Benchmark for success: a good data source is a case manager's best friend.
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Benchmarking↗
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Predictions of hospital mortality rates: a comparison of data sources.
BACKGROUND: Comparing hospital mortality rates requires accurate adjustment for patients' intrinsic differences. Commercial severity systems require either administrative data that omit vital clinical facts about patients' conditions at hospital admission or costly, time-consuming abstraction of medical records. The validity of supplementing administrative data with laboratory data has not been assessed. OBJECTIVE: To compare risk-adjusted mortality predictions using administrative data alone; administrative data plus laboratory values; and the combination of administrative, laboratory, and clinical data. DESIGN: Retrospective cohort study. SETTING: 30 acute care hospitals. PATIENTS: 46,769 patients hospitalized with acute myocardial infarction, cerebrovascular accident, congestive heart failure, or pneumonia. MEASUREMENTS: Each patient's probability of dying was estimated by using administrative data only (unrestricted administrative models), administrative data restricted to secondary diagnoses that are unlikely to be hospital-acquired complications (restricted administrative models), restricted administrative data plus laboratory data (laboratory models), and restricted administrative data plus laboratory and abstracted clinical data (clinical models). RESULTS: The unrestricted administrative models predicted death better than the restricted administrative models (average areas under the receiver-operating characteristic [ROC] curves, 0.87 and 0.75, respectively) and as well as the laboratory models and the clinical models (average areas under the ROC curves, 0.86 and 0.87, respectively). The good mortality predictions obtained by using the unrestricted administrative models result from inclusion of hospital-acquired complications that commonly precede death. The laboratory models ranked 93% of patients and 95% of hospitals in a manner similar to the clinical models; in comparison, rankings provided by the laboratory models were similar to those provided for 75% of patients and 69% of hospitals by the unrestricted administrative models and for 72% of patients and 77% of hospitals by the restricted administrative models. CONCLUSIONS: Adding laboratory data (often available electronically) to restricted administrative data sets can provide accurate predictions of inpatient death from acute myocardial infarction, cerebrovascular accident, congestive heart failure, or pneumonia. This alternative avoids the cost of data abstraction and the serious errors associated with using administrative data alone.
Adult↗
The medical record as a data source: use and abuse.
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Abstracting and Indexing↗
The epidemiology of Wegener's granulomatosis. Estimates of the five-year period prevalence, annual mortality, and geographic disease distribution from population-based data sources.
OBJECTIVE: To estimate the prevalence, annual mortality, and geographic distribution of Wegener's granulomatosis. METHODS: Analysis of national vital statistics data and hospitalization data from a national survey and from all New York State inpatient facilities. RESULTS: Between 1979 and 1988, 1,784 death certificates in the United States listed Wegener's granulomatosis as a cause of death. Nationally, an estimated 10,771 hospitalizations included Wegener's granulomatosis among the discharge diagnoses. In New York State, there were 978 hospitalizations among 571 individuals with Wegener's granulomatosis. CONCLUSION: The prevalence of Wegener's granulomatosis in the United States is approximately 3.0 per 100,000 persons. Clear differences in the geographic distribution of Wegener's granulomatosis are apparent when analysis consider rates of disease in individual counties. Contrary to previous reports, associations between disease exacerbations and season were not apparent.
Adolescent↗
Estimating the incidence and prevalence of rare rheumatologic diseases: a review of methodology and available data sources.
Where the need for descriptive epidemiology is great, population based registries can be established, at considerable cost, to provide the desired data. In many instances, however, there may be existing data and information systems that provide morbidity information on sufficiently large, well defined populations to allow reasonable estimates of the incidence and prevalence of rare rheumatologic diseases.
Connective Tissue Diseases↗
Periodically repeated multi-phasic health tests--a unique data source for detecting subject-specific normal ranges.
When a comprehensive health check-up is repeated for the purpose of health control, the individual clinical data should be evaluated carefully by a proper normal range, which must be specific to each subject, if early detection of disease is a goal. The Perfect Liberty Health Control System, a health plan run on a membership basis, has been giving its periodic multi-phasic health tests to all of the 24 000 + members biannually since 1970. Studies concerning health parameter dynamics have been made on the data obtained and these are important to the new challenging field of clinical laboratory examinations. Other helpful aspects of this punctually repeated AMHTS (Automated Multi-phasic Health Testing) on a lifetime membership basis are also presented, such as cancer detection accuracy, protection from unnecessary X-ray exposure during examinations and a new form of physician's examination supported by current laboratory-data preview.
Adult↗
Case counting in epidemiology: limitations of methods based on multiple data sources.
BACKGROUND: The application of capture-recapture methods in epidemiology has been proposed as an alternative to field surveys. This methodology is important for the future of epidemiology and deserves a critical analysis. METHODS: This paper reviews conditions for applying the capture-recapture models to epidemiological data, taking into account practical considerations, in particular the problem of case definition. RESULTS: The underlying assumptions are particularly restrictive resulting in a theoretical limitation of their applicability. In spite of the statistical developments designed to overcome these difficulties, the practical conditions for using the existing lists are often not fulfilled (availability, confidentiality). The major restriction is on the quality of the data which are often far below the standards required in specific prevalence surveys and which may differ between lists. This may result in a dramatic lack of specificity. The definition of the virtual subgroup of patients missing in all lists as generated by the statistical procedure, is questionable particularly when counting living patients. Field studies would be necessary for validation. CONCLUSIONS: In some particular situations (e.g. deceased patients, rare diseases), this methodology may provide a useful approximation to the number of ill subjects events, but users should be aware of their poor specificity. It can also be useful to complement data from surveillance systems by careful cross-checking with independent sources of information. Currently, this method cannot, in any way, replace direct population prevalence or incidence surveys.
Epidemiologic Methods↗
Data-source effects on the sensitivities and specificities of clinical features in the diagnosis of rheumatoid arthritis: the relevance of multiple sources of knowledge for a decision-support system.
An experimental computer system was developed to support diagnosis of rheumatic disorders by computing diagnostic probabilities using modified likelihood ratios. The authors examined whether the performance of the model was affected by the settings in which the data used to derive the likelihood ratios were collected. The sensitivities and specificities of various clinical features for diagnosing rheumatoid arthritis (RA) were obtained from: 1) a study of 1,570 consecutive outpatients at a rheumatology clinic; 2) a review of the literature; 3) estimates by rheumatologists; and 4) a population study. Considerable variations in sensitivity and specificity but satisfactory agreement in likelihood ratios were found across the four data sets. The likelihood ratios were then used to compute the probabilities of RA in a test series of 570 of the rheumatology clinic outpatients. The model's diagnoses with likelihood ratios from the other sources were adequate. When the likelihood ratios from these sources were combined, discrimination came close to what could be achieved by using the likelihood ratios based on the data from the clinic. The method applied in the study, which makes use of variation of input data instead of variation of test series, and the results are relevant to assessing the external validity and transferability of Bayesian decision-support systems.
Adolescent↗
[Legal aspects of health insurance claims and their potential use as a data source for epidemiological research].
Health insurance claims are legal documents for the purpose of billing health care cost and not intended for medical certification. They contain valuable public health data as well as sensitive personal information which must be kept confidential. Conflicts arise between the public interest and the privacy protection when public health researchers attempt to perform studies using health insurance claims. This article examines the legal aspects of health insurance claims and proposes legitimate procedures and forms for using claims data in public health research: researchers should act as "contractors" to perform survey under the auspices of insurers instead of requesting the "disclosure" of the personal information.
Confidentiality↗
Two new benchmarking data sources available.
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Benchmarking↗
An evaluation of the American Medical Association's Physician masterfile as a data source--one state's experience.
An evaluation of the American Medical Association's (AMA) Physician Masterfile is presented here on a state level. Both completeness and reliability of the AMA data were assessed for physicians licensed and living in Washington State. Comparison of the AMA data with state -LICENsure data indicated excellent agreement, with only a small proportion of license physicians "missing" from the AMA Masterfile. Their absence was due largely to differences in the manner in which the two systems updated their files. The reliability of the AMA data was checked by comparing it with similar, independently gathered survey data on birth date, birthplace, medical school, type of practice, specialty, board certifications, and employer. In general, despite some minor deficiencies, the AMA data were shown to be highly reliable.
American Medical Association↗
Injury surveillance. A review of data sources used by the Division of Safety Research.
Injury surveillance by the Division of Safety Research in the National Institute for Occupational Safety and Health has the following two major purposes: the detection of significant changes in the status of worker safety to help define areas for research and the assessment of importance of various safety problems for priority setting in the Division. Surveillance of occupational injuries in recent years has realized a quantum improvement due to the availability of several extensive work-injury case data bases. The Division of Safety Research utilizes three of these to provide essentially independent sources of evidence for the identification and definition of problems for safety research. The National Electronic Injury Surveillance System, based on daily reports from a representative sample of hospital emergency rooms across the nation, provides case data such as age and sex of the injured worker, injury diagnosis, and product involvement. The Supplementary Data System annually provides worker's compensation case files which include the occupation and industry of the injured worker from selected states. A third level of detail is provided by the work injury report surveys of injured workers, conducted annually, and focused on specific accident types of injury groups. Findings, include high-risk occupations, age groups, tools, and equipment.
Accidents, Occupational↗
Re: "alternative data sources and discrepant results in case-control studies of estrogens and endometrial cancer".
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Epidemiologic Methods↗
Comparing hospitals that perform coronary artery bypass surgery: the effect of outcome measures and data sources.
OBJECTIVES: The relative quality of hospital care often is judged by comparing risk-adjusted rates of adverse outcomes. This study evaluated whether hospital quality comparisons are affected by the choice of outcome and the use of administrative data instead of clinical data. METHODS: The data were collected from 2687 coronary artery bypass surgery patients from 17 hospitals. All patients were on Medicare. For 10 hospitals with 94 to 713 patients, risk-adjusted outcomes for death, major complications, and any complications were derived from a clinically rich database and an administrative database. RESULTS: The correlations between adjusted hospital rankings derived from the clinical and administrative databases were not significant: .48 for mortality, .21 for major complications, and -.14 for any complication. When only the clinical database was used, the correlation between risk-adjusted hospital rankings for mortality and major complications was .77 (P < .01) and the correlation between major complications and any complication was -.45. CONCLUSIONS: These results suggest assessing quality of care by the use of administrative data may not be adequate and that quality assessment by the use of clinical data may depend greatly on the outcome chosen.
Aged↗
Environmental health indicators and sanitation-related disease in developing countries: limitations to the use of routine data sources.
This article explores conceptual issues in the development and use of environmental health indicators for basic problems related to water and sanitation in developing countries. In this context, faecal contamination is the most important environmental health problem, responsible for the death of approximately 3 million children a year, and the infection of hundreds of millions. Good indicators would be invaluable in assessing the magnitude and source of such problems in different settings.
Adolescent↗
Alternative data sources and discrepant results in case-control studies of estrogens and endometrial cancer.
In most case-control studies, little attention has been given to two features that can affect the odds ratio: 1) self-selection of the people who are available for interviews, and 2) disagreements between the data obtained by medical records and by direct conversation. The authors investigated these problems during two separate case-control studies of estrogens and endometrial cancer. When interviews were attempted with all patients, fewer controls than cases were available. In samples of patients from a tumor registry, more controls than cases had died before the interview could be solicited, and fewer control patients could be located. In patients sampled from a diagnostic test registry, more controls than cases refused participation. The interview data about estrogen usage disagreed with previously recorded medical information in 16% (52/324) of patients). Among persons marked as "non-users" in medical record data, more cases than controls were available for interview and thus for redesignation as estrogen users. The bias produces a possible artificial increase in the odds ratio when interview and medical record data are combined. Since patients available for interview were systematically biased in favor of having both estrogen use and endometrial cancer, the odds ratio for this association should be calculated separately for record and for interview data.
Connecticut↗
Critical evaluation of medical, statistical, and occupational data sources in the Kola Peninsula of Russia pertinent to reproductive health studies.
BACKGROUND: The feasibility study described herein was prompted by a report in 1992 of possible reproductive and developmental health concerns among female workers in a Russian nickel refinery. OBJECTIVE: The primary goal was to ascertain whether medical, statistical, and occupational data bases could be accessed for information about the pregnancy histories, occupational histories, and life-style factors of the women affected. METHODS: The project was facilitated by construction of a registry of all births in three towns with a nickel refinery and verification of its contents against patients' records obtained from hospital delivery and gynecology departments and community polyclinics. Municipal Registration Board, Regional Health Statistics Board, and nickel company records were also reviewed. RESULTS: Reproductive/developmental outcome information and workplace histories were acceptable. Sample-size calculations indicated that a cohort or cross-sectional study would be amenable and suitable for the detection of an excess risk for spontaneous abortion with adequate statistical significance and power. Such investigations would need to be supplemented by workplace environmental/biological monitoring assessments for evaluation of exposure to occupational hazardous factors and a worker's questionnaire to obtain information about life-style factors. A case-control design is recommended for the study of congenital defects. CONCLUSIONS: A well-designed, comprehensive epidemiology study is technically feasible because of the availability of a favorable pool of study subjects, reproductive/developmental outcome data, information to control for major confounders, and suitable occupational records.
Adult↗
Archaeological techniques for exhumations: a unique data source for crime scene investigations.
If exhumations to retrieve a body or body samples are conducted according to archaeological methodology, they may provide evidence on events which occurred during the interment process. This article discusses the exhumation methodology employed during exhumations in a tropical environment and provides a case study to serve as an example of the data that can be obtained beyond the simple recovery of human remains.
Archaeology↗