Clinical Information System Impact on Hospitalized Patients With Chronic Disease

Evaluating the Impact of Alberta Health Services' New Provincial Clinical Information System on Patient Outcomes and Experiences With Chronic Diseases - Study Protocol for a Multi-center Interrupted Time Series Analysis

This is a retrospective, observational study using routinely collected information collected by Alberta Health Services. The study will identify patients with chronic disease, defined by one or more of the following conditions; diabetes mellitus, heart failure, coronary artery disease, chronic kidney disease, or chronic lung disease. Adult residents of Alberta with a chronic disease of interest present upon hospital admission and who survive to hospital discharge will be included in the study cohort. The primary outcome will be the composite of hospital readmission or death within 30 days of discharge. Secondary outcomes will include components of the composite, length of stay, patient experiences related to their hospital to home transition of care, and processes of care. Multi-level interrupted time series analysis will be used to compare outcomes before versus after implementation of the Connect Care CIS.

Study Overview

• Status: Not yet recruiting
• Conditions: Coronary Artery Disease; Heart Failure; Diabete Mellitus; Chronic Lung Diseases; Kidney Disease
• Intervention / Treatment: Other: Clinical Information System (CIS) / Connect Care Implementation

Detailed Description

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.

• Study Type: Observational
• Enrollment (Estimated): 124240

Contacts and Locations

• Study Contact: Name: Nusrat S Shommu, PhD; Phone Number: 4032103991; Email: nsshommu@ucalgary.ca

Study Locations

• Canada
  • Alberta
    • Calgary, Alberta, Canada, T2N 4N1
      • University of Calgary
      • Contact: Nusrat S Shommu, PhD; Phone Number: 4032103991; Email: nsshommu@ucalgary.ca
      • Principal Investigator: Matthew T James, MD, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study population consists of adult Alberta residents receiving acute-care services in Alberta Health Services (AHS) facilities who have one or more of five key noncommunicable diseases: diabetes mellitus, chronic kidney disease, coronary artery disease, heart failure, or chronic lung disease. Participants are identified from routinely collected administrative, laboratory, and pharmacy datasets, with hospital admissions included regardless of most responsible diagnosis. The population is broadly representative of adults with chronic conditions experiencing transitions from hospital to home across the province. Patient experience survey data are available for a random 10% sample of eligible discharges.

Description

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.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Adults with Key NCDs Receiving Acute Care in AHS; This single cohort includes adult patients in Alberta with one of five key noncommunicable diseases (diabetes mellitus, chronic kidney disease, coronary artery disease, heart failure, or chronic lung disease) who received care in Alberta Health Services (AHS) acute-care facilities during the study period. The cohort is followed over a 7-year window (5 years pre-implementation and 2 years post-implementation of the Clinical Information System), with outcomes measured in into quarterly intervals, both pre- and post-launch of the CIS at each site for this analysis. Sub-cohorts will be identified based on the presence of each NCD and hospitalization history, but all belong to one predefined observational study cohort for the interrupted time series analysis.

Other: Clinical Information System (CIS) / Connect Care Implementation; The intervention (exposure) is the implementation of the Connect Care Clinical Information System (CIS) across Alberta Health Services (AHS) acute-care facilities. Connect Care integrates comprehensive electronic health records, clinician communication tools, pharmacy dispensing data, laboratory and diagnostic imaging results, standardized medication reconciliation, and electronic discharge summaries. It supports coordination across hospital, specialty, and primary care settings and includes a patient-facing portal allowing access to personal health information. The CIS rollout occurred at multiple sites with staggered launch dates and represents one of the largest Epic deployments.; Other Names: Epic-Based Clinical Information System

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
All-cause unplanned hospital readmission or death within 30 days after hospital discharge	This primary outcome captures whether a patient experiences either (1) the unplanned hospital readmission for any cause or (2) death from any cause within 30 days following discharge from an acute-care hospitalization. The outcome is restricted to patients who survived to hospital discharge. Analyses will also be stratified by the presence of each of the five key NCDs (diabetes, CKD, CAD, heart failure, chronic lung disease) and by multimorbidity (two or more of the NCDs).	Within 30 days after hospital discharge

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Acute care admission frequency	Number of acute-care hospital admissions occurring during monthly intervals.	Monthly intervals across the 7-year follow-up (5 years pre-implementation, 2 years post-implementation
Length of stay in hospital	Duration of index hospitalization in days, excluding days coded as alternate level of care (occupying a hospital bed but no longer needing acute care while waiting for a transfer to a more suitable setting like long-term care, rehab, or home support), measured from admission to discharge, including multi-facility episodes.	From hospital admission date to date of discharge or switch to alternate level of care, up to a maximum of 30 days
30-day all-cause mortality	Death from any cause within 30 days after hospital discharge, assessed independently from readmission.	Within 30 days after each discharge.
30-day all-cause readmission	Any acute-care readmission occurring within 30 days after discharge, analyzed separately from mortality.	Within 30 days after each discharge.
Emergency department visits within 30 days of discharge	Count of emergency department visits within 30 days following discharge.	Within 30 days after each discharge.
Outpatient physician follow-up within 30 days	Completion of a primary care or specialist outpatient visit within 30 days after discharge (restricted to patients who survived to discharge).	Within 30 days after each discharge.
Medication dispensation within 120 days of discharge	ACE-I/ARB/ARNI prescription dispensed within 120 days for patients with heart failure, CAD, or CKD with ACR >30 mg/mmol.Statin prescription dispensed within 120 days for patients with ASCVD, diabetes (age >40 years), or CKD (age >50 years).	Within 120 days after discharge.
Outpatient laboratory testing within 30 days of discharge	Completion of recommended outpatient laboratory testing during the early post-discharge period (restricted to patients who survived to discharge).	Within 30 days after each discharge.
Multi-question composite score of Information Understanding When Leaving the Hospital from the Canadian Patient Experiences Survey on Inpatient Care	Composite score based on three questions related to Information Understanding When Leaving the Hospital	Survey completed up to12 weeks following discharge among a 10% random sample of patients discharged.

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Interrupted time series (ITS) slope and level changes	Estimated changes in outcome level and trend immediately following CIS implementation and over time, using monthly segmented regression across staggered site launch dates.	Monthly intervals for 5 years pre-implementation and 2 years post-implementation.

Collaborators and Investigators

• Sponsor: University of Calgary
• Investigators: Principal Investigator: Matthew T James, MD, PhD, University of Calgary

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): June 1, 2027
• Study Completion (Estimated): December 31, 2027

Study Registration Dates

• First Submitted: May 11, 2026
• First Submitted That Met QC Criteria: May 19, 2026
• First Posted (Actual): May 27, 2026

Study Record Updates

• Last Update Posted (Actual): May 27, 2026
• Last Update Submitted That Met QC Criteria: May 19, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Clinical Information System
• Additional Relevant MeSH Terms: Urogenital Diseases; Endocrine System Diseases; Vascular Diseases; Cardiovascular Diseases; Male Urogenital Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Heart Diseases; Metabolic Diseases; Glucose Metabolism Disorders; Arteriosclerosis; Arterial Occlusive Diseases; Coronary Disease; Myocardial Ischemia; Nutritional and Metabolic Diseases; Heart Failure; Diabetes Mellitus; Coronary Artery Disease; Kidney Diseases; Organization and Administration; Health Services Administration; Management Information Systems; cytokine inducible SH2-containing protein
• Other Study ID Numbers: REB24-1942

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Investigators are not able to make study data available due to contractual requirements of the data custodian - Alberta Health Services. Other researchers may request IPD for the study from the data custodian through the Alberta SPOR Support Unit: https://absporu.ca/research-services/service-application/

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No