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PubMed2001

Risk adjustment for older hospitalized persons: a comparison of two methods of data collection for the Charlson index.

To compare Charlson indices based on chart data and ICD-9 data for agreement overall and on rating specific comorbid conditions, and to compare mortality risks associated with these indices. Prospective cohort study. Six general medicine wards at Yale-New Haven Hospital. 524 consecutive patients who had no clinical evidence of delirium at enrollment, admitted between November 6, 1989 and July 31, 1991, aged 70 years or older. Death within 1 year of the index hospital admission date. Scores using the chart-based data were significantly higher than those using ICD-9 data. About half of the individual conditions showed fair-to-good agreement between the two scores, whereas the other half showed poor agreement. A comparison of mortality prediction indicated that the weightings assigned to individual comorbidities differed substantially from those used in Charlson's original index. While mortality prediction of each individual index was comparable, the ICD-9 and chart indices contributed independently to mortality prediction in the presence of the other. Low agreement between Charlson scores based on the two methods of data collection and their cumulative contribution to mortality prediction suggest that these indices may include different information. Our results suggest that the original Charlson index may not provide optimal risk adjustment for elderly general medicine samples. We suggest development of an empirically-derived index of comorbid conditions and weights may be warranted for older general medical patients.

Aged↗
PubMed1993

Data collection in the Adult Day Health Care Evaluation Study.

This report presents data collection measures and methods for the evaluation of Adult Day Health Care (ADHC) in the Department of Veterans Affairs (VA). Measures of patient health were survival, the Sickness Impact Profile, self-rated health, the Mini-Mental State Exam, Psychological Distress Scale, Social Support Scale, and Problem Behaviors Scale. Measures of health for the care giver were: Activities of Daily Living, Instrumental Activities of Daily Living, health perceptions, Psychological Distress Scale, life satisfaction, Social Support Scale, and Caregiver Burden Scale. We also assessed patient and care giver satisfaction with the care received by the patient. Measures of health status and outcomes were assessed primarily through patient and care giver interview at study enrollment, 6 months, and 12 months. Utilization and cost both within and outside VA were assessed for hospital, ambulatory care, nursing home, ADHC, home care, pharmacy, laboratory, and other forms of health care. Sources of utilization data included VA's computerized patient database, VA medical records, patient questionnaires, care giver questionnaires, and health care providers outside VA. Costs were obtained from VA's cost accounting system, VA Central Office, VA's contracts with outside providers, and directly from outside providers. Utilization and cost were assessed for each patient for a period of 1 year after entry into the study.

Activities of Daily Living↗
PubMed2005

The Action Plan--a new instrument to collect data on interventions in secondary prevention in adolescents.

It is difficult to draw causal conclusions about the effectiveness of secondary prevention programs for adolescents at risk, when the programs use a variety of different interventions. The Action Plan is an instrument that is designed to make collection of such data possible. This allows calculating different kinds of intervention patterns for each participant and program, which, in combination with outcome measures, gives an estimate of successful vs. less successful interventions. The study compared intervention patterns from 12 different sites in a national intervention program in Switzerland. The program, called supra-f (www.supra-f.ch), started in 1999 and will end in 2005. Results are presented from the ongoing study with approximately 600 adolescents. We calculated effect sizes (ES) to compare interventions with outcome measures. Effect sizes (ES) are presented on well being, coping, self-esteem, delinquency, and substance use (cigarettes, alcohol, cannabis) in relation to intervention packages, risk groups (low, moderate, high), and age (two groups: 11-15 and 16-20 years of age) using data collected from 1999-2002.

Adolescent↗
PubMed1999

Explaining differences in English hospital death rates using routinely collected data.

OBJECTIVES: To ascertain hospital inpatient mortality in England and to determine which factors best explain variation in standardised hospital death ratios. DESIGN: Weighted linear regression analysis of routinely collected data over four years, with hospital standardised mortality ratios as the dependent variable. SETTING: England. SUBJECTS: Eight million discharges from NHS hospitals when the primary diagnosis was one of the diagnoses accounting for 80% of inpatient deaths. MAIN OUTCOME MEASURES: Hospital standardised mortality ratios and predictors of variations in these ratios. RESULTS: The four year crude death rates varied across hospitals from 3.4% to 13.6% (average for England 8.5%), and standardised hospital mortality ratios ranged from 53 to 137 (average for England 100). The percentage of cases that were emergency admissions (60% of total hospital admissions) was the best predictor of this variation in mortality, with the ratio of hospital doctors to beds and general practitioners to head of population the next best predictors. When analyses were restricted to emergency admissions (which covered 93% of all patient deaths analysed) number of doctors per bed was the best predictor. CONCLUSION: Analysis of hospital episode statistics reveals wide variation in standardised hospital mortality ratios in England. The percentage of total admissions classified as emergencies is the most powerful predictor of variation in mortality. The ratios of doctors to head of population served, both in hospital and in general practice, seem to be critical determinants of standardised hospital death rates; the higher these ratios, the lower the death rates in both cases.

Data Collection↗
PubMed2003

An algorithm for rapid calculation of a probabilistic functional atlas of subcortical structures from electrophysiological data collected during functional neurosurgery procedures.

The paper introduces an optimal algorithm for rapid calculation of a probabilistic functional atlas (PFA) of subcortical structures from data collected during functional neurosurgery procedures. The PFA is calculated based on combined intraoperative electrophysiology, pre- and intraoperative neuroimaging, and postoperative neurological verification. The algorithm converts the coordinates of the neurologically most effective contacts into probabilistic functional maps taking into account the geometry of a stimulating electrode. The PFA calculation comprises the reconstruction of the contact coordinates from two orthogonal projections, normalizing (warping) the contacts modeled as cylinders, voxelizing the contact models, calculating the atlas, and computing probability. In addition, an analytical representation of the PFA is formulated based on Gaussian modeling. The initial PFA has been calculated from the data collected during the treatment of 274 Parkinson's disease patients, most of them operated bilaterally (487 operated hemispheres). It contains the most popular stereotactic targets, the subthalamic nucleus, globus pallidus internus, and ventral intermedius nucleus. The key application of the algorithm is targeting in stereotactic and functional neurosurgery, and it also can be employed in human and animal brain research.

Algorithms↗
PubMed2006

Simplifying data collection for process evaluation of community coalition activities--an electronic web-based application.

ISSUE ADDRESSED: It is important to document and measure coalition-based program activities in order to analyse and evaluate the process of program implementation. This paper describes the development and implementation of an electronic, web-based application to simplify data collection for this research process. METHODS: Childhood injury prevention project officers collaborated with injury prevention researchers to adapt a process log monitoring system initially developed by the Centers for Disease Control and Prevention to track coalition activities for evaluating community efforts to prevent cardiovascular disease. The adapted process log was converted into an electronic, web-based application that project officers completed daily. RESULTS: The web-based electronic log proved to be a practical tool that not only simplified the documentation and reporting processes for health professionals involved in the program, but also provided a rich source of data for subsequent comprehensive analysis of project implementation. CONCLUSION: Development, implementation and evaluation of this web-based process log, to the best of our knowledge, is the only program of its kind in use and provides a simple data collection solution for practitioners, policy makers and researchers involved in injury prevention programs and other community-based programs throughout the world.

Community Networks↗
PubMed1992

Fully three-dimensional reconstruction from data collected on concentric cubes in Fourier space: implementation and a sample application to MRI.

An algorithm is proposed for rapid and accurate reconstruction from data collected in Fourier space at points arranged on a grid of concentric cubes. The Fourier transform of the object to be reconstructed is decomposed into the sum of three functions by subdividing its domain into three non-overlapping mutually orthogonal double pyramids. Each of the three functions is zero-valued outside one of the double pyramids and has values inside that double pyramid which are the same as those of Fourier transform of the object to be reconstructed at the same points. Inverse Fourier transforms of these individual functions can be calculated using the chirp z-transform. The outputs of these inverse transforms for the three functions are estimates of their values at points of the same rectangular grid. The function to be reconstructed is estimated for this grid by adding together the three inverse transforms. The whole process has computational complexity of the same order as required for the 3D fast Fourier transform and so (for medically relevant sizes of the data set) it is faster than backprojection into the same size rectangular grid. The design of the algorithm ensures that no interpolations are needed, in contrast to methods involving backprojection with their unavoidable interpolations. As an application, a 3D data collection method for MRI has been designed which directly samples the Fourier transform of the object to be reconstructed on concentric cubes as needed for the algorithm.

Algorithms↗
PubMed1986

Data collection organization effect in the National Medical Care Utilization and Expenditure Survey.

The National Medical Care Utilization and Expenditure Survey (NMCUES), which has a complex survey design, was further complicated by combining two independently drawn national samples of households from the Research Triangle Institute (RTI) and the National Opinion Research Center (NORC). It is assumed that because the structures of both national area samples are similar, they are thereby compatible and allow for the derivation of unbiased national estimates of relevant health parameters. However, even though the two survey organizations operate under a common set of survey conditions with comparable samples, the actual data generated may differ across them, over and above differences due to pure sampling error. The NORC sample had a higher representation of individuals living in non-SMSA urban areas, of individuals with fair or poor health status, and of individuals incapable of performing usual activity. In addition, significantly higher mean estimates of the number of restricted activity days, of total charges for dental visits, for non-doctor visits and for hospital stays, and of overall total charges, characterized the NORC sample. The consistent directional difference in these health care estimates indicated a data collection organization effect was operational in the NMCUES. A comparison of item nonresponse rates, however, indicated the level of data quality on this dimension was generally equivalent across survey organizations. Further, the observed survey design differentials across organizations did not significantly differ in their impact on the precision in survey estimates. When a data collection organization effect is operational for a set of related survey statistics, as in the National Medical Care Utilization and Expenditure Survey, the use of more than one survey organization should be seriously considered.

Catchment Area, Health↗
PubMed1995

International Poison Information Center data collection capabilities.

Hundreds of poison information centers are in operation throughout the world. Their common objective is to reduce the morbidity and mortality associated with accidental and intentional poisoning exposures. However, there is little information available which describes the impact of the centers on the outcome of poisonings or on poisoning trends. The objective of this project was to determine the data collection capabilities of poison information centers outside of the US with a goal of ascertaining whether a common database existed and if an international database of poisoning exposures could be developed. A survey was developed which requested information on the specific instrument used to document poisoning exposures, how that information was compiled, whether it was available in a computer database, the type of database, and whether it was available to external agencies and at what cost. The survey was sent to 75 poison information centers outside of the US. The data were compiled and analyzed using Paradox 3.5. Twenty-four of the 75 poison information centers completed and returned the surveys. Four of the 24 had no computer capabilities and only 9 centers indicated a willingness to share data. The majority of the databases were in a DOS format, but no consistent type of database software was used. If the sample that responded to the survey is representative of the international poison information center community, there is neither a common data collection instrument nor a common toxic exposure surveillance system which can be used to identify poisoning trends or to track the outcome of poisonings. A concerted effort to create a universal database on poisoning exposures should be considered.

Data Collection↗
PubMed2006

A feasibility study of computer-assisted health-related quality of life data collection in patients with oral and oropharyngeal cancer.

Touchscreen technology (TST) has been widely used in the field of medicine. The purpose of this study was to pilot a standard TST system to administer the University of Washington Quality of Life Questionnaire (UWQOL) in a routine head and neck oncology clinic. The UWQOLv4 was completed using TST and a semi-structured interview was used to evaluate patients' experience of the data collection process. Forty-one of 44 consecutive cancer patients agreed to participate in the study. Although over three-quarters of patients reported never having used a computer, all but one found the UWQOLv4 'easy' or 'very easy' to complete using the TST. They preferred the TST method to paper copy and the vast majority completed the TST in 10min or less. TST provides a very suitable mechanism for routine health-related quality of life data collection. The system is easy to programme and relatively inexpensive.

Aged↗
PubMed2003

Electronic data collection tools for quality improvement: antibiotic utilization project.

The project goal is to provide data on patterns of broad-spectrum antibiotic use in a pediatric clinic by utilizing electronic data collection tools. This was carried out as a quality improvement project sponsored by a local health network and one of its affiliated pediatric clinics. Pharmacy data was available to show relative rates of broad-spectrum antibiotic use, but this data was not linked to diagnostic categories or to total patient visits. There was also a lack of data showing the influence of related clinical factors and of shared decision-making between parents and physicians. Data to elucidate these factors was obtained with handheld computers used by physicians and with a web survey tool was used by patients and staff.

Anti-Bacterial Agents↗
PubMed2005

Mapping choice in the NHS: cross sectional study of routinely collected data.

OBJECTIVE: To identify where in England there are likely to be most constraints on choice of hospital for patients waiting longer than six months for elective care. DESIGN: Cross sectional study using routinely collected data. SETTING: Population of England and NHS trusts and private sector hospitals in England. PARTICIPANTS: All residents in England. MAIN OUTCOME MEASURES: Availability of beds (available and unoccupied hospital beds), demand (number of people waiting longer than six months), and access (travel time to facilities) to hospital care in England. RESULTS: Most people in England already have an extensive potential choice of hospital. The number of available and unoccupied beds within 60 minutes' travel time was lowest in the Scottish borders, North Yorkshire, and parts of East Anglia, Lincolnshire, Devon, and Cornwall. This pattern was not altered by adding in private facilities. Putting demand with this supply, the number of people in a geographical area waiting longer than six months per bed within 60 minutes' travel time was highest in the south east (except London), parts of the south west (Cornwall, Bristol), East Anglia, and the Welsh border. CONCLUSION: People in the south east (outside London), East Anglia, and parts of the south west are likely to have to travel further to exercise meaningful choice of hospital for elective care.

Bed Occupancy↗
PubMed1999

Some notes on choices in data collection.

Collecting optimum X-ray diffraction data involves a number of choices and compromises, including choice of crystal, source, rotation range, exposure time and programs for integration and scaling. This paper presents a series of questions which should be considered in planning a data-collection experiment.

X-Ray Diffraction↗
PubMed1976

Medical economics survey-methods study: design, data collection, and analytical plan.

This paper describes the background, methodology, data collection, and analytical plan of a pilot investigation conducted under contract for the National Center for Health Statistics during 1975. The objective was to determine the cost effectiveness of a variety of strategies under consideration for national application to develop previously unavailable information on utilization of, and the costs and payments for, health care. Detailed data on health care utilization and expenditures were collected periodically from a panel of 691 Maryland households over a six-month interval. Issues to be tested through a random experimental design include whether periodicity (monthly vs bimonthly interviews) and type of contact (in-person vs telephone) are significant factors in the cost effectiveness of this type of survey. An extensive record check involving all providers and third-party payers identified in the household survey was carried out. Record information will be used to 1) provide a basis for measuring accuracy of household data, 2) fill gaps in household knowledge, and 3) determine whether a subset of the record sources can provide adequate information for correcting household data. The household survey resulted in an initial response rate of 77.5 per cent with a subsequent attrition rate over six months of 13.6 per cent. Signed permission to access record data was obtained for 84.9 per cent of the individuals completing the entire survey. The most intensive survey strategy, monthly, mostly in-person contact, resulted in the lowest participation. The analytical plan presents details of the approaches to be taken in making judgments on the relative accuracy and completeness of data obtained by the various survey strategies and the contribution made by availability of data from record sources.

Adolescent↗
PubMed1998

Data collection in multi-center clinical trials via Internet. A generic system in Java.

Data collection via Internet is usually performed with an HTML/CGI combination, which has a lot of disadvantages, most important the lack of security features. We therefore have developed a system written entirely in Java, which implements a true client/server application based on TCP/IP. The documents are created using a multi-lingual data dictionary, and the used GUI components are able to perform plausibility checks, which improves quality of the data. The system is designed to be easily extensible so that it can be used in almost any kind of clinical trials. It is based on a three-tier model where client requests are handled and monitored by an application server. We will describe this system and it's implementation and compare it to the HTML/CGI approach. Of special interest are security features, which are possible through the use of Java.

Computer Systems↗
PubMed1996

The second national survey of infection in hospitals: methods of data collection and overall impressions.

The Hospital Infection Society, in association with the Public Health Laboratory Service and the Infection Control Nurses Association, launched the Second National Prevalence Survey of Infection in Hospitals in 1993. On completion of the survey, 157 hospitals throughout the British Isles had taken part with approximately 37 000 patients surveyed. The survey in the Royal Hospitals Trust, Belfast, included all inpatients who were present in the wards on the survey day. Infection control nurses (ICNs) from a selected number of the other participating hospitals were sent questionnaires and asked about their methods of data collection, and their overall impression of the Second National Survey. All respondents received help in performing the survey, but only 10% provided prior training to ward staff before the survey visit. Sixty-five percent of respondents supplied information to the wards prior to the survey visit. In comparison with the questionnaire respondents, it was found that using a 'link' nurse to assist in data collection was much more efficient in relation to the time involved. Many ICNs expressed concern over the amount of time spent on this survey, although in general the value of such a survey was appreciated. Twenty-six percent of respondents indicated that they would not be willing to undertake a future survey.

Cross Infection↗
PubMed2006

Monitoring outcomes of arthritis and longitudinal data collection using patient questionnaires in routine care.

Though quantitative data might lead to improved information for clinical decisions, at the present time decisions in routine rheumatology practice generally are based largely on qualitative impressions, rather than on data. Patient questionnaires are readily accessible tools that the rheumatologist can use to go beyond impressions and to institute evidence-based guidelines appropriate to his or her own patient population and practice style. The Health Assessment Questionnaire (HAQ) and its derivatives have been shown to be the best predictors of functional and work disability, costs, joint replacement surgery, and mortality. Such questionnaires are at least as good as joint counts, radiographs, and laboratory tests in predicting these outcomes. Every encounter of a patient with a rheumatologist provides an opportunity to collect data. Based on experience with the Brooklyn Outcomes of Arthritis Registry Database, the author advocates distributing a waiting-room questionnaire to every patient who comes for an office visit. Potential benefits of recording questionnaire-based information include identifying trends or important changes in a patient's pain or physical function, providing a baseline for success with various treatment strategies for conditions of the rheumatologist's own practice, allowing patients an opportunity to express concerns, encouraging patients to disclose information they may feel is too minor to mention, and providing control data for research studies. A short questionnaire designed specifically for clinical, rather than research, use does not create a burden for office staff. Consistent use of patient questionnaires and systematic storage of the information gained can help document, track, and improve patient care in routine rheumatology practice.

Arthritis, Rheumatoid↗
PubMed1999

Under representation of morbidity from paediatric bicycle accidents by official statistics--a need for data collection in the accident and emergency department.

OBJECTIVES: To determine the accuracy of currently available data on bicycle related injuries in children. SETTING: A paediatric accident and emergency (A&E) department which annually treats approximately 30000 new patients under the age of 13 years. METHODS: Data on all attendances with bicycle related injuries over a four week period were compared with that currently available from police road traffic accident data (Stats 19) and the International Classification of Diseases, 10th revision, hospital discharge coding. RESULTS: Eighty six children attended the A&E department. Only two bicycle related injuries were identified from Stats 19, and 10 from hospital discharge data. CONCLUSION: Currently available official data do not give an accurate representation of the incidence of bicycle related injuries in children. If health promotion measures are to be assessed properly data collection needs to be improved.

Bicycling↗