An Analysis Framework to Evaluate the Epidemiology of Respiratory Pathologies Using Complex Hierarchical Datasets
Triple Aim is a framework aimed at the sustainable organization of healthcare. Three equally important objectives are: (i) improving patient experience (e.g. by focusing on Patient Related Outcome Measures and Patient Related Experience Measures), (ii) improving the health of a particular population (e.g. diabetic persons), and (iii) lowering the healthcare cost per capita. In order to monitor the Triple Aim objectives, a database of health data is required. Intego, a Flemish-Belgian general practice-based morbidity registration network, provides one of the most comprehensive databases of health data. This allows us to investigate the effectiveness of primary care interventions by analyzing the evolution of disease incidence, thereby providing a way to monitor the second objective of Triple Aim. The ultimate goal is to turn the Intego network into a general health monitoring system for the improvement of primary care in Flanders. For the monitoring of the first and third objective of Triple Aim, the Intego database needs to be coupled with other databases. Patient engagement platforms (e.g. Helena®, Meplis®,…) provide information about patients’ experiences with primary care, and data about medical costs are collected in the database of IMA (Intermutualistisch Agentschap). The combined use of these databases with the Intego database will create a data-ecosystem that we intend to use as a general health monitoring system for obtaining a sustainable healthcare system in Flanders. However, this ‘Big Data’ evolution of Intego will pose several challenges that need to be solved. This PhD project will focus on the evaluation of the epidemiology of selected pathologies (e.g. respiratory diseases such as COPD, asthma and pneumonia). Due to ICT changes in the electronic health record used for Intego, there are currently two distinct epidemiological datasets available, namely one that contains data until 2015 and the other starting from 2015. A first objective is therefore to merge the older with the recent database to get an insight in the evolution of selected pathologies. One of the objectives is to obtain a better understanding of the pneumococcal vaccination coverage in Flanders. This linking of databases will allow longitudinal analyses of epidemiological data collected over periods of more than five years. Furthermore, we are interested in studying the spatial dynamics of specific epidemiological outcomes (e.g. disease incidence, vaccination coverage, etc.) over the 60 available distinct primary care zones (PCZs) in Flanders, by using and developing geostatistical and data science methodologies. Primary care zones are new structures that will create the basis for effective integrated care and services in the locality. One such PCZ is a geographically defined area consisting of one or more communities and is managed by a care board. The prime responsibility of these primary care zones is to support and improve multidisciplinary and intersectoral collaboration at practice level. The main challenge will be the coupling of patient-specific data from one database with corresponding data from the most recent database. Since 2017, the study of the impact of environmental pollution on health is of interest. More specifically, we are interested in how environmental factors (e.g. fine dust) affect respiratory diseases and their evolution in time. This PhD project will also further investigate this relation between environmental pollution and respiratory health using the Intego database in combination with other databases.