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Kinds of Record Data Selected AbstractsA comparison of patients with intellectual disability receiving specialised and general services in Ontario's psychiatric hospitalsJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 11 2008Y. Lunsky Abstract Background Over the years, the closure of institutions has meant that individuals with intellectual disabilities (IDs) must access mainstream (i.e. general) mental health services. However, concern that general services may not adequately meet the needs of patients with ID and mental illness has led to the development and implementation of more specialised programmes. This study compares patients with ID receiving specialised services to patients with ID receiving general services in Ontario's tertiary mental healthcare system in terms of demographics, symptom profile, strengths and resources and clinical service needs. Method A secondary analysis of Colorado Client Assessment Record data collected from all tertiary psychiatric hospitals in the province was completed for all 371 inpatients with ID, from both specialised and general programmes. Results Inpatients in specialised programmes were more likely to have a diagnosis of mood disorder and were less likely to have a substance abuse or psychotic disorder. Individuals receiving specialised services had higher ratings of challenging behaviour than those in more general programmes. The two groups did not differ significantly in terms of recommended level of care, although more inpatients from specialised programmes were rated as requiring Level 4 care than inpatients from general programmes. Conclusions In Ontario, inpatients in specialised and general programmes have similar overall levels of need but unique clinical profiles that should be taken into consideration when designing interventions for them. [source] Combining Information from Cancer Registry and Medical Records Data to Improve Analyses of Adjuvant Cancer TherapiesBIOMETRICS, Issue 3 2009Yulei He Summary Cancer registry records contain valuable data on provision of adjuvant therapies for cancer patients. Previous studies, however, have shown that these therapies are underreported in registry systems. Hence direct use of the registry data may lead to invalid analysis results. We propose first to impute correct treatment status, borrowing information from an additional source such as medical records data collected in a validation sample, and then to analyze the multiply imputed data, as in Yucel and Zaslavsky (2005,,Journal of the American Statistical Association,100, 1123,1132). We extend their models to multiple therapies using multivariate probit models with random effects. Our model takes into account the associations among different therapies in both administration and probability of reporting, as well as the multilevel structure (patients clustered within hospitals) of registry data. We use Gibbs sampling to estimate model parameters and impute treatment status. The proposed methodology is applied to the data from the Quality of Cancer Care project, in which stage II or III colorectal cancer patients were eligible to receive adjuvant chemotherapy and radiation therapy. [source] Prenatal drug use and the production of infant healthHEALTH ECONOMICS, Issue 4 2007Kelly Noonan Abstract We estimate the effect of illicit drug use during pregnancy on two measures of poor infant health: low birth weight and abnormal infant health conditions. We use data from a national longitudinal study of urban parents that includes postpartum interviews with mothers, hospital medical record data on the mothers and their newborns, and information about the neighborhood in which the mother resides. We address the potential endogeneity of prenatal drug use. Depending on how prenatal drug use is measured, we find that it increases low birth weight by 4,6 percentage points and that it increases the likelihood of an abnormal infant health condition by 7,12 percentage points. Copyright © 2006 John Wiley & Sons, Ltd. [source] Measuring the Quality of Diabetes Care Using Administrative Data: Is There Bias?HEALTH SERVICES RESEARCH, Issue 6p1 2003Nancy L. Keating Objectives. Health care organizations often measure processes of care using only administrative data. We assessed whether measuring processes of diabetes care using administrative data without medical record data is likely to underdetect compliance with accepted standards for certain groups of patients. Data Sources/Study Setting. Assessment of quality indicators during 1998 using administrative and medical records data for a cohort of 1,335 diabetic patients enrolled in three Minnesota health plans. Study Design. Cross-sectional retrospective study assessing hemoglobin A1c testing, LDL cholesterol testing, and retinopathy screening from the two data sources. Analyses examined whether patient or clinic characteristics were associated with underdetection of quality indicators when administrative data were not supplemented with medical record data. Data Collection/Extraction Methods. The health plans provided administrative data, and trained abstractors collected medical records data. Principal Findings. Quality indicators that would be identified if administrative data were supplemented with medical records data are often not identified using administrative data alone. In adjusted analyses, older patients were more likely to have hemoglobin A1c testing underdetected in administrative data (compared to patients <45 years, OR 2.95, 95 percent CI 1.09 to 7.96 for patients 65 to 74 years, and OR 4.20, 95 percent CI 1.81 to 9.77 for patients 75 years and older). Black patients were more likely than white patients to have retinopathy screening underdetected using administrative data (2.57, 95 percent CI 1.16 to 5.70). Patients in different health plans also differed in the likelihood of having quality indicators underdetected. Conclusions. Diabetes quality indicators may be underdetected more frequently for elderly and black patients and the physicians, clinics, and plans who care for such patients when quality measurement is based on administrative data alone. This suggests that providers who care for such patients may be disproportionately affected by public release of such data or by its use in determining the magnitude of financial incentives. [source] Development and Validation of Quality Indicators for Dementia Diagnosis and Management in a Primary Care SettingJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2010Marieke Perry MD OBJECTIVES: To construct a set of quality indicators (QIs) for dementia diagnosis and management in a primary care setting. DESIGN: RAND modified Delphi method, including a postal survey, a stakeholders consensus meeting, a scientific expert consensus meeting, and a demonstration project. SETTING: Primary care. PARTICIPANTS: General practitioners (GPs), primary care nurses (PCNs), and informal caregivers (ICs) in postal survey and stakeholders consensus meeting. Eight national dementia experts in scientific consensus meeting. Thirteen GPs in the demonstration project. MEASUREMENTS: Mean face validity and feasibility scores. Compliance rates using GPs' electronic medical record data. RESULTS: The initial set consisted of 31 QIs. Most indicators showed moderate or good face validity and feasibility scores. Consensus panels reduced the preliminary set used in the demonstration project to 24 QIs. The overall compliance to the QIs was 45.3%. Discriminative validity of the set was good; significant differences in adherence were found between GPs with high and low levels of patients aged 65 and older in their practice, with and without PCNs, and with positive and negative attitudes toward dementia (all P<.05). Based on the demonstration project, one QI was excluded. The final set consisted of 23 QIs; 15 QIs contained innovative quality criteria on collaboration between GPs and PCNs, referral criteria, and assessment of caregivers' needs. CONCLUSION: This new set of dementia QIs is feasible, reliable, and valid and can be used to improve primary dementia care. Because of the innovative quality criteria, the set is complementary to the existing dementia QIs. [source] Comparisons of Self-Reported and Chart-Identified Chronic Diseases in Inner-City SeniorsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2009John Leikauf BA OBJECTIVES: To examine agreement between self-report of chronic disease and medical record data for inner-city seniors, their sensitivity and specificity, and the association between patient characteristics and accuracy of self-reports. DESIGN: Cross-sectional analysis. SETTING: Two hospital-based primary care practices serving a low-income inner-city population. PARTICIPANTS: Adults aged 65 and older (n=323). MEASURES: Data on self-reported asthma, depression, diabetes mellitus, and hypertension were collected through interviewer-administered surveys (in English and Spanish) and chart abstraction. Chart-based disease was defined in two ways: physician documentation and physician documentation plus use of a medication to treat that condition. Sensitivity, specificity, and agreement were calculated. Univariate and multivariable regression analyses were used to determine the associations between patient characteristics and patient,chart agreement. RESULTS: Agreement between self-report and chart data was high for diabetes mellitus (kappa=0.94) intermediate for asthma (kappa=0.66), and hypertension (kappa=0.54) and low for depression (kappa=0.4). Sensitivity and specificity were high for diabetes mellitus (0.99 and 0.96, respectively) and low for depression (0.74 and 0.72, respectively). Specificity for hypertension was lowest (0.67). Age, education, health literacy, and other patient characteristics did not have clear associations across conditions. CONCLUSION: Self-reports may be most reliable for diabetes mellitus and least reliable for depression for surveys involving older, inner-city adults. Survey research with older adults should include confirmatory data when assessing presence of depression, hypertension, and asthma. [source] Evaluation of the Personal Dental Services (Wave 1) for Lambeth, Southwark and Lewisham Primary Care Trusts , Part 2: Retrospective analyses of treatment and other dental record dataJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2005Helen Best BDS MDS PhD Abstract Aim/Objective, The purpose of the study was to undertake analyses of treatment data for the Personal Dental Services (PDS) of Lambeth, Southwark and Lewisham Primary Care Trusts and relate the analyses to the PDS goals of supporting practitioners deliver appropriate quality dental care and ensuring that appropriate quality safety net services are available for all residents. Method, Analyses of treatment data provided by the Dental Practice Board were undertaken for the post-PDS period (February 1999,March 2003, based on data availability). Analyses of the clinic notes for 1500 patients were also undertaken for the 1 year pre-PDS period (October 1997,September 1998) and post-introduction of the PDS (October 1998,June 2003). Two sets of analyses were undertaken to evaluate trends in treatment claims for the Dental Practice Board data, absolute numbers of each type of treatment claimed each month and change in numbers of types of treatments claimed over time. The clinic notes were used to undertake post-PDS, pre-PDS comparisons of the number of treatment items and grouped treatment item categories undertaken and the number of courses and percentages of private treatment items provided. The following sociodemographic characteristics of the patients were also analysed, age, gender, exemption ,status ,and ,attendance ,status. Results, Overall it was identified that the percentage reduction in the number of treatment items undertaken was 13% (95% CI ,19%, ,7%), post- as compared to the pre-PDS introduction period. On an annual basis it was identified that the percentage reduction in the number of treatment items undertaken per year per patient post-PDS was 4% (95% CI ,6%, ,2%). There were significant variations in the impact of the PDS on the number of treatment items undertaken for different types of patients. A limited number of treatment types changed significantly post- as compared to pre-PDS. The proportion of exempt patients treated did not increase ,post-PDS. Conclusions, It is possible that a less, invasive style of dental treatment was provided during the course of the PDS, however, there was only limited evidence to indicate that dentists practice style changed based on types of treatment categories provided. The PDS provided a limited safety net service for local residents. In setting program goals the nature of quality dental practice requires definition and evaluation should be undertaken on a prospective basis. [source] Quality of Care for Acute Myocardial Infarction in Elderly Patients with Alcohol-Related DiagnosesALCOHOLISM, Issue 1 2006David A. Fiellin Background: Elderly adults with alcohol-related diagnoses represent a vulnerable population that may receive lower quality of treatment during hospitalization for acute myocardial infarction. We sought to determine whether elderly patients with alcohol-related diagnoses are less likely to receive standard indicators of quality care for acute myocardial infarction. Methods: We conducted a retrospective cohort analysis using administrative and medical record data from the Cooperative Cardiovascular Project. Subjects were Medicare beneficiaries with a confirmed principal discharge diagnosis of acute myocardial infarction from all acute care hospitals in the United States over an 8-month period. Our primary outcome was the receipt of 7 guideline-recommended care measures among all eligible patients and patients who were ideal candidates for a given measure. Results: In all, 1,284 (1%) of the 155,026 eligible patients met criteria for an alcohol-related diagnosis. Among the alcohol-related diagnoses, 1,077/1,284 (84%) were for the diagnoses of alcohol dependence or alcohol abuse. Patients with alcohol-related diagnoses were less likely than those without alcohol-related diagnoses to receive ,-blockers at the time of discharge (55% vs. 60%, p=0.02). We found no other significant differences in performance of the quality indicators after stratifying by indication and adjustment for baseline characteristics. Conclusions: Alcohol-related diagnoses are not a barrier to receiving most quality of care measures in elderly patients hospitalized for acute myocardial infarction. [source] Neighbourhood deprivation and small-for-gestational-age term births in the United StatesPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 1 2009Irma T. Elo Summary Residential context has received increased attention as a possible contributing factor to race/ethnic and socio-economic disparities in birth outcomes in the United States. Utilising vital statistics birth record data, this study examined the association between neighbourhood deprivation and the risk of a term small-for-gestational-age (SGA) birth among non-Hispanic whites and non-Hispanic blacks in eight geographical areas. An SGA birth was defined as a newborn weighing <10th percentile of the sex- and parity-specific birthweight distribution for a given gestational week. Multi-level random intercept logistic regression models were employed and statistical tests were performed to examine whether the association between neighbourhood deprivation and SGA varied by race/ethnicity and study site. The risk of term SGA was higher among non-Hispanic blacks (range 10.8,17.5%) than non-Hispanic whites (range 5.1,9.2%) in all areas and it was higher in cities than in suburban locations. In all areas, non-Hispanic blacks lived in more deprived neighbourhoods than non-Hispanic whites. However, the adjusted associations between neighbourhood deprivation and term SGA did not vary significantly by race/ethnicity or study site. The summary fully adjusted pooled odds ratios, indicating the effect of one standard deviation increase in the deprivation score, were 1.15 [95% CI 1.08, 1.22] for non-Hispanic whites and 1.09 [95% CI 1.05, 1.14] for non-Hispanic blacks. Thus, neighbourhood deprivation was weakly associated with term SGA among both non-Hispanic whites and non-Hispanic blacks. [source] Estimates of Pregnancies Averted Through California's Family Planning Waiver Program in 2002PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH, Issue 3 2006Diana Greene Foster CONTEXT: During its first year of operation (1997-1998), California's family planning program, Family PACT, helped more than 750,000 clients to avert an estimated 108,000 pregnancies. Given subsequent increases in the numbers of clients served and contraceptive methods offered by the program, updated estimates of its impact on fertility are needed. METHODS: Claims data on contraceptives dispensed were used to estimate the number of pregnancies experienced by women in the program in 2002. Medical record data on methods used prior to enrollment were used to predict client fertility in the absence of the program. Further analyses examined the sensitivity of these estimates to alternative assumptions about contraceptive failure rates, contraceptive continuation and contraceptive use in the absence of program services. RESULTS: Almost 6.4 million woman-months of contraception, provided primarily by oral contraceptives (57%), barrier methods (19%) and the injectable (18%), were dispensed through Family PACT during 2002. As a result, an estimated 205,000 pregnancies,which would have resulted in 79,000 abortions and 94,000 births, including 21,400 births to adolescents,were averted. Changing the base assumptions regarding contraceptive failure rates or method use had relatively small effects on the estimates, whereas assuming that clients would use no contraceptives in the absence of Family PACT nearly tripled the estimate of pregnancies averted. CONCLUSIONS: Because all contraceptive methods substantially reduce the risk of pregnancy, Family PACT'S impact on preventing pregnancy lies primarily in providing contraceptives to women who would otherwise not use any method. [source] A Comparison of Income and Expenditure Inequality Estimates: The Australian Evidence, 1975,76 to 1993,94THE AUSTRALIAN ECONOMIC REVIEW, Issue 4 2000Paul Blacklow Using Australian unit record data this paper compares income and expenditure inequalities over the period 1975,76 to 1993,94. The study finds inconsistencies between the two inequality movements over much of this period. We also observe differences in the nature of income and consumption disparities. Both approaches show that the ,within group' inequality dominates the ,between group' component when the population is divided into household types. The inequality estimates are sensitive to the equivalence scale used as the household size deflator but not to the cost of living index used as the price deflator. [source] Australian House Prices: A Comparison of Hedonic and Repeat-Sales Measures,THE ECONOMIC RECORD, Issue 269 2009JAMES HANSEN House prices are difficult to measure due to changes in the composition of properties sold through time and changes in the quality of housing. I explore whether these issues affect simple measures of house prices, and whether regression-based measures provide an accurate alternative to measuring pure house price changes in Australia. Using unit record data for Australia's three largest cities, regression-based approaches provide a more accurate estimate of pure price changes than a median, and are comparable, with around half of the variation in prices growth explained. These results confirm that regression-based measures are useful for measuring house price changes in Australia. [source] Some Ethnic Dimensions of Income Distribution from Pre- to Post-reform New Zealand, 1984,1998*THE ECONOMIC RECORD, Issue 262 2007SRIKANTA CHATTERJEE Based on unit record data from four household surveys conducted by Statistics New Zealand for the years 1983/1984, 1991/1992, 1995/1996 and 1997/1998, this paper addresses some ethnic dimensions of income inequality among New Zealanders over the period of the surveys. It applies alternative techniques of decomposition of the Gini coefficient of inequality by subgroups of population. It then analyses how changes in the incomes of specific population subgroups affect the overall inequality. The results help quantify the economic distances among the different ethnic populations of New Zealand, and indicate how and why these distances have been changing over time. [source] Characteristics of non-fatal opioid overdoses attended by ambulance services in AustraliaAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 6 2004Paul Dietze Objective: To examine the feasibility of establishing a database on non-fatal opioid overdose in order to examine patterns and characteristics of these overdoses across Australia. Methods: Unit record data on opioid overdose attended by ambulances were obtained from ambulance services in the five mainland States of Australia for available periods, along with information or case definition and opioid overdose management within these jurisdictions. Variables common across States were examined including the age and sex of cases attended, the time of day and day of week of the attendance, and the transportation outcome (whether the victim was left at the scene or transported to hospital). Results: The monthly rate of non-fatal opioid overdose attended by ambulance was generally highest in Victoria (Melbourne) followed by NSW, with the rates substantially lower in the remaining States over the period January 1999 to February 2001. Non-fatal opioid overdose victims were most likely to be male in all States, with the proportion of males highes in Victoria (77%), and were aged around 28 years with ages lowest in Western Australia (m=26) and highest in NSW (m=30). Most of the attendances occurred in the afternoon/early evening and towards the later days of the working week in all States. The rates of transportation varied according to ambulance service practice across the States with around 94% of cases transported in Western Australia and around 18% and 29% of cases transported in Melbourne and NSW respectively. Conclusions: It is feasible to establish a database of comparable data on non-fatal opioid overdoses attended by ambulances in Australia. This compilation represents a useful adjunct to existing surveillance systems on heroin (and other opioid) use and related harms. [source] Juvenile sex offenders and institutional misconduct: the role of thought psychopathologyCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 5 2008Matt Delisi Background,Little is known about the institutional behaviour of incarcerated sex offenders. Aim,To study the relationships between juvenile sex offending, thought psychopathology and institutional misconduct. Method,We applied negative binomial regression and Area Under Curve Receiver Operating Characteristic (AUC-ROC) analyses to self-report and records data from institutionalised delinquents (N = 813) committed to the California Youth Authority to explore the links between sex offending and institutional misconduct, controlling for offender demographics, institution, index offence, and self-reported and official criminal history. Results,Juvenile sex offending was associated with six forms of institutional misconduct (sexual, general and total misconduct as reviewed by parole board) over 12 and 24 months prior to rating. Two measures of thought psychopathology, which were related to psychosis-like thought, were significantly associated with juvenile sex offender status. These constructs did not, however, mediate the independent predictive effects of adolescent sex offending on institutional misconduct. Conclusion,Interventions to help incarcerated young offenders are likely to be particularly important for those with a sex offending history as they are otherwise likely to persist with antisocial behaviours of all kinds within and beyond the institution. Attention to their thought processes may be particularly useful. Copyright © 2008 John Wiley & Sons, Ltd. [source] Measuring the Quality of Diabetes Care Using Administrative Data: Is There Bias?HEALTH SERVICES RESEARCH, Issue 6p1 2003Nancy L. Keating Objectives. Health care organizations often measure processes of care using only administrative data. We assessed whether measuring processes of diabetes care using administrative data without medical record data is likely to underdetect compliance with accepted standards for certain groups of patients. Data Sources/Study Setting. Assessment of quality indicators during 1998 using administrative and medical records data for a cohort of 1,335 diabetic patients enrolled in three Minnesota health plans. Study Design. Cross-sectional retrospective study assessing hemoglobin A1c testing, LDL cholesterol testing, and retinopathy screening from the two data sources. Analyses examined whether patient or clinic characteristics were associated with underdetection of quality indicators when administrative data were not supplemented with medical record data. Data Collection/Extraction Methods. The health plans provided administrative data, and trained abstractors collected medical records data. Principal Findings. Quality indicators that would be identified if administrative data were supplemented with medical records data are often not identified using administrative data alone. In adjusted analyses, older patients were more likely to have hemoglobin A1c testing underdetected in administrative data (compared to patients <45 years, OR 2.95, 95 percent CI 1.09 to 7.96 for patients 65 to 74 years, and OR 4.20, 95 percent CI 1.81 to 9.77 for patients 75 years and older). Black patients were more likely than white patients to have retinopathy screening underdetected using administrative data (2.57, 95 percent CI 1.16 to 5.70). Patients in different health plans also differed in the likelihood of having quality indicators underdetected. Conclusions. Diabetes quality indicators may be underdetected more frequently for elderly and black patients and the physicians, clinics, and plans who care for such patients when quality measurement is based on administrative data alone. This suggests that providers who care for such patients may be disproportionately affected by public release of such data or by its use in determining the magnitude of financial incentives. [source] Combining Information from Cancer Registry and Medical Records Data to Improve Analyses of Adjuvant Cancer TherapiesBIOMETRICS, Issue 3 2009Yulei He Summary Cancer registry records contain valuable data on provision of adjuvant therapies for cancer patients. Previous studies, however, have shown that these therapies are underreported in registry systems. Hence direct use of the registry data may lead to invalid analysis results. We propose first to impute correct treatment status, borrowing information from an additional source such as medical records data collected in a validation sample, and then to analyze the multiply imputed data, as in Yucel and Zaslavsky (2005,,Journal of the American Statistical Association,100, 1123,1132). We extend their models to multiple therapies using multivariate probit models with random effects. Our model takes into account the associations among different therapies in both administration and probability of reporting, as well as the multilevel structure (patients clustered within hospitals) of registry data. We use Gibbs sampling to estimate model parameters and impute treatment status. The proposed methodology is applied to the data from the Quality of Cancer Care project, in which stage II or III colorectal cancer patients were eligible to receive adjuvant chemotherapy and radiation therapy. [source] | |||||||||||||