Clinical Information System Impact on Hospitalized Patients With Chronic Disease

University of Calgary

Status: Not yet enrolling

Conditions: Coronary Artery Disease; Diabete Mellitus; Chronic Lung Diseases; Heart Failure; Kidney Disease

Treatments: Other: Clinical Information System (CIS) / Connect Care Implementation

Study type: Observational

Funder types: Other

Identifiers

NCT07609381

REB24-1942

Details and patient eligibility

About

This is a retrospective, observational study using routinely collected information collected by Alberta Health Services. The study will identify patients with chronic disease, defined by one or more of the following conditions; diabetes mellitus, heart failure, coronary artery disease, chronic kidney disease, or chronic lung disease. Adult residents of Alberta with a chronic disease of interest present upon hospital admission and who survive to hospital discharge will be included in the study cohort. The primary outcome will be the composite of hospital readmission or death within 30 days of discharge. Secondary outcomes will include components of the composite, length of stay, patient experiences related to their hospital to home transition of care, and processes of care. Multi-level interrupted time series analysis will be used to compare outcomes before versus after implementation of the Connect Care CIS.

Full description

The design of the protocol is a multiple-baseline interrupted time series (ITS) analysis to assess effects of the CIS on patient outcomes with five pre-specified NCDs (diabetes mellitus, coronary artery disease, heart failure, chronic kidney disease, and chronic lung disease) before versus after implementation at each cluster of sites, accounting for pre-existing trends in outcomes and correlation between different time points and sites. The primary outcome will be unplanned hospital readmission and death within 30 days of discharge. Secondary outcomes will include readmission and death as individual outcomes, length of hospital stay, processes of care, and measures of patient experience with care transitions.

The study uses retrospective administrative, clinical, and patient experience data collected between 2019 and 2024, covering periods before and after clinical information system implementation at each site. All observations will be recorded prior to study initiation and will be analyzed retrospectively within a multiple baseline interrupted time series framework.

Enrollment: 124,240 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adults aged 18 years or older at the time of hospital admission.
• Residents of Alberta eligible to receive acute-care services in AHS facilities.
• Hospitalized for any cause during the study period (5 years pre-implementation and 2 years post-implementation of the CIS).
• Meet the validated case definition for one or more of the five key NCDs (diabetes mellitus, chronic kidney disease, coronary artery disease, heart failure, or chronic lung disease) based on ICD codes, laboratory measures, or pharmacy records during standardized lookback periods (up to 5 years for diagnoses; up to 1 year for labs/pharmacy).
• Have a qualifying date for the NCD(s) that occurs prior to or during the index hospital admission.
• Eligible for inclusion in the primary and patient experience outcomes if they survive to hospital discharge.
• May enter multiple sub-cohorts if more than one NCD is present.

Exclusion criteria

• Individuals younger than 18 years at the time of hospital admission.
• Non-residents of Alberta or individuals not eligible for care within AHS facilities.
• Hospitalizations that end in death (excluded from analyses of the primary outcome and patient experience measures).
• Patients without evidence of any of the five key NCDs during the lookback period or at the index hospital admission.
• Admissions outside the study period or admissions for which necessary administrative, laboratory, or pharmacy data are unavailable.

Trial design

124,240 participants in 1 patient group

Adults with Key NCDs Receiving Acute Care in AHS

Description:

This single cohort includes adult patients in Alberta with one of five key noncommunicable diseases (diabetes mellitus, chronic kidney disease, coronary artery disease, heart failure, or chronic lung disease) who received care in Alberta Health Services (AHS) acute-care facilities during the study period. The cohort is followed over a 7-year window (5 years pre-implementation and 2 years post-implementation of the Clinical Information System), with outcomes measured in into quarterly intervals, both pre- and post-launch of the CIS at each site for this analysis. Sub-cohorts will be identified based on the presence of each NCD and hospitalization history, but all belong to one predefined observational study cohort for the interrupted time series analysis.

Treatment:

Other: Clinical Information System (CIS) / Connect Care Implementation