposively observed and interviewed workers from a wide variety of positions and backgrounds, informed by an intersectionality approach. We traced how promising approaches in person-centred dementia care (PCDC) in particular may reify the subordinated status of care workers (some more than others) and reinforce inequities within LTC systems. In multiple LTC homes, front-line care workers described experiencing physical and emotional harm in care relationships with residents which caused them distress. However, consistent with a PCDC approach, the harm was attributed to ‘behaviours’ clinically symptomatic of dementia. In framing power differentials from a medical perspective, PCDC makes it possible to interpret harmful experiences as 'part of the job’ and something workers should know to expect, prevent, avoid, redirect, or ignore. Lutz, H. (2015). Intersectionality as method. DiGeSt. Journal of diversity and gender studies, 2(1-2), 39-44.

scholarly journals Impact of Frailty on Medical and Long-Term Care Expenditures for the Elderly Age 75 or Over in Japan

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 176-176
Author(s):  
Hiroto Yoshida ◽  
Yuriko Kihara
Keyword(s):  
Long Term Care ◽  
The Elderly ◽  
Elderly Age ◽  
Term Care ◽  
Intentional Weight Loss ◽  
Long Term Care Insurance ◽  
And Gender ◽  
The Impact

Abstract This study examined the impact of frailty on medical and long-term care expenditures in an older Japanese population. The subjects were those aged 75 years and over who responded to the survey (March 2018) in Bibai, Hokkaido, Japan (n=1,203) and have never received certification of long-term care insurance at the survey. We followed up 867 individuals (72.1%) until the end of December 2018 (10 month-period). We defined frailty as a state in performing 4 items and over of 15 items which were composed of un-intentional weight loss, history of falls, etc. Among 867 subjects, 233 subjects (26.9%) were judged to be frailty group, and 634 subjects (73.1%) non-frailty group. We compared period to the new certification of long-term care insurance (LTCI), accumulated medical and long-term care expenditures adjusted for age and gender between the two groups during the follow-up period. Cox proportional hazard models were used to examine the association between baseline frailty and the new certification of LTCI. The relative hazard ratio (HR) was higher in frailty group than non-frailty group (HR=3.51, 95% CI：1.30-9.45, P=.013). The adjusted mean accumulated medical and long-term care expenditures per capita during the follow-up were significantly (P=.002) larger for those in the frailty group (629,699 yen), while those in the non-frailty group were 450,995 yen. We confirmed strong economic impact of frailty in the elderly aged 75 or over in Japan.

scholarly journals The Influence of Race and Gender on Staff-Resident Interactions in Nursing Homes

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 185-185
Author(s):  
Rachel McPherson ◽  
Barbara Resnick ◽  
Elizabeth Galik
Keyword(s):  
Racial Differences ◽  
Long Term Care ◽  
Analysis Of Covariance ◽  
Positive Interactions ◽  
Term Care ◽  
Race And Gender ◽  
Significant Difference ◽  
And Gender

Abstract Communication and interactions are an integral part of care in long-term care settings. Resident variables, such as race and gender, shape communication and interaction between staff and residents. The Quality of Interactions Schedule (QuIS) was developed to measure the quality of verbal and nonverbal interactions among nursing staff and older adults initially for those in acute care and later used as well in a variety of long term care settings. A quantified measurement of the quality of interactions between residents and staff was created to quantify the QuIS. The purpose of this study was to describe the gender and racial differences in scored quality of interactions. Data for the present study was based on baseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) implementation study. A total of 535 residents from 55 settings were included in the analyses. An analysis of covariance was conducted to determine a difference in QuIS scores between males and females while controlling for age. The second model tested for differences in QuIS scores between blacks and whites while controlling for age and gender. There was not a statistically significant difference in QuIS scores between male and female residents. There was a significant difference in QuIS scores between those who were black versus white, such that those who were black received more positive interactions from staff than those who were white. Future work should focus on a deeper examination of resident factors and staff factors that may influence these interactions.

Aging, health expenditure, proximity to death, and income in Finland

2008 ◽  
Vol 3 (2) ◽  
pp. 165-195 ◽  
Author(s):  
UNTO HÄKKINEN ◽  
PEKKA MARTIKAINEN ◽  
ANJA NORO ◽  
ELINA NIHTILÄ ◽  
MIKKO PELTOLA
Keyword(s):  
Health Care ◽  
Health Expenditure ◽  
Long Term Care ◽  
Health Care Expenditure ◽  
Term Care ◽  
Age And Gender ◽  
And Gender ◽  
Proximity To Death ◽  
Naive Model

AbstractThis study revisits the debate on the ‘red herring’, i.e. the claim that population aging will not have a significant impact on health care expenditure (HCE), using a Finnish data set. We decompose HCE into several components and include both survivors and deceased individuals into the analyses. We also compare the predictions of health expenditure based on a model that takes into account the proximity to death with the predictions of a naïve model, which includes only age and gender and their interactions. We extend our analysis to include income as an explanatory variable. According to our results, total expenditure on health care and care of elderly people increases with age but the relationship is not as clear as is usually assumed when a naïve model is used in health expenditure projections. Among individuals not in long-term care, we found a clear positive relationship between expenditure and age only for health centre and psychiatric inpatient care. In somatic care and prescribed drugs, the expenditure clearly decreased with age among deceased individuals. Our results emphasize that even in the future, health care expenditure might be driven more by changes in the propensity to move into long-term care and medical technology than age and gender alone, as often claimed in public discussion. We do not find any strong positive associations between income and expenditure for most non-LTC categories of health care utilization. Income was positively related to expenditure on prescribed medicines, in which cost-sharing between the state and the individual is relatively high. Overall, our results indicate that the future expenditure is more likely to be determined by health policy actions than inevitable trends in the demographic composition of the population.

Future Costs of Long-term Care in Japan and Sweden

2017 ◽  
Vol 48 (1) ◽  
pp. 128-147 ◽  
Author(s):  
Mårten Lagergren ◽  
Noriko Kurube ◽  
Yasuhiko Saito
Keyword(s):  
Long Term Care ◽  
Population Change ◽  
Population Aging ◽  
Population Data ◽  
Epidemiological Data ◽  
The Other ◽  
Age Group ◽  
Term Care ◽  
And Gender

Population aging is expected to increase long-term care (LTC) costs in both Japan and Sweden. This study projected LTC costs for 2010 through 2040 for different assumptions of population change, LTC need by age group and gender, and LTC provided per level of need and cost in Japan and Sweden. Population data were taken from the official national forecasts. Needs projections were based on epidemiological data from the Nihon University Japanese Longitudinal Study of Aging and the Swedish Survey of Living Conditions. Data on LTC provision by need and cost were taken from nine Japanese municipalities collected by assessments in the LTC insurance system and from surveys in eight Swedish municipalities. Total initial costs were calibrated to official national figures. Two projections based on two different scenarios were made for each country from 2010 to 2040. The first scenario assumed a constant level of need for LTC by age group and gender, and the other assumed a continuation of the present LTC need trends until 2025. For Japan, this resulted in a projected cost increase of 93% for the one and 80% for the other; for Sweden it was 52% and 24%, respectively. The results reflected differences in population aging and health development.

scholarly journals Prevalence of Multiple Sclerosis in Tuscany (Central Italy): A Study Based on Validated Administrative Data

2015 ◽  
Vol 46 (1) ◽  
pp. 37-42 ◽  
Author(s):  
Daiana Bezzini ◽  
Laura Policardo ◽  
Giuseppe Meucci ◽  
Monica Ulivelli ◽  
Sabina Bartalini ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Administrative Data ◽  
Care Home ◽  
Central Italy ◽  
Population Based ◽  
Term Care ◽  
Prevalence Studies ◽  
Hospital Discharge Records ◽  
Test Algorithm

Background: Multiple Sclerosis (MS) epidemiology in Italy is mainly based on population-based prevalence studies. Administrative data are an additional source of information, when available, in prevalence studies of chronic diseases such as MS. The aim of our study is to update the prevalence rate of MS in Tuscany (central Italy) as at 2011 using a validated case-finding algorithm based on administrative data. Methods: The prevalence was calculated using an algorithm based on the following administrative data: hospital discharge records, drug-dispensing records, disease-specific exemptions from copayment to health care, home and residential long-term care and inhabitant registry. To test algorithm sensitivity, we used a true-positive reference cohort of MS patients from the Tuscan MS register. To test algorithm specificity, we used another cohort of individuals who were presumably not affected by MS. Results: As at December 31, 2011, we identified 6,890 cases (4,738 females and 2,152 males) with a prevalence of 187.9 per 100,000. The sensitivity of algorithm was 98% and the specificity was 99.99%. Conclusions: We found a prevalence higher than the rates present in literature. Our algorithm, based on administrative data, can accurately identify MS patients; moreover, the resulting cohort is suitable to monitor disease care pathways.

Impact of a Comprehensive Long-Term Care Program on Caregivers and Persons with Multiple Sclerosis

2000 ◽  
Vol 2 (1) ◽  
pp. 23-39 ◽  
Author(s):  
EM Guagenti-Tax ◽  
TA DiLorenzo ◽  
L Tenteromano ◽  
NG LaRocca ◽  
CR Smith
Keyword(s):  
Multiple Sclerosis ◽  
Repeated Measures ◽  
Long Term Care ◽  
Care Program ◽  
Perceived Health ◽  
Community Resources ◽  
Term Care ◽  
Control Subjects ◽  
Anxiety Control

Abstract The goal of this project was to evaluate a comprehensive model of long-term care in multiple sclerosis (MS). This model consisted of workshops designed to assist participants cope with caregiving demands; medical day care to provide rehabilitation and group therapy; home visits by a psychotherapist or nurse to assist with practical and psychological issues; and case management and liaison services. Thirty patient-caregiver units receiving treatment were compared with 29 control subjects, with data being collected on 3 occasions over a 2-year period. Repeated measures analysis of variance found that physical functioning declined for MS subjects as indicated by Kurtzke score, Incapacity Status Scale score, and number of hospitalizations. The experimental group reported an increase in perceived cognitive deficits and decreased anxiety. Control subjects reported a greater decline in perceived health than experimental subjects as assessed by the SF-36 general health subscale. All caregivers reported increased overcommitment. Caregivers of controls reported significant decreases in perceived health and that health problems and caregiving activities interfered with social activities. Persons with MS in both groups reported increased satisfaction with caregiver help, while control subjects reported greater satisfaction with the timeliness of help received. These results provide valuable information about effective ways to use and integrate community resources in the provision of long-term care for persons with MS.

AGREEMENT BETWEEN CLINICAL AND ADMINISTRATIVE HEALTH DATABASES FOR MEDICATION USE IN SASKATCHEWAN'S LONG-TERM CARE RESIDENTS

2013 ◽  
Vol 67 (4) ◽  
pp. e1.7-e1
Author(s):  
Lin Yan ◽  
Lisa M Lix ◽  
Verena Schneider-Lindner ◽  
Gary F Teare ◽  
David Blackburn ◽  
...  
Keyword(s):  
Long Term Care ◽  
Medication Use ◽  
Term Care ◽  
Administrative Health Databases

Attitudes to long-term care in multiple sclerosis

2003 ◽  
Vol 17 (17) ◽  
pp. 39-43
Author(s):  
Louise Jarrett ◽  
Alison Bradford ◽  
Caroline Brown ◽  
Samantha Colhoun ◽  
Adrienne Cox ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Long Term Care ◽  
Term Care

scholarly journals Long-Term Care and Gender Equality: Fuzzy-Set Ideal Types of Care Regimes in Europe

2020 ◽  
Vol 8 (4) ◽  
pp. 92-102 ◽  
Author(s):  
Attila Bartha ◽  
Violetta Zentai
Keyword(s):  
Gender Equality ◽  
Fuzzy Set ◽  
Long Term Care ◽  
Ideal Type ◽  
Term Care ◽  
Ideal Types ◽  
Intergenerational Ties ◽  
And Gender ◽  
Care Regimes

Recent changes in the organization of long-term care have had controversial effects on gender inequality in Europe. In response to the challenges of ageing populations, almost all countries have adopted reform measures to secure the increasing resource needs for care, to ensure care services by different providers, to regulate the quality of services, and overall to recalibrate the work-life balance for men and women. These reforms are embedded in different family ideals of intergenerational ties and dependencies, divisions of responsibilities between state, market, family, and community actors, and backed by wider societal support to families to care for their elderly and disabled members. This article disentangles the different components of the notion of ‘(de)familialization’ which has become a crucial concept of care scholarship. We use a fuzzy-set ideal type analysis to investigate care policies and work-family reconciliation policies shaping long-term care regimes. We are making steps to reveal aggregate gender equality impacts of intermingling policy dynamics and also to relate the analysis to migrant care work effects. The results are explained in a four-pronged ideal type scheme to which European countries belong. While only Nordic and some West European continental countries are close to the double earner, supported carer ideal type, positive outliers prove that transformative gender relations in care can be construed not only in the richest and most generous welfare countries in Europe.

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