Browsing by Author "Yu, Amy Y. X."
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Item Open Access Passive Surveillance of Transient Ischemic Attacks in the Emergency Department: Validity of Administrative Data and Determinants of Inaccuracies in Data Coding(2016) Yu, Amy Y. X.; Hill, Michael D.; Coutts, Shelagh B.; Quan, Hude; McRae, Andrew D.Stroke is a leading cause of morbidity and transient ischemic attacks (TIA) are an ideal target for stroke prevention strategies. Administrative data are an important source of information for TIA research, but they have not been validated in the emergency department (ED). We aimed to determine the validity of TIA codes in the Canadian ED administrative database and the predictors of accurate TIA coding. We studied patients presenting to the ED with acute neurological symptoms. The National Ambulatory Care Reporting System (NACRS) database diagnosis codes were compared to the ED chart re-abstraction and 90-day final clinical diagnoses to obtain the sensitivity, specificity, and predictive values. The sensitivity of TIA codes was low to moderate (37-64%), but the specificity was high (82-93%). Quality of physician documentation was an important predictor of data accuracy. Our findings inform TIA research and surveillance methods and we identify an opportunity for improving administrative data quality.Item Open Access Sex differences in direct healthcare costs following stroke: a population-based cohort study(2021-06-29) Yu, Amy Y. X.; Krahn, Murray; Austin, Peter C.; Rashid, Mohammed; Fang, Jiming; Porter, Joan; Vyas, Manav V.; Bronskill, Susan E.; Smith, Eric E.; Swartz, Richard H.; Kapral, Moira K.Abstract Background The economic burden of stroke on the healthcare system has been previously described, but sex differences in healthcare costs have not been well characterized. We described the direct person-level healthcare cost in men and women as well as the various health settings in which costs were incurred following stroke. Methods In this population-based cohort study of patients admitted to hospital with stroke between 2008 and 2017 in Ontario, Canada, we used linked administrative data to calculate direct person-level costs in Canadian dollars in the one-year following stroke. We used a generalized linear model with a gamma distribution and a log link function to compare costs in women and men with and without adjustment for baseline clinical differences. We also assessed for an interaction between age and sex using restricted cubic splines to model the association of age with costs. Results We identified 101,252 patients (49% were women, median age [Q1-Q3] was 76 years [65–84]). Unadjusted costs following stroke were higher in women compared to men (mean ± standard deviation cost was $54,012 ± 54,766 for women versus $52,829 ± 59,955 for men, and median cost was $36,703 [$16,496–$72,227] for women versus $32,903 [$15,485–$66,007] for men). However, after adjustment, women had 3% lower costs compared to men (relative cost ratio and 95% confidence interval 0.97 [0.96,0.98]). The lower cost in women compared to men was most prominent among people aged over 85 years (p for interaction = 0.03). Women incurred lower costs than men in outpatient care and rehabilitation, but higher costs in complex continuing care, long-term care, and home care. Conclusions Patterns of resource utilization and direct medical costs were different between men and women after stroke. Our findings inform public payers of the drivers of costs following stroke and suggest the need for sex-based cost-effectiveness evaluation of stroke interventions with consideration of costs in all care settings.