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PubMed1997

Using case management systems to integrate clinical and financial data.

Integrated delivery systems can use automated case management information systems to better manage relevant clinical and financial data across the continuum of care. Effective case management systems can help caregivers track clinical and financial information; match appropriate resources to patient needs; and analyze populations to identify risk, enhance adherence to clinical guidelines, and understand provider treatment profiles.

Case Management↗
PubMed1999

[Delivery logbook: pertinence of the collected data for scientific exploitation].

OBJECTIVES: To determine if the data recorded in the delivery logbook are relevant and complete compared to the data registered in the patient's medical chart. MATERIAL AND METHODS: Prospective study during one month recording all the data registered by the midwives or the medical doctors in the delivery room immediately after the birth. To compare them to the information collected in the patient's medical chart. Our delivery logbook has 55 headings for each patient. During October 1998, we had 156 births. RESULTS: We had 5.3% of errors divided by missing data and erroneous entries. More precisely, we recorded 9.5% of errors in the antepartum data, 3.2% in intrapartum or postpartum events and 5.8% in the newborn information. CONCLUSION: This study demonstrates that medical data used for scientific projects and recorded in the delivery logbook, have to be interpreted very cautiously. It seems to be reasonable that each obstetrical unit should standardize its registration of data and carry out internal audits.

Bias↗
PubMed1992

Administrative costs in selected industrialized countries.

The costs of health administration are compared across several countries, accompanied by discussion of some of the variations in the definition of health administration. The influence of American health accounting on other countries is examined, and findings are presented regarding the relative costs of insurance-based and direct-delivery systems. Data are presented on health administrative spending providing gross as well as per capita measures.

Accounting↗
PubMed2000

[Large fetus--a retrospective study].

BACKGROUND: Large foetus is associated with increased risk of complications during labour and delivery. MATERIAL AND METHODS: Data on deliveries and outcome of 504 macrosomic newborns (> or = 4,500 g) born 1995-97 at Rogaland Central Hospital, Norway. RESULTS: 74% of the mothers were multiparae. Mean weight increase during pregnancy was 17.6 kg. In 76% of the pregnancies delivery occurred after term. There were large margins of error both in terms of measurement of fundal height and after estimation with ultrasound. 12% of the newborns had shoulder dystocia. Six children were diagnosed with a brachial plexus injury; three injuries were still present three months after birth. Induction of labour did not increase the Apgar score or diminish the frequency of shoulder dystocia, but it did increase the frequency of operative deliveries and transfer to the neonatal unit. INTERPRETATION: The study confirms that large foetus is associated with risk of complications.

Birth Injuries↗
PubMed2002

Using administrative data to identify indications for elective primary cesarean delivery.

OBJECTIVE: To develop a methodology to identify indications and normative rates for elective primary cesarean delivery using administrative data. DATA SOURCES/STUDY SETTING: All delivery discharges in 1995, as reported to the California Office of Statewide Health Planning and Development (secondary data). STUDY DESIGN: Retrospective population based study. DATA COLLECTION/EXTRACTION: Data were entered into a recursive partitioning algorithm to develop a hierarchy of conditions by which patients with multiple conditions could be sorted with respect to the binary outcome of labor or elective primary cesarean without labor. This hierarchy was examined for its clinical consistency, validated on a second sample, and compared with results obtained from logistic regression. PRINCIPAL FINDINGS: Four percent (19,664) of delivery discharges in 1995 underwent elective primary cesarean. Twelve clinical conditions contributed to the hierarchy, and accounted for 92.9 percent of all women experiencing elective primary cesarean delivery. The remaining 7.1 percent of the elective primary cesarean cases were classified as "unspecified." CONCLUSIONS: A standardized methodology (utilizing recursive partitioning algorithms) for assigning indications for elective primary cesarean is presented. This methodology relies on administrative data, classifies women with complex comorbidity patterns into clinically relevant subpopulations, and can be used to establish normative rates for benchmarking specific indications for cesarean delivery.

Algorithms↗
PubMed1996

[Quality of prenatal data in the Hessian Perinatal Registry. A comparison with data from maternal health record and results of a pregnancy survey].

In the Federal State of Hesse, Germany, pregnancy and delivery related data are collected in a central perinatal registry called "Hessische Perinatalerhebung" (HEPE) since 1981, the objective being to enforce quality assurance and to contribute to a reduction in perinatal mortality and morbidity. The delivery unit compiles these data based on the antenatal record called "Mother Passport" and the actual delivery. In order to check on the quality of data, information on risk factors obtained from the perinatal register was compared to information from antenatal records and from a questionnaire administered to pregnant women prior to delivery. The study population comprised 1978 women who delivered at the maternity unit of the Municipal Hospital of Wiesbaden, the Dr. Horst Schmidt Kliniken, in 1990 and 1991. Comparison of the three data sources revealed substantial differences: Almost all risk factors were most frequently mentioned by the mothers themselves, less by the antenatal record and even less by the perinatal register. These differences were less pronounced for data on previous pregnancies and pre-existing disease and on abnormal positioning. Considerable differences were found in relation to pregnancy induced hypertension, intra-uterine growth retardation, incapacity of the cervix, preterm labour and bleeding. Risk factors related to the social environment and personal habits like psycho-social stress and smoking were found to be extremely under-reported in the antenatal records as well as in the perinatal register. The following factors could be identified as major reasons for the different risk profiles obtained from the various data sources: [1] Data loss through the transfer of data from the antenatal record to the record form of the perinatal register or to the computer, [2] selective recording of those risk factors considered by doctors to be particularly relevant, [3] missing definition of some risk factors and [4] recording of antenatal data for the perinatal register by the delivery unit after knowing the pregnancy outcome. Antenatal data in the perinatal register of Hessen are doubtful and should not be used uncritically for comparative studies and the assessment of relative risks. The extreme under-reporting of some risk factors may even lead to giving some interventions undue priority. In future, regular validity studies should become routine. A reduction of the data losses as well as a clear separation of antenatal data and delivery data could be achieved if antenatal data would be transferred from the doctor providing antenatal care direct to the perinatal register.

Data Collection↗
PubMed1985

Person-to-person communication in an applied research/service delivery setting.

Data from a national survey (n = 1666) of researchers, practitioners, and policymakers in the field of rural mental health services were used to conduct a sociometric analysis of person-to-person communication in the field. This article describes the structure of the person-to-person communication network in terms of its connectedness, centrality, homogeneity, and differentiation. Despite the diversity of survey respondents, and apparently meager interorganizational communication, communication in he field is similar, in many respects, to that observed in "invisible colleges." While the probability of two randomly chosen individuals being in contact is low (0.0008), over 70% were connected indirectly. The person-to-person communication network is also highly centralized and exhibits higher than expected communication among respondents in the same professional role, type of work organization, and geographical region. It does not appear to be highly differentiated with respect to topic, since the majority of information providers are contacted with respect to a number of topics.

Analysis of Variance↗
PubMed1978

A study of 204 consecutive deliveries in Abidjan--Anthropometric data of newborns, mothers and placentas.

Anthropometric measurements of newborns, mothers and placentas were taken in 204 consecutive deliveries at Adjamé Maternity Hospital in Abidjan. Aclinical assessment of gestational age was made. Low mean birthweight can be attributed to a higher incidence of pre-term newborns in the present sample. Incidence of small for gestational age and large for gestational age babies is similar to that found in developed countries. Detailed analysis of correlations between maternal, placental and neonatal variables show that birthweight is dependent on nutritional status of the mothers and on size of the placenta. Young primiparae are shown to become pregnant before reaching full growth. Their weight and weight for height are significantly lower than for multiparae. The main group at risk for impaired foetal growth, prematurity and low birthweight are the children born to primiparous mothers.

Adolescent↗
PubMed2006

The 30 minutes decision-to-delivery interval for 'urgent' caesarean sections: an elusive target.

The aim of this audit was to evaluate whether the '30 minute decision-to-delivery interval' for 'urgent' caesarean section has shown consistent improvement with repeated audit within this unit. The audit dataset comprised a random sample of all urgent caesarean sections carried out in 2004 classified as 'urgent', i.e. to be completed in 30 min. Nearly one-third of caesarean sections recorded on the delivery suite database as 'urgent' were incorrectly coded. A personal review of case notes was undertaken to ensure accurate data capture. Delivery suite data was analysed by post-hoc modelling of a 'normal' (Gaussian) distribution. The proportion of true 'urgent' caesarean sections completed in 30 min was 50% and some 90% of women were delivered within 40 min. The data were normally distributed, with non-random events, accounted for 25% of the variability. A model for 'urgent' caesarean section, accommodating random and non-random factors closely matched the audit data. We conclude that non-random, institutional, factors reflecting overall delivery suite activity adversely effect the decision-to-delivery interval regardless of the performance of personnel and processes within a delivery suite.

Anesthesia, Obstetrical↗
PubMed2002

Risk factors for severe perineal tear: can we do better?

Our aim was to investigate the risk factors associated with severe perineal tears defined as either third- or forth-degree tears and, ultimately, find strategies for prevention. We carried a retrospective analysis of a computerized perinatal database, collected prospectively, from a single county hospital between January 1, 1993 and June 30, 1998. Singleton vaginal vertex deliveries were analyzed for potential risk factors using univariate and multiple logistic regression analysis including all two-way interactions. Severe perineal tear occurred in 1905 (8.2%) of 23,244 vaginal deliveries. In the multiple logistic regression analysis, the following factors carried a significantly higher risk for severe laceration: midline episiotomy, primary vaginal delivery, use of pudendal block, forceps deliveries, and birth weight more than 4000 g. The study of interactions demonstrated that mediolateral episiotomy was associated with an increased risk for severe tear only during the first vaginal delivery, but not during a repeat vaginal delivery. Our data suggest that primary vaginal delivery, fetal weight above 4000 g, and the use of pudendal analgesia can help identify in advance patients at highest risk for severe perineal tear. During the delivery of these patients usage of vacuum (instead of forceps) and restricting the use of midline episiotomy might reduce the incidence of severe perineal tear. In cases where episiotomy seems crucial, the use of a mediolateral episiotomy may reduce the likelihood of severe perineal tear.

Adolescent↗
PubMed2006

Surveillance of cesarean section deliveries, New Jersey, 1999-2004.

BACKGROUND: Nationally and in New Jersey, the cesarean delivery rate has been increasing steadily for nearly a decade, and especially since 1999. The purpose of this study was to describe recent trends in cesarean section delivery in New Jersey. METHODS: Data on delivery method, medical indications and patient characteristics were extracted from electronic birth certificate files. RESULTS: Cesarean section deliveries increased as a proportion of live births by 6 percent annually. Growth was roughly uniform across Robson's clinical classification. Repeat cesareans contributed only proportionately to the overall trend. The greatest acceleration was observed for procedures without trial of labor, and in medical situations where cesarean delivery had been relatively rare. CONCLUSIONS: Medical indications recorded on the birth certificate explained little of the rapid growth in utilization of cesarean delivery, since trends were comparable in most categories we examined. A sustained autonomous shift in practice patterns, patient preferences, or both seems the most likely driver of the overall trend.

Adult↗
PubMed1997

ICS-II USA research design and methodology.

The purpose of the WHO-sponsored International Collaborative Study of Oral Health Outcomes (ICS-II) was to provide policy-markers and researchers with detailed, reliable, and valid data on the oral health situation in their countries or regions, together with comparative data from other dental care delivery systems. ICS-II used a cross-sectional design with no explicit control groups or experimental interventions. A standardized methodology was developed and tested for collecting and analyzing epidemiological, sociocultural, economic, and delivery system data. Respondent information was obtained by household interviews, and clinical examinations were conducted by calibrated oral epidemiologists. Discussed are the sampling design characteristics for the USA research locations, response rates, samples size for interview and oral examination data, weighting procedures, and statistical methods. SUDAAN was used to adjust variance calculations, since complex sampling designs were used.

Adult↗
PubMed2004

International comparison of performance measures for screening mammography: can it be done?

OBJECTIVE: Published screening mammography performance measures vary across countries. An inter-national study was undertaken to assess the comparability of two performance measures: the recall rate and positive predictive value (PPV). These measures were selected because they do not require identification of all cancers in the screening population, which is not always possible. SETTING: The screening mammography programs or data registries in 25 member countries of the International Breast Cancer Screening Network (IBSN). METHODS: In 1999 an assessment form was distributed to IBSN country representatives in order to obtain information on how screening mammography was performed and what specific data related to recall rates and PPV were collected. Participating countries were then asked to provide data to allow calculation of recall rates, PPV and cancer detection rates for screening mammography by age group for women screened in the period 1997-1999. RESULTS: Twenty-two countries completed the assessment form and 14 countries provided performance data. Differences in screening mammography delivery and data collection were evident. For most countries, recall rates were higher for initial than for subsequent mammograms. There was no consistent relationship of initial to subsequent PPV, although PPV generally decreased as the recall rate increased. Recall rates decreased with increasing age, while PPV increased as age increased. CONCLUSION: Similar patterns for mammography performance measures were evident across countries.However, the development of a more standardized approach to defining and collecting data would allow more valid international comparisons, with the potential to optimize mammography performance. At present, international comparisons of performance should be made with caution due to differences in defining and collecting mammography data.

Breast Neoplasms↗
PubMed2006

Application of data mining approaches to drug delivery.

Computational approaches play a key role in all areas of the pharmaceutical industry from data mining, experimental and clinical data capture to pharmacoeconomics and adverse events monitoring. They will likely continue to be indispensable assets along with a growing library of software applications. This is primarily due to the increasingly massive amount of biology, chemistry and clinical data, which is now entering the public domain mainly as a result of NIH and commercially funded projects. We are therefore in need of new methods for mining this mountain of data in order to enable new hypothesis generation. The computational approaches include, but are not limited to, database compilation, quantitative structure activity relationships (QSAR), pharmacophores, network visualization models, decision trees, machine learning algorithms and multidimensional data visualization software that could be used to improve drug delivery after mining public and/or proprietary data. We will discuss some areas of unmet needs in the area of data mining for drug delivery that can be addressed with new software tools or databases of relevance to future pharmaceutical projects.

Computer Simulation↗
PubMed1984

Using computer graphics to map origin-destination data describing health care delivery systems.

An interactive graphic computer program, called FLOWMAP, is used to examine the referral patterns of cancer patients in western Washington between 1974 and 1978. FLOWMAP allows one to produce several types of maps from origin-destination data easily and inexpensively. Several maps show some of the significant geographic components of the referral of more than 7000 cancer patients among 13 counties over a 5-year period. It is shown that cancer care has become more decentralized during this period. Nine other possible applications of FLOWMAP to issues of concern regarding the delivery of health care are described. Maps produced by FLOWMAP can be expected to cost 1/30 to 1/50 of the cost of comparable manual methods. An Appendix gives some technical detail regarding the use of FLOWMAP and its data requirements.

Computers↗
PubMed2006

Central fetal monitoring: effect on perinatal outcomes and cesarean section rate.

BACKGROUND: In a trend similar to continuous electronic fetal monitoring, many hospitals are incorporating central fetal monitoring into labor and delivery suites. The objective of this study was to investigate whether the use of central fetal monitoring had an effect on neonatal outcomes or cesarean section rate. METHODS: This retrospective study involved patient data from deliveries occurring at Women and Children's Hospital of Buffalo, Buffalo, New York, between the years 2000 and 2003. In the period from January 1, 2000, to December 31, 2001, central fetal monitoring was available, whereas in the period from February 1, 2002, to December 31, 2003, it was unavailable. Data on deliveries at Women and Children's Hospital of Buffalo were obtained using the Western New York Perinatal Data System, which is an electronic data set based on birth certificate information. The method of delivery, admission to the neonatal intensive care unit, and 5-minute Apgar scores less than 7 were compared for deliveries occurring with and without the use of central fetal monitoring. These outcomes were further subdivided into full-term and preterm deliveries. RESULTS: Three thousand five hundred and twelve deliveries used central monitoring and 3,007 deliveries did not. For full-term deliveries, in the years with central fetal monitoring compared with the years without it, no differences in the cesarean section rate (13.4 vs 14.5%, not significant [NS]), the admission rate in neonatal intensive care unit (3.3 vs 3.3%, NS), or the incidence of Apgar score less than 7 (0.6 vs 0.5%, NS) were observed. For preterm deliveries, comparing the years with central fetal monitoring with the years without, no differences in the cesarean section rate (21.3 vs 21.3%, NS), the admission rate in neonatal intensive care unit (17.7 vs 20.1%, NS), or the incidence of Apgar score less than 7 (7.0 vs 6.5%, NS) were observed. Analyses pooling all deliveries also failed to show any differences in any of the parameters. CONCLUSIONS: No statistically significant difference was demonstrated in the rates of cesarean section, admission to the neonatal intensive care unit, or incidence of Apgar scores of less than 7 associated with the use of central fetal monitoring. Therefore, we could not identify any benefit to the use of central fetal heart rate monitoring.

Adolescent↗