Publications from the GEMINI Team
Explore our featured publications to learn more about how we help physicians, health care teams, and hospitals use data to gain insights into patient care and improve patient outcomes.
Diversity among healthcare leaders in Canada: a cross-sectional study of perceived gender and race
March 14, 2022
Previous research indicates that healthcare leadership in Europe and the United States is thought to lack gender and racial diversity. However, the degree to which these imbalances exist across Canadian healthcare institutions is not clear. This study sought to better understand the issue by reporting the perceived race and gender makeup of Canadian healthcare executives across the country’s largest hospitals and provincial and territorial health ministries. While the results suggest that gender parity exists among Canadian healthcare leaders, racialized individuals were significantly under-represented, with racialized women representing fewer than 5% of executives in each province. This work calls on healthcare institutions to increase racial diversity in leadership.
Outcomes in patients with and without disability admitted to hospital with COVID-19: a retrospective cohort study
January 31, 2022
A small number of studies suggest that COVID-19 patients with disabilities are at elevated risk for severe disease and death. To inform equitable pandemic supports for all, GEMINI data was examined to assess severe COVID-19 outcomes among hospitalized patients with a broad range of disabilities. Analyses revealed that patients with disabilities experienced longer hospital stays compared to those without disabilities, an effect that persisted after adjusting for age, sex, long-term care facility residence, medical comorbidity, dementia, and psychiatric disorders. Additionally, patients with disabilities (age ≤64 years) were more likely to experience unplanned 30-day readmissions than those without disabilities. The findings highlight the importance of a pandemic response that prioritizes the needs of people with disabilities in hospital and after hospitalization.
Bedspacing and Clinical Outcomes in General Internal Medicine: A Retrospective, Multicenter Cohort Study
January 18, 2022
Hospital patients are typically cared for on cohorted wards according the specialty of the physician taking care of them. However, because hospitals are often over capacity, patients may be assigned to locations other than their designated ward. Termed “bedspacing”, this phenomenon is a common approach to managing hospital capacity strain but may compromise care. To study the effects of bedspacing on general internal medicine (GIM) patients in Toronto area hospitals between 2015 and 2017, GEMINI data examined 40,440 GIM admissions, 10,745 (26.6%) of which were bed-spaced to non-GIM wards and 29,695 (73.4%) were assigned to GIM wards. After multivariable adjustment, bedspacing was associated with no significant difference in mortality, slightly shorter hospital length-of-stay, and fewer readmissions across all participating hospital sites. Although potential harms in high-risk patients remain uncertain, the findings are generally reassuring, suggesting that bedspacing of GIM patients is not consistently associated with poorer clinical outcomes.
Variations in Processes of Care and Outcomes for Hospitalized General Medicine Patients Treated by Female vs Male Physician
July 16, 2021
GEMINI data from 171,625 hospitalizations were applied in a cross-sectional study that found patients under the care of female physicians in the general medicine wards had lower in-hospital mortality than those cared by their male counterparts. While the differences were significant only when hospital and patient characteristics were adjusted, the results also support existing literature on female-mediated patient care which account for factors that are not otherwise characterized by hospital data variables through electronic medical records.
Managing drug shortages during a pandemic: tocilizumab and COVID-19
May 5, 2021
The COVID-19 pandemic has revealed weaknesses in global manufacturing and distribution of medications, exacerbating many pre-existing limitations and inequities in drug supply and creating new shortages. Tocilizumab is a life-saving therapy for adults admitted to hospital with COVID-19; demand for this drug is likely to outstrip available supply in Canada. We estimated that for every 1000 adults in hospital with COVID-19, 429 would be eligible for tocilizumab; treating them all may prevent 17 deaths and prevent 12 instances of invasive mechanical ventilation.
Patient characteristics, clinical care, resource use, and outcomes associated with hospitalization for COVID-19 in the Toronto area
December 16, 2020
In this study, we described all adult discharges from inpatient medical services and medical-surgical ICU between November 2019 and June 2020 at 7 hospitals in Ontario. Out of 43,462 discharges, 1,207 (3.0%) had COVID-19 and 783 (2.3%) had influenza. Patients with COVID-19 had similar age to patients with influenza and other conditions. Patients with COVID-19 were more likely to be male. Compared to influenza, patients with COVID-19 had significantly greater mortality, ICU use, and hospital length-of-stay. COVID-19 patients did not have a significantly different 30-day readmission rate.
Assessing the quality of clinical and administrative data extracted from hospitals: The General Medicine Inpatient Initiative (GEMINI) experience
November 4, 2020
Large clinical databases are increasingly being used for research and quality improvement, but there remains uncertainty about how computational and manual approaches can be used together to assess and improve the quality of extracted data. The GEMINI database extracts and standardizes a broad range of data. We describe computational data quality assessment and manual data validation techniques that were used for GEMINI. Manual data validation revealed that GEMINI data were ultimately highly reliable compared to the gold standard across nearly all data tables.
Prediction of personal protective equipment use in hospitals during COVID-19
October 29, 2020
Demand for PPE has increased significantly since the onset of the COVID-19 pandemic. Hospital staff are required to wear PPE at all times, with additional PPE mandated during medical procedures. This will put increased pressure on hospitals which have had problems predicting PPE usage and sourcing its supply. To meet this challenge, we predicted demand for PPE, concluding that 90% of predicted PPE usage stems from glove and surgical mask requirements.
Modelling resource requirements and physician staffing to provide virtual urgent medical care for residents of long-term care homes: a cross-sectional study
August 20, 2020
The study seeks to model resource requirements to deliver virtual urgent medical care in long-term care (LTC) facilities in light of the coronavirus 2019 (COVID-19) outbreak. Data from general medicine inpatient admissions at 7 hospitals in the Greater Toronto Area over a 7.5 year period was used to determine historical patterns of hospital resource use by LTC residents. Study data indicates that provision of acute medical care at LTC facilities would probably require rapid access to outpatient diagnostic imaging, within-facility access to laboratory services and intravenous medication and virtual consultations with physicians.
Physician-level variation in clinical outcomes and resource use in inpatient general internal medicine: an observational study.
March 27, 2020
Variations in inpatient medical care are typically attributed to system, hospital or patient factors but little is known about variations at the physician level. We described the physician-level variation in clinical outcomes and resource use in general internal medicine. The sample included 103 085 admissions to 135 attending physicians. After propensity score matching, the difference between physicians in the highest and lowest quartiles for in-hospital mortality was 2.4%; for readmission was 3.3%; for advanced imaging was 0.32 tests per admission; and for hospital length of stay was 1.2 additional days per admission.
Appropriateness of peripherally inserted central catheter use among general medical inpatients: an observational study using routinely collected data
March 8, 2020
Peripherally inserted central catheters (PICC) are among the most commonly used medical devices in hospital. This study sought to determine the appropriateness of inpatient PICC use in general medicine at five academic hospitals in Toronto, based on the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) recommendations. Among 3479 PICC placements, 1848 (53%, 95% CI 51% to 55%) were appropriate, 573 (16%, 95% CI 15% to 18%) were inappropriate and 1058 (30%, 95% CI 29% to 32%) were of uncertain appropriateness.
Value of routine echocardiography in the management of stroke
August 6, 2019
Transthoracic echocardiography is routinely performed in patients with stroke or transient ischemic attack (TIA) to help plan secondary stroke management, but recent data evaluating its usefulness in this context are lacking. We sought to evaluate the value of echocardiography for identifying clinically actionable findings for secondary stroke prevention. Of the 1862 patients with stroke or TIA we identified, 1272 (68%) had at least 1 echocardiogram. Most patients with stroke or TIA had a normal echocardiogram, with few having clinically actionable findings for secondary stroke prevention. Clinically actionable findings, specifically PFO, were more common in patients with cryptogenic stroke.