Charles Tilquin

Practical considerations on the use of the charlson comorbidity index with administrative data bases

To develop a measure of the burden of comorbid disease from the MED-ECHO data base (Québec), the so-called Charlson index was adapted to International Classification of Disease (ICD-9) codes. The resulting comorbidity index was applied to the study of inpatient death in 33,940 patients with ischemic heart disease. Multiple logistic regression was used to relate inpatient death to its predictors, including gender, principal diagnosis, age, and the comorbidity index. Various transformations of the comorbidity score were performed, and their effect on the predictive accuracy was assessed. The comorbidity index was constantly and strongly associated with death. From a statistical viewpoint, the best results were obtained when the index was transformed into four dummy independent variables (the area under the receiver-operating curve is then 0.87). In a validation analysis performed on 1990-1991 MED-ECHO data (36,012 admissions with ischemic heart disease), the comorbidity index has the same statistical properties. We conclude that the Charlson index may be an efficient approach to risk adjustment from administrative data bases, although it should be tested on other conditions.

Sex bias in the management of coronary artery disease in Quebec.

This study tests the hypothesis that, given the absence of financial barriers to major coronary procedures in Quebec, women are as likely as men to undergo such procedures. The use of coronary procedures in 33,940 patients with ischemic heart disease, admitted during 1 year to 78 Quebec hospitals, was analyzed. The male-to-female age- and severity-adjusted odds ratios for the use of these procedures were 1.47 for diagnostic procedures, 1.38 for therapeutic procedures, and 1.26 for diagnostic and therapeutic procedures. These results suggest that differences in the use of coronary procedures by sex are influenced by factors other than financial accessibility.

Using the handicap code of the ICIDH for classifying patients by intensity of nursing care requirements.

An 11-class patient classification system (PCS) has been built on a recode of two dimensions of the handicap code of the ICIDH: physical independence and mobility handicaps. The proposed system, called MAC XI, explains 78% of the variance of nursing care hours required by nursing-home residents and extended-care hospital patients. This percentage of variation is higher than the one explained by traditional dependency grids such as the Exton-Smith, Murphy, Kuntzmann and SMAF. MAC XI, based on two dimensions of the handicap code, is thus a powerful tool for predicting intensity of nursing care for staffing and budgeting purposes in long-term care institutions.

Estrategias de Medida de Los Cuidados de Enfermería

Resumen Ante la situacion de recursos limitados, el equilibrio entre la oferta y la demanda de cuidados se hace cada vez mas necesario. Esta situacion hace necesaria la utilizacion de instrumentos de medida de las cargas de trabajo en enfermeria. En este articulo se analiza la problematica entre la valoracion de las cargas de trabajo y la estimacion del tiempo de cuidados en enfermeria. A partir de una revision bibliografica del tema, se discuten las posibilidades y tecnicas de estimation del tiempo de los cuidados dados a un paciente y el tiempo de los cuidados que requiere un paciente. Se presentan dos enfoques diferentes, y algunas conclusiones del analisis de los mismos: el metodo directo o de medicion del nivel de cuidados y el metodo indirecto o sistema de clasificacion de pacientes. Se aboga por el interes del metodo directo por su transparencia, validez externa y posible integracion en el plan de cuidados de enfermeria

Développement et validation d’un instrument d’évaluation des besoins des jeunes et de leur famille en santé mentale

Au Canada, dans la province de Quebec, le phenomene de l’inadaptation chez les jeunes est d’une grande importance. Ainsi, en 1978 on evaluait a plus de 15,000 le nombre de jeunes dits mesadaptes. Malgre l’importance du phenomene, il n’existe pas presentement d’instruments fiables et valides pour determiner les programmes requis par ces jeunes.