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.
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.
Characteristics of short general internal medicine hospital stays: multicentre cross-sectional study
January 28, 2019
Short hospital stays may represent opportunities to avert unnecessary admissions or expedite inpatient care. To inform the design of interventions that target patients with potentially avoidable hospital admissions or brief stays, we examined the patient, physician and situational characteristics associated with short stays among patients admitted to general internal medicine wards and describe the use of hospital resources by these patients.
Association between the trauma of hospitalization and 30-day readmission or emergency department visit
January 1, 2019
We aim to characterize the trauma of hospitalization by measuring patient-reported disturbances in sleep, mobility, nutrition, and mood among medical inpatients, and to examine the association between these disturbances and the risk of unplanned return to hospital after discharge. A total of 207 patients participated and nearly all participants (192 [92.8%]) described a disturbance in at least 1 domain, and 61 participants (29.5%) had high trauma exposure. Trauma of hospitalization may be associated with a greater risk of 30-day readmission or emergency department visit after hospital discharge.
Prevalence and costs of discharge diagnoses in inpatient general internal medicine
July 27, 2018
The objective of this paper is to determine the prevalence and cost of conditions treated on general internal medicine (GIM) inpatient services. The costliest conditions were stroke (median cost $7122, interquartile range 5587–12,354, total cost $94,199,422, representing 6.0% of all costs) and the group of delirium, dementia, and cognitive disorders (median cost $12,831, IQR 9539–17,509, total cost $77,372,541, representing 4.9% of all costs).
Patient characteristics, resource use and outcomes associated with GIM hospital care: The GEMINI retrospective cohort study
December 13, 2017
The precise scope of hospital care delivered under general internal medicine services remains poorly quantified. The purpose of this study was to describe the demographic characteristics, medical conditions, health outcomes and resource use of patients admitted to general internal medicine at 7 hospital sites in the Greater Toronto Area. Patients admitted to general internal medicine services represent a large, heterogeneous, resource-intensive and growing population.