The Spatio-Temporal Information System on

Groupe de recherche
Authors: Alain Vanasse MD PhD, Josiane Courteau PhD, Mathieu Plante BSc, Gabriela Orzanco PhD, Mireille Courteau MSc, Dominick Boucher BSc, Shabnam Asghari MD PhD
PRIMUS
Collaborators: Théophile Niyonsenga PhD, Charmaine Dean PhD, Pierre Gosselin MD MPH, Pierre Dagenais MD PhD, Jean-Pierre Grégoire PhD,
Jacques Charron MSc, Robert Pampalon PhD, Yvan Bédard PhD
http://pages.usherb.ca/primus
The
Spatio-Temporal Information System
Chronic Diseases
on
Project overview
Context
Access to a spatio-temporal information that enables the study and surveillance of
chronic diseases is helpful for health care decision makers. This project is based on a
user’s needs assessment. The objective of this project is to provide an on-line spatiotemporal information system, bringing information on chronic diseases treatments
and outcomes using data from multiples sources.
NEEDS ASSESSMENT
& SIST-IM PERTINENCE TEST
(proof of concept)
STEPS 1 & 2
USER'S NEEDS
WORK DOCUMENT
Rx
Scientific collaboration
SPATIAL & NON-SPATIAL STATISTICAL ANALYSIS
Logistic regressions; Regression tree analysis ; Survival analysis;
Multi-level analysis; Cluster analysis; Spatial Autocorrelation;
Concentration curves
Users interested in new
knowledge generated by
the SIST and make sure,
among other things, that
the project is developed
according to their needs.
Diffusion,
communication
Semi-structured interviews
with open ended questions,
centered on morbidity,
mortality, managed care,
therapeutic management,
and health care.
STEPS 3 & 4
SIST-IM demonstation as
proof of concept.
USERS
SIST-MC
LOGICAL MODEL
collaborators
SIST-MC results
output
The SIST-MC project (Spatio-Temporal Information System for Chronic Diseases)
involved users, suppliers and researchers. It was developed in seven steps and its
systemic approach will enable the users to understand the basic concepts of the
information system and will accelerate technology transfer. An interdisciplinary
research team with research expertises in population health, epidemiology, spatial
statistics, health geography, geomatics and computer engineering is essential for
the project realization.
SIST-MC CONCEPTUAL
& LOGICAL MODELS
Predetermined
analysis input
Tests
PROVIDING
ON-LINE
USES OF
LIMITED
SIST-MC
SIST-MC
The project will significantly enhance research capacity building for Canadian
scientists involved in chronic diseases and primary care, health population and
health geomatics. It will provide a powerful tool for administrators, decisionmakers and researchers.
Health population researchers and
decision-makers in epidemiological,
clinical and administrative categories.
Application and adaptation of
JMap/SOLAP technology
STEP 7
JMap/SOLAP
technology testing
SIST-MC PROTOTYPE
Technological collaboration
Reduced aggregated
MI sample data
IS
RSS
R
AD
RU
SD
-99
96
19
PTCA
CABG
Drug Use
0-04
00
2
CVD Mortality
19
AT
SO
I
LD
N
P
IVA
N
IO
ADMINISTRATIVE
EPIDEMIOLOGICAL
E
AT
RESSOURCE UTILISATION
DB
I
O
ON
E
MORBIDITY
OS
Consult. Specialists
MI Incidence
I
Perspectives
M
I
M
R
IT
. ..
AL
MORTALITY
T
rs
te
E
IS
A
R
C
RD Y
IC
IT
RA Y
TIO
CIA GR N
M L
D I
R PR
A
IV
A
E T
N
U
IG
Fil
S
R
T
M
D
NO
T
CLINICAL
Concepts of "filters" developed by graduate
students in the context of present
and past GEOIDE projects
STEP 6
MI
CVD Readmission
MI
CO
GEOGRAPHICAL FILTERS
External
databanks
All-cause Mortality
Health outcomes
STEP 5
TRANSFERABILITY
TESTS OF THE SIST
Technological
collaboration
Time
92
-95
RL
S
CLSC
Space
DATA ACQUISITION
& STRUCTURATION
Choice of technology for
system maintenance and
data upgrading.
Model
Clinical &
epidemiological
collaboration
MANAGED CARE
THERAPEUTIC MANAGEMENT
Health outcomes
SPATIAL, GEOGRAPHICAL & POPULATIONAL DATA
Geographical units (DA, CSD, SAC, Catchment areas);
Populational level (demography, socio-economics, lifestyles,
perceptions); Health care system policies historic (health
centers, budgets, medical ressources)
Quebec Health care system historic
investigation: from research program financed
by FRSQ "Ruralité et maladies chroniques
adultes: un programme de recherche en
géomatique de la santé"
Health care system
historic document
Spatial
databases
Populational
databases
Health Insurance Number (HIN)
Quebecers unique identifier number
Specific clinical indicator
validation
(cardiovascular,
osteoporosis & diabetes
collaborators expertises)
HEALTH OUTCOMES
PATIENT LEVEL DATA
MI
OS
Régie de l’assurance
maladie du Québec
Data diffusion
autorization from the
CAI and institution's
Ethical Review Board
Data acquisition from MSSS, RAMQ,
CSST and SAAQ
Space
Health
services
Medical
care
files
Drugs
files
Charged acts
Diagnosis
(ICD-9)
Treating MD
Drugs claimed
by Quebecers
covered by the
Public
Prescription
Drug
DATA
ACQUISITION
DATA ORGANIZATION
& STRUCTURATION
$250 000 000 000
800
Admissions
en médecine*
$150 000 000 000
$100 000 000 000
600
Budgets
en santé
400
* Données non disponibles après 1999 dans les documents consultés
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Med-ÉCHO*
Hospitalizations
Death
register
Départs
assistés à la
retraite
Départs non-ciblés à la
retraite de médecins et
d’infirmières : perte d’expertise
et pénurie
Principal and
secondary
diagnosis
(ICD-9)
Treatments
Date and cause
of death
ICD-9 and
ICD-10
(since 2000)
Medical
care
files
Drugs
files
Charged acts
Diagnosis
(ICD-9)
Treating MD
Drugs claimed
by Quebecers
covered by the
Public
Prescription
Drug
1991
Stratégie de réorientation
du système de santé: Élaboration
de la Politique de la santé et du
bien-être avec 19 objectifs. Favorise la
prévention et les services
communautaires (C.L.S.C.)
Ministère de la santé et des
services sociaux (MSSS)
CSST
SAAQ
Date of
work accident
(if any)
Date of
road accident
(if any)
Medical
care
files
Drugs
files
Charged acts
Diagnosis
(ICD-9)
Treating MD
Drugs claimed
by Quebecers
covered by the
Public
Prescription
Drug
Med-ÉCHO*
Hospitalizations
Death
register
Principal and
secondary
diagnosis
(ICD-9)
Treatments
Date and cause
of death
ICD-9 and
ICD-10
(since 2000)
Physicians files
Gender
Specialty
Diploma year
1993
Diabetes (DB)
Database
Demography
Socio-economical
MI
OS
DB
CASE SELECTION OF MI
Principal diagnosis (code ICD-9: 410)
noted in the Med-ECHO register (MSSS)
CASE SELECTION OF FRAGILITY FRACTURES
Principal diagnosis of fracture in the Med-ÉCHO registeror
diagnosis of fracture in the ‘registre des services médicaux
(RAMQ)’(ICD-9: 805, 812, 814, 820, 821)Exclusion: work or
road injured one week before the inscription date
CASE SELECTION OF DIABETES
Principal or secondary diagnosis of diabetes
(ICD-9: 250)noted in the Med-ECHO register or
2 diagnosis of diabetes within 2 years In the
‘registre des services médicaux (Émond et al)’
Dépenses en
santé de 20
milliards$
Relative
stabilité
financière
d'établissements, fermeture
d'hôpitaux, coupures dans
Souci
d’avoir un suivi adéquat
des patients souffrant de
maladies chroniques
Poursuite
de la régionalisation débutée en 1992
avec la création des réseaux locaux de services de
Création des
santé et de services sociaux (ADRLSSSS) et des centres de
réseaux
santé et de services sociaux (CSSS)
universitaires
intégrés de services
(RUIS)
l’allongement des listes d’attente, la diminution du
Loi 120 :
nombre de lits et du temps de séjour, le manque de soutien pour
Régionalisation des services de
santé en créant 18 régions sociosanitaires certains patients à domicile et la fusion de certains départements
administrées par 16 régies régionales de la /établissements. Emphase sur la prévention (mcv), services à
domicile
santé et des services sociaux et deux conseils
régionaux de la santé et des services
sociaux
1992
Demography
Socio-economical
Lifestyle
Perception
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Health services
Data
Populational
Datadase
PATIENT LEVEL DATABASES
CONTEXTUAL LEVEL DATABASES
SAS 9.1
HEALTH OUTCOMES – Patient level data
Postal code
conversion files
(PCCF)
Myocardial Infarction
(MI)
Other conversion files
Osteoporosis
(OS)
Diabetes (DB)
Mortality
(Index, 1, 12 months)
All cause mortality
CVD mortality
All cause mortality
Mortality from
fracture
All cause mortality
Mortality CVD, PVD,
retinopathy
Morbidity
(1, 12 months)
CVD Readmission
Consultation fragility
fracture
Consultation for
retinopathy
Hospitalisation
Osteodensitometry
Eye examination
Material resources Utilisation
(Index, 12 months)
Geodatabases, administrative,
patient data & population data
integration specific home
program
Map-Info
PTCA
CABG
Extra hospital human resources
utilisation (3, 12 months)
Cardiologist, internist
consultation
Extra hospital human resources
utilisation (3, 12 months)
ASA, BB, ACE, Statins
Rheumatologist,
endocrinologist,
endocrinologist,
internist consultation
internist consultation
Bisphosphonate
Insulin
Hormone therapy
oral hypoglycemic
agents
Raloxifen
Spatial
Datadase
HEALTH OUTCOMES – AGGREGATED LEVEL
1991, 1996, 2001 Census
Microsoft SQL Server/OLAP
Geographical units
(DA, CSD, SAC,
Catchments' areas)
Cartographic Boundary Files
SIST-MC INTERFACE
AGGREGATED DATA
99
Time
Drug Use
99
699
04
000
Retinopathy
Eye examination
Consult. Specialists
CVD Hospitalisation
2-
95
95
Time
DB Prevalence
CVD, PVD, Mortality
Drug Use
99
604
99
000
New FF
OS Diagnosis
Consult. Specialists
Osteodensitometry
All-cause Mortality
99
2-
95
2-
FF Mortality
All-cause Mortality
99
Time
Drug Use
99
699
04
FF Incidence
0-
PTCA
CABG
RU
IS
RS
S
RL
S
CLS
C
SD
R
AD
S
IS
RS
RU
IS
RU
RS
S
RL
S
CLS
C
SD
R
AD
00
2
Consult. Specialists
MI Incidence
CVD Mortality
1
CVD Readmission
1
OS
2
Health outcomes
1
2
All-cause Mortality
Space
1
1
Health outcomes
1
DATA ORGANIZATION
& STRUCTURATION
Space
RL
S
CL
SC
SD
R
AD
Space
Geographical units
(RUIS, RSS, RLS, CLSC)
Cartographic Boundary Files
MI
Health outcomes
DB
SPATIAL & NON-SPATIAL
STATISTICAL ANALYSIS
Logistic regressions
Regression tree analysis
Survival analysis
Multi-level analysis
Cluster analysis
Spatial Autocorrelation
Concentration curves
Médecine de famille
Faculté de médecine
Date and cause
of death
ICD-9 and
ICD-10
(since 2000)
Osteoporosis
(OS)
Database
Ministère de la santé
et des services sociaux (MSSS)
Fonds de la recherche
en santé
Principal and
secondary
diagnosis
(ICD-9)
Treatments
Gender
Date of birth
Date of death
Population
SPATIAL DATABASES
Centre hospitalier universitaire
de Sherbrooke
Death
register
Gender
Specialty
Diploma year
Myocardial
Infarction (MI)
Database
COHORTS
Partners
Med-ÉCHO*
Hospitalizations
Physicians files
Gender
Specialty
Diploma year
Geographical units
(CSD)
Geographical units
(DA, CSD, SAC,
Catchments' areas)
Population
Mise
sur pied du comité
d’experts en card. tertiaire
(devient le RQCT en oct.2000)
Consolidation et
réinvestissement : rattrapage
Compressions
difficile
Sommes réinvesties
en cardiologie tertiaire
pour diminuer l’attente
Programme
Priorité
national
à l’hémodynamie, aux
Début
d’organisation de
pontages et aux valvuloplasties en
de la valorisation de la
services pour mcv et
Mise sur
cardiologie tertiaire
première ligne : mise sur pied des GMF
cancer
pied du Régime
Souci d’une
et d’équipes de travail multidisciplinaires
Virage
d’assurance-médicaments
gestion serrée des listes
(Commission Clair). Jusqu’à présent, le
ambulatoire, entraîne entre autres
Mise sur
d’attente (parfois mal
MSSS n’a pas réussi à rencontrer ses
pied de l’INSPQ et
interprétée par les
objectifs
d’Héma-Québec
médias)
Développement
d'une stratégie
Contrat de service avec
québécoise pour la
Souci d’évaluer la
hôp. américains pour listes
diabète (dont la
performance et la
d’attente
surveillance)
qualité du réseau
budgétaires: fusions
An on-line information system on chronic diseases will allow users, and particularly
decision makers, to answer important questions and produce results displayed as
tables, graphs or maps almost instantly.
Régie de l’assurance
maladie du Québec
Patients files
Gender
Date of birth
Date of death
Physicians files
Canadian Community Health
Survey / Enquêtes sociales
et de santé
2004
Chronologic ponctual events
Équipe
Début de la diminution
de soutien à l’accès aux
du nombre d’admissions
serv. chirurgicaux (dont
en médecine
chirurgie cardiaque)
Mise sur pied du programme "Défi
Dépenses en
santé de 13 milliards$ : la majeure partie va
aux hôpitaux, on valorise les spécialités plutôt que la
1ere ligne, donc réseau morcelé, pas de continuité
de soins
Spécifique aux
maladies chroniques
Ressources
humaines
Ressources
matérielles et $
Caractéristiques
organisationnelles
Développement des
services en cardiologie
tertiaire
1990
1991, 1996, 2001 Census
1000
Nombre d'établissements
(publics et privés)
$200 000 000 000
The information system SIST-MC produce aggregated data on chronic diseases,
more specificaly myocardial infarction, diabetes and osteoporosis. These data are
available for health regions, CLSC and local health network territories, but also
according to geographical attributes such as rurality and traveling time. The system
is built with the JMap/Solap software of Kheops technologies. A prototype was
made and tested with myocardial infarction.
Health Insurance Number (HIN)
Quebecers unique identifier number
Ministère de la santé et des
services sociaux (MSSS)
Quebec's health Care system chronologic evolution
Health centers, health system budgets, medical ressources
The information system use information from a retrospective cohort study with
secondary data analysis. The medical administrative databases is managed by the
Ministère de la santé et des services sociaux du Québec (MSSS) and the Régie de
l’assurance maladie du Québec (RAMQ). Spatial data are provided by Statistics
Canada and the MSSS.
Régie de l’assurance
maladie du Québec
Patients files
Gender
Date of birth
Date of death
DB
Medicoadministrative
Databases
Health Insurance Number (HIN)
Quebecers unique identifier number
Ministère de la santé et des
services sociaux (MSSS)
Patients files
Time
Databanks transfert collaboration
JMap/SOLAP 3.1