BackgroundTo evaluate screening and treatment strategies, large-scale real-world data on liver disease-related outcomes are needed. We sought to validate health administrative data for identification of cirrhosis, decompensated cirrhosis and hepatocellular carcinoma among patients with known liver disease.MethodsPrimary patient data were abstracted from patients of the Toronto Center for Liver Disease with viral hepatitis (2006–2014), and all patients with liver disease from the Kingston Health Sciences Centre Hepatology Clinic (2013). We linked clinical information to health administrative data and tested a range of coding algorithms against the clinical reference standard.ResultsA total of 6,714 patients had primary chart data abstracted. A single physician visit code for cirrhosis was sensitive (98–99%), and a single hospital diagnostic code for cirrhosis was specific (91–96%). The most sensitive algorithm for decompensated cirrhosis was one cirrhosis code with any of: a hospital diagnostic code, death code, or procedure code for decompensation (range 88–99% across groups). The most specific was one cirrhosis code and one hospital diagnostic code (range 89–98% across groups). Two physician visit codes or a single hospital diagnostic code, death code, or procedure code combined with a code for cirrhosis were sensitive and specific for hepatocellular carcinoma (sensitivity 94–96%, specificity 93–98%).ConclusionThese sensitive and specific algorithms can be used to define patient cohorts or detect clinical outcomes using health administrative data. Our results will facilitate research into the adequacy of screening and treatment for patients with chronic viral hepatitis or other liver diseases.

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I njuries have been described as the "neglected disease" of modern times. 1 Major trauma is the leading cause of death in the first 3 decades of life and the most common cause of major disability thereafter. 2 Poor mental health outcomes, such as the development of depression, posttraumatic stress disorder, chronic pain and suicidality, have become increasingly recognized factors in patients in poor recovery from major injury. 1-3 There is surprisingly little literature on the association between major injury and subsequent mental health outcomes. Although nearly 87% of patients with major trauma survive to discharge, 4 most trauma registries do not track patients after discharge, limiting our ability to understand the trajectory of patients' recovery beyond the acute phase of injury. Emerging evidence shows that survivors of trauma are at heightened risks of developing major mental health disorders. 1,2,5-9 Some patients progress to attempt or die by suicide. 2,7 For instance, 1 study followed patients admitted to US level 1 trauma centres and found symptoms of depression in 20% and posttraumatic stress disorder in 6% of patients. 10 Similarly, data from Australia show that 31% of survivors of trauma have a diagnosed psychiatric disorder by 12 months postinjury, including depression (9%) and posttraumatic stress disorder (6%). 1 Canadian data also suggest that more moderate, isolated injuries, such as concussions, may be associated with suicide. 11 More knowledge about the association between injury and mental health outcomes is needed to optimize the care of survivors of trauma. Our study builds on previous work by using large, linked, population-level health databases; a robust self-matched, before-and-after cohort design to control for confounding; and prolonged pre-and postinjury study periods. Our primary objective was to determine whether major injury is a risk factor for developing a new mental health diagnosis or death by suicide. Our secondary objective was to identify risk factors for death by suicide among this patient population.

ealth care systems with strong primary care have better health outcomes, lower costs and fewer inequities. 1 First-contact access is one of the pillars of primary care, 2 yet, in Canada, timely access to primary care continues to be a challenge. For example, only 43% of patients in Canada report being able to get an appointment the same day or the next day when sick, compared to 77% in the Netherlands, the top-ranked country for this type of access in the Commonwealth Fund's 2016 survey. 3 Canada also has the highest rates of emergency department use, with many patients reporting they went to the emergency department for a condition that could have been managed in primary care. 3 Policy-makers have hoped to address some of these issues by supporting practices to transition to medical homes. 4,5 Medical homes typically incorporate blended payment for physicians, a focus on quality and safety, and mechanisms for enhanced access. 6,7 In Ontario, reforms have included options for physicians to transition from fee-for-service to blended capitation and to apply for funding for nonphysician health