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At least 721 records · Page 40Linked to original sources
PubMed1996

Completeness and accuracy of morbidity and repeat prescribing records held on general practice computers in Scotland.

BACKGROUND: A high proportion of Scottish general practices use a standard computer software package (GPASS, general practice administration system for Scotland), and thus, Scotland is uniquely placed to amalgamate primary care data on a national scale. Practices, however, vary widely in the nature and extent of data entered on computer and a major limitation on the use of the collected data is the absence of information on the completeness and accuracy of the computer database. AIM: This study set out to assess the quality of morbidity and repeat prescribing records held on computer by general practices in Scotland. METHOD: Forty-one practices, with above average levels of morbidity data recorded on computer, were selected on a geographic basis in relation to the national population distribution. Within each practice, 250 patients aged 45-64 years were selected at random. Data relating to 19 diagnoses, six surgical procedures and 40 repeat prescription drugs were extracted from the computer records of these patients and compared with information held on patients' paper records and supplied by patients in response to a postal questionnaire. The completeness and accuracy of computer entries were assessed in terms of sensitivity and positive predictive value, respectively. RESULTS: For the 5567 patients for whom all three sources of data (validated computer records, paper records and questionnaire responses) were available, sensitivity (completeness) of morbidity recording had median values of 0.67 for diagnoses, 0.93 for surgical procedures and 0.75 over all conditions examined. Practices varied both in the completeness of recording of each condition and in their overall performance. The predictive value (accuracy) of morbidity data was uniformly high for all conditions examined (median 1.00). For repeat prescription drugs, recording on GPASS was both complete and accurate. CONCLUSION: The recording of morbidity data on GPASS for 45-64-year-old patients in a selected group of 41 highly-computerized practices is about 75% complete and highly accurate. For national morbidity studies, it seems likely that amalgamated data from the best GPASS practices will be as complete and accurate as the morbidity statistics currently derived from hospital-based activities in Scotland.

Drug Prescriptions↗
PubMed2001

Exploring the utility of demographic data and vaccination history data in the deduplication of immunization registry patient records.

Duplicate patient records pose a major problem for many immunization registries, as well as for many electronic patient record systems. This paper reports two complementary studies exploring the deduplication of immunization registry records. One study explores the utility of different demographic data elements, singly and in combination, to assist in the deduplication process. The second study explores how clinical patient data (vaccination history data) might assist in this process. To assess the utility of demographic data elements, data were used from three registries after duplicates had been identified. A computer program, IMM/Scan, was written to count the number of true-positive (TP) matches and false-positive (FP) matches found when using different Boolean combinations of demographic data elements. In this study, a strategy of "ORing high value ANDed pairs of data elements" appeared to be most powerful. To assess the utility of vaccination history data, record pairs were drawn from 440,000 patient records. Two metrics on patient history were tested: (1) the number of identical doses shared by two records, and (2) the number of "extra" doses in the combined history of two records. In this study, sample findings include: (1) for pairs of nonduplicate records, 93% had no identical doses and 90.6% had "extra" doses, and (2) for pairs of duplicate records, 83.8% had one or more identical doses and 82% contained no "extra" doses. These studies demonstrate potentially useful approaches to using demographic data and patient history data to assist the automated deduplication of immunization patient records.

Demography↗
PubMed2001

The western australian road injury database (1987-1996): ten years of linked police, hospital and death records of road crashes and injuries.

Accurate information about injuries and their causes is essential to road safety research, policy development and evaluation. Such information is most powerful when it is available for all road crashes within a jurisdiction. The Western Australian Road Injury Database achieves this through the on-going linkage of crash details from reports to police with the details of injuries to casualties contained in hospital and death records. Over the 10-year period 1987-1996, 386,132 road crashes involving 142,308 casualties were reported to the police in Western Australia. There were also 47,757 hospital discharge records and 2,906 death records related to road crashes during this period. Of the 142,308 police casualties, 17 848 had a matching hospital discharge record and 2,454 had a matching death registration. Linkage within the hospital records revealed that the 47,757 discharge records involved 43,179 individuals, of whom 39,073 were admitted to hospital once, 3,653 were admitted twice, 374 were admitted three times and 78 were admitted more than three times. Of the 43,179 hospitalised casualties, 817 had a matching death record. Linked police, hospital and death records of road crash casualties provide accurate outcome information for casualties in crashes reported to the police. In addition, estimates of under reporting of crashes for different road user groups can be made by comparing hospital records with and without a matching police record. This article demonstrates the power of a linked system to answer complex research questions related to outcome and under-reporting.

Accidents, Traffic↗
PubMed1991

Prenatal records: a national survey of content.

The uses of prenatal records extend well beyond management of patient care. They are also vehicles for communication, quality assurance, financial compensation, and legal documentation. To serve each of these functions, records should be systematic and detailed. This nationwide study was conducted to assess the extent to which prenatal records in current use include sufficient detail to serve these functions. A random sample of 2746 physicians who listed obstetrics and gynecology, obstetrics, or maternal-fetal medicine as a primary or secondary specialty in the American Medical Association file were contacted by mail and were requested to submit a blank copy of their prenatal records. The records of 969 respondents were examined for the presence or absence of 53 items that corresponded to the five functions identified above. The items of interest were present in 1% to 98% of the records. More than 90% included items of traditional medical-obstetric significance. The percentages of records with items of more contemporary relevance (e.g., cigarette smoking, risk-assessment checklists, psychological stress) were found in lower percentages of the records. Stratified and logistic regression analyses revealed that the most systematic and detailed records were commercially available, were used by physicians in hospital and government program-based practices, and were used by physicians who had completed medical school less than or equal to 15 years before the survey. The findings suggest that physicians who do not use commercially available forms or those who are in private or health maintenance organization practice or have been practicing for more than 15 years should reconsider their prenatal records in light of the functions they will serve in the 1990s and beyond.

Communication↗
PubMed1998

Validation of computerized Swedish dog and cat insurance data against veterinary practice records.

Large computerized medical databases offer great potential for epidemiological research. However, data-quality issues must be addressed. This study evaluated the agreement between veterinary practice records and computerized insurance data in a large Swedish claims database. For the year 1995, the company insured over 320,000 dogs and cats. A total of 470 hard-copy records were sampled from claims for health care (n = 236) and life insurance (n = 234). Computerized insurance data for these claims were accessed and records from the attending veterinary practices were collected. For health and life claims, respectively, 79.2 and 72.8% of practice records were retrieved. Variables compared between the computer and practice records were breed, sex, date of birth and diagnosis for the claim. The degree of agreement was categorized as agreement, minor disagreement, major disagreement or data missing. Multivariable logistic regression was used to examine factors associated with errors. The observed agreement for breed and sex was excellent. There was 28.9 and 33.8% minor disagreement for the date of birth for health and life claims, respectively. This was mainly because, prior to 1993, the date of birth was coded as the first of January when more complete information was unavailable. Major disagreement (different year of birth) was low for both health and life claims. For health and life claims, the observed agreement for diagnosis was 84.0 and 84.9%, minor disagreement was 6.4 and 4.3%, and major disagreement 5.9 and 9.4%, respectively. Although there was no difference based on size of the veterinary clinic involved, there was a tendency for better agreement between the practice record and the computerized insurance data for claims from clinics with computerized practice records (n = 40) than for clinics with manual practice records (n = 286). Rates of discrepancy were affected by the clerk who processed the claims. Records processed by two of the 21 clerks had significantly more disagreements. Given the nature of the data, it was only possible to calculate a measure of observed agreement. In general, the agreement between data in the insurance-company database and from the practice records was excellent for demographic data such as breed and sex and fair for diagnostic information and date of birth. In general, the data are adequate to support ongoing research with due considerations of certain limitations.

Animals↗
PubMed2003

Comparison of recordings obtained with computerized axiography and mechanical pantography at 2 time intervals.

PURPOSE: The purpose of this study was to compare recordings of mandibular movements obtained with a Denar mechanical pantograph to those obtained with a Denar computerized axiograph (Cadiax compact). MATERIALS AND METHODS: Pantographic recordings and computerized axiograms were collected on 10 subjects. All of the subjects had intact dentition and no clinical signs or symptoms of temporomandibular dysfunction. Tracings produced with the 2 instruments were compared using pantographic reproducibility indices (PRIs). Recordings with each instrument were repeated twice and assessed for consistency. Pearson's correlation coefficient was used to compare PRI scores obtained with the pantograph and the axiograph. Recordings with both instruments were repeated 2 weeks to 1 month later, and new PRI scores were calculated. Consistency between initial and second PRI scores for each instrument was assessed using a coefficient of stability. RESULTS: The coefficients of stability between the initial and second recordings were r = 0.91 for mechanical pantography and r = -0.06 for computerized axiography. Comparison of recordings made by mechanical pantography and computerized axiography at the initial and second recordings showed poor concordance, with coefficients of 0.23 and -0.11, respectively. CONCLUSIONS: PRI scores recorded with the mechanical pantograph were consistent between the initial and second recordings. In contrast, recordings with the computerized axiograph appeared highly inconsistent across time. PRI scores calculated from the axiographs were significantly higher than PRI scores calculated from pantographic tracings for the same subject.

Adult↗
PubMed2001

Auditing nursing content in patient records.

The objective of this paper is twofold: (a) to explore different approaches in reviewing records based on a literature review of studies of audits of patient records and (b) to apply these approaches on a sample of records to illuminate consequences of their application. The method used was a literature review of papers on recording of nursing care (n = 56). Based on our findings, an audit of a stratified sample of records (n = 298) from Swedish community health care and nursing homes was performed, applying the different approaches for auditing previously described in the literature. The review showed that audits of patient records were performed using four different approaches with varying aims. The focus of the four approaches can be described as formal structure, process comprehensiveness, knowledge-based and concordance with actual care. The results of this study suggest that audits of patient records should not be solely limited to encompass the formal structure of recording. To avoid a superficial picture or a false sense of high quality and to obtain a more complete and reliable portrait of the quality of recording, we suggest the process comprehensiveness approach in combination with a critical review of the knowledge base for the assessment, diagnosis and interventions of patient records.

Medical Records↗
PubMed2002

Feasibility of AsthmaCritic, a decision-support system for asthma and COPD which generates patient-specific feedback on routinely recorded data in general practice.

BACKGROUND: Introducing decision-support systems as a tool to stimulate the dissemination of clinical guidelines in daily practice has been disappointing. Researchers have argued that integration of such systems with clinical practice is a prerequisite for acceptance. The big question concerns the feasibility of a true integration--if only routinely recorded data are used for such a system, can patient-specific feedback be produced? OBJECTIVE: The aim of this study was to assess the feasibility of generating patient-specific feedback based on routinely recorded data in general practice by AsthmaCritic, a decision-support system for asthma and chronic obstructive pulmonary disease (COPD). METHODS: We built the decision-support system AsthmaCritic and assessed its ability to detect asthma and COPD patient records and generate patient-specific feedback by retrospective analysis of routinely recorded data in 103 713 electronic patient records from primary care practices. We grouped feedback into categories of comments by age group (<12 years and > or =12 years). The main outcome measures were the number and percentage of "triggered" (selected) asthma and COPD patient records, and the number and percentage of records on which AsthmaCritic produced at least one feedback comment during the 1-year study period, by category of comments. RESULTS: AsthmaCritic detected 8784 (8.5%) asthma and COPD patient records. During the study period, AsthmaCritic generated 255 664 feedback comments (mean 3.4 per patient visit). The most frequently generated category of comments in the case of patients aged > or =12 years was "non-compliant prescription" (23.7%), whereas the most frequent category in the case of patients <12 years was "non-compliant route" (31.1%). CONCLUSIONS: This study shows that, using routinely recorded data only, AsthmaCritic is able to detect asthma and COPD patient records for further analysis and to produce patient-specific feedback.

Adolescent↗
PubMed2006

Continuity of care through medical records--an explorative study on GPs' management considerations.

BACKGROUND: The growing complexity of care with more professionals involved is a threat to the delivery of coherent and consistent care. Excellent exchange of information between professionals may be a way to maintain continuity of care. Relevant information to be passed over includes thoughts about future management for individual patients. AIM: To explore the nature of GPs' thoughts about future management, and to determine the extent to which such thoughts are actually recorded in medical records. DESIGN OF STUDY: Cross-sectional study of 5741 consultations. SETTING: Thirty GPs from 17 practices in a region in the eastern part of The Netherlands. METHODS: The GPs responded to an electronic questionnaire, directly after 200 successive consultations. The questionnaire included items on management considerations, consultation characteristics and personal continuity. We compared the data from the questionnaire to the actual recording of management considerations in the patient records. RESULTS: The GPs had management considerations in 66.4% of the consultations, involving mainly considerations about additional testing (15.5%), adjustment of medication (22.5%), alternative treatment plans (18.6%), possible referral (11.8%) and coping behaviour (18.0%). These considerations were seldom recorded in the electronic patient record; additional testing (3.0%) adjustment of medication (2.9%) and alternative treatment plans (4.1%). Surprisingly however, GPs rarely found that management considerations from earlier consultations were lacking in the medical record. CONCLUSION: GPs often have thoughts on how to deal with this patient, but hardly ever record such considerations. We recommend the development of tools that facilitate the recording of management considerations in electronic patient records.

Continuity of Patient Care↗
PubMed2005

A practical method for collecting 3-day food records in a large cohort.

BACKGROUND: Recent studies suggest that diet records are more valid measures of nutrient intake than are food-frequency questionnaires. However, food records are considered unsuitable for large studies due to the need to train participants and to review and correct completed records. METHODS: We evaluated a self-administered 3-day food record protocol in Washington State. One hundred men and women age 50-76 years were mailed a food record and serving-size booklet. Sixty-five people returned a completed food record and were subsequently interviewed to obtain missing information. The food records were analyzed with and without added information from the interview. RESULTS: The most common error was incomplete description, which affected 8% of recorded foods. Differences in mean nutrient intake between the uncorrected and corrected records were within 5%, and nutrient estimates from the 2 methods were highly correlated. CONCLUSIONS: This streamlined protocol yielded data comparable to those collected by more burdensome protocols, suggesting that the use of food records may be feasible in large cohort studies.

Aged↗
PubMed2001

Health of teenagers in residential care: comparison of data held by care staff with data in community child health records.

AIM: To identify whether there are gaps in information available to care staff about the health related needs of one group of teenagers in residential care which could be addressed by reviewing the community child health records. METHODS: Data were collected on the residents of a children's home during a three month period, comparing information from children's home records with information from community child health records. RESULTS: Data were collected from children's home records for 36 residents and child health records obtained for 29. Child health records provided the only information on 53% of child protection registrations and 17.5% of statements of special educational needs. Most information on birth history, developmental and early medical history, immunisations, growth, hearing, and colour vision came from the child health records. Immunisation uptake was below the national average, and particularly poor for BCG and school leaver tetanus, low dose diphtheria, and polio boosters. Emotional and behavioural problems were present in 100% of the residents and this information was known to the home. Poor use of "Looking After Children" records was identified, and there was a paucity of information in the home records and child health records about results of annual looked after medical examinations. CONCLUSION: Important information about the health needs of looked after teenagers was not known to the children's home staff. Community paediatricians should be proactive in identifying and addressing these needs.

Adolescent↗
PubMed1996

Fair shares in health care? Ethnic and socioeconomic influences on recording of preventive care in selected inner London general practices. Healthy Eastenders Project.

OBJECTIVE: To describe the association of ethnic and socioeconomic status with recording of preventive care information by selected general practitioners. DESIGN: Random selection of people aged 20-64 registered with 43 general practitioners. Ethnic and social characteristics of stratified samples were determined at interview in the subject's home. Recording of preventive information was ascertained from general practitioners' medical records. SETTING: Inner London borough of Tower Hamlets. SUBJECTS: 505 ut of 739 people confirmed as residents at their home address (190 white, 86 black, 112 Bangladeshi, 105 Chinese or Vietnamese, 12 other). MAIN OUTCOME MEASURES: Socioeconomic characteristics, consultation with general practitioner, and recorded preventive activities for ethnic groups. RESULTS: Minority ethnic groups were considerably more disadvantaged than white people and five times more likely to be overcrowded (31% v 6%), three times less likely to own their own home(11% v 37%), twice as likely to be in social classes IV and V (54% v 28%) and less likely to be employed (34% v 63%). There were no significant differences between white, black, Bangladeshi, and Chinese or Vietnamese subjects in recording smoking, blood pressure, alcohol consumption, weight, and height in the general practitioners' medical records. White women were more likely to have a record of mammography (46% v 20%; P=0.03) and of cervical smears than women in minority ethnic groups. CONCLUSION: Despite major socioeconomic inequity, equitable recording of preventive activity for the major causes of death for white, black and Bangladeshi populations is possible. Chinese and Vietnamese people had lower levels of recording and consultation. Mammography and, to a lesser extent, cervical cytology are inequitably recorded and require additional support at practice level.

Adult↗
PubMed1994

The effect of audit and feedback on data recording in the accident and emergency department.

Thirteen newly appointed senior house officers (SHOs) at two hospitals were assessed in the recording of two variables: Glasgow Coma Scale (GCS) and diagnostic coding at Hospital A, and GCS at Hospital B. At Hospitals A and B baseline recordings of these variables were established. Active feedback (in the form of data presentation and discussion) was given at 6 and 11 weeks and a final 4-week audit was performed on GCS recordings at 20 weeks. Analysis of GCS recordings of head injuries at Hospitals A and B showed an increase from baseline values of 162/401 (40%) to 336/420 (80%) after feedback 1, and after feedback 2 recordings increased to 379/429 (88%). This was maintained in the last 4-week audit which showed recordings of 220/244 (90%). Further analysis of Hospital A's data showed the SHOs recorded diagnostic coding in 1335/4406 (30%) of cases. After feedback 1, recordings increased to 2550/3327 (77%). After feedback 2 there was no change in recording 2712/3530 (77%). Active feedback improves data recording. The first feedback has a greater impact than the second. Two feedbacks produce a sustained effect in 6 months.

Craniocerebral Trauma↗
PubMed1994

Records contributing to national genetic evaluations by year, registration status, herd size, and region.

Lactation records from official DHIA were screened for usability in computing USDA-DHIA genetic evaluations. Counts of usable lactation records by state, registration status, and year were examined. Number of cows enrolled in official record-keeping plans of DHIA was the denominator for calculation of percentage of official DHIA records usable in genetic evaluations for state-years. Percentage of official records usable for genetic evaluations had a small increase from 44% during 1968 to 49% during 1978, had a steep increase through 1988 (65%), and then showed little change during the last 2 yr. Number of usable records of registered cows for genetic evaluations increased from 604,570 during 1968 to 864,630 during 1990, which, nevertheless, represented a decline from 64% of all usable records during 1968 to only 42% during 1990. Effects of year, DHIA region, average herd size, and average percentage of registered cows were important for explaining variation in percentage of records usable for genetic evaluations for state-years. States with large average herd sizes and low percentages of dairy cows that were registered had low percentages of records usable for genetic evaluations. Increased official DHIA participation and improved sire identification increases the percentage of records usable for genetic evaluations and helps facilitate genetic improvement.

Animals↗
PubMed1990

Identification of adverse events occurring during hospitalization. A cross-sectional study of litigation, quality assurance, and medical records at two teaching hospitals.

STUDY OBJECTIVES: To estimate the efficacy of a medical record review for identifying adverse events and negligent case suffered by hospitalized patients. DESIGN: Cross-sectional study comparing an objective medical record review with information available from hospital quality assurance records as well as risk management and litigation records. SETTING: Two metropolitan teaching hospitals in the northeastern United States. MEASUREMENTS AND MAIN RESULTS: Using the litigation and risk management records as a criterion standard, we found that the medical record review had a sensitivity of 80% (93 of 116; 95% CI, 73% to 88%) for discovering adverse events and a sensitivity of 76% (51 of 67; 95% CI, 66% to 86%) for discovering negligent care. We estimated that record review of a random sample of hospitalizations across a geographic region would have even higher sensitivity (adverse-event sensitivity, 84%; negligence sensitivity, 80%). Moreover, we found that the adverse events we failed to discover led to less costly malpractice claims. A significant number of adverse events (20 of 172) among hospitalizations never gave rise to litigation or risk management investigation. Six of the twenty were due to negligent care. Quality assurance efforts at the level of the clinical departments in one hospital led to review of only 12 out of 82 risk management records. CONCLUSIONS: The overwhelming majority of adverse events and episodes of negligent care are discoverable with the methods we used to evaluate medical records. Quality assurance efforts using similar record review methods should be further evaluated.

Cross-Sectional Studies↗
PubMed1990

Computerized medical records: the need for a standard.

Major concepts introduced in this paper are as follows. 1) Organization, with its attendant qualities of accuracy, consistency, legibility, completeness, and simplicity, is the heart of the medical record. Technology should not be allowed to obscure this goal. 2) The main function of the computerized medical record is data storage with the qualities of organization noted above. This function must be clearly separated from condensation, analysis, or other secondary manipulation of data. 3) Many aspects of data manipulation call for the judgment of a physician. This judgement may be aided by computer software, but not replaced by it. 4) Present technological barriers, most notably speed, permanent large storage, and voice input should not influence the design of the effective computerized record. Future technology will be able to service the carefully designed medical record. 5) Textual parts of the computerized medical record can follow a simple and machine independent outline format. All parts of the record should use a textual introduction emphasizing patient and record identification. 6) A patient profile is central to each patient file. Updating this profile as needed must be recognized as a primary function of the physician at every patient encounter. 7) Acceptance of a standard for the computerized medical record now, before technology has matured and software diversified, will avoid a pitfall commonly experienced in other fields and save substantial healthcare funds. This standard should be geared to the needs of physicians and patients, not to the constraints of technology. The future of medical computing is bright. Obstacles to the practical use of the computerized medical record exist, but we may expect these to vanish within a few years. The great challenge to physicians now is to take this opportunity to control a new technology, rather than to be driven by it. The soul of good medicine is not in the equipment available, but in the rational and carefully thoughtout use of those tools at hand. We must recognize now the need for a uniform style of computerized medical record before the technological establishment besieges us with a flood of specialized, non-interchangeable, and expensive machines. Indeed, a bit of careful thought now as the foundation is laid can prevent the tangled confusion so typical of new technology. We have a golden opportunity to avoid a new round of escalating medical costs.

Data Display↗
PubMed2000

Computerized medical record in a private neurotology practice.

OBJECTIVE: To develop a computerized medical record for a private neurotology practice using a relational database with templates. BACKGROUND: Computers have been used in the medicine many years for billing, scheduling appointments, and word processing. Neurotology represents a relatively narrow field of medicine, which is particularly suited to a computerized record. A computerized medical record should allow for better data storage and retrieval as well as better documentation of the patient care given. METHODS: Using a commercially available, record-keeping software in a local area computer network. templates were developed for several common neurotologic problems. A template for a neurotologic examination was also developed. These were adapted from templates developed by a group otolaryngology practice in a neighboring city. Data entry templates for vestibular and audiologic tests were also developed. Implementation of the computerized record was accomplished in phases, allowing elimination of the paper record. RESULTS: A fully computerized medical record has been developed and maintained in a private neurotology practice over the past year. Patient response to the computerized record system has been favorable. Office personnel have adapted well to a paperless record, and referring physicians have welcomed the documents generated by the computer. CONCLUSION: Computerizing the medical records of a neurotology practice is possible and allows for improved documentation, ongoing assessment of treatment results, and improved efficiency among office staff.

Humans↗
PubMed2001

[Evaluation of a patient-held medical record by patients--results from the Ried Medical Quality Network].

In the "medical-quality network Ried", an independent practice network in the south of Hessia, an A 4 format patient held record for multi-morbid chronically ill patients is used since 1997. 655 patients (response-rate 71.0%) from sixteen general practitioner (GP) practices were surveyed by written questionnaire. Respondents were in average 68.1 years of age, and for 16.3 years with their GP. 52.2% were male. Patients had their own records for 24.2 months and had in average 1.9 (women) or 2.3 (men) serious health problems. Women had in average 5.0, men had 4.8 different drugs prescribed. 96.7% of the respondents thought that the patient-held record is a good idea, 85.5% felt more secure and 98.7% have it always at hand at home. The patient-held record provides better information about ones own health (92.1%) and 96.6% want to be able to look at their own record. The patient-held record makes it easier for patients to talk to doctors (86.6%) and provides a better overview for the GP (90.8%). The more drugs patients have to take, the more important it becomes for them to have their own record. 68.6% take the record on holyday, 57% take it to other doctors than the GP. 76.4% reported that the patient-held record was used at least once by a specialist, 61.3% by a hospital. 21.8% remembered emergency situations where it was helpful. Only 4.8% thought that it is tiresome. Few proposals for improvement were made, mainly focussing on a smaller format. On the basis of these results patient-held records should be a core activity of practice networks, especially for this type of patients.

Adult↗