Health and Care Data: Approaches to data linkage for evidence-informed policy.

An indispensable prerequisite for answering research questions in health services research is the availability and accessibility of comprehensive, high-quality data. It can be assumed that health services research in the coming years will be increasingly based on data linkage, i.e.

Understanding disparities in post-operative mortality for Indigenous patients.

There is an urgent need for high-quality evidence regarding post-operative mortality among Indigenous peoples. Our group recently published a national audit of 4,000,000 procedures conducted between 2005-2017, which identified considerable disparities in post-operative mortality between Indigenous Māori and non-Indigenous New Zealanders. Understanding the primary drivers of these disparities-for Māori, but likely also other Indigenous populations worldwide-requires us to consider the multiple levels at which these drivers might arise.

Lessons learned from developing a COVID-19 algorithm governance framework in Aotearoa New Zealand.

Aotearoa New Zealand's response to the COVID-19 pandemic has included the use of algorithms that could aid decision making. Te Pokapū Hātepe o Aotearoa, the New Zealand Algorithm Hub, was established to evaluate and host COVID-19 related models and algorithms, and provide a central and secure infrastructure to support the country's pandemic response. A critical aspect of the Hub was the formation of an appropriate governance group to ensure that algorithms being deployed underwent cross-disciplinary scrutiny prior to being made available for quick and safe implementation.

Regional variation in post-operative mortality in New Zealand.

Background: There is a growing body of evidence that access to best practice perioperative care varies within our population. In this study, we use national-level data to begin to address gaps in our understanding of regional variation in post-operative outcomes within New Zealand.

Methods: Using National Collections data, we examined all inpatient procedures in New Zealand public hospitals between 2005 and 2017 (859 171 acute, 2 276 986 elective/waiting list), and identified deaths within 30 days.

Disparities in post-operative mortality between Māori and non-Indigenous ethnic groups in New Zealand.

Aim: To describe disparities in post-operative mortality experienced by Indigenous Māori compared to non-Indigenous New Zealanders.

Methods: We completed a national study of all those undergoing a surgical procedure between 2005 and 2017 in New Zealand. We examined 30-day and 90-day post-operative mortality for all surgical specialties and by common procedures.

Assessment of Variation in Electronic Health Record Capabilities and Reported Clinical Quality Performance in Ambulatory Care Clinics, 2014-2017.

Importance: Electronic health records (EHRs) are widely promoted to improve the quality of health care, but information about the association of multifunctional EHRs with broad measures of quality in ambulatory settings is scarce.

Objective: To assess the association between EHRs with different degrees of capabilities and publicly reported ambulatory quality measures in at least 3 clinical domains of care.

Design, Setting, And Participants: This cross-sectional and longitudinal study was conducted using survey responses from 1141 ambulatory clinics in Minnesota, Washington, and Wisconsin affiliated with a health system that responded to the Healthcare Information and Management Systems Society Annual Survey and reported performance measures in 2014 to 2017.

Implementation of routine electronic health record-based child abuse screening in General Emergency Departments.

Background: Routine child abuse screening is an approach to early identification of abuse. Previous studies evaluated paper-based screens; the widespread use of electronic health records suggests that screening is more likely to succeed if integrated into the electronic record.

Objective: To implement an electronic health record-based child abuse screen in a diverse hospital system and to evaluate the screening rate, rate of positive screens, and number of reports to Child Protective Services and assess whether hospital and patient characteristics are associated with these rates.

Postoperative Death After Lower-Limb Amputation in a National Prevalent Cohort of Patients With Diabetes.

Objective: The objectives of this study were to ) describe postoperative mortality after lower-limb amputation in a national prevalent cohort of patients with diabetes, and ) investigate whether postoperative mortality differs by demographic subgroup, patient morbidity level, and health system factors related to the facility in which the amputation occurred.

Research Design And Methods: A national prevalent cohort of 302,339 individuals diagnosed with diabetes between 2005 and 2014 was followed until the end of 2014 for major and minor lower-limb amputation and subsequent postoperative mortality by using national health data collections. Kaplan-Meier survival analysis was used to determine postoperative survival, whereas Cox proportional hazards models were used to describe the relative hazard of postoperative mortality, adjusted for covariates.

The Electronic Health Record and Health IT to Decrease Racial/Ethnic Disparities in Care.

The Electronic Health Record (EHR) now has high penetration in both ambulatory and hospital care. How can this technology be utilized to reduce racial and ethnic disparities in health care quality? We suggest a three-step process. First, routinely obtain accurate, detailed, and complete race and ethnicity data.

Electronic health record "super-users" and "under-users" in ambulatory care practices.

Objectives: This study explored variation in the extent of use of electronic health record (EHR)-based health information technology (IT) functionalities across US ambulatory care practices. Use of health IT functionalities in ambulatory care is important for delivering high-quality care, including that provided in coordination with multiple practitioners.

Study Design: We used data from the 2014 Healthcare Information and Management Systems Society Analytics survey.

Childhood immunisations in Northland, New Zealand: declining care and the journey through the immunisation pathway.

Aim: In a region with high rates of immunisation refusal, we examine whether refusing an immunisation at 6 weeks (the first scheduled immunisation) predicts the pattern for subsequent scheduled immunisations, and the characteristics of those who declined these immunisations.

Method: We used data from the National Immunisation Register to identify 11,972 children born between 1 January 2009 and 31 December 2013 (inclusive), and who had their first immunisation (due at 6 weeks age) in Northland, New Zealand. At each immunisation event, individual vaccines are recorded as being delivered or declined.

Under the same roof: co-location of practitioners within primary care is associated with specialized chronic care management.

Background: International and national bodies promote interdisciplinary care in the management of people with chronic conditions. We examine one facilitative factor in this team-based approach - the co-location of non-physician disciplines within the primary care practice.

Methods: We used survey data from 330 General Practices in Ontario, Canada and New Zealand, as a part of a multinational study using The Quality and Costs of Primary Care in Europe (QUALICOPC) surveys.

Working and hypertension: gaps in employment not associated with increased risk in 13 European countries, a retrospective cohort study.

Background: There is growing evidence to suggest unemployment has a role in the development and incidence of cardiovascular disease. This study explores the contribution of breaks in employment to the development of hypertension, a key risk factor for coronary heart disease.

Methods: We use data from the Survey of Health, Ageing, and Retirement in Europe to estimate the association between gaps in employment of 6 months or more ('Not Working', NW) and the incidence of hypertension in 9,985 individuals aged 50 or over across 13 European countries.

Diabetes associated with early labor-force exit: a comparison of sixteen high-income countries.

The economic burden of diabetes and the effects of the disease on the labor force are of substantial importance to policy makers. We examined the impact of diabetes on leaving the labor force across sixteen countries, using data about 66,542 participants in the Survey of Health, Ageing and Retirement in Europe; the US Health and Retirement Survey; or the English Longitudinal Study of Ageing. After matching people with diabetes to those without the disease in terms of age, sex, and years of education, we used Cox proportional hazards analyses to estimate the effect of diabetes on time of leaving the labor force.

The mismeasurement of quality by readmission rate: how blunt is too blunt an instrument?: a quantitative bias analysis.

Background: The rate of readmission is widely used as a measure of hospital quality of care, often with funding implications for outlying facilities.

Objectives: This study explored the plausibility of readmission as a proxy for health care quality with quantitative bias analysis and the application of a structural Directed Acyclic Graph framework. It applies this paradigm to observed ethnic differences in the odds of readmission in a sample of New Zealand hospital patients.

Ethnic disparities in the quality of hospital care in New Zealand, as measured by 30-day rate of unplanned readmission/death.

Objective: To compare the quality of hospital care for New Zealand (NZ) Māori and NZ European adult patients, using the rate of unplanned readmission or death within 30 days of discharge as an indicator of quality.

Design: Retrospective cohort study.

Setting: NZ public hospitals.

Not in my hospital? Ethnic disparities in quality of hospital care in New Zealand: a narrative review of the evidence.

There are well-documented differences in health outcomes between Maori and New Zealand Europeans, some of which persist despite adjustment or control for socioeconomic status and demographic variables. Lalonde defined the health system as being a determinant of health: is it possible that the services that are designed to improve health and well-being may be contributing to the ethnic health disparities in New Zealand? This narrative review studied the evidence for disparities in the quality of public hospital care for Maori and non-Maori in New Zealand. Medline and Embase databases were employed to identify studies assessing quality of care within the New Zealand hospital setting, with the analysis of ethnic groups.

The validity of readmission rate as a marker of the quality of hospital care, and a recommendation for its definition.

Aim: To perform a review of relevant literature regarding the use of readmission rate as a marker of the quality of hospital care, summarise its validity, and recommend a definition for its use.

Methods: Literature search was performed on the Embase and Medline databases, with relevant articles extracted and reviewed.

Conclusions: Readmission rate as a marker of the quality of hospital care has been used both internationally and nationally, although its validity has only been partially substantiated.

The readmission rate as an indicator of the quality of elective surgical inpatient care for the elderly in New Zealand.

Aim: To conduct a hypothesis-raising and descriptive study of the rate of readmission/death for patients aged over 64 years as a measure of the quality of inpatient care, for elective surgical procedures between 2001 and 2004.

Methods: Data from the New Zealand Health Information Service was used to calculate an annual rate for patients aged 65 years or over between July 2000 and July 2004 who were readmitted or deceased within 30-days of discharge following an: elective transurethral prostatectomy, laparoscopic cholecystectomy, knee arthroplasty, hip arthroplasty, or inguinal hernia repair.

Results: It is probable that the risk of readmission/death within 30-days of discharge ('RoD') rose 13% (95% CI of increase: 0%, 27%) from 7.