Amy Metcalfe

Administrative data are increasingly used to conduct research on depression and inform health services and health policy. Depression surveillance using administrative data is an alternative to surveys, which can be more resource-intensive. The objectives of this study were to: (1) systematically review the literature on validated case definitions to identify depression using International Classification of Disease and Related Health Problems (ICD) codes in administrative data and (2) identify individuals with and without depression in administrative data and develop an enhanced case definition to identify persons with depression in ICD-coded hospital data. (1) Systematic review: We identified validation studies using ICD codes to indicate depression in administrative data up to January 2013. (2) Validation: All depression case definitions from the literature and an additional three ICD-9-CM and three ICD-10 enhanced definitions were tested in an inpatient database. The diagnostic accuracy of all case definitions was calculated [sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV)]. (1) Systematic review: Of 2,014 abstracts identified, 36 underwent full-text review and three met eligibility criteria. These depression studies used ICD-9 and ICD-10 case definitions. (2) Validation: 4,008 randomly selected medical charts were reviewed to assess the performance of new and previously published depression-related ICD case definitions. All newly tested case definitions resulted in Sp >99%, PPV >89% and NPV >91%. Sensitivities were low (28-35%), but higher than for case definitions identified in the literature (1.1-29.6%). Validating ICD-coded data for depression is important due to variation in coding practices across jurisdictions. The most suitable case definitions for detecting depression in administrative data vary depending on the context. For surveillance purposes, the most inclusive ICD-9 & ICD-10 case definitions resulted in PPVs of 89.7% and 89.5%, respectively. In cases where diagnostic certainty is required, the least inclusive ICD-9 and −10 case definitions are recommended, resulting in PPVs of 92.0% and 91.1%. All proposed case definitions resulted in suboptimal levels of sensitivity (ranging from 28.9%-35.6%). The addition of outpatient data (such as pharmacy records) for depression surveillance is recommended and should result in improved measures of validity.

Prenatal screening is often misconstrued by patients as screening for trisomy 21 alone; however, other chromosomal anomalies are often detected. This study aimed to systematically review the literature and use diagnostic meta-analysis to derive pooled detection and false positive rates for aneuploidies other than trisomy 21 with different prenatal screening tests. Non-invasive prenatal testing had the highest detection (DR) and lowest false positive (FPR) rates for trisomy 13 (DR: 90.3%; FPR: 0.2%), trisomy 18 (DR: 98.1%; FPR: 0.2%), and 45,X (DR: 92.2%; FPR: 0.1%); however, most estimates came from high-risk samples. The first trimester combined test also had high DRs for all conditions studied (trisomy 13 DR: 83.1%; FPR: 4.4%; trisomy 18 DR: 91.9%; FPR: 3.5%; 45,X DR: 70.1%; FPR: 5.4%; triploidy DR: 100%; FPR: 6.3%). Second trimester triple screening had the lowest DRs and highest FPRs for all conditions (trisomy 13 DR: 43.9%; FPR: 8.1%; trisomy 18 DR: 70.5%; FPR: 3.3%; 45,X DR: 77.2%; FPR: 9.3%). Prenatal screening tests differ in their ability to accurately detect chromosomal anomalies. Patients should be counseled about the ability of prenatal screening to detect anomalies other than trisomy 21 prior to undergoing screening.

Objective: Nutritional information panels are required on all packaged food products in the USA, yet are perceived as difficult to use by consumers. Nutritional symbols have been developed by various groups to assist consumers in making healthier food purchases. Different nutritional criteria are used depending on the authorizing body of these symbols. The present study assesses the nutrient profile of baby and toddler foods in light of their accompanying nutritional symbols.Design: Kruskal–Wallis and χ² tests were used to assess differences in the nutritional content of products based on the presence and issuing body of nutritional symbols.Setting: Nine grocery, drug and department stores in Philadelphia, PA, USA.Subjects: Two hundred and forty packaged baby and toddler foods.Results: Products whose nutritional symbol was issued by government/health professionals contained significantly more Ca (P = 0·002), fibre (P = 0·001), protein (P = 0·005), vitamin A (P = 0·011), vitamin C (P < 0·001) and Zn (P < 0·001) and less sugar (P = 0·004) per serving than products without a nutritional symbol and products whose nutritional symbol was issued by the manufacturer.Conclusions: Products with a nutritional symbol issued by government/health professionals were healthier than foods with nutritional symbols issued by the manufacturer directly and foods with no nutritional symbols.

Background: Congenital anomaly (CA) surveillance provides epidemiologic data that are necessary for health planning. Approaches to CA surveillance vary; however, an increasing number of jurisdictions rely on administrative health databases for case ascertainment. This study aimed to assess the validity of CA coding in three administrative databases compared with a CA registry.Methods: A cohort of 5862 live and stillborn infants from Calgary Alberta Canada was created through linking 12 clinical and administrative databases. Diagnostic codes for all health care contacts (hospitalizations, emergency room visits, out‐patient physician visits) in the first 3 months of life were examined for relevant International Classification of Disease codes. Sensitivity, positive predictive values, and kappa coefficients were calculated, and data from the Alberta Congenital Anomalies Surveillance System was used as the reference standard.Results: The ability of administrative data to accurately ascertain CAs varied by data source and the specificity of the diagnosis. Consistently, hospitalization data out‐performed other administrative data sources in terms of sensitivity, positive predictive values, and kappa. Kappa scores for CAs easily visible at birth ranged from moderate (0.62 for emergency room visits and 0.65 for out‐patient physician claims) to good (0.83 for hospitalization data) depending on the data source.Conclusion: The validity of CA coding in administrative databases compared with a CA registry varies by database used and by CA studied. This has important implications for national surveillance efforts. Condition‐specific validity should be assessed locally before use of these data sources for research or planning purposes. Birth Defects Research (Part A) 100:59–66, 2014.

Objective Abnormal maternal serum analytes (pregnancy associated plasma protein A, total human chorionic gonadotropin, alpha fetoprotein, Inhibin A, and unconjugated estriol) measured as part of aneuploidy screening programs have been associated with adverse obstetrical outcomes in euploid pregnancies. This study aimed to determine if their predictive ability could be enhanced with additional information on obstetrical history. Method Forty-five thousand two hundred eighty-seven women participated in the screening program and delivered euploid singleton infants between 2010 and 2012 in British Columbia, Canada. A split-sample design was used to develop and validate prognostic models for serious perinatal events (stillbirth, preterm birth <32 weeks, or HELLP syndrome) and severe pre-eclampsia [pre-eclampsia with preterm birth <34 weeks or small for gestational age <10th percentile] using logistic regression. Results Three thousand five hundred four women (7.7%) had at least one abnormal marker using standard cut-off values. The combination of serum markers and clinical risk factors improved the ability of statistical models to predict a serious perinatal event [area under the curve (AUC) = 0.62] and severe pre-eclampsia (AUC = 0.78) compared with serum markers or clinical risk factors alone. Conclusions While detection rates are low, the combination of maternal serum markers and obstetrical history helps to identify a small subset of women at higher risk for serious perinatal events and severe pre-eclampsia. © 2013 John Wiley & Sons, Ltd.

Objective The aim of this research was to determine the impact of observed versus hypothesized service utilization on the cost of first trimester screening (FTS) and prenatal diagnosis for trisomy 21 in a Canadian province. Methods A population-based pregnancy cohort was created by linking 12 clinical and administrative databases. Care trajectories were derived to examine utilization patterns for FTS, prenatal diagnosis, and pregnancy termination. A literature review was conducted to determine what utilization parameters were used in economic evaluations of FTS. Local cost data was applied to observed and hypothesized care trajectories. Results The observed mean cost per fetus with trisomy 21 detected prenatally using FTS was $129 606.04 compared with $27 021.45 for women who did not access FTS. Observed utilization of FTS and prenatal diagnosis among screen positive women and termination of pregnancy following prenatal diagnosis of trisomy 21 were substantially lower than hypothesized in existing cost effectiveness studies. Cost estimates were sensitive to hypothetical changes in utilization of prenatal screening, prenatal diagnosis, and pregnancy termination. Conclusion Literature-based estimates of the cost-effectiveness of prenatal screening may not accurately represent current local practice due to potentially unrealistic assumptions about what proportion of women will proceed to invasive testing and ultimately terminate an affected pregnancy. © 2013 John Wiley & Sons, Ltd.

Background: Recent declines in the provision of prenatal care by family physicians and the integration of midwives into the Canadian health care system have led to a shift in the pattern of prenatal care provision; however it is unknown if this also impacts use of other health services during pregnancy. This study aimed to assess the impact of the type of prenatal care provider on the self-reported use of ancillary services during pregnancy. Methods: Data for this study was obtained from the All Our Babies study, a community-based prospective cohort study of women’s experiences during pregnancy and the post-partum period. Chi-square tests and logistic regression were used to assess the association between type of prenatal care provider and use of ancillary health services in pregnancy. Results: During pregnancy, 85.8% of women reported accessing ancillary health services. Compared to women who received prenatal care from a family physician, women who saw a midwife were less likely to call a nurse telephone advice line (OR = 0.30, 95% CI: 0.18-0.50) and visit the emergency department (OR = 0.47, 95% CI: 0.24-0.89), but were more likely receive chiropractic care (OR = 4.07, 95% CI: 2.49-6.67). Women who received their prenatal care from an obstetrician were more likely to visit a walk-in clinic (OR = 1.51, 95% CI: 1.11-2.05) than those who were cared for by a family physician. Conclusions: Prenatal care is a complex entity and referral pathways between care providers and services are not always clear. This can lead to the provision of fragmented care and create opportunities for errors and loss of information. All types of care providers have a role in addressing the full range of health needs that pregnant women experience.