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Morbidity, mortality and missed appointments in healthcare: a national retrospective data linkage study.

ABSTRACT: BACKGROUND:Recently, studies have examined the underlying patient and practice factors for missed appointments, but less is known about the impact on patient health. People with one or more long-term conditions who fail to attend appointments may be at risk of premature death. This is the first study to examine the effect of missed primary healthcare appointments on all-cause mortality in those with long-term mental and physical health conditions. METHODS:We used a large, nationwide retrospective cohort (n = 824,374) extracted from routinely collected general practice data across Scotland over a 3-year period from September 2013 until September 2016. This data encompasses appointment history for approximately 15% of the Scottish population, and was linked to Scottish deaths records for patients who had died within a 16-month follow-up period. We generated appointment attendance history, number of long-term conditions and prescriptions data for patients. These factors were used in negative binomial and Cox's proportional hazards modelling to examine the risk of missing appointments and all-cause mortality. RESULTS:Patients with a greater number of long-term conditions had an increased risk of missing general practice appointments despite controlling for number of appointments made, particularly among patients with mental health conditions. These patients were at significantly greater risk of all-cause mortality, and showed a dose-based response with increasing number of missed appointments. Patients with long-term mental health conditions who missed more than two appointments per year had a greater than 8-fold increase in risk of all-cause mortality compared with those who missed no appointments. These patients died prematurely, commonly from non-natural external factors such as suicide. CONCLUSIONS:Missed appointments represent a significant risk marker for all-cause mortality, particularly in patients with mental health conditions. For these patients, existing primary healthcare appointment systems are ineffective. Future interventions should be developed with a particular focus on increasing attendance by these patients.

SUBMITTER: McQueenie R

PROVIDER: S-EPMC6329132 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Morbidity, mortality and missed appointments in healthcare: a national retrospective data linkage study.

McQueenie Ross R Ellis David A DA McConnachie Alex A Wilson Philip P Williamson Andrea E AE

BMC medicine 20190111 1

<h4>Background</h4>Recently, studies have examined the underlying patient and practice factors for missed appointments, but less is known about the impact on patient health. People with one or more long-term conditions who fail to attend appointments may be at risk of premature death. This is the first study to examine the effect of missed primary healthcare appointments on all-cause mortality in those with long-term mental and physical health conditions.<h4>Methods</h4>We used a large, nationwi ...[more]

PMID: 30630493

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Project description:BackgroundMany studies have shown significant gaps in mortality, and cause specific mortality by educational status. This study investigated these measures in Israel by educational and ethnic status in recent decades.MethodA mortality follow-up till 2017 was done of a cohort of Israeli residents aged 25-64 in 2000 who remained in Israel and had available educational data, grouped into under 8, 9-11, 12, 13-15 and 16 and above years of education. Indirect age adjustment was used to calculate Standard Mortality Ratios (SMRs) by sex and educational group, and a Cox regression model to assess relative risk of total and cause specific mortality controlling for age and ethnic group (Jews and Others and Arabs).The analysis was repeated for each ethnic group separately.Results2,776,422 persons were included of whom 174,792 (6.3%) died till 2017. SMR's for total mortality of males and females with less than 8 years of education compared to 16 and over were 2.2 and 1.8, respectively. Corresponding HR were 2.13 (95% CI 2.08-2.18) and 1.77 (95% CI 1.72-1.82), respectively. The highest cause specific hazard ratios in males were for homicide, 4.40 (95% CI 3.19-6.07), respiratory diseases, 4.01 (95% CI 3.61-4.44), infectious diseases, 3.55 (95% CI 3.15-3.19) and diabetes 3.41 (95% CI 3.06-3.79) and in females for diabetes, 4.41 (95% CI 3.76-5.16), infectious diseases, 4.16 (95% CI 3.52-4.91), respiratory diseases, 4.13 (95% CI 3.55-4.81), and heart disease, 2.96 (95% CI 2.66-3.29). Education-adjusted risk of all-cause mortality for Arab males was 1.07 (1.05-1.09) times that of Jews and Others and non-significant in females. High mortality risk was found for Arab males and females compared to Jews and Others for homicide, diabetes, heart and cerebrovascular disease and for respiratory disease in males. Lower risk was found for suicide and infectious diseases in both sexes and cancer in females.ConclusionWe found significant effect of educational level on all-cause and cause specific mortality, particularly respiratory diseases, infectious diseases, diabetes and homicide. Our results highlight the importance of increasing the educational level of all groups in the population and of encouraging healthy behavior in the lower educated.

Project description:ObjectivesAre multiple missed appointments in general practice associated with increased use of hospital services and missingness from hospital care? This novel study explores this in a population representative sample for the first time.Design, setting, participantsA large, retrospective cohort (n = 824,374) of patient records from a nationally representative sample of GP practices, Scotland, 2013-2016. Requested data were extracted by a Trusted Third Party for the NHS, anonymised and linked to a unique patient ID, in the NHS Safehaven for analysis using established NHS Scotland linkage. We calculated the per-patient number of GP missed appointments from individual appointments and investigated the likelihood of hospital appointment or admission outcomes using a negative binomial model offset by number of GP appointments made. These models also controlled for age, sex, Scottish Index of Multiple Deprivation (SIMD) and number of long- term conditions (LTCs).Main outcome measuresHospital attendance: Outpatient clinic attendances; hospital admissions; Emergency Department (ED) attendances. Hospital missingness: 'Did not attend' (DNAs) outpatient clinic appointments, 'irregular discharges' from admissions, and 'left before care completed' ED care episodes.ResultsAttendance: Patients in the high missed GP appointment (HMA) category were higher users of outpatient services (rate ratio (RR) 1.90, 95% confidence intervals (CI) 1.88-1.93) compared to those who missed none (NMA) with a much higher attendance risk at mental health services (RR 4.56, 95% CI 4.31-4.83). HMA patients were more likely to be admitted to hospital; general admissions (RR 1.67, 95% CI 1.65-1.68), maternity (RR 1.24, 95% CI 1.20-1.28) and mental health (RR 1.23, 95% CI 1.15-1.31), compared to NMA patients. Missing GP appointments was not associated with ED attendance; (RR 1.00, CI 0.99-1.01). Missingness: HMA patients were at greater risk of missing outpatient appointments (RR 1.62, 95% CI 1.60-1.64) than NMA patients; with a much higher risk of non-attendance at mental health services (RR 7.83, 95% CI 7.35-8.35). Patients were more likely to leave hospital before their care plan was completed-taking 'irregular discharges' (RR 4.56, 95% CI 4.31-4.81). HMA patients were no more at risk of leaving emergency departments 'without care being completed' (RR1.02, 95 CI 0.95-1.09).ConclusionsPatients who miss high numbers of GP appointments are higher users of outpatient and inpatient hospital care but not of emergency departments, signalling high treatment burden. The pattern of 'missingness' is consistent from primary care to hospital care: patients who have patterns of missing GP appointments have patterns of missing many outpatient appointments and are more likely to experience 'irregular discharge' from in-patient care. Missingness from outpatient mental health services is very high. Policymakers, health service planners and clinicians should consider the role and contribution of 'missingness' in health care to improving patient safety and care.

Project description:IntroductionSevere acute pancreatitis (AP) requiring critical care admission (ccAP) impacts negatively on long-term survival.ObjectiveTo document organ-specific new morbidity and identify risk factors associated with premature mortality after an episode of ccAP.DesignCohort study.SettingElectronic healthcare registries in Scotland.ParticipantsThe ccAP cohort included 1471 patients admitted to critical care with AP between 1 January 2008 and 31 December 2010 followed up until 31 December 2014. The population cohort included 3450 individuals from the general population of Scotland frequency-matched for age, sex and social deprivation.MethodsRecord linkage of routinely collected electronic health data with population matching.Primary and secondary outcome measuresPatient demographics, comorbidity (Charlson Comorbidity Index), acute physiology, organ support and other critical care data were linked to records of mortality (death certificate data) and new-onset morbidity. Kaplan-Meier and Cox regression analyses were used to identify risk factors associated with mortality.Results310 patients with AP died during the index admission. Outcomes were not ascertained for five patients, and the deprivation quintile was not known for six patients. 340 of 1150 patients in the resulting postdischarge ccAP cohort died during the follow-up period. Greater comorbidity measured by the Charlson score, prior to ccAP, negatively influenced survival in the hospital and after discharge. The odds of developing new-onset diabetes mellitus after ccAP compared with the general population were 10.70 (95% CI 5.74 to 19.94). A new diagnosis of myocardial infarction, stroke, heart failure, liver disease, peptic ulcer, renal failure, cancer, peripheral vascular disease and lung disease was more frequent in the ccAP cohort than in the general population.ConclusionsThe persistent deleterious impact of severe AP on long-term outcome and survival is multifactorial in origin, influenced by pre-existing patient characteristics and acute episode features. Further mechanistic and epidemiological investigation is warranted.

Project description:BackgroundCOVID-19 rapidly spread around the world, putting health systems under unprecedented pressure and continuous adaptations. Well-established health information systems (HIS) are crucial in providing data to allow evidence-based policymaking and public health interventions in the pandemic response. This study aimed to compare morbidity information between two databases for COVID-19 management in Portugal and identify potential complementarities.MethodsThis is an observational study using records from both COVID-19 cases surveillance (National Epidemiological Surveillance System; SINAVE) and related deaths (National e-Death Certificates Information System; SICO) systems, which were matched on sex, age, municipality of residence and date of death. After the linkage, morbidity reported in SINAVE and identified in SICO, through the application of Charlson and Elixhauser comorbidity indexes algorithms, were compared to evaluate agreement level.ResultsOverall, 2285 matched cases were analyzed, including 53.9% males with a median age of 84 years. According to the method of data reporting assessment, the presence of any morbidity ranged between 26.3% and 62.5%. The reporting of ten morbidities could be compared between the information reported in SINAVE and SICO databases. The proportion of simultaneous reporting in both databases ranged between 5.7% for diabetes and 0.0% for human immunodeficiency virus infection or coagulopathy. Minimal or no agreement was found when assessing the similarity of the morbidity reporting in both databases, with neoplasms showing the highest level of agreement (0.352, 95% IC: 0.277-0.428; p < 0.001).ConclusionDifferent information about reported morbidity could be found in two HIS used to monitor COVID-19 cases and related deaths, as data are independently collected. These results show that the interoperability of SICO and SINAVE databases would potentially improve available HIS and improve available information to decision-making and address COVID-19 pandemic management.

Project description:IntroductionThe aims of this program of research are to use linked health and law enforcement data to describe individuals presenting to emergency and inpatient healthcare services with an acute alcohol harm or problematic alcohol use; measure their health service utilisation and law enforcement engagement; and quantify morbidity, mortality, offending and incarceration.Methods and analysisWe will assemble a retrospective cohort of people presenting to emergency departments and/or admitted to hospitals between 1 January 2005 and 31 December 2014 in New South Wales, Australia with a diagnosis denoting an acute alcohol harm or problematic alcohol use. We will link these data with records from other healthcare services (eg, community-based mental healthcare data, cancer registry), mortality, offending and incarceration data sets. The four overarching areas for analysis comprise: (1) describing the characteristics of the cohort at their first point of contact with emergency and inpatient hospital services in the study period with a diagnosis indicating an acute alcohol harm and/or problematic alcohol use; (2) quantifying health service utilisation and law enforcement engagement; (3) quantifying rates of mortality, morbidity, offending and incarceration; and (4) assessing predictors (eg, age, sex) of mortality, morbidity, offending and incarceration among this cohort.Ethics and disseminationEthics approval has been provided by the New South Wales Population and Health Services Research Ethics Committee. We will report our findings in accordance with the REporting of studies Conducted using Observational Routinely collected health Data (RECORD) statement and Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) where appropriate. We will publish data in tabular, aggregate forms only. We will not disclose individual results. We will disseminate project findings at scientific conferences and in peer-reviewed journals. We will aim to present findings to relevant stakeholders (eg, addiction medicine and emergency medicine specialists, policy makers) to maximise translational impact of research findings.

Dataset Information

Morbidity, mortality and missed appointments in healthcare: a national retrospective data linkage study.

Publications

Morbidity, mortality and missed appointments in healthcare: a national retrospective data linkage study.

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