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At least 595 records · Page 33Linked to original sources
PubMed2006

[The quality of diagnosis and procedure coding in Orthopaedic surgery Northern Jutland].

INTRODUCTION: When the aim is for high quality, efficiency and a balanced allocation of resources in health services, there is a constant demand for optimisation of the quality of registration regarding diagnosis, treatment and DRG-values (DRG = Diagnosis Related Groups). Since the mid-nineties the DRG-system has been used to shed light on productivity in Danish hospitals. This study investigates the quality of registrations after the introduction of an organization for registrations in the county of Northern Jutland. MATERIAL AND METHODS: The registrations from 554 orthopaedic patients, both in-patient and day case surgery, during a two-week period, were scrutinised critically and changed as appropriate, based on a thorough examination of the medical records. RESULTS: In 37% of the courses registrations were found insufficient or incorrect. In 27% of the cases there was a need for a change in either the diagnosis taken action on, a secondary diagnosis or the treatment registration. 10% had two or three changes. In 11% of the courses of treatment the DRG-value was changed. On average DKK 974 were added, constituing in total only 0.4% of the total DRG-value. But single variations from deductions of DKK 56,000 to an addition of DKK 39,000 were observed. The gravest mistakes are elucidated. CONCLUSION: Locally, there is a need for continuous instruction of both doctors and secretaries regarding correct registration of diagnosis and treatment as well as an improvement of the registration facilities. On a national basis more precise recommendations are required within the medical specialist areas in order to secure an unambiguous registration.

Denmark↗
PubMed1980

Physician response to computer reminders.

A computerized medical record system was designed to detect and remind the responsible clinician about clinical events that might need corrective action. These reminders significantly increased the clinician response rate (in terms of test orders and treatment changes) to the events in question. The addition of relevant medical literature citations to the reminders did not significantly change the clinician response rate as compared with that with reminders alone, nor did it stimulate the physicians to read any of the cited articles kept in an immediately available "library" of reprints.

Clinical Competence↗
PubMed1995

Geographical variations in the organisation of general practice.

AIMS: To describe organisational characteristics of New Zealand general practice and to investigate inter-regional variations in these characteristics. METHODS: Data were collected by standardised questionnaires from general practitioners in Auckland, Waikato and Taranaki. The Waikato data were collected in July-August 1991 by postal survey, the Taranaki data were collected May-June 1992 by postal survey and the Auckland data were collected December 1990 to January 1991 by face-to-face interview. RESULTS: The response rates were Auckland 98% (167/171), Waikato 84% (185/220) and Taranaki 79% (79/100). There were significantly more overseas trained graduates in rural areas than in urban areas. Average practice size was 2.3 full time equivalent doctors, with each 100 doctors employing 71 nurses and 77 receptionists. The number of patients seen per week ranged from 109-141. Almost all (95%) general practitioners operated appointment systems. One in five general practitioners had patients in private hospitals, and more than half (58%) had patients in rest homes. At the time of interview, 29% of Auckland general practitioners used computers in their practices compared with over 50% in Waikato and Taranaki (p < 0.05). A smaller proportion of Auckland general practitioners had access to age/sex registers and fewer Auckland general practitioners had a recall system. Of Auckland general practitioners with recall systems, a greater proportion used them for mammograms, blood pressure and lipid measurements compared with elsewhere. CONCLUSIONS: There are some significant regional variations in the functional characteristics of general practice in New Zealand which should be taken into account when planning primary care services in different regions. Should budget holding and managed care be introduced, computerised practices will be required. This will have significant resource implications.

Adult↗
PubMed1994

Coverage List: a provider-patient database supporting advanced hospital information services.

We have developed a provider-patient database system, known as Coverage List, which maintains the associations between house staff and inpatients in a teaching hospital. Coverage List automatically links each patient to the proper resident when the patient is admitted, and updates the linkage whenever the resident coverage changes due to night or weekend coverage, physician illness, changes in clinical rotations, and other factors. Using this association, decision-support applications that detect significant clinical events can transmit them directly to the responsible resident. Sign-out and patient-review systems, which collect information on all of a physician's patients, always know the patients for whom that physician is responsible. Nurses who need to contact a physician about a patient issue always know which physician is covering that patient. Coverage List also manages schedule entry and display for physicians, or for any other staff members. A physician can enter individual schedule changes, sign out her service and her pager for the day, and page consultants automatically without going through an operator. These functions support clinical practice directly and enhance the value of other clinical programs.

Algorithms↗
PubMed1993

[A proposal for a computerized clinical records file for a department of general surgery].

The author suggest a computerized program for filing clinical records of surgical institution. The proposed file is written in DB III plus (Ashton-Tate) and consists of one file .dbf and 4 files .prg. The database file contains anagraphic and clinical data of the patients. The program files make it possible to attribute a personal code to patients, print records of single patients, calculate the time of operation and assist in codifying diagnostic related groups (DRGs). The author stresses the utility of a medical computerized records system containing only few but important clinical data. It makes it possible to perform the most analysis of surgical series without the aid of a professional programmer.

Computer Systems↗
PubMed1993

Physician inpatient order writing on microcomputer workstations. Effects on resource utilization.

OBJECTIVE: To assess the effects on health care resource utilization of a network of microcomputer workstations for writing all inpatient orders. DESIGN: Randomized controlled clinical trial. SETTING: Inpatient internal medicine service of an urban public hospital. SUBJECTS: A total of 5219 internal medicine patients and the 68 teams of house officers, medical students, and faculty internists who cared for them. INTERVENTION: Microcomputer workstations, linked to a comprehensive electronic medical record system, for writing all inpatient orders. MAIN OUTCOME MEASURES: Total inpatient charges for each admission and charges for specific categories of orders. A time-motion study of selected interns assessed the ordering system's time consumption. RESULTS: Intervention teams generated charges that were $887 (12.7%) lower per admission than did control teams (P = .02). Significant reductions (P < .05) were demonstrated separately for bed charges, diagnostic test charges, and drug charges. Reductions of similar proportion and statistical significance were found for hospital costs. The mean length of stay was 0.89 day shorter for intervention resident teams (P = .11). Interns in the intervention group spent an average of 33 minutes longer (5.5 minutes per patient) during a 10-hour observation period writing orders than did interns in the control group (P < .0001). CONCLUSIONS: A network of microcomputer workstations for writing all inpatient orders significantly lowered patient charges and hospital costs. This would amount to savings of more than $3 million in charges annually for this hospital's medicine service and potentially tens of billions of dollars nationwide. However, the system required more physician time than did the paper charts. Research at other sites and system advances to reduce time requirements are warranted.

Computer Communication Networks↗
PubMed1996

The computerised surgical logbook: why bother?

Many people find computers intimidating. Even those happy to use a word processor will often steer clear of database programs since they are often regarded as only useful to people who have special expertise with computers. In fact, this is no more true for databases than it is for word processors. Anyone who can handle the latter can easily reap the many benefits of putting their surgical logbook onto a database program. The author explains what a database is, why he believes it is a good idea to use one to computerise surgical logbooks and how to go about doing it.

Databases, Factual↗
PubMed1996

Clinical decision support for physician order-entry: design challenges.

We report on a joint development effort between ALLTEL Information Services Health Care Division and IBM Worldwide Healthcare Industry to demonstrate concurrent clinical decision support using Arden Syntax at order-entry time. The goal of the partnership is to build a high performance CDS toolkit that may be easily customized for multiple health care enterprises. Our work uses and promotes open technologies and health care standards while building a generalizable interface to a legacy patient-care system and clinical database. This paper identifies four areas of design challenges and solutions unique to a concurrent order-entry environment: the clinical information model, the currency of the patient virtual chart, the granularity of event triggers and rule evaluation context, and performance.

Artificial Intelligence↗
PubMed1997

Inhaled steroids and the risk of hospitalization for asthma.

OBJECTIVE: To determine if anti-inflammatory treatment for asthma reduces the risk of asthma hospitalization. DESIGN: Retrospective cohort study. SETTING: A health maintenance organization (HMO) in eastern Massachusetts. PARTICIPANTS: Members of the HMO who were identified during the period October 1991 through September 1994 as having a diagnosis of asthma using a computerized medical record system. MAIN OUTCOME: Hospitalization for asthma. RESULTS: Of the 16941 eligible persons, 742 (4.4%) were hospitalized for asthma. The overall relative risk (RR) of hospitalization among those who received inhaled steroids was 0.5 (95% confidence interval [CI], 0.4-0.6) after adjustment for beta-agonist dispensing. Additional adjustment for age, race, other asthma medications, and amount and type of ambulatory care for asthma did not substantially affect the inverse relationship between use of inhaled steroids and hospitalization. Cromolyn was similarly associated with reduced risk, especially among children (RR,0.8; 95% CI, 0.7-0.9). In contrast, increasing beta-agonist use was associated with increasing hospitalization risk even after adjustment for other factors and medications. The steroid-associated protection was most marked among individuals who received the largest amount of beta-agonist. CONCLUSIONS: Inhaled steroids and, to a lesser extent, cromolyn confer significant protection against exacerbations of asthma leading to hospitalization. These results support the use of inhaled steroids by individuals who require more than occasional beta-agonist use to control asthma symptoms.

Administration, Inhalation↗
PubMed1998

[A method for auditing medical records quality: audit of 467 medical records within the framework of the medical information systems project quality control].

Future hospital accreditation could take into account the quality of medical files. The objectives of this study is to test a method for auditing and evaluating the quality of the handing of medical files. We conducted a retrospective regional audit based on the frame of reference the National Agency for Medical Development and Evaluation, by using a sample of cases, stratified by establishment. In our region, the global budgets of 47 public and private hospitals participating in the public hospital service, are adjusted while keeping in mind the medicalised activity data (PMSI). This audit was proposed to the doctors of the Department of Medical Information on the occasion of the regulatory PMSI quality control. A total of 467 questionnaires were given by 39 of the 47 sollicited hospitals (83%). The methodological aspects (questionnaire, cooperative approach...) are discussed. The make-up of medical files can alos be improved by raising the percentage of the presence of important data or documents such as the reason for admission (74.1%), the surgery report (83.2%), and the hospitalisation report (66.6%). A system for classifying the paraclinical results is shared and systematic throughout the service or hospital in only 73.2% of cases. The quality of the handing of medical files seems problematic in our hospitals and actions for improving the quality should be undertaken as a priority.

Accreditation↗