Acute Pancreatitis During and After Pregnancy: Incidence, Risk Factors, and Prognosis.

BACKGROUND: Acute pancreatitis may complicate pregnancy and both are associated with gallstones, but its incidence is not well known. AIMS: To validate hospital discharge records in diagnosing acute pancreatitis and gallstones and to evaluate acute pancreatitis incidence in non pregnant, pregnant and after delivery using hospital discharge records METHODS: We identified all hospital discharge records of hospitalized Sicilian women of childbearing age (2011-2016). We determined agreement between 300 hospital discharge records and hospital records in diagnosing acute pancreatitis and gallstones. Acute pancreatitis incidence, prognosis, and their relationship with age and gallstones were calculated in the three groups using hospital discharge records. RESULTS: There was 92% and 88% agreement in diagnosing acute pancreatitis and gallstones between hospital discharge and hospital records. In non pregnant, 1,564 of 7,236,863 women-years (21.61/100,000 person-years) developed acute pancreatitis. During pregnancy, 34 of 226,492 women-years developed acute pancreatitis (20.02/100,000 person-years). Postpartum acute pancreatitis incidence was higher than non pregnant, only in the first 2 years with the peak in the first semester (95.4/100,000 person-years). The increased incidence of postpartum acute pancreatitis was associated with gallstones in youngest women (gallstones acute pancreatitis in women below 20 years old versus non pregnant: rate ratios 16.61; 95% CI 8.40-32.87). CONCLUSIONS: Agreement in acute pancreatitis and gallstones diagnosis between hospital discharge and hospital records was accurate. Acute pancreatitis incidence was increased only in the first 2 years after delivery in young women with gallstones.

HOSPITAL ADMISSIONS OF ADOLESCENTS IN SERGIPE, FROM 2002 TO 2012.

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.

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.

Facilitators and barriers in implementing medication safety practices across hospitals within 11 European Union countries

BACKGROUND: The study was carried out as part of the European Network for Patient Safety (EUNetPas) project in 2008-2010. OBJECTIVE: To investigate facilitators and barriers in implementation process of selected medication safety practices across hospitals within European Union countries. METHODS: This was an implementation study of seven selected medication safety practices in 55 volunteering hospitals of 11 European Union (EU) member states. The selected practices were: two different versions of medicine bed dispensation; safety vest; discharge medication list for patients; medication reconciliation at patient discharge; medication reconciliation at patient admission and patient discharge, and sleep card. The participating hospitals submitted an evaluation report describing the implementation process of a chosen practice in their organisation. The reports were analysed with inductive content analysis to identify general and practice-specific facilitators and barriers to the practice implementation. RESULTS: Altogether 75 evaluation reports were submitted from 55 hospitals in 11 EU member states. Implementation of the medication safety practices was challenging and more time consuming than expected. The major reported challenge was to change the work process because of the new practice. General facilitators for successful implementation were: existence of safety culture, national guidelines and projects, expert support, sufficient resources, electronic patient records, interdisciplinary cooperation and clinical pharmacy services supporting the practice implementation. CONCLUSIONS: The key for the successful implementation of a medication safety practice is to select the right practice for the right problem, in the right setting and with sufficient resources in an organization with a safety culture

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CALL ME BY YOUR NAME. Paciente protegido: reflexiones sobre lo que implica privar del nombre propio para la Seguridad del Paciente / CALL ME BY YOUR NAME. Protected patient: reflections on removing the patient's name in Patient Safety

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Using hospital discharge data for injury research or surveillance? An observational study illustrating the impact of administrative change.

INTRODUCTION: Hospital discharge data provide an important basis for determining priorities for injury prevention and monitoring trends in incidence. This study aims to illustrate the impact of a recent change in administrative practice on estimates of hospitalised injury incidence and to investigate the extent to which different case selection affects trends in injury incidence rates. METHODS: New Zealand (NZ) hospital discharges (2000-2014) with a primary diagnosis of injury were identified. Additional case selection criteria included first admissions only, and for serious injury, a high threat-to-life estimate. Comparisons were made, over time and by District Health Board, between hospitalised injury incidence estimates that included, or not, short-stay emergency department (SSED) discharges. RESULTS: Of the 1 229 772 injury hospital discharges, 365 114 were SSED; 16% of the annual total in 2000, 38% in 2014. Identification of readmissions prior to the exclusion of SSED discharges resulted in 30 724 cases being erroneously removed. Age-standardised rates of hospitalised injury over the 15-year period increased by, on average, 2.7% per year when SSED discharges were included; there was minimal secular change (-0.2%) when SSEDs were excluded. For serious hospitalised injury, the annual increase was 2.3% when SSED was included compared with 1.1% when SSEDs were excluded. CONCLUSION: Spurious trends in hospitalised injury incidence can result when administrative practices are not appropriately accounted for. Exclusion of SSED discharges before the identification of readmissions and the use of a severity threshold are recommended to minimise the reporting bias in NZ hospitalised injury incidence estimates.

Cause of death coding in Switzerland: evaluation based on a nationwide individual linkage of mortality and hospital in-patient records.

BACKGROUND: Cause of death statistics are an important tool for quality control of the health care system. Their reliability, however, is controversial. Comparing death certificates with their corresponding medical records is implemented only occasionally but may point to quality problems. We aimed at exploring the agreement between information in the cause of death statistics and hospital discharge diagnoses at death. METHODS: Selection of disease categories was based on ICD-10 Tabulation List for Morbidity and ICD-10 Mortality Tabulation List 2. Index cases were defined as deaths having occurred among Swiss residents 2010-2012 in a hospital and successfully linked to the Swiss National Cohort. Rare, external and ill-defined causes were excluded from comparison, leaving 53,605 deaths from vital statistics and 47,311 deaths from hospital discharge statistics. For 95% of individuals, respective information from the 2000 census could be retrieved and used for multiple logistic regression. RESULTS: For 83% of individuals the underlying cause of death could be traced among hospital diagnoses and for 77% the principal hospital diagnosis among the cause of death information. Mirroring different evaluation of complex situations by individual physicians, rates of agreement varied widely depending on disease/cause of death, but were generally in line with similar studies. Multiple logistic regression revealed however significant variation in reporting that could not entirely be explained by age or cause of death of the deceased suggesting differential exploitation of available diagnosis information. CONCLUSION: Substantial regional variation and lower agreement rates among socially disadvantaged groups like single, less educated, or culturally less integrated persons suggest potential for improving reporting of diagnoses and causes of death by physicians in Switzerland. Studies of this kind should be regularly conducted as a quality monitoring.

Assessing the quality of medical death certification: a case study of concordance between national statistics and results from a medical record review in a regional hospital in the Philippines.

BACKGROUND: Medical certificates of cause of death (MCCOD) issued by hospital physicians are a key input to vital registration systems. Deaths certified by hospital physicians have been implicitly considered to be of high quality, but recent evidence suggests otherwise. We conducted a medical record review (MRR) of hospital MCCOD in the Philippines and compared the cause of death concordance with certificates coded by the Philippines Statistics Authority (PSA). METHODS: MCCOD for adult deaths in Bohol Regional Hospital (BRH) in 2007-2008 and 2011 were collected and reviewed by a team of study physicians. Corresponding MCCOD coded by the PSA were linked by a hospital identifier. The study physicians wrote a new MCCOD using the patient medical record, noted the quality of the medical record to produce a cause of death, and indicated whether it was necessary to change the underlying cause of death (UCOD). Chance-corrected concordance, cause-specific mortality fraction (CSMF) accuracy, and chance-corrected CSMF were used to examine the concordance between the MRR and PSA. RESULTS: A total of 1052 adult deaths were linked between the MRR and PSA. Median chance-corrected concordance was 0.73, CSMF accuracy was 0.85, and chance-corrected CSMF accuracy was 0.58. 74.8% of medical records were deemed to be of high enough quality to assign a cause of death, yet study physicians indicated that it was necessary to change the UCOD in 41% of deaths, 82% of which required addition of a new UCOD. CONCLUSIONS: Medical records were generally of sufficient quality to assign a cause of death and concordance between the PSA and MRR was reasonably high, suggesting that routine mortality statistics data are reasonably accurate for describing population level causes of death in Bohol. While overall agreement between the PSA and MRR in major cause groups was sufficient for public health purposes, improvements in death certification practices are recommended to help physicians differentiate between treatable (immediate) COD and COD that are important for public health surveillance.

Hospital mortality statistics in Tanzania: availability, accessibility, and quality 2006-2015.

BACKGROUND: Accurate and reliable hospital information on the pattern and causes of death is important to monitor and evaluate the effectiveness of health policies and programs. The objective of this study was to assess the availability, accessibility, and quality of hospital mortality data in Tanzania. METHODS: This cross-sectional study involved selected hospitals of Tanzania and was carried out from July to October 2016. Review of hospital death registers and forms was carried out to cover a period of 10 years (2006-2015). Interviews with hospital staff were conducted to seek information as regards to tools used to record mortality data, staff involved in recording and availability of data storage and archiving facilities. RESULTS: A total of 247,976 death records were reviewed. The death register was the most (92.3%) common source of mortality data. Other sources included the International Classification of Diseases (ICD) report forms, Inpatient registers, and hospital administrative reports. Death registers were available throughout the 10-year period while ICD-10 forms were available for the period of 2013-2015. In the years between 2006 and 2010 and 2011-2015, the use of death register increased from 82 to 94.9%. Three years after the introduction of ICD-10 procedure, the forms were available and used in 28% (11/39) hospitals. The level of acceptable data increased from 69% in 2006 to 97% in 2015. Inconsistency in the language used, use of non-standard nomenclature for causes of death, use of abbreviations, poorly and unreadable handwriting, and missing variables were common data quality challenges. About 6.3% (n = 15,719) of the records had no patient age, 3.5% (n = 8790) had no cause of death and ~ 1% had no sex indicated. The frequency of missing sex variable was most common among under-5 children. Data storage and archiving in most hospitals was generally poor. Registers and forms were stored in several different locations, making accessibility difficult. CONCLUSION: Overall, this study demonstrates gaps in hospital mortality data availability, accessibility, and quality, and highlights the need for capacity strengthening in data management and periodic record reviews. Policy guidelines on the data management including archiving are necessary to improve data.

Improving hospital death certification in Vietnam: results of a pilot study of injury-related fatalities.

BACKGROUND: Vietnam has prioritised the establishment of a civil registration system for deaths but as yet is unable to report accurate national statistics for the population of 93.5 million people due to inadequate mortality data. Verbal autopsy data suggest that injury is a third leading cause of death (by International Statistical Classification of Diseases and Related Health Problems 10th Revision chapters) in Vietnam, with road traffic injuries in particular a significant and increasing challenge. The study aims to present a more accurate profile of the number and probable causes of these deaths based on data collected hospitals using a version of the WHO death certificate modified for the Vietnamese context. METHODS: Death data collected from Viet Duc Surgical and Trauma Hospital in Vietnam between 1 March 2013 to 31 March 2015 was analysed to explore the number and probable causes of deaths for deaths resulting from an injury. RESULTS: A total of 1616 deaths were recorded for Viet Duc Hospital, of which 73% (1181/1616) were associated with an injury. Most (83%; n=871/1049) injury-related deaths for which immediate cause of death was documented were as a result of head/brain injuries. Injury-related deaths were most commonly caused by from traffic accidents (72%, 853/1181). The majority of patients suffering injury-related deaths were discharged home to die (93%, 1097/1181). CONCLUSION: The study confirms some findings from previous studies about deaths from injuries, while disagreeing with others, highlighting the challenge for Vietnam in collecting these data. Gathering detailed death data provides essential evidence on which to base decisions about allocation of government funding and policy for injury prevention and treatment.

Accuracy of Administrative Data for Antimicrobial Administration in Hospitalized Children.

Administrative data are often used as a proxy for medication-administration record (MAR) data. Multicenter MAR data were compared retrospectively with administrative data from January 2010 through June 2013 from the Pediatric Health Information Systems database. We found that administrative data were more concordant with bill-upon-administration than bill-upon-dispense data.

Estudio de inventario de casos de tuberculosis en un hospital de tercer nivel con vigilancia activa, implicaciones para la notificación oportuna y el control de la infección / No disponible

Fundamentos. Se evaluó la exhaustividad del registro EDO de tuberculosis, sus factores asociados, la vigilancia activa (VA) y los notificadores. Métodos. Hospital de tercer nivel de la Comunidad de Madrid, 2003-2009. Se calcularon exhaustividades observadas y estimadas por método captura y recaptura sobre los registros EDO, CMBD y SIM. Se ajustó un modelo de regresión logística para los factores. Se describió la contribución de notificadores y VA según responsabilidad. Resultados. Sobre 316 casos, la exhaustividad observada fue 86,4% y la estimada 76,9%. La notificación se asoció desfavorablemente a casos ≥ 55 años, extrapulmonares y sin hallazgos microbiológicos. La VA redujo la infradeclaración 2-3 veces, recuperando casos no detectados por CMBD-SIM. La contribución fue del 31,5%, Servicios Clínicos, 39,7%, Microbiología y 28,8%, VA. Conclusiones. La exhaustividad de EDO fue elevada, aunque menor en presentaciones de enfermedad menos esperables. La notificación de los Servicios Clínicos fue baja resultando útil la VA en la mejora de EDOP

Background. We assessed the completeness of the EDO tuberculosis registry, its related factors, the active surveillance (AS) and the notifiers. Methods. Third level Hospital of the Community of Madrid, 2003-2009. The observed and estimated completeness were calculated by capture and recapture on the EDO, CMBD and SIM records. A logistic regression model for the factors was adjusted. The contribution of notifiers and AS was described according to their responsibility. Results. From 316 cases, the observed completeness was 86.4% and the estimated 76.9%. We found unfavorable association with cases ≥ 55 years, extrapulmonary and without microbiological findings. The AS reduced the underdeclaration 2-3 times, recovering cases not detected by CMBDSIM. The contribution was 31.5%, Clinical Services, 39.7%, Microbiology and 28.8%, AS. Conclusions. The completeness of EDO was high, although lower in the less expected presentations of disease. The notification of the Clinical Services was low, and the AS was useful in the improvement of EDO

Fetal death certificate data quality: a tale of two U.S. counties.

PURPOSE: Describe the relative frequency and joint effect of missing and misreported fetal death certificate (FDC) data and identify variations by key characteristics. METHODS: Stillbirths were prospectively identified during 2006-2008 for a multisite population-based case-control study. For this study, eligible mothers of stillbirths were not incarcerated residents of DeKalb County, Georgia, or Salt Lake County, Utah, aged ≥13 years, with an identifiable FDC. We identified the frequency of missing and misreported (any departure from the study value) FDC data by county, race/ethnicity, gestational age, and whether the stillbirth was antepartum or intrapartum. RESULTS: Data quality varied by item and was highest in Salt Lake County. Reporting was generally not associated with maternal or delivery characteristics. Reasons for poor data quality varied by item in DeKalb County: some items were frequently missing and misreported; however, others were of poor quality due to either missing or misreported data. CONCLUSIONS: FDC data suffer from missing and inaccurate data, with variations by item and county. Salt Lake County data illustrate that high quality reporting is attainable. The overall quality of reporting must be improved to support consequential epidemiologic analyses for stillbirth, and improvement efforts should be tailored to the needs of each jurisdiction.

Recording Adverse Events Following Joint Arthroplasty: Financial Implications and Validation of an Adverse Event Assessment Form.

BACKGROUND: In Ireland, funding of joint arthroplasty procedures has moved to a pay-by-results national tariff system. Typically, adverse clinical events are recorded via retrospective chart-abstraction methods by administrative staff. Missed or undocumented events not only affect the quality of patient care but also may unrealistically skew budgetary decisions that impact fiscal viability of the service. Accurate recording confers clinical benefits and financial transparency. The aim of this study was to compare a prospectively implemented adverse events form with the current national retrospective chart-abstraction method in terms of pay-by-results financial implications. METHODS: An adverse events form adapted from a similar validated model was used to prospectively record complications in 51 patients undergoing total hip or knee arthroplasties. Results were compared with the same cohort using an existing data abstraction method. Both data sets were coded in accordance with current standards for case funding. RESULTS: Overall, 114 events were recorded during the study through prospective charting of adverse events, compared with 15 events documented by customary method (a significant discrepancy). Wound drainage (15.8%) was the most common complication, followed by anemia (7.9%), lower respiratory tract infections (7.9%), and cardiac events (7%). A total of €61,956 ($67,778) in missed funding was calculated as a result. CONCLUSION: This pilot study demonstrates the ability to improve capture of adverse events through use of a well-designed assessment form. Proper perioperative data handling is a critical aspect of financial subsidies, enabling optimal allocation of funds.

[Measurement of Quality with Routine Data]. / Qualitätsmessung aus Routinedaten.

There is a growing interest in quality measurement in the healthcare sector. Hospitals in Germany are obligated to participate in measures for external quality assurance and they must establish an internal quality management system. In addition to the legal requirements, measurement of quality is also possible with routine data. Suitable sources are the ICD system or unstandardized information from treatment documentation. The selection of suitable quality indicators is necessary to interpret the data. Complications or achievement of surgical objectives can be suitable quality indicators. Analysis of procedures or the assessment of waiting time are also possible indicators. Our first data concerning waiting time show that with increasing use of an electronic patient guidance system, the waiting time decreased in our outpatient department. Assessment of quality indicators from routine data enables a continuous measurement of quality over a long period. Measures to increase quality can easily be checked. Routine data also provide the possibility to participate in a public reporting of quality indicators.

Accuracy of ethnicity data recorded in hospital-based patient clinical records and the Australia and New Zealand Dialysis and Transplant Registry.

AIM: Sustained health inequities are experienced by indigenous and minority populations. Accurate ethnicity data are fundamental to healthcare planning and provision and monitoring of health outcomes to address such inequities. This study investigated the accuracy of ethnicity data in a large clinical registry of end-stage kidney disease patients (the Australia and New Zealand Dialysis and Transplant Registry; ANZDATA) and hospital-based patient clinical records compared with self-reported ethnicity data collected in the 'Dialysis Outcomes in those aged ≥65 years' (DOS65+) study. METHODS: Self-reported ethnicity data were collected, as per national guidelines, from DOS65+ participants and compared with ethnicity data recorded for these participants in ANZDATA and hospital-based patient clinical records. Ethnicities were first prioritised and then grouped into one of the following: European, Maori, Pacific, Asian and Other. Cohen's Kappa statistics were calculated to determine overall non-random agreement. Concordances for ethnic group categories were calculated. RESULTS: There was high concordance between self-reported ethnicity and ethnicity recorded in both the ANZDATA (κ=0.95) and hospital-based patient clinical records (κ=0.93). Concordances for ethnic group categories between datasets ranged from 86% to 100%. CONCLUSION: Our findings show a high level of agreement for ethnicity recorded for end-stage kidney disease patients between the three datasets, suggesting robust data to support health planning and research. Despite this, alignment of ethnicity data collection methods, as per national guidelines, should occur for all databases used for research and clinical practice in New Zealand.

Pharmacotherapy follow-up of patients under treatment with biologic agents for chronic inflammatory systemic conditions: an agreement among hospital pharmacists for the standardized collection of a minimum set of data / Seguimiento farmacoterapéutico en pacientes en tratamiento con agentes biológicos por enfermedades sistémicas inflamatorias crónicas: acuerdo entre farmacéuticos hospitalarios para la recopilación estandarizada de un conjunto mínimo de datos

Background and objective: The objective of this study was to reach a consensus on the minimum set of data that would allow to optimize the pharmacotherapy follow-up of patients on biologic agents for chronic systemic inflammatory conditions, through structured and standardized collection with an electronic tool in the hospital pharmacy. Materials and method: A scientific committee was formed (n = 5 hospital pharmacists). The Delphi Technique was used, 2 rounds of consultation by e-mail for hospital pharmacists. A structured questionnaire was used, based on a bibliographic review and recommendations by the scientific committee; 37 statements were assessed with the Likert 5-point scale (1= ‘Strongly Disagree’; 5= ‘Strongly Agree’). Consensus was reached when 75% or more of panel members assigned a score of 1-2 (rejection consensus) or 4-5 (agreement consensus) to the matter reviewed. Descriptive statistical analyses were conducted. Results: The study included 21 hospital pharmacists (70 were invited, there was 70% response). Consensus was reached for 100% of statements. The minimum set of data was agreed upon, as well as the recommendations that the pharmacist had to collect and make during visits: to document the health status, health-related quality of life, changes in treatment compliance and in patient autonomy, as well as the conditions to make feasible the systematic collection of the minimum data set. Conclusions: There is consensus among hospital pharmacists about a minimum data set to be collected, through an electronic tool, which will order, standardize and structure the pharmacotherapy follow-up of patients with chronic inflammatory conditions on treatment with biologic agents in the spanish public health system (AU)

Fundamento y objetivo: El objetivo de este estudio fue consensuar un conjunto mínimo de datos cuya recopilación sistemá- tica y estandarizada, mediante una herramienta electrónica en la farmacia hospitalaria, permitiera optimizar el seguimiento farmacoterapéutico de los pacientes tratados con agentes biológicos por enfermedades sistémicas inflamatorias crónicas. Material y método: Se constituyó un comité científico (n = 5 farmacéuticos hospitalarios). Se empleó la técnica Delphi, 2 rondas de consulta, por correo electrónico entre farmacéuticos hospitalarios. Se utilizó un cuestionario estructurado basado en una revisión bibliográfica y en recomendaciones del comité científico, valorándose 37 afirmaciones en una escala Likert de 5 puntos (1 = ‘En total desacuerdo’; 5 = ‘Totalmente de acuerdo’). Se alcanzó consenso cuando el 75% o más de los panelistas puntuaron 1-2 (consenso-rechazo) o 4-5 (consenso-acuerdo) la cuestión planteada. Se realizaron análisis estadísticos descriptivos. Resultados: Participaron 21 farmacéuticos hospitalarios (70 invitados, 70% respuesta). Se logró consenso en el 100% de las afirmaciones. Se acordó el conjunto mínimo de datos y de recomendaciones que el farmacéutico debe recoger y hacer en las visitas; documentar el estado de salud, la calidad de vida relacionada con la salud, los cambios en la adherencia al tratamiento y en la autonomía de los pacientes, así como las condiciones para hacer factible la recopilación sistemática del conjunto mínimo de datos. Conclusiones: Existe consenso entre los farmacéuticos hospitalarios en un conjunto mínimo de datos cuya recopilación, mediante una herramienta electrónica, ordenará, estandarizará y sistematizará el seguimiento farmacoterapéutico de los pacientes con enfermedades inflamatorias crónicas en tratamiento con agentes biológicos en el entorno sanitario público español (AU)

Measuring the operational impact of digitized hospital records: a mixed methods study.

BACKGROUND: Digitized (scanned) medical records have been seen as a means for hospitals to reduce costs and improve access to records. However, clinical usability of digitized records can potentially have negative effects on productivity. METHODS: Data were collected during follow-up outpatient consultations in two NHS hospitals by non-clinical observers using a work sampling approach in which pre-defined categories of clinician time usage were specified. Quantitative data was analysed using two-way ANOVA models and the Mann-Whitney U test. A focus group was held with clinicians to qualitatively explore their experiences using digitized medical records. The quantitative and qualitative results were synthesized. RESULTS: Four hundred six consultations were observed. Using paper records, there was a significant difference in consultation times between hospitals (p = 0.016) and a significant difference in consultation times between specialties within hospitals (p = 0.003). Using digitized records there was a significant difference in consultation times between specialties within a hospital (p = 0.001). Excluding outliers, there was no significant difference between consultation times using digitized records compared with consultations using paper records in the same hospital, either at site (p > =0.285) or specialty level (p > =0.122). With digitized records at site A, two out of three specialties showed a significant increase in time spent searching computer records (p < =0.010, Δ = 01:50-07:10) and one specialty had a corresponding reduction in time spent searching paper records (p = 0.015, Δ = -00:28). Site B showed a notable increase in direct patient care (p < 0.001, Δ = 04:20-06:00) and time spent searching computer records (p < =0.043, Δ = 00:10-01:40) and reductions in the other time categories. The focus group confirmed that the most recent clinical letter was a vital document in the patient record, often containing most of the required information. Concerns were expressed about consistency of scanning practice, causing uncertainty about what could be relied upon to exist in the digitized record. Benefits of digitized records included: access from multiple locations, better prepared ward rounds, improved inpatient handovers and an improved timeline of patient events. Limitations of digitized records included: increased complexity of creating a patient summary, display of specialised content such as hand-drawn diagrams, inability to quickly flick through the pages to find relevant content. CONCLUSIONS: Digitized medical records can be implemented without detrimental operational impact. Inherent differences between specialties can outweigh the differences between paper and digitized records. Clear and consistent operational processes are vital for the reliability and usability of digitized medical records. Divergent views about usability (such as whether patient summary information is better or worse) may reflect familiarity with features of the digitized record.

Risk-adjustment models for heart failure patients' 30-day mortality and readmission rates: the incremental value of clinical data abstracted from medical charts beyond hospital discharge record.

BACKGROUND: Hospital discharge records (HDRs) are routinely used to assess outcomes of care and to compare hospital performance for heart failure. The advantages of using clinical data from medical charts to improve risk-adjustment models remain controversial. The aim of the present study was to evaluate the additional contribution of clinical variables to HDR-based 30-day mortality and readmission models in patients with heart failure. METHODS: This retrospective observational study included all patients residing in the Local Healthcare Authority of Bologna (about 1 million inhabitants) who were discharged in 2012 from one of three hospitals in the area with a diagnosis of heart failure. For each study outcome, we compared the discrimination of the two risk-adjustment models (i.e., HDR-only model and HDR-clinical model) through the area under the ROC curve (AUC). RESULTS: A total of 1145 and 1025 patients were included in the mortality and readmission analyses, respectively. Adding clinical data significantly improved the discrimination of the mortality model (AUC = 0.84 vs. 0.73, p < 0.001), but not the discrimination of the readmission model (AUC = 0.65 vs. 0.63, p = 0.08). CONCLUSIONS: We identified clinical variables that significantly improved the discrimination of the HDR-only model for 30-day mortality following heart failure. By contrast, clinical variables made little contribution to the discrimination of the HDR-only model for 30-day readmission.