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At least 181 records · Page 10Linked to original sources

A comprehensive clinical database for mental health care in England.

BACKGROUND: Monitoring and researching clinical care calls for comprehensive clinical databases. In mental health care these need to cover all aspects of the care of each patient and to accommodate the complexity of care which may last from weeks to years. This paper describes the pilot work for a mental health clinical database intended to be implemented throughout the English National Health Service. METHODS: In collaboration with three pilot sites, a set of data extracts was defined which could reasonably easily be produced, mostly using existing statistical data collection systems. Software was designed to integrate these extracts into patient-based records describing overall spells of mental health care. These data were extracted from their systems for a 6-month pilot period. RESULTS: Two of the three sites produced data sets, which appeared to give a reasonably complete account of the work undertaken in the pilot period. Known differences in service design and clinical perspective between the two sites were clearly reflected. CONCLUSIONS: The approach to extracting and collating the data is workable within existing resources and produces illuminating data for clinical audit, management and planning. Completeness and accuracy of data is likely to be a continuing problem, as for any routine data capture exercise. However, the process of integrating data from several channels assists this, as inconsistencies become apparent and can be tackled. The approach is now being implemented throughout England.

Adolescent↗

Improving patient identification data on the Patient Master Index.

A unique health identification number may be heralded as the solution to unique patient identification within the Australian health care sector; however, there is scope for individual health care facilities to improve the data integrity of their Patient Master Index (PMI) to improve patient identification at a local level.

Australia↗

Evaluating the impact of modeling choices on the performance of integrated genetic and clinical models.

The value of genetic information for improving the performance of clinical risk prediction models has yielded variable conclusions. Many methodological decisions have the potential to contribute to differential results across studies. Here, we performed multiple modeling experiments integrating clinical and demographic data from electronic health records (EHR) and genetic data to understand which decision points may affect performance. Clinical data in the form of structured diagnostic codes, medications, procedural codes, and demographics were extracted from two large independent health systems and polygenic risk scores (PRS) were generated across all patients with genetic data in the corresponding biobanks. Crohn's disease was used as the model phenotype based on its substantial genetic component, established EHR-based definition, and sufficient prevalence for model training and testing. We investigated the impact of PRS integration method, as well as choices regarding training sample, model complexity, and performance metrics. Overall, our results show that including PRS resulted in higher performance by some metrics but the gain in performance was only robust when combined with demographic data alone. Improvements were inconsistent or negligible after including additional clinical information. The impact of genetic information on performance also varied by PRS integration method, with a small improvement in some cases from combining PRS with the output of a clinical model (late-fusion) compared to its inclusion an additional feature (early-fusion). The effects of other modeling decisions varied between institutions though performance increased with more compute-intensive models such as random forest. This work highlights the importance of considering methodological decision points in interpreting the impact on prediction performance when including PRS information in clinical models.

Preprint↗

Romanian perspective on health reporting.

Since 1990 the Romanian healthcare system has been crossing a stage of dramatic change. The healthcare reform, which is in progress, has structural, organizational and functional implications at the country level. The Ministry of Health is now preparing for the big IT changes. A Healthcare Management Information System (HMIS) will assure in the very next future automate data collection on health status of the population and on resource allocation and consumption. It is not an easy way towards the use of the Data Warehouse concept and On Line Analytical Processing technology for creating and accessing the data repository. Therefore we decided to integrate existing applications related to health system indicators until the HMIS will assure a high performance analysis and data interpretation.

Data Interpretation, Statistical↗

The epidemiological information system.

Increasing demand for health care services coupled with limited resources require that services should be planned and delivered on the basis of a priority of needs. The Eastern Health Board is developing an Epidemiological Information System in order to measure such needs. The system will bring together computerized health data from diverse sources into an integrated information system and powerful software will be used to analyse and map the data on a small area basis. Pilot work suggests that this approach can be useful in identifying areas of greater need.

Catchment Area, Health↗

The geographical distribution of diagnostic medical and dental X-ray services in South Africa

AIM: The aim of this study was threefold, viz.: (i) to evaluate the availability and accessiblity of medical and dental X-ray services in South Africa; (ii) to evaluate geographical information systems (GIS) as a tool for management of health care technologies; and (iii) to guide policy and develop a process to provide optimal utilisation of X-ray services in South Africa. METHODS: Information supplied by the Department of Health on licensed X-ray equipment was integrated with census data and processed with GIS. Four key areas were assessed, viz. distribution, accessibility, age and availability of X-ray services in South Africa. RESULTS: The analysis shows a vast inequity in the distribution of X-ray services on a provincial as well as a district level, although on the national level the distribution of X-ray services meets the World health Organisation criteria. CONCLUSION: GIS is a useful tool in evaluating and planning of essential health services/techniques. However, care must be taken in interpreting the data on a macro level, as this masks vast inequities on the district level. RECOMMENDATIONS: The indicators of coverage should be expanded, similar reports should be prepared for the nine provinces, and these data should be integrated into the clinic planning programme. Radiological services should be added to and managed as part of an essential district health care technology package.

Journal Article↗

Measuring health and economic status of older adults in developing countries.

Aging and health care are the emerging policy issues in the Third World. However, we currently do not have the data to address these issues because economic status and health have not been integrated into a single survey design. This article discusses the rationale for the principal features of an emerging new international survey design which includes integration of younger and older families; reliance on retrospective data; intensive measurement of economic status, health outcomes and utilization and intergenerational transfers; and the combination of a household and community survey.

Aged↗

Integrated health care management through comprehensive information systems.

The true impact of a company's benefit strategy can be known only when relevant indicators can be adequately tracked, evaluated and brought together. An unparalleled opportunity exists to creatively apply computer technologies to address decision makers' needs for integrated health care information.

Data Collection↗

Integrating heterogeneous pieces of evidence in systematic reviews.

Researchers preparing systematic reviews often encounter various types of evidence, which can generally be categorized as direct or indirect. The former directly relates an exposure, diagnostic strategy, or therapeutic intervention to the occurrence of a principal health outcome. Evidence is indirect if two or more bodies of evidence are required to relate the exposure, diagnostic strategy, or intervention to the principal health outcome. Heterogeneity of data sources complicates integration of both direct and indirect evidence. Participants in different studies may have a wide spectrum of baseline risk and sociodemographic and cultural characteristics. A variety of formulations and intensities of exposures, diagnostic strategies, and interventions, as well as diversity in the selection and definition of control groups, may be encountered. Outcome measures may be different, and similar outcomes may be measured or reported differently. Heterogeneity of study designs and of methodologic features and quality within a given design may be found. The effective integration of direct and indirect evidence requires development of explicit models that serve as analytic frameworks for linking the important pieces of evidence. A model can be viewed as a series of subquestions, with each important subquestion warranting a systematic review. Several subjective and quantitative methods can then be used to integrate the evidence. Tabular displays of major findings and strength of evidence for each subquestion can help reviewers, patients, and providers to integrate the differing research findings and draw reasonable conclusions. Various quantitative techniques, such as decision analysis and the confidence profile method, are also available. No single integration approach is clearly superior, none obviates uncertainty, and all underscore the role of careful judgment in integrating evidence.

Evidence-Based Medicine↗

Advances in health information technology for patients.

Patients now have access to a wide variety of health-related educational material via computers and other sources. To ensure quality, security, and data integrity, it is likely that these databases of patient health information will become part of the information that HIM professionals manage and coordinate for patient use in the clinical setting. This article describes the health information resources available to patients.

Advance Directives↗

Telematics and smart cards in integrated health information system.

Telematics and information technology are the base on which it will be possible to build an integrated health information system to support population and improve their quality of life. This system should be based on record linkage of all data based on the interactions of the patients with the health structures, such as general practitioners, specialists, health institutes and hospitals, pharmacies, etc. The record linkage can provide the connection and integration of various records, thanks to the use of telematic technology (either urban or geographical local networks, such as the Internet) and electronic data cards. Particular emphasis should be placed on the introduction of smart cards, such as portable health cards, which will contain a standardized data set and will be sufficient to access different databases found in various health services. The inter-operability of the social-health records (including multimedia types) and the smart cards (which are one of the most important prerequisites for the homogenization and wide diffusion of these cards at an European level) should be strongly taken into consideration. In this framework a project is going to be developed aiming towards the integration of various data bases distributed territorially, from the reading of the software and the updating of the smart cards to the complete management of the patients' evaluation records, to the quality of the services offered and to the health planning. The applications developed will support epidemiological investigation software and data analysis. The inter-connection of all the databases of the various structures involved will take place through a coordination center, the most important system of which we will call "record linkage" or "integrated database". Smart cards will be distributed to a sample group of possible users and the necessary smart card management tools will be installed in all the structures involved. All the final users (the patients) in the whole network of services involved will be monitored for the duration of the project. The system users will also include general practitioners, social workers, physicians, health operators, pharmacists, laboratory workers and administrative personnel of the municipality and of the health structures concerned.

Aged↗

The Biobank Rare Variant consortium powers the discovery of rare genetic associations through global collaboration.

Rare coding variants can have large effects on disease risk and provide direct routes from human genetics to disease mechanisms and therapeutic targets, but their discovery is constrained by sample size, particularly for low-prevalence diseases. Here we establish the Biobank Rare Variant Analysis (BRaVa) consortium, a global rare variant association resource that integrates sequencing and linked health-record data from ten biobanks and cohorts comprising over 1.2 million individuals across diverse ancestries. We performed gene-based meta-analyses of rare coding variation across 33 clinical endpoints and 11 quantitative traits. Aggregating evidence across biobanks and ancestries identified 514 gene-trait associations, including 31 not previously reported in prior studies or curated association resources following systematic literature review. Notably, 36.1% of gene-level associations were undetectable in any individual biobank, and 91 emerged only through cross-ancestry meta-analysis, demonstrating that federated integration enables discovery beyond the reach of single cohorts. Similar gains were observed at the variant level, where 25.0% of phenotype-locus associations were detectable only through meta-analysis. Effect size estimates were correlated across ancestries with concordant directions of effect, supporting the generalizability of rare variant associations. The identified signals implicate pathways involved in transcriptional and epigenetic regulation, metabolism, vascular and epithelial biology, and immune function, highlighting rare coding variation as an engine for biological discovery across medical record phenotypes. For example, damaging variation in ANKRD12 implicates inflammatory transcriptional dysregulation in asthma and chronic obstructive pulmonary disease, and ultra-rare predicted loss-of-function variants in NAA15 link protein acetylation processes to type 2 diabetes risk. BRaVa establishes a scalable framework and freely available community resource for rare variant meta-analysis across global biobanks. Public release of gene- and variant-level association summary statistics provides a reference map of rare coding variant associations to support disease gene discovery, biological interpretation, and therapeutic target prioritization as sequencing-linked health-record resources continue to expand.

Journal Article↗

Sorting out the Baby Bells' strategies.

After months of uncertainty, the seven regional Bell operating companies have divided into two camps: those that provide only the infrastructure for health care networks, and those that offer infrastructure along with other networking features, such as systems integration and central data repositories. In their quest for health care market share, the Bells face a number of obstacles. For example, they can't provide long-distance service, and they face restrictive rate regulations. In addition, increased interest in cable TV and wireless communication ventures has led some of the Bells to downsize their health care ambitions.

Computer Communication Networks↗

Integrated outcomes: where CIOs need to be thinking.

Financial data have been the mainstay in health care organization business decision making. CIOs can lead efforts to add clinical and satisfaction data and create more customer-focused integrated outcomes systems.

Data Collection↗