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Objective: The At Home/Chez Soi trial for homeless individuals with mental illness showed scattered-site Housing First with Assertive Community Treatment (ACT) to be more effective than treatment as usual. This study evaluated the cost-effectiveness of Housing First with ACT and treatment as usual.Methods: Between October 2009 and June 2011, a total of 950 homeless individuals with serious mental illness were recruited in five Canadian cities: Vancouver, Winnipeg, Toronto, Montreal, and Moncton. Participants were randomly assigned to Housing First (N=469) or treatment as usual (N=481) and followed up for up to 24 months. The intervention consisted of scattered-site Housing First, using rent supplements, with ACT. The treatment-as-usual group had access to all other services. The perspective of society was adopted for the cost-effectiveness analysis. Days of stable housing served as the outcome measure. Retrospective questionnaires captured service use data.Results: Most (69%) of the costs of the intervention were offset by savings in other costs, such as emergency shelters, reducing the net annual cost of the intervention to about Can$6,311 per person. The incremental cost-effectiveness ratio was Can$41.73 per day of stable housing (95% confidence interval=Can$1.96-$83.70). At up to Can$60 per day, Housing First had more than an 80% chance of being cost-effective, compared with treatment as usual. Cost-effectiveness did not vary by participant characteristics.Conclusions: Housing First with ACT appeared about as cost-effective as Housing First with intensive case management for people with moderate needs. The optimal mix between the two remains to be determined. [ABSTRACT FROM AUTHOR]

Understanding the progression of chronic diseases, such as chronic obstructive pulmonary disease (COPD), is important to inform early diagnosis, personalized care, and health system management. Data from clinical and administrative systems have the potential to advance this understanding, but traditional methods for modelling disease progression are not well-suited to analyzing data collected at irregular intervals, such as when a patient interacts with a healthcare system. We applied a continuous-time hidden Markov model to irregularlyspaced healthcare utilization events and patient-level characteristics in order to analyze the progression through discrete states of 76,888 patients with COPD. A 4-state model allowed classification of patients into interpretable states of disease progression and generated insights about the role of comorbidities, such as cardiovascular diseases, in accelerating severe trajectories. These results can improve the understanding of the evolution of COPD and point to new hypotheses about chronic disease management and comorbidity. [ABSTRACT FROM AUTHOR]

Background: Limited evidence on the costs of homelessness in Canada is available. We estimated the average annual costs, in total and by cost category, that homeless people with mental illness engender from the perspective of society. We also identified individual characteristics associated with higher costs. Methods: As part of the At Home/Chez Soi trial of Housing First for homeless people with mental illness, 990 participants were assigned to the usual-treatment (control) group in 5 Canadian cities (Vancouver, Winnipeg, Toronto, Montréal and Moncton) between October 2009 and June 2011. They were followed for up to 2 years. Questionnaires ascertained service use and income, and cityspecific unit costs were estimated. We adjusted costs for site differences in sample characteristics. We used generalized linear models to identify individual-level characteristics associated with higher costs. Results: Usable data were available for 937 participants (94.6%). Average annual costs (excluding medications) per person in Vancouver, Winnipeg, Toronto, Montréal and Moncton were $53 144 (95% confidence interval [CI] $46 297-$60 095), $45 565 (95% CI $41 039-$50 412), $58 972 (95% CI $52 237-$66 085), $56 406 (95% CI $50 654-$62 456) and $29 610 (95% CI $24 995-$34 480), respectively. Net costs ranged from $15 530 to $341 535. Distributions of costs across categories varied significantly across cities. Lower functioning and a history of psychiatric hospital stays were the most important predictors of higher costs. Interpretation: Homeless people with mental illness generate very high costs for society. Programs are needed to reorient this spending toward more effectively preventing homelessness and toward meeting the health, housing and social service needs of homeless people. [ABSTRACT FROM AUTHOR]

Within population health information systems, indicators are commonly presented as independent, cross-sectional measures, neglecting the multivariate, longitudinal nature of disease progression, health care use, and profiles of performance. We use administrative claims data of Montreal, Canada to identify patterns across indicators and over time in chronic obstructive pulmonary disease patients. We first cluster regions based on four health service indicators. Our second approach discovers individual-level trajectories based on a hidden Markov model using the same four indicators. Both approaches offer additional insights by facilitating the discovery and interpretation of indicators, such as a dual interpretation of low use of general practitioner services. These approaches to the analysis and visualization of health indicators can provide a foundation for information displays that will help decision makers identify areas of concern, predict future disease burden, and implement appropriate policies. [ABSTRACT FROM AUTHOR]

Summary: BioCaster was launched in 2008 to provide an ontology-based text mining system for early disease detection from open news sources. Following a 6-year break, we have re-launched the system in 2021. Our goal is to systematically upgrade the methodology using state-of-the-art neural network language models, whilst retaining the original benefits that the system provided in terms of logical reasoning and automated early detection of infectious disease outbreaks. Here, we present recent extensions such as neural machine translation in 10 languages, neural classification of disease outbreak reports and a new cloud-based visualization dashboard. Furthermore, we discuss our vision for further improvements, including combining risk assessment with event semantics and assessing the risk of outbreaks with multi-granularity. We hope that these efforts will benefit the global public health community., Availability and Implementation: BioCaster web-portal is freely accessible at http://biocaster.org., (© The Author(s) 2022. Published by Oxford University Press.)

We report the baseline usability of a novel web-based application, the Population Health Record (PopHR), designed to facilitate the effective use of population health information by public health professionals and to support evidence-based decision-making. The usability test was conducted with ten potential users who each completed eight tasks using the PopHR system. Participant responses were recorded, including timestamps for each data entry. Overall, the task completion rate was 96% while the success rate was 88%. The average time-on-task was 3.11 minutes, with more time spent on tasks requiring a user to stratify data along multiple dimensions, such as age, sex, or geographical region. Usability scores indicated that the current version of PopHR has good usability. Potential improvements identified included adding supporting information, offering different visualizations, and enhancing system stability. These findings are examples of addressable usability problems encountered in developing a population health record system.