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Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 4/2020

01-04-2020 | Care | Review Article/Brief Review

Data initiatives supporting critical care research and quality improvement in Canada: an environmental scan and narrative review

Authors: Nicholas Jackson Chornenki, BSc, Patricia Liaw, PhD, Sean Bagshaw, MD, MSc, Karen Burns, MD, MSc, Peter Dodek, MD, MSc, Shane English, MD, MSc, Eddy Fan, MD, PhD, Nicolay Ferrari, PhD, Robert Fowler, MDCM, MS (Epi), Alison Fox-Robichaud, MD, MSc, Allan Garland, MD, MSc, Robert Green, MD, DABEM, Paul Hebert, MD, MSc, Michelle Kho, PhD, Claudio Martin, MD, MSc, David Maslove, MD, MSc, Ellen McDonald, RN, Kusum Menon, MD, MSc, Srinivas Murthy, MD, MSc, John Muscedere, MD, MSc, Damon Scales, MD, PhD, Henry Thomas Stelfox, MD, PhD, Han Ting Wang, MD, MSc, Matthew Weiss, MD, MSc, the Canadian Critical Care Trials Group (CCCTG) and Canadian Critical Care Translational Biology Group (CCCTBG)

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 4/2020

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Abstract

Purpose

Collection and analysis of health data are crucial to achieving high-quality clinical care, research, and quality improvement. This review explores existing hospital, regional, provincial and national data platforms in Canada to identify gaps and barriers, and recommend improvements for data science.

Source

The Canadian Critical Care Trials Group and the Canadian Critical Care Translational Biology Group undertook an environmental survey using list-identified names and keywords in PubMed and the grey literature, from the Canadian context. Findings were grouped into sections, corresponding to geography, purpose, and patient sub-group initiatives, using a narrative qualitative approach. Emerging themes, impressions, and recommendations towards improving data initiatives were generated.

Principal findings

In Canada, the Canadian Institute for Health Information Discharge Abstract Database contains high-level clinical data on every adult and child discharged from acute care facilities; however, it does not contain data from Quebec, critical care-specific severity of illness risk-adjustment scores, physiologic data, or data pertaining to medication use. Provincially mandated critical care platforms in four provinces contain more granular data, and can be used to risk adjust and link to within-province data sets; however, no inter-provincial collaborative mechanism exists. There is very limited infrastructure to collect and link biological samples from critically ill patients nationally. Comprehensive international clinical data sets may inform future Canadian initiatives.

Conclusion

Clinical and biological data collection among critically ill patients in Canada is not sufficiently coordinated, and lags behind other jurisdictions. An integrated and inclusive critical care data platform is a key clinical and scientific priority in Canada.
Appendix
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Literature
1.
go back to reference Marshall JC. Global collaboration in acute care clinical research: opportunities, challenges, and needs. Crit Care Me74d. 2017; 45: 311-20. Marshall JC. Global collaboration in acute care clinical research: opportunities, challenges, and needs. Crit Care Me74d. 2017; 45: 311-20.
3.
go back to reference Stow PJ, Hart GK, Higlett T, et al. Development and implementation of a high-quality clinical database: the Australian and New Zealand Intensive Care Society Adult Patient Database. J Crit Care 2006; 21: 133-41.CrossRef Stow PJ, Hart GK, Higlett T, et al. Development and implementation of a high-quality clinical database: the Australian and New Zealand Intensive Care Society Adult Patient Database. J Crit Care 2006; 21: 133-41.CrossRef
4.
go back to reference Harrison DA, Brady AR, Rowan K. Case mix, outcome and length of stay for admissions to adult, general critical care units in England, Wales and Northern Ireland: the Intensive Care National Audit & Research Centre Case Mix Programme Database. Crit Care 2004; 8: R99-111.CrossRef Harrison DA, Brady AR, Rowan K. Case mix, outcome and length of stay for admissions to adult, general critical care units in England, Wales and Northern Ireland: the Intensive Care National Audit & Research Centre Case Mix Programme Database. Crit Care 2004; 8: R99-111.CrossRef
6.
go back to reference Cook SF, Visscher WA, Hobbs CL, Williams RL; Project IMPACT Clinical Implementation Committee. Project IMPACT: results from a pilot validity study of a new observational database. Crit Care Med 2002; 30: 2765-70. Cook SF, Visscher WA, Hobbs CL, Williams RL; Project IMPACT Clinical Implementation Committee. Project IMPACT: results from a pilot validity study of a new observational database. Crit Care Med 2002; 30: 2765-70.
7.
go back to reference Brown SE, Ratcliffe SJ, Kahn JM, Halpern SD. The epidemiology of intensive care unit readmissions in the United States. Am J Respir Crit Care Med 2012; 185: 955-64.CrossRef Brown SE, Ratcliffe SJ, Kahn JM, Halpern SD. The epidemiology of intensive care unit readmissions in the United States. Am J Respir Crit Care Med 2012; 185: 955-64.CrossRef
11.
go back to reference Keenan SP, Martin CM. Creation of a Critical Care Research Network. Curr Opin Crit Care 1998; 4: 470-5.CrossRef Keenan SP, Martin CM. Creation of a Critical Care Research Network. Curr Opin Crit Care 1998; 4: 470-5.CrossRef
12.
go back to reference Keenan SP, Martin CM, Kossuth JD, Eberhard J, Sibbald WJ. The critical care research network: a partnership in community-based research and research transfer. J Eval Clin Pract 2000; 6: 15-22.CrossRef Keenan SP, Martin CM, Kossuth JD, Eberhard J, Sibbald WJ. The critical care research network: a partnership in community-based research and research transfer. J Eval Clin Pract 2000; 6: 15-22.CrossRef
13.
go back to reference Chen LM, Martin CM, Morrison TL, Sibbald WJ. Interobserver variability in data collection of the APACHE II score in teaching and community hospitals. Crit Care Med 1999; 27: 1999-2004.CrossRef Chen LM, Martin CM, Morrison TL, Sibbald WJ. Interobserver variability in data collection of the APACHE II score in teaching and community hospitals. Crit Care Med 1999; 27: 1999-2004.CrossRef
14.
go back to reference Brundin-Mather R, Soo A, Zuege DJ, et al. Secondary EMR data for quality improvement and research: a comparison of manual and electronic data collection from an integrated critical care electronic medical record system. J Crit Care 2018; 47: 295-301.CrossRef Brundin-Mather R, Soo A, Zuege DJ, et al. Secondary EMR data for quality improvement and research: a comparison of manual and electronic data collection from an integrated critical care electronic medical record system. J Crit Care 2018; 47: 295-301.CrossRef
15.
go back to reference Stelfox HT, Bastos J, Niven DJ, Bagshaw SM, Turin TC, Gao S. Critical care transition programs and the risk of readmission or death after discharge from ICU. Intensive Care Med 2016; 42: 401-10.CrossRef Stelfox HT, Bastos J, Niven DJ, Bagshaw SM, Turin TC, Gao S. Critical care transition programs and the risk of readmission or death after discharge from ICU. Intensive Care Med 2016; 42: 401-10.CrossRef
16.
go back to reference Stelfox HT, Soo A, Niven DJ, et al. Assessment of the safety of discharging select patients directly home from the intensive care unit: a multicenter population-based cohort study. JAMA Intern Med 2018; 178: 1390-9.CrossRef Stelfox HT, Soo A, Niven DJ, et al. Assessment of the safety of discharging select patients directly home from the intensive care unit: a multicenter population-based cohort study. JAMA Intern Med 2018; 178: 1390-9.CrossRef
19.
go back to reference Bagshaw SM, Iwashyna TJ, Bellomo R, Zuege D, Wang X. Timing of onset of persistent critical illness: a multi-centre retrospective cohort study. Intensive Care Med. 2018; 44: 2134-44.CrossRef Bagshaw SM, Iwashyna TJ, Bellomo R, Zuege D, Wang X. Timing of onset of persistent critical illness: a multi-centre retrospective cohort study. Intensive Care Med. 2018; 44: 2134-44.CrossRef
20.
go back to reference Wenner JB, Norena M, Khan N, et al. Reliability of intensive care unit admitting and comorbid diagnoses, race, elements of Acute Physiology and Chronic Health Evaluation II score, and predicted probability of mortality in an electronic intensive care unit database. J Crit Care 2009; 24: 401-7.CrossRef Wenner JB, Norena M, Khan N, et al. Reliability of intensive care unit admitting and comorbid diagnoses, race, elements of Acute Physiology and Chronic Health Evaluation II score, and predicted probability of mortality in an electronic intensive care unit database. J Crit Care 2009; 24: 401-7.CrossRef
21.
go back to reference Dodek P, Kozak JF, Norena M, Wong H. More men than women are admitted to 9 intensive care units in British Columbia. J Crit Care 2009; 24(630): e1-8. Dodek P, Kozak JF, Norena M, Wong H. More men than women are admitted to 9 intensive care units in British Columbia. J Crit Care 2009; 24(630): e1-8.
22.
go back to reference Ayas NT, Norena M, Wong H, Chittock D, Dodek PM. Pneumothorax after insertion of central venous catheters in the intensive care unit: association with month of year and week of month. Qual Saf Health Care 2007; 16: 252-5.CrossRef Ayas NT, Norena M, Wong H, Chittock D, Dodek PM. Pneumothorax after insertion of central venous catheters in the intensive care unit: association with month of year and week of month. Qual Saf Health Care 2007; 16: 252-5.CrossRef
23.
go back to reference Palepu A, Khan NA, Norena M, Wong H, Chittock DR, Dodek PM. The role of HIV infection and drug and alcohol dependence in hospital mortality among critically ill patients. J Crit Care 2008; 23: 275-80.CrossRef Palepu A, Khan NA, Norena M, Wong H, Chittock DR, Dodek PM. The role of HIV infection and drug and alcohol dependence in hospital mortality among critically ill patients. J Crit Care 2008; 23: 275-80.CrossRef
24.
go back to reference Khan NA, Palepu A, Norena M, et al. Differences in hospital mortality among critically ill patients of Asian, Native Indian, and European descent. Chest 2008; 134: 1217-22.CrossRef Khan NA, Palepu A, Norena M, et al. Differences in hospital mortality among critically ill patients of Asian, Native Indian, and European descent. Chest 2008; 134: 1217-22.CrossRef
27.
go back to reference Dodek P, Chanques G, Brown G, et al. Role of organisational structure in implementation of sedation protocols: a comparison of Canadian and French ICUs. BMJ Qual Saf 2012; 21: 715-21.CrossRef Dodek P, Chanques G, Brown G, et al. Role of organisational structure in implementation of sedation protocols: a comparison of Canadian and French ICUs. BMJ Qual Saf 2012; 21: 715-21.CrossRef
28.
go back to reference Dodek PM, Norena M, Ayas NT, Romney M, Wong H. Length of stay and mortality due to Clostridium difficile infection acquired in the intensive care unit. J Crit Care 2013; 28: 335-40.CrossRef Dodek PM, Norena M, Ayas NT, Romney M, Wong H. Length of stay and mortality due to Clostridium difficile infection acquired in the intensive care unit. J Crit Care 2013; 28: 335-40.CrossRef
29.
go back to reference Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985; 13: 818-29.CrossRef Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985; 13: 818-29.CrossRef
30.
go back to reference Miranda DR, de Rijk A, Schaufeli W. Simplified therapeutic intervention scoring system: the TISS-28 items–results from a multicenter study. Crit Care Med 1996; 24: 64-73.CrossRef Miranda DR, de Rijk A, Schaufeli W. Simplified therapeutic intervention scoring system: the TISS-28 items–results from a multicenter study. Crit Care Med 1996; 24: 64-73.CrossRef
34.
go back to reference Garland A, Yogendran M, Olafson K, Scales DC, McGowan KL, Fransoo R. The accuracy of administrative data for identifying the presence and timing of admission to intensive care units in a Canadian province. Med Care 2012; 50: e1-6.CrossRef Garland A, Yogendran M, Olafson K, Scales DC, McGowan KL, Fransoo R. The accuracy of administrative data for identifying the presence and timing of admission to intensive care units in a Canadian province. Med Care 2012; 50: e1-6.CrossRef
35.
go back to reference Marshall JC, Cook D, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple Organ Dysfunction Score: a reliable descriptor of a complex clinical outcome. Crit Care Med 1995; 23: 1638-52.CrossRef Marshall JC, Cook D, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple Organ Dysfunction Score: a reliable descriptor of a complex clinical outcome. Crit Care Med 1995; 23: 1638-52.CrossRef
38.
go back to reference Rose L, Scales DC, Atzema C, et al. Emergency department length of stay for critical care admissions. A population-based study. Ann Am Thorac Soc 2016; 13: 1324-32. Rose L, Scales DC, Atzema C, et al. Emergency department length of stay for critical care admissions. A population-based study. Ann Am Thorac Soc 2016; 13: 1324-32.
40.
go back to reference Needham DM, Sepulveda KA, Dinglas VD, et al. Core outcome measures for clinical research in acute respiratory failure survivors. An international modified Delphi consensus study. Am J Respir Crit Care Med 2017; 196: 1122-30. Needham DM, Sepulveda KA, Dinglas VD, et al. Core outcome measures for clinical research in acute respiratory failure survivors. An international modified Delphi consensus study. Am J Respir Crit Care Med 2017; 196: 1122-30.
Metadata
Title
Data initiatives supporting critical care research and quality improvement in Canada: an environmental scan and narrative review
Authors
Nicholas Jackson Chornenki, BSc
Patricia Liaw, PhD
Sean Bagshaw, MD, MSc
Karen Burns, MD, MSc
Peter Dodek, MD, MSc
Shane English, MD, MSc
Eddy Fan, MD, PhD
Nicolay Ferrari, PhD
Robert Fowler, MDCM, MS (Epi)
Alison Fox-Robichaud, MD, MSc
Allan Garland, MD, MSc
Robert Green, MD, DABEM
Paul Hebert, MD, MSc
Michelle Kho, PhD
Claudio Martin, MD, MSc
David Maslove, MD, MSc
Ellen McDonald, RN
Kusum Menon, MD, MSc
Srinivas Murthy, MD, MSc
John Muscedere, MD, MSc
Damon Scales, MD, PhD
Henry Thomas Stelfox, MD, PhD
Han Ting Wang, MD, MSc
Matthew Weiss, MD, MSc
the Canadian Critical Care Trials Group (CCCTG) and Canadian Critical Care Translational Biology Group (CCCTBG)
Publication date
01-04-2020
Publisher
Springer International Publishing
Keyword
Care
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 4/2020
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-020-01571-1

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