Three datasets are better than one! Alcohol related diagnoses from ambulance to

hospital admission, Melbourne, AustraliaSharon Matthews

Jason FerrisBelinda Lloyd

Background

• Routine monitoring plays a significant role in the development of responsive policy, prevention and intervention

• Need to explore innovative methods to understand and respond to alcohol and drug related harms

Aims

• To use linked data to explore the diagnostic path from an alcohol related ambulance attendance to emergency and hospital admission in Melbourne , Australia between 2004/05 – 2008/09

Methods

Data• Alcohol related ambulance attendances• Victorian emergency department admissions (VEMD)• Victorian hospital admissions (VAED)• 2004/05 – 2008/09

Linked data : Ambulance ED Hospital admission

Ambulance Attendances

- Ambo Project database 1998 -present- Additional coding of Ambulance

Victoria Patient Care Records (electronic from 2006) to identify alcohol and other

drug related attendances- 17885 alcohol only cases 2004/05

to 2008/09

Emergency Department Presentations

- Victorian Emergency Minimum dataset (VEMD)

- Detailed demographic, clinical and administrative information on all presentations to Victorian public hospitals with 24/7 ED

Hospital Admissions

- Victorian Admitted Episodes Dataset (VAED)

- Acute hospital separations (public, private, denominational hospitals)

- Principal diagnosis using ICD10 classification

- 2004/05 – 2008/09

Staged linkage – using:

Ambulance case number Ambulance case date

(time/date stamp)Validated using:Patient age Patient gender Hospital Time between

attendance and ED (<2 hours)

Outcome –63,156 linked records = 90.3% patients transported to ED (any AOD involvement)

Treatment pathway – Alcohol intoxication attendances

2004/05 2005/06 2006/07 2007/08 2008/09

Ambulance 3,758 4,218 5,439 5,663 6,783

↓ ↓ ↓ ↓ ↓

Transported 2,112 (56.2)

2,510 (59.5)

3,433 (63.1)

3,760 (66.4)

4,479 (66.0)

↓ ↓ ↓ ↓ ↓

Admitted to ED 1,869 (49.7)

2,210 (52.4)

3,023 (55.6)

3,300 (58.3)

4,161 (61.3)

↓ ↓ ↓ ↓ ↓

Admitted to Hospital

349 (9.3)

367 (8.7)

624 (11.5)

725 (12.8)

898 (13.2)

Age of alcohol intoxicated patients transported to ED (%)

2004/5 2005/6 2006/7 2007/8 2008/90-19 15 12 14 12 1420-29 19 18 20 20 2130-39 20 18 21 21 1940-49 23 24 19 18 1850-59 15 18 14 15 1560-69 5 6 8 8 870+ 3 3 4 5 5

Alcohol intoxication attendances coded in ED presentations (%)

2004/05%

2005/06%

2006/07%

2007/08%

2008/09%

Mental & behavioural disorders due to the use of alcohol

40 36 39 35 37

Poisoning/toxic effects of substances 11 8 9 9 8

Injuries to the head 3 3 9 12 13

Total ICD 10 codes used as primary 189 212 244 254 300

Missing any ICD diagnosis 226 257 305 380 460

Alcohol intoxication attendances coded in hospital admissions (%)

2004/05%

2005/06%

2006/07%

2007/08%

2008/09%

Mental & behavioural disorders due to the use of alcohol 41.8 30.8 33.8 28.8 35.1

Poisoning/toxic effects of substances 16.9 8.7 13 12.3 8.5

Injuries to the head 3.7 2.7 11.7 14.1 15.4

Total ICD 10 codes used as primary 99 134 175 217 231

Limitations

• Data are not collected for research purposes• Coding practices can change over time• Some missing cases

Summary

• Increase in older patients – particularly 60 years and over

• Less than half of acutely alcohol intoxicated patients have AOD principal diagnosis in ED or hospital

• Single dataset usage provides an incomplete picture resulting in underestimation of the role of alcohol in cases

• Increase in external causes for acutely intoxicated patients – particularly head injuries

Utility of linkage

• Use of multiple data sources necessary to examine and respond to AOD harms

• Enhanced models to estimate AOD burden• Provide an evidence base regarding the nature of

AOD presentations in settings where data are not routinely available

• Monitor outcomes following intervention• Contribute to policy and intervention across acute,

treatment and other settings

Acknowledgements

• Funded by Victorian Department of Health• VEMD and VAED data provided by the Victorian

Department of Health• Ambulance data derived from the Ambo Project – a

collaborative project between Turning Point and Ambulance Victoria, and funded by the Victorian Department of Health

• Thanks to project team

Sharon MatthewsResearch Fellow Population Health ResearchPhD Candidate Monash University

T: +61 3 9412 9957sharonm@turningpoint.org.au