Michael J Schull

• MD, MSc, FRCPC
• CEO at Institute for Clinical Evaluative Sciences

Objective There is growing recognition of the importance of community data governance to build accountability of research institutions to communities. Our organization, a steward of health and administrative population-level data, has previously implemented community governance structures for Indigenous data. This scoping initiative explores develo...

Objective Stewards of population-level data have an obligation to serve the public interest. As one such publicly funded data steward, our Public Advisory Council (PAC) co-led and determined the focus of an analysis project using population-level administrative health data. We describe our engagement strategies herein. ApproachThe 20-member PAC was...

Objective and ApproachWe analyzed barriers and enablers to accessing pan-Canadian health sector data and data analytic services for three distinct user groups: 1) academic researchers, 2) health-system knowledge users (KUs), and 3) private sector researchers. Specifically, we a) conducted a legislative and policy scan regarding use of health admini...

There is growing recognition of the importance of patient, public and community engagement in health research, which has not been used widely in analyzing health administrative datasets. In Ontario, health data are stewarded by ICES, whose strategic decision making is guided by a diverse Public Advisory Council (PAC). In a first foray into publicly...

BACKGROUND Canadian data suggest that patients of lower socioeconomic status with acute myocardial infarction receive less beneficial therapy and have worse clinical outcomes, raising questions regarding care disparities even in universal health care systems. We assessed the contemporary association of marginalization with clinical outcomes and hea...

https://theconversation.com/want-to-know-if-your-data-are-managed-responsibly-here-are-15-questions-to-help-you-find-out-217422

Background We studied the association between neighborhood material deprivation, a metric estimating inability to attain basic material needs, with outcomes and processes of care among incident heart failure (HF) patients in a universal healthcare system. Methods In a population‐based retrospective study (2007‐2019), we examined the association of...

IntroductionAround the world, many organisations are working on ways to increase the use, sharing, and reuse of person-level data for research, evaluation, planning, and innovation while ensuring that data are secure and privacy is protected. As a contribution to broader efforts to improve data governance and management, in 2020 members of our team...

Background: Research on factors associated with recurrent emergency department (ED) visits and their implications for improving dementia care is lacking. The objective of this study was to examine associations between the individual characteristics of older adults living with dementia and recurrent ED visits. Methods: We used health administrati...

Background: Patients with acute heart failure are frequently or systematically hospitalized, often because the risk of adverse events is uncertain and the options for rapid follow-up are inadequate. Whether the use of a strategy to support clinicians in making decisions about discharging or admitting patients, coupled with rapid follow-up in an ou...

Objective To test and refine a list of 12 minimum specification essential requirements (min specs) for data trusts, data repositories, and other data collaborations that had been generated and published by a team of 19 Canadians in 2020. ApproachWe convened an international team of more than 50 people to discuss, test, and refine the 12 min specs....

ObjectivesCOVID-19 accentuated the importance of breaking down data siloes and aligning incentives for data access, collection, and use. Health Data Research Network Canada (HDRN Canada) is responding to this challenge, bringing together people and organizations to transform health data use in Canada. ApproachHDRN Canada’s foundation is its partner...

Objective In response to the COVID-19 pandemic, Sunnybrook Health Sciences Centre launched the first virtual emergency department (VED) in Toronto, Ontario. The objective of this pilot project was to leverage linked administrative data to describe the healthcare utilization of VED patients compared to matched patients who attended an ED in person....

Background Substance use is common among people who visit emergency departments (EDs) frequently. We aimed to characterize subgroups within this cohort to better understand care needs/gaps, and generalizability of characteristics in three Canadian provinces. Methods This was a retrospective cohort study (April 1 st , 2013 to March 31 st , 2016) of...

Background: Community-dwelling people with dementia have been affected by COVID-19 pandemic health risks and control measures that resulted in worsened access to health care and service cancellation. One critical access point in health systems is the emergency department. We aimed to determine the change in weekly rates of visits to the emergency...

Background: There are limited data on the association of material deprivation with clinical care and outcomes after atrial fibrillation (AF) diagnosis in jurisdictions with universal health care. Methods: This was a population-based cohort study of individuals ≥66 years of age with first diagnosis of AF between April 1, 2007, and March 31, 2019,...

Background The factors that underlie persistent frequent visits to the emergency department are poorly understood. This study aimed to characterize people who visit emergency departments frequently in Ontario and Alberta, by number of years of frequent use. Methods This was a retrospective cohort study aimed at capturing information about patients...

Background: The population that visits emergency departments frequently is heterogeneous and at high risk for mortality. This study aimed to characterize these patients in Ontario and Alberta, compare them with controls who do not visit emergency departments frequently, and identify subgroups. Methods: This was a retrospective cohort study that...

Background: Community-dwelling older adults living with dementia visit the emergency department (ED) more frequently than other older adults, but research on the reasons for repeated visits is lacking. We examined the rate of repeated ED visits and reasons for visits in a cohort of individuals with dementia. Methods: We conducted a population-ba...

Background SARS-Cov-2 infection rates are high among residents of long-term care (LTC) homes. We used machine learning to identify resident and community characteristics predictive of SARS-Cov-2 infection. Methods We linked 26 population-based health and administrative databases to identify the population of all LTC residents tested for SARS-Cov-2...

IntroductionHealth care systems have faced unprecedented challenges due to the COVID-19 pandemic. Access to timely population-based data has been vital to informing public health policy and practice. Methods We describe how ICES, an independent not-for-profit research and analytic institute in Ontario, Canada, pivoted existing research infrastructu...

Objective We sought to compare strengths of association among multiple emergency department (ED) input, throughput and output metrics and the outcome of 72-h ED re-visits.Methods This database analysis used healthcare administrative data from three urban, university-affiliated EDs in Calgary, Canada, calendar years 2010–2014. We used data from all...

ICES upholds a strong reputation for generating high-quality evidence to inform policy and practice through its collaborations with a broad range of health system stakeholders including government policymakers and healthcare providers including clinicians. Supported by the Ontario Ministry of Health and Ministry of Long-Term Care, the ICES Applied...

ICES upholds a strong reputation for generating high-quality evidence to inform policy and practice through its collaborations with a broad range of health system stakeholders including government policymakers and healthcare providers including clinicians. Supported by the Ontario Ministry of Health and Ministry of Long-Term Care, the ICES Applied...

Background There are limited data on the association of poverty with outcomes and care patterns after an atrial fibrillation (AF) diagnosis in jurisdictions with universal healthcare. The Canadian province of Ontario provides publicly funded healthcare and prohibits private payment for medically necessary physician and in-hospital care. It also cov...

Background: While individuals living in long-term care (LTC) homes have experienced adverse outcomes of SARS-CoV-2 infection, few studies that have examined a broad range of predictors of 30-day mortality in this population. Methods: We studied residents living in LTC homes in Ontario, Canada, who underwent PCR testing for SARS-CoV-2 infection f...

This cross-sectional study compares rates of emergency department visits and hospitalizations for assault and maltreatment by age category and sex in Ontario, Canada, before vs during the COVID-10 pandemic.

Objective To assess implementation and to identify barriers and facilitators to implementation, sustainability and scalability of an implementation strategy to provide lay health workers (LHWs) with the knowledge, skills and tools needed to implement an intervention to support patient tuberculosis (TB) treatment adherence. Design Mixed-methods des...

Purpose: This paper reports the quantitative component of a mixed-methods study of patient flow in the 10 urban health regions/zones of Western Canada. We assessed whether jurisdictions differed meaningfully in their emergency flow performance, defined as mean emergency department length of stay (ED LOS). Methods: We used hierarchical linear mod...

Background Heart failure (HF) is an ambulatory care sensitive condition and a leading reason for emergency department (ED) visits and hospitalizations. Improved decision-making and care may enhance safety and efficiency for patients presenting to the ED with acute HF. Objectives We will evaluate an intervention comprised of two complementary compo...

It is not known whether non-ABO antibodies confers any protective effect against SARS-CoV-2 infection or COVID-19 severe illness, alone, or in conjunction with O blood group. This cohort study included 413,576 persons in Ontario, Canada with known ABO blood group and non-ABO antibody screen status, and who subsequently underwent SARS-CoV-2 viral RN...

New variants of concern (VOCs) now account for 67% of all Ontario SARS-CoV-2 infections. Compared with early variants of SARS-CoV-2, VOCs are associated with a 63% increased risk of hospitalization, a 103% increased risk of intensive care unit (ICU) admission and a 56% increased risk of death due to COVID-19. VOCs are having a substantial impact...

Background: Frequent emergency department users disproportionately account for rising health care costs. We aimed to characterize frequent emergency department users in British Columbia, Canada. Methods: We performed a retrospective analysis using health administrative databases. We included patients aged 18 years or more with at least 1 emergen...

Objective: Frequent emergency department (ED) users are heterogeneous. We aimed to identify subgroups and assess their mortality. Methods: We identified patients ≥18 years with ≥1 ED visit in British Columbia from April 1, 2012 to March 31, 2015, and linked to hospitalization, physician billing, prescription, and mortality data. Frequent users were...

Background With the global shortage of skilled health workers estimated at 7.2 million, outpatient tuberculosis (TB) care is commonly task-shifted to lay health workers (LHWs) in many low- and middle-income countries where the shortages are greatest. While shown to improve access to care and some health outcomes including TB treatment outcomes, lac...

Introduction There is widespread enthusiasm to improve health through the application of artificial intelligence and machine learning (AI/ML) methods to large population-level health datasets. Achieving this may require successful collaboration between institutions as well as between computer scientists (CS), machine learning researchers (MLR) and...

Background: The ABO and rhesus (Rh) blood groups may influence risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Objective: To determine whether ABO and Rh blood groups are associated with risk for SARS-CoV-2 infection and severe coronavirus disease 2019 (COVID-19) illness. Design: Population-based cohort study....

BACKGROUND In Canada, 30 to 60% of patients presenting to emergency departments (ED) are ambulatory. This category has been labeled as a source of ED overuse. Acting on the presumption that primary care practices (PCP) and walk-in clinics (WIC) offer equivalent care at a lower cost, governments have invested massively in improving access to these a...

Background In Canada, 30%-60% of patients presenting to emergency departments are ambulatory. This category has been labeled as a source of emergency department overuse. Acting on the presumption that primary care practices and walk-in clinics offer equivalent care at a lower cost, governments have invested massively in improving access to these al...

Administrative health data is recognized for its value for conducting population-based research that has contributed to numerous improvements in health. In Canada, each province and territory is responsible for administering its own publicly funded health care program, which has resulted in multiple sets of administrative health data. Challenges to...

The Emergency Department Return Visit Quality Program was launched in Ontario, Canada, to promote a culture of quality. It mandates the province’s largest-volume emergency departments (EDs) to audit charts of patients who had a return visit leading to hospital admission, including some of their 72-hour all-cause return visits with admission and all...

This article explores the approach that ICES (formerly the Institute for Clinical Evaluative Sciences)uses to encourage public engagement at both the research study and corporate level. ICES is anindependent not-for-profit research institute in the province of Ontario, Canada. This article wasco-written by ICES’ public engagement team and four memb...

Introduction: Increasingly, the label "data trust" is being applied to repeatable mechanisms or approaches to sharing data in a timely, fair, safe, and equitable way. However, there is an absence of practical guidance regarding how to establish and operate a data trust. Aim and approach: In December 2019, the Canadian Institute for Health Inform...

Many countries around the world are creating COVID-19 trial datasets and databases of COVID-19-related data such as test results that cover entire populations. It is our strong recommendation, and sincere hope, that these data assets will be brought together through record linkage so that their scientific value and impact for society can be amplifi...

Background: In pandemics, local hospitals need to anticipate a surge in health care needs. We examined the modelled surge because of the coronavirus disease 2019 (COVID-19) pandemic that was used to inform the early hospital-level response against cases as they transpired. Methods: To estimate hospital-level surge in March and April 2020, we sim...

Background: Although hospital readmission for heart failure (HF) is an issue for both men and women, little is known about differences in readmission rates by sex. Consequently, strategies to optimize readmission reduction programs and care strategies for women and men remain unclear. Our study aims were: (1) to identify studies examining readmiss...

Introduction: Increasingly, the label data trust is being applied to repeatable mechanisms or approaches to sharing data in a timely, fair, safe and equitable way. However, there is a gap in terms of practical guidance about how to establish and operate a data trust. Aim and Approach: In December 2019, the Canadian Institute for Health Information...

Background: A hospital-level pandemic response involves anticipating local surge in healthcare needs. Methods: We developed a mechanistic transmission model to simulate a range of scenarios of COVID-19 spread in the Greater Toronto Area. We estimated healthcare needs against 2019 daily admissions using healthcare administrative data, and applied ou...

Authentic Emergency Department Leadership During a Pandemic - Eddy Lang, Howard Ovens, Michael J. Schull, Carolyn Snider

ICES was founded in 1992 to study the health care system and promote effective, efficient and equitable health care. Over 27 years later, the goal remains largely unchanged, though the institute has grown in size and impact. Created as an independent not-for-profit research institute and given what was, at the time, unprecedented access to administ...

Study objective Common outcomes of care valued by emergency department (ED) patients who are not hospitalized have been characterized, but no measurement instrument has been developed to date. We developed and validated a patient-reported outcome measure for use with adult ED patients who are discharged home (PROM-ED). Methods In previous research...

Background: High-sensitivity cardiac troponin (hs-cTn) assays enhance detection of lower circulating troponin concentrations, but the impact on outcomes in clinical practice is unclear. Our objective was to compare outcomes of chest pain patients discharged from emergency departments (EDs) using hs-cTn and conventional troponin (cTn) assays. Meth...

Background: Currently, 11% of patients seen in the emergency department for atrial fibrillation die within 1 year of the visit. Our objective was to examine the association of rapid (within 3 days), early (7 days), and basic (30 days) outpatient physician follow-up with short- and long-term outcomes in patients with atrial fibrillation discharged...

Background and rationale There is widespread enthusiasm to improve health through the application of artificial intelligence and machine learning (AI/ML) methods to large population-level health datasets. Achieving this may require successful collaboration between institutions as well as between computer scientists (CS), machine learning researcher...

https://theconversation.com/plain-language-about-health-data-is-essential-for-transparency-and-trust-123319

https://theconversation.com/the-public-needs-to-know-why-health-data-are-used-without-consent-123669

Background There has been increased attention on reducing hospital readmission rates. However, little is known about any difference in readmission rates in heart failure by sex, although evidence exists demonstrating differences in the etiology of heart failure. As a result, strategies to optimize readmission reduction programs and care strategies...

Objectives The objective of the CAEP Global Emergency Medicine (EM) panel was to identify successes, challenges, and barriers to engaging in global health in Canadian academic emergency departments, formulate recommendations for increasing engagement of faculty, and guide departments in developing a Global EM program. Methods A panel of academic G...

Population data science [1] researchers are not alone in recognizing the value of health and health-related data. In the era of big data, and with advent of machine learning and other artificial intelligence methods, organizations around the world are actively working to turn data into knowledge, and, in some cases, profit. The media and members of...

Introduction: Population health programs are increasingly reliant on Health Information Technology (HIT). Program HIT architecture description is a necessary step prior to evaluation. Several sociotechnical frameworks have been used previously with HIT programs. The Informatics Stack is a novel framework that provides a thorough description of HIT...

Background Across countries, a small group of patients accounts for the majority of health care spending. These patients are more likely than other patients to experience problems with quality and safety in their care, suggesting that efforts targeting efficiency and quality among this population might have significant payoffs for health systems. B...

Objective Delays in triage processes in the emergency department (ED) can compromise patient safety. The aim of this study was to provide proof-of-concept that a self-check-in kiosk could decrease the time needed to identify ambulatory patients arriving in the ED. We compared the use of a novel automated self-check-in kiosk to identify patients on...

Introduction : Emergency department (ED) return visits are used for quality monitoring. Health information technology (HIT) has historically supported return visit programs in the same hospital or hospital system. The Emergency Department Return Visit Quality Program (EDRVQP) is a novel population level continuous quality improvement (QI) program c...

Introduction : Emergency Department (ED) crowding is a pervasive problem and is associated with adverse patient outcomes. Yet, there are no widely accepted, universal ED crowding metrics. The objective of this study is to identify ED crowding metrics with the strongest association to the risk of ED revisits within 72 hours, which is a patient-orien...

Objectives: The primary study objective was to describe the development of a data dictionary for a feasibility analysis of 11 emergency department (ED) key performance indicators (KPIs). The secondary objective was to internally validate the data dictionary by measuring the inter-observer agreement between data abstractors at participating study s...

Objective To compare performance and factors predicting failure to reach Ontario and Australian government time targets between a Canadian (Sunnybrook Hospital) and an Australian (Austin Health) academic tertiary‐level hospitals in 2012, and to assess for change of factors and performance in 2016 between the same hospitals. Methods This was a retr...

Background: The 1-year mortality rate in patients with heart failure who are discharged from an emergency department is 20%. We sought to determine whether early follow-up after discharge from the emergency department was associated with decreased mortality or subsequent admission to hospital. Methods: This retrospective cohort study conducted i...

Background: Improved risk stratification of acute heart failure in the emergency department may inform physicians' decisions regarding patient admission or early discharge disposition. We aimed to validate the previously-derived Emergency Heart failure Mortality Risk Grade for 7-day (EHMRG7) and 30-day (EHMRG30-ST) mortality. Methods: We conduct...

Background: Chest pain is one of the most common reasons for emergency department (ED) visits in developed countries. Whether higher volume EDs have better outcomes, specifically for patients with chest pain, is unknown and pertinent. Methods and results: We conducted a study using population-based data on 498 291 patients ≥40 years old, present...

Introduction The Applied Health Research Question (AHRQ) portfolio is an initiative funded by the Ontario Ministry of Health and Long-Term Care, leveraging the linked data and scientific expertise at ICES to answer questions that directly impact healthcare policy, planning or practice. Objectives and Approach The objective of this project was to e...

Introduction Researchers and decision makers from across Canada use linked provincial administrative data for analysis and to address research and policy questions. Currently there are several impediments to working harmoniously across provincial boundaries. A group of academic and policy researchers are working to address these multi-jurisdictiona...

Information is increasingly digital, creating opportunities to respond to pressing issues about human populations in near real time using linked datasets that are large, complex, and diverse. The potential social and individual benefits that can come from data-intensive science are large, but raise challenges of balancing individual privacy and the...

Introduction In Ontario, the top 5% of high-cost users account for 66% of health care costs. The heavy use of resources combined with perceived inefficiencies offer an imperative to target strategies to redesign care to better meet patient needs and increase value. Objectives and Approach As part of a request submitted to the Applied Health Resear...

Introduction Improving the care and management of patients with diabetes, particularly those with extreme blood glucose and/or cholesterol levels, has been identified as a key priority area for healthcare in Ontario. A multi-organizational collaboration produces audit-and-feedback reports distributed to consenting primary care physicians across the...

Introduction Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder (NDD) that presents with a high degree of heterogeneity (e.g., co-occurrence of other NDDs and other co-morbid conditions), contributing to differential health system needs. Genetics are known to play an important role in ASD and may be associated with different disease tr...

Introduction Canadian provincial health systems have a data advantage – longitudinal population-wide data for publicly funded health services, in many cases going back 20 years or more. With the addition of high performance computing (HPC), these data can serve as the foundation for leading-edge research using machine learning and artificial intell...

We write to you, here in the pages of the International Journal of Population Data Science, for the second time in our capacity of co-directors of the International Population Data Linkage Network (IPDLN – www.ipdln.org). Time has certainly passed quickly since our first communication, where we introduced ourselves, and discussed planned initiative...

Introduction Integrating health and social services data is critical to understanding social determinants of health and responding to public expectations for evidence-based policies amidst changing demographics and fiscal constraint. While academia has long understood the importance of social determinants of health, real and perceived obstacles ha...

Background In December 2017 the Canadian Institutes of Health Research (CIHR) issued a request for proposals to develop a pan-Canadian health data platform. This platform will enable cross-jurisdictional research by facilitating the use of rich provincial and national data and ensure engagement with patients and specific populations including Indig...

Introduction The importance of Indigenous data sovereignty and Indigenous-led research processes is increasingly being recognized in Canada and internationally. For First Nations in Ontario, Canada, access to routinely-collected demographic and health systems data is critical to planning and measuring health status and outcomes in their population...

Introduction: Patient-reported outcome measures (PROM) are questionnaires that can be used to elicit care outcome information from patients. We sought to develop and validate the first PROM for adult patients without a primary mental health or addictions presentation receiving emergency department (ED) care and who were not hospitalized. Methods: P...

Study objective: This study compares how throughput and output factors affect emergency department (ED) median waiting room time. Methods: Administrative health care use records were used to identify all daytime (8 am to 8 pm) visits made to adult EDs in Winnipeg, Canada, between April 1, 2012, and March 31, 2013. First, we measured the waiting...

Background: More than 25% of the population has hypertension. The number of patients seeking care for hypertension in emergency departments has increased by more than 60% in the last decade, with less than 10% of these patients subsequently admitted to hospital. Managing physicians recommend early follow-up to patients who are discharged from the...

Information is increasingly digital, creating opportunities to respond to pressing issues about human populations using linked datasets that are large, complex, and diverse. The potential social and individual benefits that can come from data-intensive science are large, but raise challenges of balancing individual privacy and the public good, buil...

Animated presentation that provides examples of how members of the general public reacted - in terms of facial expression and verbatim statements - to information about users and uses of administrative health data in research.

Objective Patients with cardiovascular diseases are common in the emergency department (ED), and continuity of care following that visit is needed to ensure that they receive evidence-based diagnostic tests and therapy. We examined the frequency of follow-up care after discharge from an ED with a new diagnosis of one of three cardiovascular disease...

Background and objectives: Patients discharged home from an emergency department with AKI are not well described. This study describes their characteristics and outcomes and compares these outcomes to two referent groups. Design, setting, participants, & measurements: We conducted a population-based retrospective cohort study in Ontario, Canada...

Study objective Much effort has been expended to understand what care experiences patients value in the emergency department (ED), yet little is known about which outcomes patients value after ED care. Our goal is to define outcomes of ED care that are valued by patients discharged from the ED, with the goal of informing the development of a patien...

Objective: Ontario established emergency department length-of-stay (EDLOS) targets but has difficulty achieving them. We sought to determine predictors of target time failure for discharged high acuity patients and intensive care unit (ICU) admissions. Methods: This was a retrospective, observational study of 2012 Sunnybrook Hospital emergency d...

Introduction: Over 700 different input, throughput and output metrics have been used to quantify ED crowding. Of these, only ED length-of-stay (ED LOS) has been shown to be associated with mortality. No comparative evaluation of ED crowding metrics has been performed to determine which ones have the strongest association with patient mortality. The...

Objectives There is a growing need to broaden access to administrative health data in order to support decision making and planning by health system stakeholders. An initiative funded by the Ontario Ministry of Health and Long-Term Care, the Applied Health Research Question (AHRQ) portfolio leverages the linked administrative health data holdings a...