Improving case ascertainment of a population-based birth defects registry in New York State using hospital discharge data

BACKGROUND: The assessment of the data quality of population-based registration systems is essential to understanding the reliability and usefulness of disease surveillance and research findings resulting from the use of registry data. Since the New York State Congenital Malformations Registry (CMR) uses passive case ascertainment, the completeness of the registry data is an important aspect of the quality of information. This paper presents the results of hospital audits, which were conducted to capture the unreported cases using hospital discharge files, and evaluates the effectiveness of the audits. METHODS: Children age 2 years or younger and diagnosed with reportable birth defects for the birth years 1998-2000 were selected from hospital discharge files of all reporting hospitals in the New York Statewide Planning and Research Cooperative System (SPARCS) and matched to the CMR database for the same birth year period.The unmatched reports from the SPARCS hospital discharge files that the CMR possibly missed were sent to hospitals, requesting submission of the missed reports. Two audits on all reporting hospitals in New York State were conducted: 1) 1998 and 1999 birth cohorts audited from June 2000 to March 2002, and 2) 2000 birth cohort audited from November 2001 to November 2002. RESULTS: Hospital audits using SPARCS hospital discharge data identified 5,460 reports that the CMR missed for the selected 66 hospitals analyzed. About 86% of these reports had reportable conditions and were added to the CMR, which comprised 21.4% of all reports from the 66 hospitals for the birth years 1998-2000. The number of reports that would have been missed without audits decreased from the 1998 and 1999 birth cohort (25.1%) to the 2000 birth cohort (13.9%). Low reporting rates and, thus, a high percent of added reports, were found for hospitals with a relatively small number of annual reports and for some specific birth defects such as chromosomal anomalies, anencephalus and congenital anomalies of the urinary system. CONCLUSION: The current study demonstrates that using hospital discharge data to improve case ascertainment is a valuable and effective method of enhancing birth defect surveillance, particularly for those hospitals with low reporting rates.     

Common bile duct injury during laparoscopic cholecystectomy in Ontario: Does ICD-9 coding indicate true incidence?

BACKGROUND: Recent reports in the scientific and lay press have suggested that bile duct injuries during laparoscopic cholecystectomy are common in Ontario. The reports were based on administrative data collected by hospital medical records departments and the Canadian Institute for Health Information (CIHI). The current study involved a direct inspection of hospital records to determine if the CIHI data accurately captured the rate of clinically significant bile duct complications. METHODS: For the period 1991 to 1995, records of bile duct injuries after laparoscopic cholecystectomy were independently evaluated to clarify the clinical significance of the complications. Of 21 Ontario hospitals for which data on complications had been reported in the media, 18 provided detailed information on all patients reported to have suffered bile duct complications classified by the hospital as "major". In addition, each institution provided information on a random sample of one-sixth of the patients who had suffered complications classified as "minor". The reviewer then examined each relevant hospital chart to assess the grade and significance of the reported complications. RESULTS: All 24 bile duct injuries classified by the hospitals as "major" were confirmed as major (clinically relevant) injuries. Of the 80 bile duct complications classified by the hospitals as "minor", 76 (95%) were irrelevant to patient outcome. The discrepancy between data collected and reported frequency of injury lies in the use of nonspecific coding methods. INTERPRETATION: The rate of significant bile duct injuries cannot be inferred from nonspecific codes taken from the International Classification of Diseases, ninth revision, and presented in hospital discharge records. Therefore, such data must be interpreted with extreme caution.     

公立医疗机构政府补偿与监管机制的研究框架

在补偿机制扭曲、政府监管滞后的背景下,科学设定公立医疗机构政府补偿标准和方式,改进政府监管手段和能力对保障公立医疗机构公益性具有重要意义。上海市闵行区开展了基于公益性绩效的政府补偿机制改革和基于信息平台的政府监管机制改革。文章以新公共行政理论为指导,总结闵行区政府补偿和监管机制的特点,评价改革的效果,并且探索分析补偿和监管机制改革对医疗机构运行绩效的影响,为深化公立医院改革提供决策参考。     

Psychiatric discharge summaries: what do general practitioners want?

Aims As part of an initiative to improve and standardise our discharge summaries, we investigated the preferences of general practitioners (GPs) with regards to the information provided in summaries.Method Our study methods included sending a questionnaire to all GPs in our area gathering their views on what information to include in discharge summaries on first and on subsequent inpatient episodes.Results The response rate was 68%. Most GPs wanted a comprehensive first discharge summary, particularly stressing the importance of practical information. Subsequent discharge summaries could exclude case histories.Clinical implications Contrary to previous studies indicating a demand for brief reports, this survey indicates that the GPs surveyed value considerable detail in adult psychiatry discharge summaries. It is important to include these views in setting standards for the auditing process and before implementing changes.     

卫生技术评估认知与需求现况调查

??????? 目的 了解浙江省卫生技术及管理人员对卫生技术评估（HTA）的认知和需求,为进一步开展HTA工作提供建议。方法 采用问卷调查与访谈相结合的方法对3家医院,1家公共卫生机构,8家卫生行政机构的102位运用HTA结果的潜在使用者和22位决策者进行了调查。结果 被调查者认为卫生技术相关政策法规在卫生技术信息来源最为重要,卫生技术临床疗效在用于决策的卫生技术相关信息中最为重要,相关研究质量太差是影响卫生技术评估的最大障碍。结论 浙江省卫生技术及管理人员对于HTA有一定的认知与需求,但关注度不够,针对遇到的障碍提出了HTA进一步发展的建议。     

Initial management of cutaneous malignant melanoma.

Appropriate initial surgical management of primary cutaneous malignant melanoma is important since no effective treatment exists once the tumour metastasizes. The author reviews methods of initial treatment, excisional biopsy with adequate margins being the most common. He also reports results from a questionnaire survey on the type of microstaging used at hospitals across Canada. Two thirds of the pathologists who responded to the questionnaire preferred to use both Clark''s and Breslow''s method of microstaging. As a result, the author believes that the best histopathologic classification to use for predicting outcome has yet to be established.     

基于数据包络分析的三级医院适宜规模研究

目的 研究三级医院床位和人员的适宜规模,控制医院过度发展和资源浪费。方法 以北京市三级医院为研究样本,确定投入-产出指标,利用DEAP（2.1）软件,分析1991—2011年北京市三级医院规模报酬状态,找出规模报酬拐点,从而确定三级医院适宜规模。结果 2011年,41所医院中,有39家医院处于DEA有效状态,2家医院处于DEA非有效状态;时间序列纵向分析中,有18家医院出现规模报酬拐点。北京市三级综合医院的适宜规模的严格控制标准为：床位606张,95%CI：(425,786),在职职工1 219人,95%CI：(797,1 641);较宽松的控制标准为：床位1 058张,95%CI：(831,1 284),在职职工2 236人,95%CI：(1 716,2 757)。结论 研究得到了三级公立医院的规模控制标准,要严格控制公立医院的规模和特大型医院的数量,注重提高医院的运行效率,缩短平均住院日。     

武汉市公立医院药品价格水平实证研究

目的 了解武汉市公立医院的药品相对价格水平,揭示药品市场现存的问题。方法 选择全国市场销售排名前100位的药品全部纳入研究样本,收集武汉市12家公立医院和14家零售药房的药品价格数据,对定量资料进行统计分析,对公立医院间及其与零售药房间的药品价格进行差异性比较。结果 公立医院的药品均价高于零售药房同商品名药品的均价;公立医院间同商品名的药品均价差异不显著,但同通用名的药品价格差异有较大的波动性。结论 进一步建立健全药品监管制度,加快削弱公立医院的垄断地位,严格药品招标采购管理,建立健全国家基本药物制度。     

广州地区三级甲等医院急诊科样本周转时间现况研究

??????? 目的 调查广州地区三级甲等医院急诊科样本周转时间（TAT),为持续改进检验流程提供科学依据。方法 2012-04-02至2013-03-29期间,从广州地区4家三级甲等医院急诊科,随机抽取8 196例样本,利用医院信息系统（HIS）全程记录检验申请、付费、采集样本、输送、检验前处理、检验、审核、取报告、医生处理等过程。结果 8 196例样本TAT的中位数为72.9 min,付费、采集样本、输送、检验前处理、检验、审核、取报告、医生处理分别用时9.1 min、5.1 min、9.7 min、12.5 min、13.8 min、5.3min、12.9 min、3.9 min,实验室内TAT为32.1 min。结论 广州地区三级甲等医院急诊科常见样本的TAT 基本符合临床需要,但部分项目的TAT有待进一步缩短。     

Communication of results of necropsies in north east Thames region.

OBJECTIVE--To evaluate the adequacy of reporting of results of necropsy to referring clinicians and to general practitioners. DESIGN--Questionnaire survey of referring clinicians and general practitioners of deceased patients in four districts in North East Thames region. Patients were selected by retrospective systematic sampling of 50 or more necropsy reports in each district. SETTING--One teaching hospital, one inner London district general hospital, and two outer London district general hospitals. PARTICIPANTS--70 consultants and 146 general practitioners who were asked about 214 necropsy reports; coroners'' reports were excluded. MAIN OUTCOME MEASURES--Time taken for dispatch of final reports after necropsy, consultants'' recognition of the reports, general practitioners'' recognition of the reports or of their findings, and consultants'' recall of having discussed the findings with relatives. RESULTS--Only two hospitals dispatched final reports including histological findings (mean time to dispatch 144 days and 22 days respectively). 42 (60%) consultants and 83 (57%) general practitioners responded to the survey. The percentage of reports seen by consultants varied from 37% (n = 13) to 87% (n = 36); in all, only 47% (39/83) of general practitioners had been informed of the findings by any method. Consultants could recall having discussed findings with only 42% (47/112) of relatives. CONCLUSIONS--Communication of results of necropsies to hospital clinicians, general practitioners, and relatives is currently inadequate in these hospitals. IMPLICATIONS AND ACTION--A report of the macroscopic findings should be dispatched immediately after necropsy to clinicians and general practitioners; relatives should routinely be invited to discuss the necroscopic findings. One department has already altered its practice.     

An online literature mining tool for protein phosphorylation

A web-based version of the RLIMS-P literature mining system was developed for online mining of protein phosphorylation information from MEDLINE abstracts. The online tool presents extracted phosphorylation objects (phosphorylated proteins, phosphorylation sites and protein kinases) in summary tables and full reports with evidence-tagged abstracts. The tool further allows mapping of phosphorylated proteins to protein entries in the UniProt Knowledgebase based on PubMed ID and/or protein name. The literature mining, coupled with database association, allows retrieval of rich biological information for the phosphorylated proteins and facilitates database annotation of phosphorylation features.     

Parents Accidentally Substitute Similar Sounding Sibling Names More Often than Dissimilar Names

When parents select similar sounding names for their children, do they set themselves up for more speech errors in the future? Questionnaire data from 334 respondents suggest that they do. Respondents whose names shared initial or final sounds with a sibling’s reported that their parents accidentally called them by the sibling’s name more often than those without such name overlap. Having a sibling of the same gender, similar appearance, or similar age was also associated with more frequent name substitutions. Almost all other name substitutions by parents involved other family members and over 5% of respondents reported a parent substituting the name of a pet, which suggests a strong role for social and situational cues in retrieving personal names for direct address. To the extent that retrieval cues are shared with other people or animals, other names become available and may substitute for the intended name, particularly when names sound similar.     

宁夏县级医院耳鼻咽喉科医疗服务能力分析

目的 通过对宁夏县级医院耳鼻咽喉科医疗服务现状的调查,了解其发展瓶颈与不足,提出提升宁夏县级医院耳鼻咽喉科医疗服务能力的建议。方法 采用整群抽样方法,对宁夏县级公立综合医院耳鼻咽喉科进行问卷调查,并抽样访谈部分医院耳鼻咽喉科主任,回收、整理、分析相关数据,定量定性分析调查医院耳鼻咽喉科医疗服务能力。结果 宁夏县级医院耳鼻咽喉科各项现状指标均低于县医院标准要求,科室人员与设备数量严重不足,可开展医疗技术项目少,门诊、出院人数逐年提高。结论 宁夏县级医院耳鼻咽喉科医疗服务能力不足,建议科室制定发展规划,创新发展方式;开发人力资源,提升技术水平;借助信息平台,共建学科联盟。     

A lung function information system

A lung function information system (LFIS) was developed for the data analysis of pulmonary function tests at different locations. This system was connected to the hospital information system (HIS) for the retrieval of patient data and the storage of the lung function variables of patients to generate follow-up reports and to support financial and administrative management. The application programs were developed in such a way that high flexibility was obtained with respect to the patient-computer-technician interaction. The sampled data are stored on a disc to correct earlier decisions, perform recalculations and reanalyse the data for research purposes. When the measurements performed on a patient are authorized, the sampled data are deleted, except for when they are needed for future research. A distributed computer system was chosen to combine the benefits of a centralized system with those of several stand-alone systems. The main tasks of the central unit are to store collected data and computer programs, generate a final lung function report on laser printer and provide a connection to the HIS. In the satellite computers, which are located close to the lung function equipment, the signals and raw data are processed. Furthermore, the satellite computers were in use for program development and several research projects, and for the offline data processing of the lung function measurements from two other hospitals by means of a modem connection. The LFIS improved the quantity and quality of data acquisition. It resulted in an increased capacity of about 50% concerning spirometry, and facilitated time-consuming complex analyses. It also avoided miscalculations and mistakes in reports previously experienced with hand calculations.     

THE CALIFORNIA TUMOR REGISTRY—A Summary Report on the Cancer Experience in 36 Hospitals

The California Tumor Registry was started in 1947. It consists of case abstracts of medical records on neoplasm patients seen in 40 hospitals in California and now contains data on more than 159,000 cases, with 15,000 new cases being added each year. Follow-up reports are requested annually on each case not known to be dead.The Registry is designed to (1) promote the continuing care of the patient, (2) to evaluate cancer control methods, (3) to advance knowledge of the epidemiology of cancer, and (4) to suggest leads for laboratory and clinical research.From a series of 110,628 neoplasm cases reported to the California Tumor Registry in 1942-1954, data are presented on 76,499 cancer cases initially diagnosed in reporting hospitals. Histopathologic confirmation, age, sex, stage, treatment, follow-up, and survival of cancer patients are discussed. Use of the Registry information for analyzing cancer experience for epidemiological study and for evaluation of treatment methods are also described.The report is intended to illustrate the types of data that can be obtained from the California Tumor Registry. More comprehensive reports on specific aspects of cancer control will be forthcoming.     

The California Tumor Registry: a summary report on the cancer experience in 36 hospitals

The California Tumor Registry was started in 1947. It consists of case abstracts of medical records on neoplasm patients seen in 40 hospitals in California and now contains data on more than 159,000 cases, with 15,000 new cases being added each year. Follow-up reports are requested annually on each case not known to be dead. The Registry is designed to (1) promote the continuing care of the patient, (2) to evaluate cancer control methods, (3) to advance knowledge of the epidemiology of cancer, and (4) to suggest leads for laboratory and clinical research. From a series of 110,628 neoplasm cases reported to the California Tumor Registry in 1942-1954, data are presented on 76,499 cancer cases initially diagnosed in reporting hospitals. Histopathologic confirmation, age, sex, stage, treatment, follow-up, and survival of cancer patients are discussed. Use of the Registry information for analyzing cancer experience for epidemiological study and for evaluation of treatment methods are also described. The report is intended to illustrate the types of data that can be obtained from the California Tumor Registry. More comprehensive reports on specific aspects of cancer control will be forthcoming.     

A comprehensive overview of medical error in hospitals using incident-reporting systems, patient complaints and chart review of inpatient deaths

Background

Incident reporting systems (IRS) are used to identify medical errors in order to learn from mistakes and improve patient safety in hospitals. However, IRS contain only a small fraction of occurring incidents. A more comprehensive overview of medical error in hospitals may be obtained by combining information from multiple sources. The WHO has developed the International Classification for Patient Safety (ICPS) in order to enable comparison of incident reports from different sources and institutions.

Methods

The aim of this paper was to provide a more comprehensive overview of medical error in hospitals using a combination of different information sources. Incident reports collected from IRS, patient complaints and retrospective chart review in an academic acute care hospital were classified using the ICPS. The main outcome measures were distribution of incidents over the thirteen categories of the ICPS classifier “Incident type”, described as odds ratios (OR) and proportional similarity indices (PSI).

Results

A total of 1012 incidents resulted in 1282 classified items. Large differences between data from IRS and patient complaints (PSI = 0.32) and from IRS and retrospective chart review (PSI = 0.31) were mainly attributable to behaviour (OR = 6.08), clinical administration (OR = 5.14), clinical process (OR = 6.73) and resources (OR = 2.06).

Conclusions

IRS do not capture all incidents in hospitals and should be combined with complementary information about diagnostic error and delayed treatment from patient complaints and retrospective chart review. Since incidents that are not recorded in IRS do not lead to remedial and preventive action in response to IRS reports, healthcare centres that have access to different incident detection methods should harness information from all sources to improve patient safety.     

Vermicomposting of mixed solid textile mill sludge and cow dung with the epigeic earthworm Eisenia foetida

This paper reports the results of a study of vermicomposting with Eisenia foetida of solid textile mill sludge mixed with cow dung in different ratios in a 90 days composting experiment. Vermicomposting resulted in significant reduction in C:N ratio and increase in TKN. Total K and Ca were lower in the final cast than the initial feed mixture. Microbial activity measured as dehydrogenase activity increased up to 75 days and decreased on further incubation. Total P was higher in the final product than the initial feed mixture. Total heavy metal contents were lower in the final product than initial feed mixture. Solid textile mill sludge can be potentially useful as raw substrate in vermicomposting if mixed with up to 30% cow dung (on dry weight basis). The growth and cocoon production of the worm species in different feed mixtures were also investigated.