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PubMed2003

The application of geographic information systems and global positioning systems in humanitarian emergencies: lessons learned, programme implications and future research.

Geographic information systems (GIS), global positioning systems and remote sensing have been increasingly used in public health settings since the 1990s, but application of these methods in humanitarian emergencies has been less documented. Recent areas of application of GIS methods in humanitarian emergencies include hazard, vulnerability, and risk assessments; rapid assessment and survey methods; disease distribution and outbreak investigations; planning and implementation of health information systems; data and programme integration; and programme monitoring and evaluation. The main use of GIS in these areas is to provide maps for decision-making and advocacy, which allow overlaying types of information that may not normally be linked. GIS is also used to improve data collection in the field (for example, for rapid health assessments or mortality surveys). Development of GIS methods requires further research. Although GIS methods may save resources and reduce error, initial investment in equipment and capacity building may be substantial. Especially in humanitarian emergencies, equipment and methodologies must be practical and appropriate for field use. Add-on software to process GIS data needs to be developed and modified. As equipment becomes more user-friendly and costs decrease, GIS will become more of a routine tool for humanitarian aid organisations in humanitarian emergencies, and new and innovative uses will evolve.

Altruism↗
PubMed2002

Assessing population health care need using a claims-based ACG morbidity measure: a validation analysis in the Province of Manitoba.

OBJECTIVES: To assess the ability of an Adjusted Clinical Group (ACG)-based morbidity measure to assess the overall health service needs of populations. Data Sources/Study Setting. Three population-based secondary data sources: registration and health service utilization data from fiscal year 1995-1996; mortality data from vital statistics reports from 1996-1999; and Canadian census data. The study included all continuously enrolled residents in the universal health care plan in Manitoba. STUDY DESIGN: Using 60 small geographic areas as the units of analysis, we compared a population-based "ACG morbidity index," derived from individual ACG assignments in fiscal year 1995-1996, with the standardized mortality ratio (ages < 75 years) for 1996-1999. Key variables included a population-based socioeconomic status measure and age- and sex-standardized physician utilization ratios. DATA EXTRACTION METHODS: The ACGs were assigned based on the complement of diagnoses assigned to persons on physician claims and hospital separation abstracts. The ACG index was created by weighting the ACGs using average health care expenditures. PRINCIPAL FINDINGS: The ACG morbidity index had a strong positive linear relationship with the subsequent rate of premature death in the small areas of Manitoba. The ACG index was able to explain the majority of the relationships between mortality and both socioeconomic status and physician utilization. CONCLUSIONS: In Manitoba, ACGs are closely related to premature mortality, commonly accepted as the best single indicator for health service need in populations. Issues in applying ACGs in settings where needs adjustment is a primary objective are discussed.

Adolescent↗
PubMed2002

The cost of doing business: cost structure of electronic immunization registries.

OBJECTIVE: To predict the true cost of developing and maintaining an electronic immunization registry, and to set the framework for developing future cost-effective and cost-benefit analysis. DATA SOURCES/STUDY SETTING: Primary data collected at three immunization registries located in California, accounting for 90 percent of all immunization records in registries in the state during the study period. STUDY DESIGN: A parametric cost analysis compared registry development and maintenance expenditures to registry performance requirements. DATA COLLECTION/EXTRACTION METHODS: Data were collected at each registry through interviews, reviews of expenditure records, technical accomplishments development schedules, and immunization coverage rates. PRINCIPAL FINDINGS: The cost of building immunization registries is predictable and independent of the hardware/software combination employed. The effort requires four man-years of technical effort or approximately $250,000 in 1998 dollars. Costs for maintaining a registry were approximately $5,100 per end user per three-year period. CONCLUSIONS: There is a predictable cost structure for both developing and maintaining immunization registries. The cost structure can be used as a framework for examining the cost-effectiveness and cost-benefits of registries. The greatest factor effecting improvement in coverage rates was ongoing, user-based administrative investment.

California↗
PubMed2003

Integration of different data bodies for humanitarian decision support: an example from mine action.

Geographic information systems (GIS) are increasingly used for integrating data from different sources and substantive areas, including in humanitarian action. The challenges of integration are particularly well illustrated by humanitarian mine action. The informational requirements of mine action are expensive, with socio-economic impact surveys costing over US$1.5 million per country, and are feeding a continuous debate on the merits of considering more factors or 'keeping it simple'. National census offices could, in theory, contribute relevant data, but in practice surveys have rarely overcome institutional obstacles to external data acquisition. A positive exception occurred in Lebanon, where the landmine impact survey had access to agricultural census data. The challenges, costs and benefits of this data integration exercise are analysed in a detailed case study. The benefits are considerable, but so are the costs, particularly the hidden ones. The Lebanon experience prompts some wider reflections. In the humanitarian community, data integration has been fostered not only by the diffusion of GIS technology, but also by institutional changes such as the creation of UN-led Humanitarian Information Centres. There is a question whether the analytic capacity is in step with aggressive data acquisition. Humanitarian action may yet have to build the kind of strong analytic tradition that public health and poverty alleviation have accomplished.

Agriculture↗
PubMed2004

Burden of allergic disease in the UK: secondary analyses of national databases.

BACKGROUND: Although allergy represents an important source of patient morbidity and healthcare utilization, there is little reliable information on the overall disease burden posed by allergic conditions in the UK. OBJECTIVES: Focusing on the following conditions: allergic rhinitis, anaphylaxis, asthma, conjunctivitis, eczema/dermatitis, food allergy and urticaria/angioedema, we sought to (i) describe the prevalence, incidence and outcomes of allergic disorders; (ii) describe the NHS healthcare burden posed by allergic disorders; (iii) estimate the costs of allergic disorders from a healthcare perspective. METHODS: Secondary analyses of data from the Health Survey for England, Scottish Health Survey, International Study of Allergies and Asthma in Childhood, European Community Respiratory Health Survey, Morbidity Statistics from General Practice 1991/1992, Royal College of General Practitioners Weekly Returns Service, Prescribing Analysis and Cost data, Hospital Episodes Statistics and national mortality data. RESULTS: Thirty-nine percent of children and 30% of adults have been diagnosed with one or more atopic conditions. Six percent of general practice consultations and 0.8% of hospital admissions are for allergic diseases. Treatments for asthma and other allergic disorders currently account for 10% of primary care prescribing costs. Direct NHS costs for managing allergic problems are estimated at over one billion UK pounds per annum. CONCLUSIONS: Allergic disorders are common throughout the UK, affecting males and females of all ages and peoples from all social classes and ethnic groups. They currently represent a substantial burden of morbidity and health service cost.

Adolescent↗
PubMed2003

Cause of death in patients with end-stage renal disease: assessing concordance of death certificates with registry reports.

OBJECTIVES: To assess concordance in reporting, in two Australian national datasets, of cause of death of patients with end-stage renal disease (ESRD). METHODS: For deaths in 1997-99, we compared 'cause of death' and 'primary renal disease', as coded in the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA), with 'underlying' and 'associated' causes of death (based on death certificates), as coded by the Australian Bureau of Statistics (ABS). Dates of birth and death and sex identified the same individuals in the two datasets. Deaths from the three States for which date of birth was not available from death certificates were excluded. Cause of death was compared at the ICD-10 chapter level. RESULTS: Of 1,728 ANZDATA patients from NSW, SA, WA, NT and ACT who died during 1997-99, 1,117 (65%) could be matched to a record in the ABS dataset for the corresponding jurisdictions. The death certificates of 219 (20%) of these 1,117 patients made no mention of chronic renal failure. Overall, agreement on cause of death was poor (kappa = 0.22). Using ANZDATA information on cause of death and ABS underlying cause of death, only 38% of patients had the same cause (at the ICD-10 chapter level) recorded in both datasets. Additional information on primary renal disease (ANZDATA) and up to 12 associated causes of death (ABS) was required to obtain substantial agreement. CONCLUSION AND IMPLICATIONS: Death certificates and ANZDATA records provide differing causes of death for ESRD patients. Information from these sources was not directly comparable. Neither dataset provided a complete picture of renal disease as a cause of death in Australia.

Australia↗
PubMed2003

Immunisation coverage in Australia corrected for under-reporting to the Australian Childhood Immunisation Register.

OBJECTIVE: To assess the level of under-reporting to the Australian Childhood Immunisation Register (ACIR) and the resulting underestimation of national immunisation coverage using ACIR data, and to correct national immunisation estimates for under-reporting. METHODS: A national population-based telephone survey was conducted in May-July 2001 of two random samples of children born in 1998 and 1999 who were recorded on the ACIR as incompletely immunised at either 12 months or 24 months of age. Parents were asked whether and when their child had received the vaccinations required to qualify as fully immunised. Survey data were then used to correct ACIR-derived coverage estimates at 12 and 24 months of age. RESULTS: Of 640 surveyed children in the 12-month group, 258 (40%) met the study definition of 'definitely immunised'. This adjusted the ACIR coverage estimate upwards by 2.7% to 94% (95% CI 93.6-94.1). Of 698 surveyed children in the 24-month group, 387 (55%) met the study definition of 'definitely immunised' at the second birthday. Adjusted coverage for doses due by 24 months was 89.8% (95% CI 89.6-90.1), 5% higher than recorded on the ACIR. CONCLUSIONS: Immunisation coverage in Australia for all scheduled vaccines due by 12 months of age is 94% and for all vaccines due by two years of age is almost 90%. The ACIR underestimates coverage by up to 5%. As the ACIR database relies on provider notification, published estimates of immunisation coverage are unlikely to rise significantly above current levels, unless mechanisms are put in place to further improve notification to the ACIR.

Australia↗
PubMed2004

Characteristics of non-fatal opioid overdoses attended by ambulance services in Australia.

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 on 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 highest 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.

Adult↗
PubMed2006

Hospital readmissions for asthma: a feasibility study comparing strategies for linking hospital morbidity data.

OBJECTIVE: To investigate whether the variables in the National Hospital Morbidity Database (NHMD) provide sufficient information to validly link hospital admission records for the same person so that persons admitted and re-admissions for a specified disease can be enumerated. METHODS: Records of hospital admissions where asthma was the principal diagnosis were extracted from the New South Wales Inpatient Statistics Collection for the period July 2000 to June 2003 and linked using several strategies. The optimal' strategy applied probabilistic record linkage, using many demographic and administrative variables. A range of restricted strategies, using only those variables that were available with the NHMD (sex, date of birth, and either postcode or statistical local area of residence) and linking them deterministically, were evaluated and their validity for quantifying readmission for asthma within 28 days was assessed relative to the optimal strategy. RESULTS: The optimal and restricted linkage strategies obtained similar estimates of readmissions. Approximately 95% of readmissions within 28 days identified using the optimal strategy were also identified using the restricted strategies. CONCLUSIONS: Linking hospital records where asthma was the principal diagnosis using only those variables available in the NHMD enabled reliable identification of hospital readmissions tor asthma. IMPLICATIONS: This methodology may have useful applications for monitoring the rate of readmissions for asthma and other chronic diseases nationally.

Adolescent↗
PubMed2004

Consistency of performance ranking of comorbidity adjustment scores in Canadian and U.S. utilization data.

OBJECTIVE: The performance of standard comorbidity scores to control confounding is poorly defined in health care utilization data across elderly populations. We sought to evaluate and rank the performance of comorbidity scores across selected U.S. and Canadian elderly populations using health care utilization databases. DESIGN: Cross-population validation study. PARTICIPANTS: Study participants were residents age 65 years or older who had prescription drug coverage through state-funded programs selected from several large health care utilization databases available to the investigators: British Columbia, BC (N = 141,161), New Jersey, NJ (N = 235,881), and Pennsylvania, PA (N = 230,913). MEASUREMENTS: We calculated 6 commonly used comorbidity scores for all subjects during the baseline year (1994 for NJ and PA, and 1995 for BC). These included scores based on diagnoses (Romano, Deyo, D'Hoore, Ghali) and prescription drugs (CDS-1, CDS-2). The study outcome was 1-year mortality. The performance of scores was measured by c-statistics derived from multivariate logistic regression that included age and gender. MAIN RESULTS: Across these 4 large elderly populations, we found the same rank order of performance in predicting 1-year mortality after including age and gender in each model: Romano (c-statistic 0.754 to 0.771), Deyo (c-statistic 0.753 to 0.768), D'Hoore (c-statistic 0.745 to 0.760), Ghali (c-statistic 0.733 to 0.745), CDS-1 (c-statistic 0.689 to 0.738), CDS-2 (c-statistic 0.677 to 0.718), and age and gender alone (c-statistic 0.664 to 0.681). Performance was improved by an average of 6% by adding the number of different prescription drugs received during the past year. CONCLUSIONS: Performance ranking of 6 frequently used comorbidity scores was consistent across selected elderly populations. We recommend that investigators use these performance data as one important factor when selecting a comorbidity score for epidemiologic analyses of health care utilization data.

Aged↗
PubMed2004

A glossary for evidence based public health.

This glossary seeks to define and explain some of the main concepts underpinning evidence based public health. It draws on the published literature, experience gained over several years analysis of the topic, and discussions with public health colleagues, including researchers, practitioners, policy makers, and students.

Evidence-Based Medicine↗
PubMed2002

Public health, GIS, and the internet.

Internet access and use of georeferenced public health information for GIS application will be an important and exciting development for the nation's Department of Health and Human Services and other health agencies in this new millennium. Technological progress toward public health geospatial data integration, analysis, and visualization of space-time events using the Web portends eventual robust use of GIS by public health and other sectors of the economy. Increasing Web resources from distributed spatial data portals and global geospatial libraries, and a growing suite of Web integration tools, will provide new opportunities to advance disease surveillance, control, and prevention, and insure public access and community empowerment in public health decision making. Emerging supercomputing, data mining, compression, and transmission technologies will play increasingly critical roles in national emergency, catastrophic planning and response, and risk management. Web-enabled public health GIS will be guided by Federal Geographic Data Committee spatial metadata, OpenGIS Web interoperability, and GML/XML geospatial Web content standards. Public health will become a responsive and integral part of the National Spatial Data Infrastructure.

Geographic Information Systems↗
PubMed2002

Public health, GIS, and spatial analytic tools.

We review literature that uses spatial analytic tools in contexts where Geographic Information Systems (GIS) is the organizing system for health data or where the methods discussed will likely be incorporated in GIS-based analyses in the future. We conclude the review with the point of view that this literature is moving toward the development and use of systems of analysis that integrate the information geo-coding and data base functions of GISystems with the geo-information processing functions of GIScience. The rapidity of this projected development will depend on the perceived needs of the public health community for spatial analysis methods to provide decision support. Recent advances in the analysis of disease maps have been influenced by and benefited from the adoption of new practices for georeferencing health data and new ways of linking such data geographically to potential sources of environmental exposures, the locations of health resources and the geodemographic characteristics of populations. This review focuses on these advances.

Cluster Analysis↗