Clinical Information System Impact on Hospitalized Patients With Chronic Disease

The design of the protocol is a multiple-baseline interrupted time series (ITS) analysis to assess effects of the CIS on patient outcomes with five pre-specified NCDs (diabetes mellitus, coronary artery disease, heart failure, chronic kidney disease, and chronic lung disease) before versus after implementation at each cluster of sites, accounting for pre-existing trends in outcomes and correlation between different time points and sites. The primary outcome will be unplanned hospital readmission and death within 30 days of discharge. Secondary outcomes will include readmission and death as individual outcomes, length of hospital stay, processes of care, and measures of patient experience with care transitions.

The study uses retrospective administrative, clinical, and patient experience data collected between 2019 and 2024, covering periods before and after clinical information system implementation at each site. All observations will be recorded prior to study initiation and will be analyzed retrospectively within a multiple baseline interrupted time series framework.

Inclusion criteria

• Adults aged 18 years or older at the time of hospital admission.
• Residents of Alberta eligible to receive acute-care services in AHS facilities.
• Hospitalized for any cause during the study period (5 years pre-implementation and 2 years post-implementation of the CIS).
• Meet the validated case definition for one or more of the five key NCDs (diabetes mellitus, chronic kidney disease, coronary artery disease, heart failure, or chronic lung disease) based on ICD codes, laboratory measures, or pharmacy records during standardized lookback periods (up to 5 years for diagnoses; up to 1 year for labs/pharmacy).
• Have a qualifying date for the NCD(s) that occurs prior to or during the index hospital admission.
• Eligible for inclusion in the primary and patient experience outcomes if they survive to hospital discharge.
• May enter multiple sub-cohorts if more than one NCD is present.

Exclusion criteria

• Individuals younger than 18 years at the time of hospital admission.
• Non-residents of Alberta or individuals not eligible for care within AHS facilities.
• Hospitalizations that end in death (excluded from analyses of the primary outcome and patient experience measures).
• Patients without evidence of any of the five key NCDs during the lookback period or at the index hospital admission.
• Admissions outside the study period or admissions for which necessary administrative, laboratory, or pharmacy data are unavailable.