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Introduction: Autism is a lifelong neurodevelopmental condition that is estimated to impact 1 in 44 children. In Aotearoa New Zealand, the rate of autism among Pasifika children and young people (38.6 per 10,000 people) is substantively lower than other ethnic groups (67.5 for European and 47.2 for Māori); however, the complexities associated with Autism diagnosis in Pasifika is unknown. Aim: We compared rates of Autism and co-occurring diagnoses of conditions as a proxy for Autism case complexity between Pasifika and NMNP young people (aged 0-24 years) in Aotearoa New Zealand. Methods: This national, cross-sectional study was undertaken using data from a national database; the Integrated Data Infrastructure (IDI). Three separate indicators were created to reflect different types of complexity for someone with autism: Asperger’s syndrome (identifies those with lower complexity with fewer demands on support services); intellectual disability (higher needs/greater complexity); ORS funding (higher needs/greater complexity). Findings: In this present study, Pasifika in Aotearoa New Zealand had much lower autism identification rates in comparison to Non-Māori Non-Pasifika (NMNP) (53.3 per 10,000 vs 83 per 10,000). After adjusting for socioeconomic differences, Pasifika had significantly lower odds (Odds Ratio (OR) = 0.47) of having an Asperger’s syndrome diagnosis. However, Pasifika had significantly higher odds of having an intellectual disability (OR = 2.23) and being Ongoing Resources Scheme funded (OR = 2.18). Conclusions: Using this method within the IDI, Pasifika children in Aotearoa continue to have lower rates of Autism diagnosis; however, they are more likely to have a higher complexity of autism diagnosis.

The Aotearoa New Zealand Integrated Data Infrastructure (IDI) is a national database containing a wide range of data about people and households. There is limited information about public views regarding its use for research. A qualitative study was undertaken to examine the views of forty individuals attending a large hospital in Auckland, including those of Māori ethnicity and young people. Semi-structured interview data were analysed using Braun and Clarke's method of thematic analysis. Seven key themes emerged: 1) Limited knowledge about medical data held in national databases; 2) Conditional support for the use of the IDI, including for research; 3) Concerns regarding the misuse of IDI data; 4) The importance of privacy; 5) Different views regarding consent for use of data for research; 6) Desire for access to personal data and the results of research; and 7) Concerns regarding third party and commercial use. Young people and those of Māori ethnicity were more wary of data misuse than others. Although there is reasonable support for the secondary use of public administrative data in the IDI for research, there is more work to be done to ensure ethical and culturally appropriate use of this data via improved consent privacy management processes and researcher training.

To investigate whether tamariki Māori screened for attention-deficit/hyperactivity disorder (ADHD) concerns in the B4 School Check (B4SC) between 2011 to 2018 are as likely to receive ADHD medication as non-Māori children.Using population-level data from the Integrated Data Infrastructure, we investigated whether ADHD medication dispensing differed for tamariki Māori screened for ADHD concerns relative to non-Māori children. Analyses were also stratified by area-level deprivation and urban/rural profile of residence.In our cohort of 414,171 children, 2.8% of Māori and 1.6% of non-Māori were screened as showing ADHD concerns. Among those with ADHD concerns, tamariki Māori had a lower likelihood of ADHD medication dispensing following the B4SC (10.8%) relative to non-Māori children (14.9%), but this effect was only significant among those living in the most deprived quintile and outside of major urban areas.Our study indicates that inequities to accessing ADHD treatment may exist for tamariki Māori living in highly deprived neighbourhoods or outside of major urban areas. Further research is needed to understand what the specific barriers may be to accessing ADHD medication treatment for Māori in these areas.

Objective To identify and explore differences in spending and utilization of key health services at the end of life among hip fracture patients across seven developed countries. Data Sources Individual-level claims data from the inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC). Study Design We retrospectively analyzed utilization and spending from acute hospital care, emergency department, outpatient primary care and specialty physician visits, and outpatient drugs. Patterns of spending and utilization were compared in the last 30, 90, and 180 days across Australia, Canada, England, Germany, New Zealand, Spain, and the United States. We employed linear regression models to measure age- and sex-specific effects within and across countries. In addition, we analyzed hospital-centricity, that is, the days spent in hospital and site of death. Data Collection/Extraction Methods We identified patients who sustained a hip fracture in 2016 and died within 12 months from date of admission. Principal Findings Resource use, costs, and the proportion of deaths in hospital showed large variability being high in England and Spain, while low in New Zealand. Days in hospital significantly decreased with increasing age in Canada, Germany, Spain, and the United States. Hospital spending near date of death was significantly lower for women in Canada, Germany, and the United States. The age gradient and the sex effect were less pronounced in utilization and spending of emergency care, outpatient care, and drugs. Conclusions Across seven countries, we find important variations in end-of-life care for patients who sustained a hip fracture, with some differences explained by sex and age. Our work sheds important insights that may help ongoing health policy discussions on equity, efficiency, and reimbursement in health care systems.

A wide inequality in incidence and severity of childhood oral health conditions between Pasifika and non-Pasifika in Aotearoa/New Zealand (Aotearoa/NZ) persists with some evidence that the gap is widening. To develop an evidence base for strengths-based solutions, this study seeks to investigate the association between parental education and detected oral health conditions in Pasifika children.A secondary cross-sectional analysis of linked routinely collected national databases of children (Pasifika and Non-Māori non-Pasifika [NMNP]) aged 0-9 years in 2013 who completed a Before School Check (B4SC) and had their birth parents file a 2013 New Zealand census return. Parental education is represented by their self-reported highest qualification level gained. Logistic regression models were employed to investigate childhood caries and hospitalisations related to oral health conditions after adjusting for social and economic factors.During the five-year period of 2013-2017, 21 744 (10.2%) children (Pasifika and NMNP) completed the B4SC and experienced caries. Pasifika children experienced caries three times more than NMNP children (23.6% and 7.9%, respectively) and 1.8 times more dental hospitalisations (6.0% and 3.4%, respectively). Each additional level of parental education reduced their Pasifika child's odds of experiencing caries (unadjusted odds ratio [OR] = 0.83, 95% CI: 0.82-0.85) and dental hospitalization (unadjusted OR = 0.89, 95% CI: 0.87-0.91). Less than half of the reduced odds for parental education could be attributed to other covariate factors, by 43% and 25%; respectively, for caries and hospitalisations.Our findings show good educational achievement is associated with better oral health for offspring beyond other benefits that can be attributed to non-education influences. Increased education for Pasifika parents is likely to directly confer better oral health for their children. The findings from this study may provide meaningful evidence for future developments in Pasifika education policy as an investment into the health of subsequent generations of Pasifika children.

Aim: The aims of this paper are to quantify the impact of parental education on the five-year incidence of mental health conditions (MHC) in Pacific young people and to investigate the influence of other factors. Method: The analyses in this paper used data extracted from Aotearoa/New Zealand’s Integrated Data Infrastructure (IDI). Data relating to 383,595 young people (48,768 Pacific), identified in the 2013 Census, aged 12-24 years, and their parents’ were used. Logistic regression models were used to investigate the incidence of children with MHC from 2013-2018. Results: Mental health conditions were identified in one of five Pacific young people. Irrespective of ethincity, increased parental education was associated with decreased MHC. However, the association was only significant for those in specialist mental health care (OR=0. 897, 95%CI:0.881-0.913) but not for those seen in other health settings (OR=0. 989, 95%CI:0.974-1.004). The association, for specialist settings, was not mediated by the contribution of other factors (OR=0.941, 95%CI:0.926-0.958). However, increased parents education with the addition of social, cultural and economic advantages the number of Pacific children seen in the specialist mental health setting could be nearly halved. Conclusion: The findings show that a parental educational advantage exists for children who access specialist mental health care. However, there are more complex but far greater opportunities for the health of Pacific families if a coordinated education, housing, employment and health solution were possible. The gains from a multi-disciplinary Pacific solution exist in terms of reduced severity for and level of care to Pacific children with MHC.

AIM This study aimed to investigate the variability by ethnicity, socio-economic status and location in coverage and testability of the universal B4 School Check vision screening in children aged 4-5 years in New Zealand. METHODS Aggregated data from 1 July 2011 to 30 June 2015 were sourced from the Statistics New Zealand Integrated Data Infrastructure. Sourced data were attendance at vision screening and record of visual acuity measurement stratified by ethnicity, socio-economic status and region. Children who attended screening were compared with the eligible population (n = 252 279) to calculate coverage. Testability was determined by comparing the children with a recorded visual acuity measurement in each eye with those who attended screening. RESULTS Overall vision screening coverage was 89.5% and testability was 97.8%. Ethnic differences were evident for coverage (85.7% in Pacific children, 92.5% in European children) and testability (96.4% in Māori children, 98.4% in European children). Socio-economic differences were also observed for coverage (86.4% in most deprived areas, 92.4% in least deprived), testability (most deprived 96.3%, least deprived 98.7%) and by region (coverage range of 80.4-96.4% and testability range of 93.2-99.3%). CONCLUSIONS Significant disparities exist in vision screening coverage and testability for New Zealand pre-school children. Equity-focused initiatives are required to improve outcomes for children from Māori and Pacific families, and those from households in lower socio-economic areas. Understanding region-specific challenges and successes could support more equitable access to vision screening between regions. Further research is required to determine sources of inequities and to investigate interactions between ethnicity, socio-economic status and location.

One of the most pressing challenges facing most health care systems is rising costs. As the population ages and the demand for health care services grows, there is a growing need to understand the drivers of these costs across systems. This paper attempts to address this gap by examining utilization and spending of the course of a year for two specific high-need high-cost patient types: a frail older person with a hip fracture and an older person with congestive heart failure and diabetes. Data on utilization and expenditure is collected across five health care settings (hospital, post-acute rehabilitation, primary care, outpatient specialty and drugs), in six countries (Canada (Ontario), France, Germany, Spain (Aragon), Sweden and the United States (fee for service Medicare) and used to construct treatment episode Purchasing Power Parities (PPPs) that compare prices using baskets of goods from the different care settings. The treatment episode PPPs suggest other countries have more similar volumes of care to the US as compared to other standardization approaches, suggesting that US prices account for more of the differential in US health care expenditures. The US also differs with regards to the share of expenditures across care settings, with post-acute rehab and outpatient speciality expenditures accounting for a larger share of the total relative to comparators.

Objective: Models of psychometric screening to identify individuals with neurodevelopmental disabilities (NDDs) have had limited success. In Aotearoa/New Zealand, routine developmental surveillance of preschool children is undertaken using the Before School Check (B4SC), which includes psychometric and physical health screening instruments. This study aimed to determine whether combining multiple screening measures could improve the prediction of NDDs. Methods: Linked administrative health data were used to identify NDDs, including attention deficit hyperactivity disorder, autism spectrum disorder and intellectual disability, within a multi-year national cohort of children who undertook the B4SC. Cox proportional hazards models, with different combinations of potential predictors, were used to predict onset of a NDD. Harrell’s c-statistic for composite models were compared with a model representing recommended cutoff psychometric scores for referral in New Zealand. Results: Data were examined for 287,754 children, and NDDs were identified in 10,953 (3.8%). The best-performing composite model combining the Strengths and Difficulties Questionnaire, the Parental Evaluation of Developmental Status, vision screening and biological sex had ‘excellent’ predictive power (C-statistic: 0.83) compared with existing referral pathways which had ‘poor’ predictive power (C-statistic: 0.68). In addition, the composite model was able to improve the sensitivity of NDD diagnosis detection by 13% without any reduction in specificity. Conclusions: Combination of B4SC screening measures using composite modelling could lead to significantly improved identification of preschool children with NDDs when compared with surveillance that rely on individual psychometric test results alone. This may optimise access to academic, personal and family support for children with NDDs.

New Zealand has few estimates of the prevalence of autism spectrum disorder and no national registry. The use of administrative data sources is expanding and could be useful in autism spectrum disorder research. However, the extent to which autism spectrum disorder can be captured in these data sources is unknown. In this study, we utilised three linked administrative health data sources from the Integrated Data Infrastructure to identify cases of autism spectrum disorder among New Zealand children and young people. We then investigated the extent to which a range of mental health, neurodevelopmental and related problems co-occur with autism spectrum disorder. In total, 9555 unique individuals aged 0–24 with autism spectrum disorder were identified. The identification rate for 8-year-olds was 1 in 102. Co-occurring mental health or related problems were noted in 68% of the autism spectrum disorder group. The most common co-occurring conditions were intellectual disability, disruptive behaviours and emotional problems. Although data from the Integrated Data Infrastructure may currently undercount cases of autism spectrum disorder, they could be useful for monitoring service and treatment-related trends, types of co-occurring conditions and for examining social outcomes. With further refinement, the Integrated Data Infrastructure could prove valuable for informing the national incidence and prevalence of autism spectrum disorder and the long-term effectiveness of clinical guidelines and interventions for this group. Lay abstract New Zealand has few estimates of the prevalence autism spectrum disorder and no national registry or data set to identify and track cases. This hinders the ability to make informed, evidence-based decisions relating to autism spectrum disorder. In this study, we utilised linked health and non-health data to develop a method for identifying cases of autism spectrum disorder among children and young people in New Zealand. In addition, we examined rates of co-occurring mental health, neurodevelopmental and related conditions among this cohort and compared these to the general population. The method identified almost 10,000 children and young people with autism spectrum disorder in New Zealand. Co-occurring mental health or related problems were found in over 68% of this group (nearly seven times higher than the general population), and around half were identified with multiple co-occurring conditions. The most frequently identified conditions were intellectual disability, disruptive behaviours and emotional problems. We have developed a useful method for monitoring service and treatment-related trends, number and types of co-occurring conditions and examining social outcomes among individuals with autism spectrum disorder. While the method may underestimate the prevalence of autism spectrum disorder in New Zealand, it provides a significant step towards establishing a more comprehensive evidence base to inform autism spectrum disorder–related policy.

While sensationalist headlines and highly publicised criminal cases have led many to believe there is a link between autism and criminal behaviour, extant literature presents an unresolved debate. We sought to address this issue by examining the prevalence of criminal justice system interactions among young adults with and without autism, and by assessing whether offence types differ between these groups. This was a national birth cohort study using linked health and criminal justice system data. Cox proportional hazard models were employed to compare criminal justice system interactions between young adults with and without autism, controlling for important socio-demographic characteristics. Data were acquired for 1197 people with autism and 147,879 without autism. Young adults with autism had significantly lower rates of being proceeded against by police, charged in court, and convicted in court compared to those without autism. However, those charged with an offence were significantly more likely to be charged with serious and violent offences, offences against the person and against property. Our findings indicate that, although young people with autism were not over-represented in the criminal justice system, disparities in offence types and incarceration rates among those charged with an offence suggest the importance of identification and appropriate response to autism within the criminal justice system. Lay abstract Sensationalist headlines and highly publicised criminal cases lead many in the public to believe that people with autism are more likely to engage in criminal behaviour. However, recent studies present an unresolved debate, and indicate this may not necessarily be the case. The aims of this study were to examine the prevalence of criminal justice system interactions among young adults with and without autism, and determine whether offence types differ between these groups. We tracked a national birth cohort until their 25th birthday, detecting criminal justice system interactions from age 17 onwards. Linked health and criminal justice system data were used to identify those with autism and detect interactions with the criminal justice system. We found that young people with autism interacted with the criminal justice system at lower rates compared to those without autism. However, there were considerable differences in the types of offences these young people were charged with. For example, among those charged with an offence, people with autism were more likely to be charged with a serious offence, punishable by 2 or more years in prison. We conclude that although young people with autism are not over-represented in the criminal justice system, disparities in offence types and incarceration rates among those charged with an offence suggest the importance of identification and appropriate response to autism within the criminal justice system.

ObjectiveTo compare within-country variation of health care utilization and spending of patients with chronic heart failure (CHF) and diabetes across countries.Data sourcesPatient-level linked data sources compiled by the International Collaborative on Costs, Outcomes, and Needs in Care across nine countries: Australia, Canada, England, France, Germany, New Zealand, Spain, Switzerland, and the United States.Data collection methodsPatients were identified in routine hospital data with a primary diagnosis of CHF and a secondary diagnosis of diabetes in 2015/2016.Study designWe calculated the care consumption of patients after a hospital admission over a year across the care pathway-ranging from primary care to home health nursing care. To compare the distribution of care consumption in each country, we use Gini coefficients, Lorenz curves, and female-male ratios for eight utilization and spending measures.Principal findingsIn all countries, rehabilitation and home nursing care were highly concentrated in the top decile of patients, while the number of drug prescriptions were more uniformly distributed. On average, the Gini coefficient for drug consumption is about 0.30 (95% confidence interval (CI): 0.27-0.36), while it is, 0.50 (0.45-0.56) for primary care visits, and more than 0.75 (0.81-0.92) for rehabilitation use and nurse visits at home (0.78; 0.62-0.9). Variations in spending were more pronounced than in utilization. Compared to men, women spend more days at initial hospital admission (+5%, 1.01-1.06), have a higher number of prescriptions (+7%, 1.05-1.09), and substantially more rehabilitation and home care (+20% to 35%, 0.79-1.6, 0.99-1.64), but have fewer visits to specialists (-10%; 0.84-0.97).ConclusionsDistribution of health care consumption in different settings varies within countries, but there are also some common treatment patterns across all countries. Clinicians and policy makers need to look into these differences in care utilization by sex and care setting to determine whether they are justified or indicate suboptimal care.

To identify a national population of individuals living with schizophrenia in New Zealand, and to examine health, social support, justice, economic outcomes and estimated government costs compared to a matched comparison group.Data were sourced from the Integrated Data Infrastructure. Individuals with a schizophrenia diagnosis in public hospital discharge or specialist secondary mental health service data, aged 18 to 64 and living in New Zealand were included in the schizophrenia population. Propensity score matching was used to select a comparison group of individuals without schizophrenia from the New Zealand resident population and compare outcomes and costs.In 2015 there were 18,096 people living with schizophrenia in New Zealand, a prevalence of 6.7 per 1,000 people. Compared to the matched comparison population, individuals with schizophrenia had higher hospitalisation rates for mental (OR=52.80) and physical (OR=1.18) health conditions. They were more likely to receive social welfare benefits (OR=17.64), less likely to be employed (OR=0.11) and had lower income ($26,226 lower). Per-person government costs were higher for the schizophrenia group across all domains, particularly health ($14,847 higher) and social support ($11,823 higher).Schizophrenia is associated with a range of adverse health, social and economic outcomes and considerably higher government costs compared to the general population.

Contains fulltext : 245434.pdf (Publisher’s version ) (Open Access) OBJECTIVE: This study explores differences in spending and utilization of health care services for an older person with frailty before and after a hip fracture. DATA SOURCES: We used individual-level patient data from five care settings. STUDY DESIGN: We compared utilization and spending of an older person aged older than 65 years for 365 days before and after a hip fracture across 11 countries and five domains of care as follows: acute hospital care, primary care, outpatient specialty care, post-acute rehabilitative care, and outpatient drugs. Utilization and spending were age and sex standardized.. DATA COLLECTION/EXTRACTION METHODS: The data were compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries as follows: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States. PRINCIPAL FINDINGS: The sample ranged from 1859 patients in Spain to 42,849 in France. Mean age ranged from 81.2 in Switzerland to 84.7 in Australia. The majority of patients across countries were female. Relative to other countries, the United States had the lowest inpatient length of stay (11.3), but the highest number of days were spent in post-acute care rehab (100.7) and, on average, had more visits to specialist providers (6.8 per year) than primary care providers (4.0 per year). Across almost all sectors, the United States spent more per person than other countries per unit ($13,622 per hospitalization, $233 per primary care visit, $386 per MD specialist visit). Patients also had high expenditures in the year prior to the hip fracture, mostly concentrated in the inpatient setting. CONCLUSION: Across 11 high-income countries, there is substantial variation in health care spending and utilization for an older person with frailty, both before and after a hip fracture. The United States is the most expensive country due to high prices and above average utilization of post-acute rehab care.

IMPORTANCE: Autistic students often experience poor educational outcomes that have implications for later life, including unemployment, interactions with the criminal justice system, increased risk for substance abuse, and low socioeconomic status. Improving educational outcomes is critical for ensuring that autistic young people can reach their potential. OBJECTIVE: To quantify differences in suspension rates between autistic and nonautistic students and to assess whether high-need education-based funding for autistic students is associated with reduced rates of school suspension. DESIGN, SETTING, AND PARTICIPANTS: This national cohort study used linked health and education data from New Zealand’s Integrated Data Infrastructure. Data were obtained for students aged 5 to 16 years from January 1 to December 31, 2018, and analyzed July 7, 2021, to January 1, 2022. A novel case identification method was used to identify autistic students. EXPOSURES: High-need education-based funding (Ongoing Resourcing Scheme [ORS]) obtained before 2019. MAIN OUTCOMES AND MEASURES: Rates of suspension from school. Crude and adjusted analyses of the association between suspension rates and autism among the full population with adjustment made for sociodemographic characteristics (sex, age, ethnicity, deprivation, and urban or rural profile of residence) were conducted using complete-case, 2-level random intercept logistic multivariable regressions. To assess the association between ORS funding and suspension, analysis was restricted to autistic students. RESULTS: Of the 736 911 students in the study population, 9741 (1.3%) were identified as autistic (median [SD] age, 10 [3.2] years; 7710 [79.1%] boys), and 727 170 (98.7%) as nonautistic (median [SD] age, 10 [3.4] years; 369 777 [50.9%] boys). School suspension was experienced by 504 autistic students (5.2%) and 13 845 nonautistic students (1.9%). After adjustment for demographic characteristics, autistic students had significantly higher odds of suspension than their nonautistic peers (adjusted odds ratio, 2.81; 95% CI, 2.55-3.11). Of the 9741 autistic students, 2895 (29.7%) received high-need education-based (ORS) funding. Suspensions were experienced by 57 autistic students (2.0%) with high-need funding and 447 autistic students (6.5%) without high-need funding. After adjustment for demographic characteristics, co-occurring conditions, and level of disability support need, autistic students with high-need funding had significantly lower odds of suspension than autistic students without high-need funding (adjusted odds ratio, 0.29; 95% CI, 0.21-0.40). CONCLUSIONS AND RELEVANCE: In this cohort study, the findings of disparities in suspension rates between autistic and nonautistic students underscore the challenges faced in providing inclusive education for all young people, regardless of disability status. This study found that high-need funding was associated with reduced suspension rates among autistic students, suggesting that if appropriate supports are afforded to autistic students, a more inclusive education can be provided.

Contains fulltext : 245458.pdf (Publisher’s version ) (Open Access) OBJECTIVE: The objective of this study was to explore cross-country differences in spending and utilization across different domains of care for a multimorbid persona with heart failure and diabetes. DATA SOURCES: We used individual-level administrative claims or registry data from inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States (US). DATA COLLECTION/EXTRACTION METHODS: Data collected by ICCONIC partners. STUDY DESIGN: We retrospectively analyzed age-sex standardized utilization and spending of an older person (65-90 years) hospitalized with a heart failure exacerbation and a secondary diagnosis of diabetes across five domains of care: hospital care, primary care, outpatient specialty care, post-acute rehabilitative care, and outpatient drugs. PRINCIPAL FINDINGS: Sample sizes ranged from n = 1270 in Spain to n = 21,803 in the United States. Mean age (standard deviation [SD]) ranged from 76.2 (5.6) in the Netherlands to 80.3 (6.8) in Sweden. We observed substantial variation in spending and utilization across care settings. On average, England spent $10,956 per person in hospital care while the United States spent $30,877. The United States had a shorter length of stay over the year (18.9 days) compared to France (32.9) and Germany (33.4). The United States spent more days in facility-based rehabilitative care than other countries. Australia spent $421 per person in primary care, while Spain (Aragon) spent $1557. The United States and Canada had proportionately more visits to specialist providers than primary care providers. Across almost all sectors, the United States spent more than other countries, suggesting higher prices per unit. CONCLUSION: Across 11 countries, there is substantial variation in health care spending and utilization for a complex multimorbid persona with heart failure and diabetes. Drivers of spending vary across countries, with the United States being the most expensive country due to high prices and higher use of facility-based rehabilitative care.

Objective: To establish a methodological approach to compare two high-need, high-cost (HNHC) patient personas internationally. Data sources: Linked individual-level administrative data from the inpatient and outpatient sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States. Study design: We outline a methodological approach to identify HNHC patient types for international comparisons that reflect complex, priority populations defined by the National Academy of Medicine. We define two patient profiles using accessible patient-level datasets linked across different domains of care—hospital care, primary care, outpatient specialty care, post-acute rehabilitative care, long-term care, home-health care, and outpatient drugs. The personas include a frail older adult with a hip fracture with subsequent hip replacement and an older person with complex multimorbidity, including heart failure and diabetes. We demonstrate their comparability by examining the characteristics and clinical diagnoses captured across countries. Data collection/extraction methods: Data collected by ICCONIC partners. Principal findings: Across 11 countries, the identification of HNHC patient personas was feasible to examine variations in healthcare utilization, spending, and patient outcomes. The ability of countries to examine linked, individual-level data varied, with the Netherlands, Canada, and Germany able to comprehensively examine care across all seven domains, whereas other countries such as England, Switzerland, and New Zealand were more limited. All countries were able to identify a hip fracture persona and a heart failure persona. Patient characteristics were reassuringly similar across countries. Conclusion: Although there are cross-country differences in the availability and structure of data sources, countries had the ability to effectively identify comparable HNHC personas for international study. This work serves as the methodological paper for six accompanying papers examining differences in spending, utilization, and outcomes for these personas across countries. © 2021 The Authors. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust.

Contains fulltext : 245435.pdf (Publisher’s version ) (Open Access) OBJECTIVE: This study explores variations in outcomes of care for two types of patient personas-an older frail person recovering from a hip fracture and a multimorbid older patient with congestive heart failure (CHF) and diabetes. DATA SOURCES: We used individual-level patient data from 11 health systems. STUDY DESIGN: We compared inpatient mortality, mortality, and readmission rates at 30, 90, and 365 days. For the hip fracture persona, we also calculated time to surgery. Outcomes were standardized by age and sex. DATA COLLECTION/EXTRACTION METHODS: Data was compiled by the International Collaborative on Costs, Outcomes and Needs in Care across 11 countries for the years 2016-2017 (or nearest): Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States. PRINCIPAL FINDINGS: The hip sample across ranged from 1859 patients in Aragon, Spain, to 42,849 in France. Mean age ranged from 81.2 in Switzerland to 84.7 in Australia, and the majority of hip patients across countries were female. The congestive heart failure (CHF) sample ranged from 742 patients in England to 21,803 in the United States. Mean age ranged from 77.2 in the United States to 80.3 in Sweden, and the majority of CHF patients were males. Average in-hospital mortality across countries was 4.1%. for the hip persona and 6.3% for the CHF persona. At the year mark, the mean mortality across all countries was 25.3% for the hip persona and 32.7% for CHF persona. Across both patient types, England reported the highest mortality at 1 year followed by the United States. Readmission rates for all periods were higher for the CHF persona than the hip persona. At 30 days, the average readmission rate for the hip persona was 13.8% and 27.6% for the CHF persona. CONCLUSION: Across 11 countries, there are meaningful differences in health system outcomes for two types of patients.

Objective/background Sleep problems in children on the autism spectrum are prevalent and persistent. Such problems are the result of a combination of biopsychosocial factors, including abnormal melatonin secretion. Exogenous melatonin is an empirically supported and popular treatment for sleep problems. However, we know little about rates of melatonin dispensing and associated variables. This study investigated rates of melatonin dispensing and the sociodemographic and child characteristics associated with its use in New Zealand. Methods This nationwide cross-sectional study used linked administrative health data obtained via the Integrated Data Infrastructure (IDI). Data were obtained for 11,202, 0–18 year old children on the autism spectrum. Descriptive data, and adjusted and unadjusted risk ratios, were calculated for sociodemographic and child characteristics. Results Melatonin is accessed by almost one quarter of children on the autism spectrum in New Zealand, with higher observed rates among females and those aged between 5 and 11 years, of European ethnicity, and presenting with co-occurring mental health conditions. Conclusions Findings are largely consistent with research investigating both sleep disturbances and psychotropic drug use among children on the autism spectrum. High rates of melatonin use, age- and sex-related differences in its use, and the complexity associated with the presence of co-occurring conditions necessitates development of practice guidelines for melatonin dispensing. Further investigation into the duration of melatonin use and the interaction between child characteristics, co-occurring conditions, sociodemographic variables and melatonin dispensing is warranted.

Background In a novel endeavour we aimed to develop a clinically relevant case identification method for use in research about the mental health of children and young people in New Zealand using the Integrated Data Infrastructure (IDI). The IDI is a linked individual-level database containing New Zealand government and survey microdata. Methods We drew on diagnostic and pharmaceutical information contained within five secondary care service use and medication dispensing datasets to identify probable cases of mental health and related problems. A systematic classification and refinement of codes, including restrictions by age, was undertaken to assign cases into 13 different mental health problem categories. This process was carried out by a panel of eight specialists covering a diverse range of mental health disciplines (a clinical psychologist, four child and adolescent psychiatrists and three academic researchers in child and adolescent mental health). The case identification method was applied to the New Zealand youth estimated resident population for the 2014/15 fiscal year. Results Over 82,000 unique individuals aged 0–24 with at least one specified mental health or related problem were identified using the case identification method for the 2014/15 fiscal year. The most prevalent mental health problem subgroups were emotional problems (31,266 individuals), substance problems (16,314), and disruptive behaviours (13,758). Overall, the pharmaceutical collection was the largest source of case identification data (59,862). Conclusion This study demonstrates the value of utilising IDI data for mental health research. Although the method is yet to be fully validated, it moves beyond incidence rates based on single data sources, and provides directions for future use, including further linkage of data to the IDI.

To examine trends in antidepressant dispensing to childred and young people in New Zealand aged 1-24 years between 2007/08 and 2015/16 using the national Integrated Data Infrastructure (IDI), and to determine whether these trends vary by age, sex, ethnicity and socioeconomic deprivation.In a novel endeavour, data on antidepressant dispensing, age, sex, ethnicity and socioeconomic status were sourced from the IDI, a linked individual-level database containing New Zealand government and survey microdata.The total rate of dispensing of antidepressants to young people increased by 44% from 1,870 per 100,000 in 2007/08 to 2,694 per 100,000 in 2015/16. Increases were larger for the 13-17 age group than the 1-12- or 18-24-year age groups. New Zealand European/Other ethnicities had the highest dispensing rates (3,623 out of every 100,000 people received an antidepressant in 2015/16), followed by Māori (1,980/100,000), Asian (902/100,000) and Pasifika (819/100,000) had the lowest. Dispensing rates increased with increasing deprivation, except in the most deprived quintile, where rates were lower than all other quintiles.This study demonstrates the value of utilising IDI data for health research, while providing directions for future use, including further linkage of IDI datasets. Overall there was a trend towards an increase in the use of antidepressants across all age, sex and ethnic groups, but notable variation in dispensing between different ethnic and socioeconomic groups. Despite our inability to determine the clinical rationale for increased dispensing of antidepressants, the available data highlight some potentially significant improvements as well as disparities in healthcare.

The rate of overdose related to the use of licit and illicit opioids has drastically increased over the last decade in the United States. The epicenter has been West Virginia with the highest rates of overdoses accounting for 41.5 deaths per 100 000 people among the 33 091 deaths in 2015. The purpose of this research was to examine and analyze the cause of the opioid epidemic and subsequent responses to it in the state of West Virginia. This study conducted a literature review using 37 references that were published between the years 2009 and 2018, complemented with a semistructured interview. The number of people injecting drugs has increased from 36% in 2005 to 54% in 2015. The total US cost of prescription opioid abuse in 2011 has been estimated at $25 billion, and criminal justice system costs to $5.1 billion. The reasons for this opioid epidemic incidence in West Virginia have been a combination of sociocultural factors, a depressed economy, lack of education, and a high rate of prescribing and dispensing of prescription opioids.

Background International data and guidance on prescribing for children and young people with autism spectrum disorder (ASD) are limited. National administrative datasets such as the New Zealand Integrated Data Infrastructure (IDI) may offer a cost-effective and sustainable way to monitor prescribing trends in the context of clinical and systemic change. Method Medication dispensing for New Zealand children and young people with ASD was explored using the IDI. Psychotropic and non-psychotropic medication dispensing rates, and rates of polypharmacy within a one-year period were examined. Comparisons of medication use were made to children and young people with another neurodevelopmental condition, attention deficit hyperactivity disorder (ADHD), and the general population. Results The vast majority (83 %) of children and young people with ASD were prescribed medication within a one-year period and they received a mean of four unique medications. High dispensing of antihistamine, asthma, gastrointestinal, and psychotropic medications was observed. Just over half (57 %) of those with ASD experienced polypharmacy of three or more medications, and 11 % of 10 or more. Medication dispensing rates were significantly higher among the ASD group compared to those with ADHD and the general population. Polypharmacy rates were higher among both the ASD and ADHD group compared to the general population. Conclusions It is clear that New Zealand children and young people with ASD experience a significant and disproportionate medication burden. Although further investigation is needed to fully understand underlying reasons and clinical implications, the IDI appears to be a valuable means of monitoring prescribing trends over time.