Can Patients with Dementia Be Identified in Primary Care Electronic Medical Records Using Natural Language Processing?

Unlabelled: Dementia and mild cognitive impairment can be underrecognized in primary care practice and research. Free-text fields in electronic medical records (EMRs) are a rich source of information which might support increased detection and enable a better understanding of populations at risk of dementia. We used natural language processing (NLP) to identify dementia-related features in EMRs and compared the performance of supervised machine learning models to classify patients with dementia.

Impact of the COVID-19 Pandemic on Home Care Services Among Community-Dwelling Adults With Dementia.

Objective: To examine how the COVID-19 pandemic impacted use of home care services for individuals with dementia across service types and sociodemographic strata.

Design: Population-based time series analysis.

Setting And Participants: Community-dwelling adults with dementia in Ontario, Canada, from January 2019 to September 2020.

Validation of canadian health administrative data algorithms for estimating trends in the incidence and prevalence of osteoarthritis.

Objective: To estimate the 1) accuracy of algorithms for identifying osteoarthritis (OA) using health administrative data; and 2) population-level OA prevalence and incidence over time in Ontario, Canada.

Method: We performed a retrospective chart abstraction study to identify OA patients in a random sample of 7500 primary care patients from electronic medical records. The validation sample was linked with several administrative data sources.

Improving Care for Patients With or at Risk for Chronic Kidney Disease Using Electronic Medical Record Interventions: A Pragmatic Cluster-Randomized Trial Protocol.

Background: Many patients with or at risk for chronic kidney disease (CKD) in the primary care setting are not receiving recommended care.

Objective: The objective of this study is to determine whether a multifaceted, low-cost intervention compared with usual care improves the care of patients with or at risk for CKD in the primary care setting.

Design: A pragmatic cluster-randomized trial, with an embedded qualitative process evaluation, will be conducted.

Identification of Physician-Diagnosed Alzheimer's Disease and Related Dementias in Population-Based Administrative Data: A Validation Study Using Family Physicians' Electronic Medical Records.

Background: Population-based surveillance of Alzheimer's and related dementias (AD-RD) incidence and prevalence is important for chronic disease management and health system capacity planning. Algorithms based on health administrative data have been successfully developed for many chronic conditions. The increasing use of electronic medical records (EMRs) by family physicians (FPs) provides a novel reference standard by which to evaluate these algorithms as FPs are the first point of contact and providers of ongoing medical care for persons with AD-RD.

Wait times to rheumatology care for patients with rheumatic diseases: a data linkage study of primary care electronic medical records and administrative data.

Background: The Wait Time Alliance recently established wait time benchmarks for rheumatology consultations in Canada. Our aim was to quantify wait times to primary and rheumatology care for patients with rheumatic diseases.

Methods: We identified patients from primary care practices in the Electronic Medical Record Administrative data Linked Database who had referrals to Ontario rheumatologists over the period 2000-2013.

The association between diabetes and breast cancer stage at diagnosis: a population-based study.

Women with diabetes have higher breast cancer incidence and mortality. The purpose of this study was to examine the impact of diabetes on stage at breast cancer diagnosis, as a possible reason for their higher mortality. Using population-based health databases from Ontario, Canada, this retrospective cohort study examined stage at diagnosis (II, III, or IV vs I) among women aged 20-105 years who were newly diagnosed with invasive breast cancer between 2007 and 2012.

How infectious disease outbreaks affect community-based primary care physicians: comparing the SARS and H1N1 epidemics.

Objective: To compare how the infectious disease outbreaks H1N1 and severe acute respiratory syndrome (SARS) affected community-based GPs and FPs.

Design: A mailed survey sent after the H1N1 outbreak compared with the results of similar survey completed after the SARS outbreak.

Setting: Greater Toronto area in Ontario.

Effects of implementing electronic medical records on primary care billings and payments: a before-after study.

Background: Several barriers to the adoption of electronic medical records (EMRs) by family physicians have been discussed, including the costs of implementation, impact on work flow and loss of productivity. We examined billings and payments received before and after implementation of EMRs among primary care physicians in the province of Ontario. We also examined billings and payments before and after switching from a fee-for-service to a capitation payment model, because EMR implementation coincided with primary care reform in the province.

An administrative data validation study of the accuracy of algorithms for identifying rheumatoid arthritis: the influence of the reference standard on algorithm performance.

Background: We have previously validated administrative data algorithms to identify patients with rheumatoid arthritis (RA) using rheumatology clinic records as the reference standard. Here we reassessed the accuracy of the algorithms using primary care records as the reference standard.

Methods: We performed a retrospective chart abstraction study using a random sample of 7500 adult patients under the care of 83 family physicians contributing to the Electronic Medical Record Administrative data Linked Database (EMRALD) in Ontario, Canada.

Feasibility and validity of the self-administered computerized assessment of mild cognitive impairment with older primary care patients.

We investigated whether a validated computerized cognitive test, the Computerized Assessment of Mild Cognitive Impairment (CAMCI), could be independently completed by older primary care patients. We also determined the optimal cut-off for the CAMCI global risk score for mild cognitive impairment against an independent neuropsychological reference standard. All eligible patients aged 65 years and older, seen consecutively over 2 months by 1 family practice of 13 primary care physicians, were invited to participate.

Impact of socio-economic status on breast cancer screening in women with diabetes: a population-based study.

Aims: There is evidence to suggest that mammography rates are decreased in women with diabetes and in women of lower socio-economic status. Given the strong association between low socio-economic status and diabetes, we explored the extent to which differences in socio-economic status explain lower mammography rates in women with diabetes.

Methods: A population-based retrospective cohort study in Ontario, Canada, of women aged 50 to 69 years with diabetes between 1999 and 2010 age matched 1:2 to women without diabetes.

The rising burden of rheumatoid arthritis surpasses rheumatology supply in Ontario.

Objectives: Accurate data on the burden of rheumatoid arthritis (RA) are scarce, but critical in helping health care providers and decision makers to optimize clinical and public health strategies for disease management. We quantified the burden of RA in Ontario from 1996 to 2010 by age, sex and health planning region.

Methods: We used the Ontario Rheumatoid Arthritis administrative Database (ORAD), a validated population-based cohort of all Ontarians with RA, to estimate the crude prevalence and incidence of RA among men and women, and by age group from 1996 to 2010.

Access to rheumatologists among patients with newly diagnosed rheumatoid arthritis in a Canadian universal public healthcare system.

Objectives: Our objective was to estimate the percentage of patients with incident rheumatoid arthritis (RA) who were seen by a rheumatologist within 3, 6 and 12 months of suspected diagnosis by a family physician, and assess what factors may influence the time frame with which patients are seen.

Setting: Ontario, Canada.

Participants: Over 2000-2009, we studied patients with incident RA who were initially diagnosed by a family physician.

Assessing the validity of using administrative data to identify patients with epilepsy.

Objective: Previous validation studies assessing the use of administrative data to identify patients with epilepsy have used targeted sampling or have used a reference standard of patients in the neurologist, hospital, or emergency room setting. Therefore, the validity of using administrative data to identify patients with epilepsy in the general population has not been previously assessed. The purpose of this study was to determine the validity of using administrative data to identify patients with epilepsy in the general population.

A qualitative descriptive study on the alignment of care goals between older persons with multi-morbidities, their family physicians and informal caregivers.

Background: Goal setting is a recommended approach in clinical care that can help individuals with multi-morbidities and their caregivers manage chronic conditions. In this paper, the types of goals that were important for older persons with multi-morbidities were explored from the perspectives of patients, their caregivers and physicians. Comparisons of goals were made across each patient, caregiver and physician triad to determine alignment.

Office-based procedures among urban and rural family physicians in Ontario.

Objective: To compare FP and GP performance of office-based procedures between urban and rural practices.

Design: Descriptive cohort study using health administrative data.

Setting: Ontario.

Assessing methods for measurement of clinical outcomes and quality of care in primary care practices.

Purpose: To evaluate the appropriateness of potential data sources for the population of performance indicators for primary care (PC) practices.

Methods: This project was a cross sectional study of 7 multidisciplinary primary care teams in Ontario, Canada. Practices were recruited and 5-7 physicians per practice agreed to participate in the study.

Tracking family medicine graduates. Where do they go, what services do they provide and whom do they see?

Background: There are continued concerns over an adequate supply of family physicians (FPs) practicing in Canada. While most resource planning has focused on intake into postgraduate education, less information is available on what postgraduate medical training yields. We therefore undertook a study of Family Medicine (FM) graduates from the University of Toronto (U of T) to determine the type of information for physician resource planning that may come from tracking FM graduates using health administrative data.

Did changing primary care delivery models change performance? A population based study using health administrative data.

Background: Primary care reform in Ontario, Canada started with the introduction of new enrollment models, the two largest of which are Family Health Networks (FHNs), a capitation-based model, and Family Health Groups (FHGs), a blended fee-for-service model. The purpose of this study was to evaluate differences in performance between FHNs and FHGs and to compare performance before and after physicians joined these new primary care groups.

Methods: This study used Ontario administrative claims data to compare performance measures in FHGs and FHNs.