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PubMed2005

Computerized reminders to improve isolation rates of patients with drug-resistant infections: design and preliminary results.

Infections with multi-drug resistant organisms (MDROs) are a steadily increasing threat to inpatients as they move through the hospital. We constructed a computerized reminder system, integrated with existing data sources maintained by the infection control service. We tested the hypothesis that computerized reminders from a centralized infection control expert system can improve rates of barrier isolation in patients with MDROs. Immediately after institution of this reminder system, isolation of eligible ward patients increased from a baseline rate of 33% to 95% (p<0.0001). The median time to isolation decreased from 16.6 hours to 0 hours, indicating that the majority of patients post-intervention had isolation orders written prior to arrival on the ward. We conclude that a computerized reminder system can dramatically increase the clinical impact of data sources maintained by hospital Infection Control services.

Drug Resistance, Multiple↗
PubMed1996

Incidence and distribution of injury among schoolchildren aged 11-15.

OBJECTIVES: To measure the incidence and age and sex distribution of self reported experience of injuries in the preceding 12 month period among a representative national sample of Scottish schoolchildren and to validate the findings against other data sources. DESIGN: Self completed questionnaire administered in schools, April-June 1994. SUBJECTS: 4710 pupils aged 11, 13, and 15 years drawn from a representative sample of 270 classes with returns from 224 classes (83.2% completion rate). OUTCOME MEASURES: Number, type, site, and severity of injuries reported. RESULTS: 41.9% of pupils reported a medically attended injury, with injury incidence significantly higher in boys than in girls. Using the abbreviated injury scale (maximum abbreviated injury score) one third of injuries were either moderate or severe. CONCLUSION: The incidence and distribution of self reported injury is consistent with estimates based on other data sources thus confirming the utility of this method of injury surveillance in this age group.

Accidents↗
PubMed2006

Who searches the internet for health information?

OBJECTIVE: To determine what types of consumers use the Internet as a source of health information. DATA SOURCES: A survey of consumer use of the Internet for health information conducted during December 2001 and January 2002. STUDY DESIGN: We estimated multivariate regression models to test hypotheses regarding the characteristics of consumers that affect information seeking behavior. DATA COLLECTION: Respondents were randomly sampled from an Internet-enabled panel of over 60,000 households. Our survey was sent to 12,878 panel members, and 69.4 percent of surveyed panel members responded. We collected information about respondents' use of the Internet to search for health information and to communicate about health care with others using the Internet or e-mail within the last year. PRINCIPAL FINDINGS: Individuals with reported chronic conditions were more likely than those without to search for health information on the Internet. The uninsured, particularly those with a reported chronic condition, were more likely than the privately insured to search. Individuals with longer travel times for their usual source of care were more likely to use the Internet for health-related communication than those with shorter travel times. CONCLUSIONS: Populations with serious health needs and those facing significant barriers in accessing health care in traditional settings turn to the Internet for health information.

Adult↗
PubMed2006

Effect of using information from only one system for dually eligible health care users.

OBJECTIVE: We sought to determine whether all diagnoses and total illness burden of patients who use both the VA and Medicare health care systems can be obtained from examination of data from only one of these systems. METHODS: Cohorts included all age-eligible Medicare users who also used the VA health care system in fiscal years 2000-2002 but were not enrolled in a Medicare HMO. Relative risk scores (RRS; a measure of illness burden developed by DxCG, Inc., Boston, MA) were calculated using VA, Medicare, and all diagnoses from both VA and Medicare data sources. The relationship between RRS and reliance on Medicare versus the VA system also was explored. We explored whether differences in VA and Medicare RRS were caused by veterans who mainly used pharmacy services or by an underweighting in the RRS calculation of mental health diagnoses. Finally, we explored the relationship between inpatient utilization and RRS in each system. RESULTS: On average for a given patient who used both VA and Medicare services, more diagnoses were recorded in Medicare ( approximately 13-15) than in the VA system ( approximately 8) for dual users. On average only 2 diagnoses were common to both the VA and Medicare. Medicare data alone accounted for approximately 80% of individuals' total illness burden, and VA data alone lead to RRSs that capture one-third of the total illness burden. The ratio of RRS when calculated using Medicare and VA separately was approximately 2.4. RRS was only weakly to moderately correlated with inpatient utilization in each system. CONCLUSION: Using data from just Medicare or VA data sources when conducting research on dually eligible veterans may seriously underestimate total illness burden of the population and also may lead to an underidentification of individuals in a particular disease class.

Aged↗
PubMed1998

Validation of an electronic, population-based prescription database.

BACKGROUND: The Drug Programs Information Network (DPIN), Manitoba's (Canada) new electronic prescription database, is a valuable data source for pharmacoepidemiologic research. Pharmacies are required to submit to the DPIN all prescriptions for Pharmacare, the province's drug insurance plan, but submission of prescriptions for social assistance recipients and treaty status Indians is discretionary. OBJECTIVE: The completeness of the DPIN prescription database was assessed to determine whether treaty status Indians and social assistance recipients were underrepresented. DESIGN: Prescriptions dispensed during March 13-17, 1995, in a stratified sample of Manitoba pharmacies were linked to DPIN by prescription number to determine the proportions submitted for Indian Affairs, Social Services, and Pharmacare recipients. Pharmacare records in the DPIN were compared with original pharmacy records to evaluate data accuracy. RESULTS: Of 2196 Indian Affairs and 1879 Social Services prescriptions dispensed in 58 pharmacies, a corresponding prescription was found in the DPIN for 79.7% (98% CI 78.0% to 81.4%) and 90.1% (98% CI 88.8% to 91.4%) of prescriptions, respectively. These proportions were significantly lower than the estimated proportion of Pharmacare prescriptions submitted (93%, 98% CI 92.4% to 93.6%). Ninety-two percent of 8012 DPIN Pharmacare prescriptions matched the original prescription on the drug name, quantity, and days' supply. CONCLUSIONS: This study established that the DPIN is a valid and reliable data source for studying prescription use among the majority of Manitoban residents. However, the DPIN database has differential validity and underrepresents prescriptions dispensed for the aboriginal population.

Databases, Factual↗
PubMed2005

Report cards and nursing homes.

PURPOSE: We first describe which states have produced nursing home report cards; second, we compare what information is provided in these report cards; third, we identify data sources used to produce the report cards; and, finally, we examine seven factors previously shown to be associated with the usefulness of report-card information and provide several examples from current reporting efforts to illustrate how nursing home report cards could be improved. DESIGN AND METHODS: We searched the Web sites for each state agency responsible for elder affairs-nursing homes. For those states identified as having a nursing home report card, we further examined the information presented. RESULTS: We identified 19 states as having nursing home report cards (AZ, CO, FL, IL, IN, IO, MD, MA, MS, NV, NJ, NY, OH, PA, RI, TX, UT, VT, and WI). The information presented in these report cards differs quite substantially across states, although the data sources for report cards do not differ substantially. How the information is presented and our evaluation of the usefulness of the information is also highly varied. IMPLICATIONS: Providing nursing home report-card information may be important in helping elders and their families choose a nursing facility. With 19 states identified in our research as providing nursing home report-card information on the World Wide Web, we were surprised and encouraged at this number of initiatives. We give some insight into the kinds of information that can be found on these report cards and what steps could be taken to improve how the information is presented.

Consumer Behavior↗
PubMed1998

Predicting hospitalization and functional decline in older health plan enrollees: are administrative data as accurate as self-report?

OBJECTIVE: To compare the predictive accuracy of two validated indices, one that uses self-reported variables and a second that uses variables derived from administrative data sources, to predict future hospitalization. To compare the predictive accuracy of these same two indices for predicting future functional decline. DESIGN: A longitudinal cohort study with 4 years of follow-up. SETTING: A large staff model HMO in western Washington State. PARTICIPANTS: HMO Enrollees 65 years and older (n = 2174) selected at random to participate in a health promotion trial and who completed a baseline questionnaire. MEASUREMENT: Predicted probabilities from the two indices were determined for study participants for each of two outcomes: hospitalization two or more times in 4 years and functional decline in 4 years, measured by Restricted Activity Days. The two indices included similar demographic characteristics, diagnoses, and utilization predictors. The probabilities from each index were entered into a Receiver Operating Characteristic (ROC) curve program to obtain the Area Under the Curve (AUC) for comparison of predictive accuracy. RESULTS: For hospitalization, the AUC of the self-report and administrative indices were .696 and .694, respectively (difference between curves, P = .828). For functional decline, the AUC of the two indices were .714 and .691, respectively (difference between curves, P = .144). CONCLUSIONS: Compared with a self-report index, the administrative index affords wider population coverage, freedom from nonresponse bias, lower cost, and similar predictive accuracy. A screening strategy utilizing administrative data sources may thus prove more valuable for identifying high risk older health plan enrollees for population-based interventions designed to improve their health status.

Activities of Daily Living↗
PubMed2000

Children are not goldfish--mark/recapture techniques and their application to injury data.

OBJECTIVES: Mark/recapture (or capture-recapture) is a simple technique commonly applied to estimate the hypothetical total (including undercount) in a register composed of cases from two or more independent and separately incomplete case lists. This paper seeks to illustrate serious drawbacks in the use of the mark/recapture technique when applied to injuries. SETTING AND SUBJECTS: Northumbrian children under 15 years of age who were seriously injured in motor vehicle accidents (MVAs) over a five year period ascertained from two data sources: police reports and hospital inpatient records. METHODS: Individuals (n) appearing in both police (S) and hospital (H) case lists are identified using various matching criteria. The separate and combined influence of age, sex, and casualty class (cyclist, passengers, pedestrians) on the probability of such matching is estimated using multivariate techniques. The hypothetical total incidence of child MVA victims (N) is calculated from N = (S x H)/n. MAIN OUTCOMES: Estimates of the incidences of "serious" injuries in MVAs under various conditions of stratification and matching. The overall procedure is tested for conformity with accepted criteria for valid use of mark/recapture. RESULTS: About one third of the 1009 police and 836 hospital records could be exactly matched. There were significant variations in matching proportions by class of accident (pedestrian v passenger v cyclist). This selective recapture or "heterogeneity" was not affected by sex, but was independently influenced by the age of the child. Further uncertainty was introduced when matching criteria were slightly relaxed. Estimates of the total population of children with serious injuries vary accordingly from 1729 to 2743. A number of plausible reasons why these two data sources might not be unbiased or mutually independent samples of the total target population are proposed as explanations for this heterogeneity. CONCLUSION: This typical example of two sample mark/recapture estimation in an epidemiological setting can be shown to violate virtually all the requirements for valid use of the technique. Very little can be deduced accurately about the scale or characteristics of an unobserved group by the use of mark/recapture applied to two overlapping health event registers.

Accidents, Traffic↗
PubMed2004

Estimates of chronic hepatitis B virus infection in Australia, 2000.

OBJECTIVES: To estimate the prevalence of chronic hepatitis B virus (HBV) infection in Australia and attributable proportions associated with specific demographic groups at higher risk of infection. METHODS: Two methods were used to estimate prevalence of HBV surface antigen (HBsAg): (1) Population-based: results of a national serosurvey using sera collected opportunistically from laboratories across Australia were used for 1-59 year olds, with the HBsAg prevalence for 50-59 years extrapolated to the population aged 60 years and over; (2) Risk group-based: estimates for selected high-risk groups (injecting drug users, homosexual men, Indigenous Australians and people born in high-prevalence countries), using source data from antenatal HBV screening in central Sydney, HBV prevalence studies, and estimates for low-risk groups (first-time blood donors) were combined proportionally to their representation in the population. RESULTS: Prevalence of HBsAg in the national serosurvey increased, with age, from 0.0% for 1-4 and 5-9 year olds to 1.3-1.8% for the 40-49 year age group. Australian population HBsAg prevalence based on minimum and adjusted estimates from this serosurvey were 91,500 (0.49%) and 163,000 (0.87%) infections, respectively. The risk group method estimated an Australian HBsAg prevalence of 88,000 infections (0.47%). Approximately 50% of people with chronic HBV infection were estimated to be immigrants from either South-East Asia (33.3%) or North-East Asia (16.2%). CONCLUSION: The range of estimates for chronic HBV infection in Australia is broad, reflecting the uncertainty in source data. A national blood survey encompassing a large and representative population sample may help to provide more accurate estimates. A large proportion of people with chronic HBV infection are Asian born.

Adolescent↗
PubMed1993

[Evaluation of the exhaustiveness and representativeness of a surveillance system using the capture-recapture method. Application to the surveillance of meningococcal infections in France in 1989 and 1990].

If surveillance data is to be correctly interpreted, the degree of exhaustiveness and representativeness of the surveillance system must be known. The capture-recapture method, which can be used for this evaluation - provided that at least two data sources are available - was applied to the surveillance of meningococcal infections in France. To identify those cases common to both surveillance systems, cases of the disease occurring in 1989 and 1990 and appearing on detailed Mandatory Notification (MN) records (702 cases) or reported to the National Reference Centre (NRC) (727 cases) were compared. The total number of cases of meningococcal infection was estimated at 1,367, using the capture-recapture method. Exhaustiveness rates, which did not differ for the various bacterial strains, were 51% for MN and 53% for NRC, although large regional differences were found for both systems. More cases were notified to MN in the age group 5-24 (60%), than in other age groups (49%). Quarterly exhaustiveness rates were unrelated to incidence of the disease. A district by district analysis of the correlation between exhaustiveness rates for each system suggests that the two data sources were probably independent. Scrupulous identification of common cases and study of the independence of the two systems are indispensable prerequisites for using this method, which provides a good alternative to exhaustive studies.

Adolescent↗
PubMed2004

Practical introduction to record linkage for injury research.

The frequency of early fatality and the transient nature of emergency medical care mean that a single database will rarely suffice for population based injury research. Linking records from multiple data sources is therefore a promising method for injury surveillance or trauma system evaluation. The purpose of this article is to review the historical development of record linkage, provide a basic mathematical foundation, discuss some practical issues, and consider some ethical concerns. Clerical or computer assisted deterministic record linkage methods may suffice for some applications, but probabilistic methods are particularly useful for larger studies. The probabilistic method attempts to simulate human reasoning by comparing each of several elements from the two records. The basic mathematical specifications are derived algebraically from fundamental concepts of probability, although the theory can be extended to include more advanced mathematics. Probabilistic, deterministic, and clerical techniques may be combined in different ways depending upon the goal of the record linkage project. If a population parameter is being estimated for a purely statistical study, a completely probabilistic approach may be most efficient; for other applications, where the purpose is to make inferences about specific individuals based upon their data contained in two or more files, the need for a high positive predictive value would favor a deterministic method or a probabilistic method with careful clerical review. Whatever techniques are used, researchers must realize that the combination of data sources entails additional ethical obligations beyond the use of each source alone.

Databases, Factual↗
PubMed2001

Back-projection estimates of the number of dependent heroin users in Australia.

AIMS: To plan an appropriate response to heroin use in Australia, good estimates are needed of the numbers of dependent heroin users, the group who are most in need of treatment, most at risk of fatal opioid overdose and most at risk of contracting and transmitting blood-borne viruses. METHODS: Back-projection methods were used to estimate the numbers of people starting dependent heroin injecting in Australia between 1960 and 1997. Separate analyses were based on national opioid overdose deaths and numbers of new entrants to methadone treatment in New South Wales (NSW). Estimates of the rates at which dependent heroin users cease heroin use, commence methadone treatment or die from opioid overdoses were estimated from external data sources. RESULTS: Back-projection estimates derived from opioid overdose deaths indicated that there were 104 000 (lower limit of 72 000 and upper limit of 157 000) people who were heroin dependent in Australia between 1960 and 1997. Of these it was estimated that 67 000 (39 000-120 000) were still heroin dependent at the end of 1997. Back-projection estimates based on numbers of new entrants to methadone treatment in NSW indicated that there were 108 000 (82 000-141 000) heroin-dependent people in Australia between 1960 and 1997, of whom 71 000 (47 000-109 000) were estimated to be heroin dependent at the end of 1997. Both analyses indicated that the number of heroin-dependent people in Australia has increased substantially from the early 1970s onwards. CONCLUSIONS: Back-projection estimates based on analyses of treatment entries and opioid overdose deaths provide an additional method for estimating the numbers of heroin-dependent people in the population. The addition of these methods to existing methods, using different data sources and statistical methods, should improve consensus estimates of the numbers of heroin-dependent people.

Adolescent↗
PubMed2006

Disparities in primary care for vulnerable children: the influence of multiple risk factors.

OBJECTIVES: To analyze vulnerability as a profile of multiple risk factors for poor pediatric care based on race/ethnicity, poverty status, parent education, insurance, and language. Profiles are used to examine disparities in child/adolescent health status and primary care experience. DATA SOURCES: Cross-sectional data on 19,485 children/adolescents 0-19 years of age from the 2001 California Health Interview Survey. STUDY DESIGN: Multiple logistic regression models are used to examine risk profiles in relation to health status and three aspects of primary care: access (physician and dental visit; access surety), continuity (regular source of care), and comprehensiveness (i.e., health promotion counseling). PRINCIPAL FINDINGS: About 43 percent of (or 4.4 million) children in California have two or more risk factors (RF). Controlling for age and gender, more RFs is associated with poorer health status (i.e. percent reporting "excellent/very good" health: no RFs=81 percent, 1=71 percent, 2=57 percent, 3=45 percent, 4=35 percent, 5=28 percent, all p<.001). Controlling for health status, higher risk profiles is associated with poorer primary care access and continuity, but greater comprehensiveness of care. For example, higher risk profile children are less likely to have a regular source of care: one RF (prevalence ratio [PR]=0.92, confidence interval [CI]: 0.86-0.98), two (PR=0.77, CI: 0.69-0.84), three (PR=0.55, CI: 0.46-0.65), and four or more (PR=0.31, CI: 0.22-0.44), all p<.001. CONCLUSIONS: This study demonstrates a dose-response relationship of higher risk profiles with poorer child health status, access to, and continuity of primary care. Having gained access, however, adolescents with higher risk profiles are more likely to receive health promotion counseling. Higher profiles appear to be associated with greater barriers to accessing primary care for children in "fair or poor" health, suggesting that vulnerable children who have the greatest health care needs also have the greatest difficulty obtaining primary care.

Adolescent↗
PubMed2006

An algorithm to derive a numerical daily dose from unstructured text dosage instructions.

PURPOSE: The General Practice Research Database (GPRD) is a database of longitudinal patient records from general practices in the United Kingdom. It is an important data source for pharmacoepidemiology studies, but until now it has been tedious to calculate the daily dose and duration of exposure to drugs prescribed. This is because general practitioners routinely record dosage instructions as free text rather than in a structured way. The objective was to develop and assess the validity of an automated algorithm to derive the daily dose from text dosage instructions. METHODS: A computer program was developed to derive numerical information from unstructured text dosage instructions. It was tested on dosage texts from a random sample of one million prescription entries. A random sample of 1,000 of these converted texts were manually checked for their accuracy. RESULTS: Out of the sample of one million prescription entries, 74.5% had text containing the daily dose, 14.5% had text but did not include a quantitative daily dose statement and 11.0% had no text entered. Of the 1000 texts which were checked manually, 767 stated the daily dose. The program interpreted 758 (98.8%) of these correctly, produced errors in four cases and failed to extract the dose from five texts. CONCLUSIONS: An automated algorithm has been developed which can accurately extract the daily dose from almost 99% of general practitioners' text dosage instructions. It increases the utility of GPRD and other prescription data sources by enabling researchers to estimate the duration of drug exposure more efficiently.

Adverse Drug Reaction Reporting Systems↗
PubMed2003

SOURCE: a unified genomic resource of functional annotations, ontologies, and gene expression data.

The explosion in the number of functional genomic datasets generated with tools such as DNA microarrays has created a critical need for resources that facilitate the interpretation of large-scale biological data. SOURCE is a web-based database that brings together information from a broad range of resources, and provides it in manner particularly useful for genome-scale analyses. SOURCE's GeneReports include aliases, chromosomal location, functional descriptions, GeneOntology annotations, gene expression data, and links to external databases. We curate published microarray gene expression datasets and allow users to rapidly identify sets of co-regulated genes across a variety of tissues and a large number of conditions using a simple and intuitive interface. SOURCE provides content both in gene and cDNA clone-centric pages, and thus simplifies analysis of datasets generated using cDNA microarrays. SOURCE is continuously updated and contains the most recent and accurate information available for human, mouse, and rat genes. By allowing dynamic linking to individual gene or clone reports, SOURCE facilitates browsing of large genomic datasets. Finally, SOURCEs batch interface allows rapid extraction of data for thousands of genes or clones at once and thus facilitates statistical analyses such as assessing the enrichment of functional attributes within clusters of genes. SOURCE is available at http://source.stanford.edu.

Animals↗
PubMed2006

State-mandated benefit review laws.

OBJECTIVE: To determine which states have laws that require the review of mandated health insurance benefits and describe the various approaches states take in reviewing mandated benefits, as stated in the mandated benefit review (MBR) laws. DATA SOURCES: We queried online databases of the individual state statutes and reviewed the state statutes and state legislative agendas for all 50 states and Washington, DC to identify those states with active MBR laws as of September 2004. STUDY DESIGN: We reviewed the identified MBR laws to catalog their various components. The components chosen for this analysis include: general review strategy, designated reviewers, time frame for conducting reviews, criteria used in the review, requirements to use actuaries, sources of funding, and state data collection systems. Two of the authors independently created analysis categories and coded the MBR laws to document details on the major components of the laws. PRINCIPAL FINDINGS: We identified 26 state MBR laws active as of September 2004. A majority of the MBR laws specified a prospective review approach and only one law used an exclusively retrospective review approach. A substantial amount of variation was found with regards to the designated reviewers, time frames for conducting reviews, and criteria used in the review. Few states specified the use of actuaries, sources of funding, and state data collection systems. CONCLUSIONS: The number of states that have enacted MBR laws has increased substantially in recent years, however, different states have structured the review of mandated benefits differently, according to the values and perceived needs of the state legislatures. It is important that states increasingly consider a broader scope of review criteria so state decision makers can position themselves to mandate only those benefits that add real value to the state's health care system.

Insurance Benefits↗
PubMedDate not supplied

New drugs of 1998.

OBJECTIVE: To provide information regarding the most important properties of the new therapeutic agents marketed in 1998. DATA SOURCES: Published studies, drug information reference sources, and product labeling. DATA SYNTHESIS: In 1998, 44 new therapeutic agents were marketed. The indications and information on dosage and administration for each new agent are reviewed, as are the most important pharmacokinetic properties, adverse events, drug interactions, and other precautions. Practical considerations for the use of the new agents are also discussed. Where possible, the properties of the new drugs are compared with those of older drugs marketed for the same indications. CONCLUSION: A number of the new therapeutic agents marketed in 1998 have important advantages over older medications. An understanding of the properties of these agents is important for the pharmacist to effectively counsel patients about their use and to serve as a valuable source of information for other health professionals regarding these drugs.

Drug Approval↗
PubMedDate not supplied

New drugs of 1999.

OBJECTIVE: To provide information regarding the most important properties of the new therapeutic agents marketed in 1999. DATA SOURCES: Published studies, drug information reference sources, and product labeling. DATA SYNTHESIS: In 1999, 28 new therapeutic agents were marketed. The indications and information on dosage and administration for each new agent are reviewed, as are the most important pharmacokinetic properties, adverse events, drug interactions, and other precautions. Practical considerations for the use of the new agents are also discussed. Where possible, the properties of the new drugs are compared with those of older drugs marketed for the same indications. CONCLUSIONS: A number of the new therapeutic agents marketed in 1999 have important advantages over older medications. An understanding of the properties of these agents is important for the pharmacist to effectively counsel patients about their use and to serve as a valuable source of information for other health care professionals regarding these drugs.

Animals↗