HELPING DECISION-MAKERS VISUALIZE INEQUITIES IN HEALTH IMPACT ASSESSMENT- LINKED ELECTRONIC RECORDS, MORTALITY AND REGIONAL DISPARITIES IN PORTUGAL
Author(s)
Bacelar-Nicolau L1, Rodrigues T2, Fernandes E2, Lobo MF3, Nisa C3, Azzone V4, Teixeira-Pinto A5, Rocha-Gonçalves FN6, Azevedo LF3, Freitas A3, Normand ST4, Costa-Pereira A3, Pereira Miguel J1
1Faculty of Medicine &ISAMB, University of Lisbon, Lisbon, Portugal, 2Faculty of Medicine, University of Lisbon, Lisbon, Portugal, 3Faculty of Medicine, University of Porto, Porto, Portugal, 4Harvard Medical School, Boston, MA, USA, 5The University of Sydney, Sydney, Australia, 6IPO Porto, Porto, Portugal
OBJECTIVES: Show how multivariate methods outputs visualization may help decision-makers identify inequities through health impact assessment (HIA). Show how a policy promoting quality of linked Electronic Health Records (EHR) regarding Acute Myocardial Infarction (AMI) patients may be associated to mortality and regional inequities. METHODS: Data: Adults (>=20 years) admitted in Portuguese NHS Hospitals with AMI diagnosis during the 2nd semester 2012, followed regularly in NHS Primary Care (PC) during 2013. Variables: Mortality outcome at December 31 2013, 4 PC registered indicators- Blood Pressure, Cholesterol, Triglycerides, Waist Circumference, Body Mass Index (BMI); 5 regions Norte, Centro, LVT, Alentejo, Algarve; adjustment variables sex, age, AMI hospital readmissions during the 2nd semester 2012, surgery during hospital admission, mean admission duration>6 days, hospital diagnosis>=6. Statistical Procedures: X and Fisher exact tests; logistic regressions, simple and stratified by region, estimating crude and adjusted ORs (and 95%CI); multivariate correspondence analysis (MCA). RESULTS: Regions Algarve and LVT present the highest no-registration percentages for every indicator. Norte, usually followed by Algarve and then Centro, has the lowest percentage of no-registration. Patients without registered information for all health indicators are more than twice as likely to be deceased, than patients with information registered (OR>2.0). Norte presents higher OR for Cholesterol and Triglycerides (OR>13.0) and Blood pressure (OR>3) and Alentejo for BMI (OR near7). Centro presents high values especially regarding Cholesterol and Triglycerides (3.173 and 4.409). MCA summarizes previous findings with a very clear, visual graphical aid. CONCLUSIONS: HIA assesses health impacts (here, mortality) of policies (EHR policy to promote PC uniform information registration), identifying groups where effects are worse (regional equity concerns). Disparities between regions are found regarding registering information, but also concerning association patterns of mortality and registration of these health indicators. Complex multivariate methodologies may generate visual outputs easily interpreted by decision-makers. This work was partially funded by FCT, QREN, COMPETE (HMSP-ICT/0013/2011).
Conference/Value in Health Info
2016-10, ISPOR Europe 2016, Vienna, Austria
Value in Health, Vol. 19, No. 7 (November 2016)
Code
PHS109
Topic
Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity
Disease
Cardiovascular Disorders, Geriatrics, Reproductive and Sexual Health