Eventos adversos e incidentes notificados em um centro de materiais e esterilização / Adverse events and incidents reported in a materials and sterilization center

Objetivo: Caracterizar as notificações dos incidentes e eventos adversos do Centro de Material e Esterilização (CME) de um hospital de ensino. Método: Estudo retrospectivo, documental, descritivo e quantitativo em um CME classe II, em que foram analisadas as notificações contidas no banco de dados do Núcleo do Sistema de Gestão da Qualidade e Segurança do paciente, entre 2016 e 2020. Como técnica de análise dos dados coletados, utilizou-se o diagrama de causa e efeito, e a descrição das notificações foram agrupadas conforme o diagrama de 6M: método; material; mão de obra; máquina; medida; e meio ambiente. Resultados: Entre as notificações realizadas, as variáveis matéria-prima e método foram as que mais geraram incidentes durante todo o período, representando 28,54 e 26,44%, respectivamente. Além disso, o Centro Cirúrgico foi o que mais notificou e foi notificado pelo CME. Conclusão: Foi possível conhecer os incidentes que mais predominam no CME da instuição, e as variáveis materiais e método, com o centro cirúrgico, foram as variáveis e setor que mais geraram notificações no período pesquisado (AU)

Hospital admissions of adolescents in sergipe, from 2002 to 2012 / Internações hospitalares de adolescentes em sergipe, de 2002 a 2012

ABSTRACT Objective: To describe hospital admissions of adolescents living in Sergipe, Northeast Brazil, from 2002 to 2012. Methods: Descriptive study, based on data collected from the Hospital Information System of the Unified Health System. Hospital admissions were divided into four groups of causes: by pregnancy, childbirth and puerperium; by external causes; by primary care conditions; and other causes. Numbers, percentages and coefficients were used in the analysis and compared by year, sex, age (from 10 to 14 and from 15 to 19 years), and the average annual cost of hospitalizations for each group of causes. Results: In the period studied, there were 149,850 hospital admissions of adolescents, 58.4% for pregnancy, childbirth and puerperium, 9.3% for primary care conditions, 8.3% for external causes and 24.0% for other causes. All coefficients decreased from 2002 to 2012 by 39.7%. Primary care conditions had the most significant reduction (143.1%), followed by external causes (60.1%). As for age groups, the coefficients for external causes in the age group of 15 to -19 years, and for pregnancy, childbirth and puerperium, in the age range of 10 to 14 years, are noteworthy because they remained stable in the period. There was an increase in the average cost of all admissions (234.7%), especially for external causes. Conclusions: Health actions to reduce hospital admission due to conditions sensitive to primary care should be given more attention, as well as those related to external causes and pregnancy, among adolescents living in Sergipe, Northeastern Brazil.

RESUMO Objetivo: Descrever as internações hospitalares de adolescentes residentes em Sergipe, de 2002 a 2012. Métodos: Estudo descritivo, a partir de dados do Sistema de Informação Hospitalar do Sistema Único de Saúde, no qual as internações foram divididas em quatro grupos de causas: primeiro, por gravidez, parto e puerpério; segundo, por causas externas; terceiro, por condições sensíveis à atenção primária; e quarto, demais internações. Para a análise, foram utilizados os números, percentuais e coeficientes, por ano, sexo, idade (de 10 a 14; e de 15 a 19 anos) e custo médio anual das internações segundo os grupos de causas. Resultados: No período, ocorreram 149.850 hospitalizações de adolescentes, sendo 58,4% por gravidez, parto e puerpério; 9,3% por condições sensíveis à atenção primária; 8,3% por causas externas; e 24,0% foram as demais internações. Houve redução de 39,7% em todos os coeficientes entre 2002 e 2012, sendo que as por condições sensíveis à atenção primária apresentaram maior redução (143,1%), seguidas das causas externas (60,1%). Em relação às faixas etárias, chama a atenção os coeficientes por causas externas na idade de 15 a 19 anos e a gravidez, parto e o puerpério, dos 10 a 14 anos, por apresentarem estabilidade no período. Houve aumento do custo médio de todas as internações, de 234,7%, destacando-se o das causas externas. Conclusões: Impõe-se a necessidade de se incrementar ações de saúde para diminuir as hospitalizações por condições sensíveis à atenção primária, à incidência das causas externas e à gravidez entre os adolescentes sergipanos.

Câncer de tireoide no Brasil: estudo descritivo dos casos informados pelos registros hospitalares de câncer, 2000-2016 / Cáncer de tiroides en Brasil: estudo descriptivo de los casos informados por los registros hospitalarios, 2000-2016 / Thyroid cancer in Brazil: a descriptive study of cases held on hospital-based cancer registries, 2000-2016

Objetivo: Descrever o perfil clínico-epidemiológico de casos hospitalares de câncer primário de tireoide no Brasil. Métodos: Estudo descritivo dos casos informados pelos registros hospitalares de câncer que tiveram primeira consulta para tratamento no período 2000-2016 e cujo acompanhamento foi realizado pela instituição do registro informante. Resultados: Dos 52.912 casos, 83,4% eram femininos e 96,9% eram carcinomas diferenciados. Apresentaram menor tempo mediano para diagnóstico os casos anaplásicos (11 dias) e os residentes da região Sul do país (5 dias). O tratamento foi iniciado em até 60 dias em 88,8% dos casos que chegaram à instituição do registro sem diagnóstico e em 34,9% dos que chegaram com diagnóstico. Conclusão: Os achados são consistentes com a epidemiologia do câncer de tireoide, com predominância do sexo feminino e do carcinoma diferenciado. A análise do tempo para início do tratamento sugere dificuldades de acesso para aqueles que chegaram às instituições dos registros com diagnóstico.

Objetivo: Describir el perfil clínico y epidemiológico de los casos de cáncer de tiroides en Brasil. Métodos: Estudio descriptivo de casos reportados por los registros hospitalarios de cáncer que tuvieron su primera consulta de tratamiento en el período 2000-2016 y el monitoreo fue realizado por la institución del registro. Resultados: De los 52.912 casos, 83,4% eran mujeres y 96,9% era de carcinomas diferenciados. El tiempo promedio hasta el diagnóstico fue menor en los anaplásicos (11 días) y en la región Sur (5 días). El tratamiento se inició dentro de los 60 días en 88.8% de los casos que llegaron a la institución de registro sin diagnóstico y en 34.9% de los que llegaron con diagnóstico. Conclusión: Los resultados son consistentes con la epidemiología del cáncer de tiroides, con predominio del sexo femenino y carcinomas diferenciados. El análisis del tiempo de tratamiento sugiere dificultades de acceso para casos que llegaron con diagnóstico.

Objective: To describe the clinical and epidemiological profile of primary thyroid cancer hospital cases in Brazil. Methods: This is a descriptive study of cases held on hospital cancer records who had their first consultation for treatment in the period 2000-2016 and who were monitored by the hospitals providing those records. Results: Of the 52,912 cases, 83.4% were female and 96.9% were differentiated carcinoma cases. The median time to diagnosis was shorter for anaplastic cases (11 days) and for those living in Brazil's Southern region (5 days). Treatment was initiated within 60 days in 88.8% of cases that arrived at the hospitals without diagnosis and in 34.9% of those who arrived with diagnosis. Conclusion: The findings are consistent with thyroid cancer epidemiology, with a predominance of female cases and differentiated carcinomas. Analysis of time-to-treatment suggests access difficulties for those who already had diagnosis when they arrived at the hospitals.

Using a Chagas disease hospital database: a clinical and epidemiological patient profile

Abstract INTRODUCTION: Chagas disease (CD) prevention and control rely on studies of its distribution, characteristics of individuals affected and mode of transmission. CD data in Brazil are scarce; a retrospective analysis of the clinical characteristics of 80 patients treated at the Clinical Hospital of UNICAMP, Campinas, Brazil, was performed. METHODS: Patient data records were analyzed. RESULTS: Thirty percent of the patients probably got infected through vector-borne transmission, 65% came from endemic areas, a predominance of cardiac and cardiodigestive forms was found among males, and the cardiac form prevailed (51%). CONCLUSIONS: The results update the view on the epidemiology of CD in Campinas, Brazil.

Caracterização sociodemográfica e clínica de idosas com câncer do colo do útero / Sociodemographic and clinical characterization of elderly women with cervical cancer / Caracterización sociodemográfica y clínica de ancianas con cáncer de cuello de útero

RESUMO Objetivo Caracterizar aspectos sociodemográficos e clínicos de idosas com câncer do colo do útero no Maranhão, Brasil. Método Estudo retrospectivo, descritivo de base secundária. Resultados 553 idosas com câncer do colo do útero no período de 2009 a 2013, cadastrados no registro de base hospitalar de câncer. Apresentavam média de idade 69,91 anos, com predomínio de mulheres de cor parda 46%, ensino fundamental incompleto com 42%, estado civil casadas 45,4%, e nunca terem tido hábitos etilista e tabagista com 58,3% e 39,4%. O carcinoma de células escamosas foi o mais frequente 80,5%, com estadiamento tardio 3B 29,0%. Ao final do primeiro tratamento, 43,6% encontravam-se sem evidência de doença ou em remissão completa. Conclusão Os resultados apontam necessidade de buscar melhorar as campanhas para a faixa etária estudada. Melhorando a cobertura por meio de campanhas de estímulo à realização do exame citopatológico, e estimulem os profissionais da área da saúde a identificar as mulheres em atraso na realização desse exame, quando do seu comparecimento aos serviços de saúde, evitando, assim, a perda de oportunidades de prevenção.(AU)

ABSTRACT Objective To characterize sociodemographic and clinical aspects of elderly women with cervical cancer in Maranhão, Brazil. Materials and Method Retrospective and descriptive study of secondary sources. Results 559 elderly women with cervical cancer from 2009 to 2013 and registered in the hospital-based cancer registry were included in the study. The mean age was 69.91 years, with a predominance of brown women (46%), with incomplete primary education (42%), married (45.4%), and without drinking and smoking habits (58.3% and 39.4%, respectively). Squamous cell carcinoma was the most frequent type pf cancer (80.5%) with advanced stage 3B in 29.0% of the cases. At the end of the first treatment, 43.6% did not show any evidence of disease or complete remission. Conclusion Results point to the need to improve campaigns for the age group studied, as well as the coverage through campaigns to promote cytopathological examination. Also health professionals should be encouraged to identify women who are behind in the examination when attending health services, thus avoiding the loss of prevention opportunities.(AU)

RESUMEN Objetivo Caracterizar aspectos sociodemográficos y clínicos de ancianos con cáncer de cuello de útero en Maranhão, Brasil. Método Estudio retrospectivo, descriptivo de fuente secundaria. Resultados Se incluyeron 559 ancianos con cáncer del cuello del útero en el período de 2009 a 2013, del registro de base hospitalaria de cáncer. En el caso de las mujeres, eran de color pardo 46%, con educación básica incompleta 42%, casadas el 45,4%. El carcinoma de células escamosas fue el más frecuente (80,5%) con estadío tardío 3B el 29,0%, Al final del primer tratamiento, el 43,6% se encontraba sin evidencia de enfermedad o en remisión completa. Conclusión Los resultados apuntan a la necesidad de mejorar las campañas para el grupo de edad estudiado y la cobertura por medio de campañas de estímulo a la realización del examen citopatológico, así mismo, estimular a los profesionales del área de la salud a identificar a las mujeres atrasadas en la realización de ese examen durante su comparecencia a los servicios de salud, evitando así la pérdida de oportunidades de prevención.(AU)

Using data linkage to report surgical treatment of breast cancer in Canada.

BACKGROUND: National population information about the surgical treatment rate for primary cancers, including breast cancer, has remained a significant data gap in Canada. This gap has implications for cancer care planning and evaluating health system performance. New linkages between the Canadian Cancer Registry and hospital discharge records were conducted by Statistics Canada in 2016. Using already existing, routinely collected health administrative data, these linkages allow viable reporting of surgical cancer treatment for the first time for all provinces and territories (except Quebec). DATA AND METHODS: Hospital record information about type and date of surgical treatment of tumours was provided by information from linked data. These linked data reported 50,740 incident primary malignant breast tumours diagnosed between January 1, 2010, and December 31, 2012, among females aged 19 years or older. The unadjusted treatment rate for primary surgical intervention within one year was calculated as the proportion of total tumours that were linkable to hospital records. RESULTS: For three combined years (2010, 2011 and 2012), 88.3% (N=44,780) of patients overall received at least one surgical treatment. Variations to the surgical rate occurred across jurisdictions, with the highest rate at 91-92% for Prince Edward Island, Newfoundland and Labrador, British Columbia and New Brunswick. Generally, there was an inverse gradient between surgical treatment rate and tumour stage. DISCUSSION: The surgical treatment rate of new primary breast cancers varied across provinces and territories from 2010 to 2012. New linked data could be used to further identify geographic and demographic inequities in terms of receiving surgical cancer treatment and contribute to the evaluation of cancer system performance and outcomes.

Timing of singleton births by onset of labour and mode of birth in NHS maternity units in England, 2005-2014: A study of linked birth registration, birth notification, and hospital episode data.

BACKGROUND: Maternity care has to be available 24 hours a day, seven days a week. It is known that obstetric intervention can influence the time of birth, but no previous analysis at a national level in England has yet investigated in detail the ways in which the day and time of birth varies by onset of labour and mode of giving birth. METHOD: We linked data from birth registration, birth notification, and Maternity Hospital Episode Statistics and analysed 5,093,615 singleton births in NHS maternity units in England from 2005 to 2014. We used descriptive statistics and negative binomial regression models with harmonic terms to establish how patterns of timing of birth vary by onset of labour, mode of giving birth and gestational age. RESULTS: The timing of birth by time of day and day of the week varies considerably by onset of labour and mode of birth. Spontaneous births after spontaneous onset are more likely to occur between midnight and 6am than at other times of day, and are also slightly more likely on weekdays than at weekends and on public holidays. Elective caesarean births are concentrated onto weekday mornings. Births after induced labours are more likely to occur at hours around midnight on Tuesdays to Saturdays and on days before a public holiday period, than on Sundays, Mondays and during or just after a public holiday. CONCLUSION: The timing of births varies by onset of labour and mode of birth and these patterns have implications for midwifery and medical staffing. Further research is needed to understand the processes behind these findings.

Validation of verbal autopsy methods using hospital medical records: a case study in Vietnam.

BACKGROUND: Information on causes of death (COD) is crucial for measuring the health outcomes of populations and progress towards the Sustainable Development Goals. In many countries such as Vietnam where the civil registration and vital statistics (CRVS) system is dysfunctional, information on vital events will continue to rely on verbal autopsy (VA) methods. This study assesses the validity of VA methods used in Vietnam, and provides recommendations on methods for implementing VA validation studies in Vietnam. METHODS: This validation study was conducted on a sample of 670 deaths from a recent VA study in Quang Ninh province. The study covered 116 cases from this sample, which met three inclusion criteria: a) the death occurred within 30 days of discharge after last hospitalisation, and b) medical records (MRs) for the deceased were available from respective hospitals, and c) the medical record mentioned that the patient was terminally ill at discharge. For each death, the underlying cause of death (UCOD) identified from MRs was compared to the UCOD from VA. The validity of VA diagnoses for major causes of death was measured using sensitivity, specificity and positive predictive value (PPV). RESULTS: The sensitivity of VA was at least 75% in identifying some leading CODs such as stroke, road traffic accidents and several site-specific cancers. However, sensitivity was less than 50% for other important causes including ischemic heart disease, chronic obstructive pulmonary diseases, and diabetes. Overall, there was 57% agreement between UCOD from VA and MR, which increased to 76% when multiple causes from VA were compared to UCOD from MR. CONCLUSIONS: Our findings suggest that VA is a valid method to ascertain UCOD in contexts such as Vietnam. Furthermore, within cultural contexts in which patients prefer to die at home instead of a healthcare facility, using the available MRs as the gold standard may be meaningful to the extent that recall bias from the interval between last hospital discharge and death can be minimized. Therefore, future studies should evaluate validity of MRs as a gold standard for VA studies in contexts similar to the Vietnamese context.

Linking hospital patient records for suspected or established acute coronary syndrome in a complex secondary care system: a proof-of-concept e-registry in National Health Service Scotland.

Aims: To implement secondary care electronic record linkage for patients hospitalized with suspected or known acute coronary syndrome (ACS) in a complex regional health care system and evaluate this e-Registry in terms of patterns of service delivery and 1-year outcomes. Methods and results: Existing electronic hospital records were linked to create episodes of care using (i) a patient administration system, (ii) invasive cardiovascular procedure referrals, and (iii) a catheter laboratory record. Data were extracted for admissions (1 October 2013-30 September 2014) with International Classification of Disease (ICD)-10 diagnosis of angina (I200-I209), myocardial infarction (I210-I229), other ischaemic heart disease (I240-I249) or heart failure (I50), linked to other sources to develop a secondary care ACS e-registry and analysed within a Safe Haven. Episodes of care were categorized into care pathways and evaluated in terms of patient characteristics, as well as service delivery metrics and outcomes including mortality. In all, 2327 patients had 2472 episodes of care. Diagnoses were hierarchically classified as ST-elevation myocardial infarction (STEMI) (586, 25.2%), non-ST-elevation myocardial infarction (NSTEMI) (1068, 45.9%), unspecified myocardial infarction (146, 6.3%), unstable angina (527, 22.6%) for the first hospitalization for each patient within the study period. Six care pathways were mapped. Percutaneous coronary intervention rate for STEMI was 80.2% and for NSTEMI 33.1%. Unadjusted all-cause mortality was 9.0% and 3.0% for STEMI and NSTEMI at 30 days, rising to 11.9% and 11.6% at 1 year. Analyses were validated by independent source data verification. Conclusion: The e-registry has enabled analysis of ACS hospitalizations in a complex health care system with implications for quality improvement and research.

Registros hospitalares de câncer em Pernambuco: da gestão ao registro / Hospital-Based Cancer Registries in Pernambuco: from Management to Registry / Registros Hospitalares de Cáncer em Pernambuco: de la Administración a el Registro

Introdução: as neoplasias vêm ganhando destaque no perfil epidemiológico das doenças nas populações do mundo, inclusive no Brasil. assim, a vigilância do câncer precisou adotar novas estratégias para se adequar à realidade. uma delas, o r egistro Hospitalar de câncer (rHc), coleta dados de pacientes diagnosticados e/ou tratados para câncer, sendo importante para qualificar a assistência a eles prestada e para reconhecimento e disseminação de informações sobre morbimortalidade e fatores de risco para o câncer, visando à implementação de medidas para prevenção e controle. Objetivo: d escrever as estratégias utilizadas pela gestão estadual de Pernambuco para a qualificação do rHc e seus resultados. Métodos: estudo transversal, descritivo, de abordagem mista. Para análise qualitativa, foram utilizados documentos da gestão estadual, de 2012 a 2015, relacionados aos rHc de Pernambuco. Para análise quantitativa, foram utilizadas algumas variáveis da ficha de tumor disponíveis ao público no i ntegrador rHc, do ano de 2012. os resultados foram apresentados por meio de linha do tempo e tabela. Resultados: a análise documental revelou a adoção de várias estratégias para melhoria do rHc entre 2012 e 2015, foram elas: reuniões com as equipes das unidades hospitalares, implantação do projeto de diagnóstico e intervenção, capacitações e participações em eventos de âmbito nacional. o envio dos bancos de dados apresentou melhora no mesmo período. Quanto à incompletude das informações, apenas uma variável atingiu o patamar de qualidade desejado. Conclusão: as estratégias adotadas pela gestão estadual em conjunto com as equipes das unidades hospitalares parecem ter melhorado a qualidade dos rHc.

Introduction: neoplasms have been playing an increasingly important role in the epidemiological profile of populations all over the world, including in Brazil. Therefore, cancer surveillance has needed reformulation to adapt to this reality. one of these tools is the Hospital-based c ancer r egistry (Hcr ), which collects data from patients who were diagnosed with and/ or treated for cancer. The Hcr is important to qualify the assistance given to those patients, as well as for the recognition and dissemination of information on morbidity and mortality and cancer risk factors, aiming to implement measures for prevention and control. Objective: to describe the strategies used by the state management in Pernambuco to qualify the Hcr and its results. Methods: c ross-sectional, descriptive, mixed method research. For documental analysis, we used documents from the state management, from 2012 to 2015, regarding the Hcr in Pernambuco. For quantitative analysis, we used cancer records available to the public in the i ntegrador rHc tool, from 2012. r esults were presented in timeline and tables about the dispatching of data banks situation and absolute and relative frequencies. Results: d ocumental analysis revealed the adoption of many strategies for improving the Hcr between 2012 and 2015: meetings with hospital teams, implantation of the diagnosis and intervention project, trainings and participation in nationwide events. The dispatching of data banks was improved during that period. as for incompleteness of information, only one variable showed the desired level of quality. Conclusion: The strategies adopted by the state management along with hospital teams seems to have improved the quality of the Hcr.

Introducción: las neoplasias se han destacado cada vez más en el perfil epidemiológico de poblaciones de todo el mundo, incluso en Brasil. e n consecuencia de esto, la vigilancia de cáncer ha necesitado adoptar nuevas estrategias para adecuarse a la realidad. u na de las herramientas utilizadas para esto es el r egistro Hospitalario de cáncer (rHc), que reúne los datos de los pacientes que fueron diagnosticados y/o tratados de cáncer, siendo importante para calificar la asistencia prestada a esos pacientes, así como para el reconocimiento y diseminación de informaciones sobre morbimortalidad y factores de riesgo para el cáncer, buscando la implementación de medidas para prevención y control. Objetivo: describir las estrategias utilizadas por la gestión del estado de Pernambuco para la calificación del rHc y sus resultados. Métodos: estudio transversal, descriptivo, de abordaje mixta. Para el análisis cualitativo fueron utilizados documentos de la gestión estadual, entre los años de 2012 y 2015, relacionados al rHc de r ecife. Para el análisis cuantitativo fueron usadas algunas variables de la ficha de tumor disponibles para el público en el integrador rHc, del año de 2012. los resultados fueron presentados por medio de línea del tiempo y tablas de situación de envío de datos y de frecuencias absolutas y relativas. Resultados: e l análisis documental reveló la adopción de varias estrategias para mejorar el rHc entre 2012 y 2015, fueron ellas: reuniones con los equipos de las unidades hospitalarias, implantación del proyecto de diagnóstico e intervención, capacitaciones y participaciones en eventos de ámbito nacional. e l envío de los bancos de datos presentó mejora en el mismo periodo. e n cuanto a la incompletud de las informaciones, solamente una variable ha alcanzado en el nivel de calidad deseado. Conclusión: las estrategias adoptadas por la gestión estadual en conjunto con los equipos de las unidades hospitalarias parecen haber mejorado la calidad de los rHc.

Issues using linkage of hospital records and death certificate data to determine the size of a potential palliative care population.

BACKGROUND: Studies aiming to identify palliative care populations have used data from death certificates and in some cases hospital records. The size and characteristics of the identified populations can show considerable variation depending on the data sources used. It is important that service planners and researchers are aware of this. AIM: To illustrate the differences in the size and characteristics of a potential palliative care population depending on the differential use of linked hospital records and death certificate data. DESIGN: Retrospective cohort study. SETTING/PARTICIPANTS: The cohort consisted of 23,852 people aged 20 years and over who died in Western Australia between 1 January 2009 and 31 December 2010 after excluding deaths related to pregnancy or trauma. Within this cohort, the number, proportion and characteristics of people who died from one or more of 10 medical conditions considered amenable to palliative care were identified using linked hospital records and death certificate data. RESULTS: Depending on the information source(s) used, between 43% and 73% of the 23,852 people who died had a condition potentially amenable to palliative care identified. The median age at death and the sex distribution of the decedents by condition also varied with the information source. CONCLUSION: Health service planners and researchers need to be aware of the limitations when using hospital records and death certificate data to determine a potential palliative care population. The use of Emergency Department and other administrative data sources could further exacerbate this variation.

Retrospective study of human cystic echinococcosis over the past decade in France, using a nationwide hospital medical information database.

No specific surveillance system of cystic echinococcosis infections in humans exists in France. The incidence and trends over time have not been documented since the last decade of the twentieth century. We performed the current analysis to assess human cystic echinococcosis epidemiology over a 10-year period in France (including the island of Corsica but excluding the overseas territories) using a nationwide hospital medical information database. A total number of 2629 patients were identified in this database between 2005 and 2014. The average annual incidence rate was 0.42 hospitalized cases/100,000 inhabitants. It was highest in the Island of Corsica (1.76 cases/100,000) and in the region Provence-Alpes-Côte d'Azur (0.85 cases/100,000). This retrospective analysis of hospital records provides a population-based estimate of cystic echinococcosis incidence and trends over a 10-year period at a national level. It indicates a significant decrease of the incidence between 2005 and 2014 at the national level and in the area that reported the highest incidence. It stresses the fact that in France, cystic echinococcosis is not re-emerging and that the incidence remains low in comparison with similar studies in other Mediterranean countries.

Incidence and Variation of Discrepancies in Recording Chronic Conditions in Australian Hospital Administrative Data.

Diagnostic data routinely collected for hospital admitted patients and used for case-mix adjustment in care provider comparisons and reimbursement are prone to biases. We aim to measure discrepancies, variations and associated factors in recorded chronic morbidities for hospital admitted patients in New South Wales (NSW), Australia. Of all admissions between July 2010 and June 2014 in all NSW public and private acute hospitals, admissions with over 24 hours stay and one or more of the chronic conditions of diabetes, smoking, hepatitis, HIV, and hypertension were included. The incidence of a non-recorded chronic condition in an admission occurring after the first admission with a recorded chronic condition (index admission) was considered as a discrepancy. Poisson models were employed to (i) derive adjusted discrepancy incidence rates (IR) and rate ratios (IRR) accounting for patient, admission, comorbidity and hospital characteristics and (ii) quantify variation in rates among hospitals. The discrepancy incidence rate was highest for hypertension (51% of 262,664 admissions), followed by hepatitis (37% of 12,107), smoking (33% of 548,965), HIV (27% of 1500) and diabetes (19% of 228,687). Adjusted rates for all conditions declined over the four-year period; with the sharpest drop of over 80% for diabetes (47.7% in 2010 vs. 7.3% in 2014), and 20% to 55% for the other conditions. Discrepancies were more common in private hospitals and smaller public hospitals. Inter-hospital differences were responsible for 1% (HIV) to 9.4% (smoking) of variation in adjusted discrepancy incidences, with an increasing trend for diabetes and HIV. Chronic conditions are recorded inconsistently in hospital administrative datasets, and hospitals contribute to the discrepancies. Adjustment for patterns and stratification in risk adjustments; and furthermore longitudinal accumulation of clinical data at patient level, refinement of clinical coding systems and standardisation of comorbidity recording across hospitals would enhance accuracy of datasets and validity of case-mix adjustment.

Improving outcomes using German Inpatient Quality Indicators in conjunction with peer review procedures.

Some hospital comparisons seem to generate confusion because different methods of outcome comparisons lead to different results in hospital rankings. This article questions the concept of overall comparisons of hospitals, which are multiproduct enterprises and may have specialties that provide good results in some areas despite having worse outcomes in others. Therefore, the authors argue for a disease specific view of outcome measurement. The concept of the German Inpatient Quality Indicators is explained. These indicators cover volume, mortality, and other information by a disease specific approach, which includes information for potential patients as well as specific feedback to the physicians responsible for the respective specialty. This article focuses on the feedback to the hospitals and explains how these indicators can be used for improvement in conjunction with a peer review process. The indicators provide information to the hospitals regarding their relative position because German reference values are available for all indicators. Thus, the indicators can serve as a trigger instrument for identifying possible quality problems. Based on these indications, peer review can be used to analyze the treatment processes and to eventually verify weaknesses and define actions for improvement. The first studies indicate that the use of this approach within hospital quality management can largely improve hospital outcomes in hospitals with subpar results compared to the German average.

[Quality assurance with administrative data (QSR): follow-up in quality measurement - an analysis of patient records]. / Qualitätssicherung mit Routinedaten (QSR): Follow-up in der Qualitätsmessung - Eine Analyse fallübergreifender Behandlungsverläufe.

The present study analyses the information gain obtained by evaluating adverse events during follow-up compared to the sole analysis of events during the initial hospital stay for quality measurement purposes. The analysis is based on AOK administrative data from the years 2010 to 2012. The analyses were carried out for 10 quality indicators from the 4 QSR sectors knee replacement for osteoarthritis, appendectomy, prostate surgery for benign prostatic syndrome (BPS) and therapeutic cardiac catheterization (PCI) in patients with myocardial infarction. A total of 409,774 AOK cases were included. For almost all indicators considered, a relevant share of complications can be found to have occurred only after discharge from the initial hospitalization (7.7 %-92.6 %). Furthermore, there is only a weak connection between the findings from the first hospitalization and those from the follow-up period (0.0449 < r < 0.1935). 26-66 % of the hospitals will be classified differently based on Standardized Mortality/Morbidity Ratio (SMR) quartiles if follow-up events are included in the quality assessment (with the exception of "Other Complications after PCI" of 14 %). In summary, quality assessment is improved considerably by evaluating the follow-up period for almost all indicators considered. A quality measurement based solely on events in the initial hospital stay obscures relevant adverse events that have an impact on a comparative hospital quality assessment for these indicators.

Determine the therapeutic role of radiotherapy in administrative data: a data mining approach.

BACKGROUND: Clinical data gathered for administrative purposes often lack sufficient information to separate the records of radiotherapy given for palliation from those given for cure. An absence, incompleteness, or inaccuracy of such information could hinder or bias the study of the utilization and outcome of radiotherapy. This study has three specific purposes: 1) develop a method to determine the therapeutic role of radiotherapy (TRR); 2) assess the accuracy of the method; 3) report the quality of the information on treatment "intent" recorded in the clinical data in Ontario, Canada. A general purpose is to use this study as a prototype to demonstrate and test a method to assess the quality of administrative data. METHODS: This is a population based retrospective study. A random sample was drawn from the treatment records with "intent" assigned in treating hospitals. A decision tree is grown using treatment parameters as predictors and "intent" as outcome variable to classify the treatments into curative or palliative. The tree classifier was applied to the entire dataset, and the classification results were compared with those identified by "intent". A manual audit was conducted to assess the accuracy of the classification. RESULTS: The following parameters predicted the TRR, from the strongest to the weakest: radiation dose per fraction, treated body-region, disease site, and time of treatment. When applied to the records of treatments given between 1990 and 2008 in Ontario, Canada, the classification rules correctly classified 96.1% of the records. The quality of the "intent" variable was as follows: 77.5% correctly classified, 3.7% misclassified, and 18.8% did not have an "intent" assigned. CONCLUSIONS: The classification rules derived in this study can be used to determine the TRR when such information is unavailable, incomplete, or inaccurate in administrative data. The study demonstrates that data mining approach can be used to effectively assess and improve the quality of large administrative datasets.

Algorithm for analysis of administrative pediatric cancer hospitalization data according to indication for admission.

BACKGROUND: Childhood cancer relies heavily on inpatient hospital services to deliver tumor-directed therapy and manage toxicities. Hospitalizations have increased over the past decade, though not uniformly across childhood cancer diagnoses. Analysis of the reasons for admission of children with cancer could enhance comparison of resource use between cancers, and allow clinical practice data to be interpreted more readily. Such comparisons using nationwide data sources are difficult because of numerous subdivisions in the International Classification of Diseases Clinical Modification (ICD-9) system and inherent complexities of treatments. This study aimed to develop a systematic approach to classifying cancer-related admissions in administrative data into categories that reflected clinical practice and predicted resource use. METHODS: We developed a multistep algorithm to stratify indications for childhood cancer admissions in the Kids Inpatient Databases from 2003, 2006 and 2009 into clinically meaningful categories. This algorithm assumed that primary discharge diagnoses of cancer or cytopenia were insufficient, and relied on procedure codes and secondary diagnoses in these scenarios. Clinical Classification Software developed by the Healthcare Cost and Utilization Project was first used to sort thousands of ICD-9 codes into 5 mutually exclusive diagnosis categories and 3 mutually exclusive procedure categories, and validation was performed by comparison with the ICD-9 codes in the final admission indication. Mean cost, length of stay, and costs per day were compared between categories of indication for admission. RESULTS: A cohort of 202,995 cancer-related admissions was grouped into four categories of indication for admission: chemotherapy (N=77,791, 38%), to undergo a procedure (N=30,858, 15%), treatment for infection (N=30,380, 15%), or treatment for other toxicities (N=43,408, 21.4%). The positive predictive value for the algorithm was >95% for each category. Admissions for procedures had higher mean hospital costs, longer hospital stays, and higher costs per day compared with other admission reasons (p<0.001). CONCLUSIONS: This is the first description of a method for grouping indications for childhood cancer admission within an administrative dataset into clinically relevant categories. This algorithm provides a framework for more detailed analyses of pediatric hospitalization data by cancer type.

Variation in the recording of common health conditions in routine hospital data: study using linked survey and administrative data in New South Wales, Australia.

OBJECTIVES: To investigate the nature and potential implications of under-reporting of morbidity information in administrative hospital data. SETTING AND PARTICIPANTS: Retrospective analysis of linked self-report and administrative hospital data for 32,832 participants in the large-scale cohort study (45 and Up Study), who joined the study from 2006 to 2009 and who were admitted to 313 hospitals in New South Wales, Australia, for at least an overnight stay, up to a year prior to study entry. OUTCOME MEASURES: Agreement between self-report and recording of six morbidities in administrative hospital data, and between-hospital variation and predictors of positive agreement between the two data sources. RESULTS: Agreement between data sources was good for diabetes (κ=0.79); moderate for smoking (κ=0.59); fair for heart disease, stroke and hypertension (κ=0.40, κ=0.30 and κ =0.24, respectively); and poor for obesity (κ=0.09), indicating that a large number of individuals with self-reported morbidities did not have a corresponding diagnosis coded in their hospital records. Significant between-hospital variation was found (ranging from 8% of unexplained variation for diabetes to 22% for heart disease), with higher agreement in public and large hospitals, and hospitals with greater depth of coding. CONCLUSIONS: The recording of six common health conditions in administrative hospital data is highly variable, and for some conditions, very poor. To support more valid performance comparisons, it is important to stratify or control for factors that predict the completeness of recording, including hospital depth of coding and hospital type (public/private), and to increase efforts to standardise recording across hospitals. Studies using these conditions for risk adjustment should also be cautious of their use in smaller hospitals.