The Dutch Uniform Multicenter Registration system for genetic disorders and malformation syndromes.

In medical genetics, several systems are used to classify and code genetic disorders for the purpose of automated registration. In the Netherlands, a genetic diagnosis code system has been developed that links a unique four-digit code to a principal description and all current synonyms. The main goal of this coding system is to enable nationwide uniformity of coding, without losing access to information stored in the past, identified by the ICD/BPA code (the International Classification of Diseases as adapted by the British Paediatric Association) and/or the MIM code (McKusick's classification in Mendelian Inheritance in Man). To this effect, the Dutch diagnosis code is cross-referenced with the 2 pre-existing classification systems. Developments in medical genetics make regular updates of all coding systems necessary. In the Netherlands, new diagnosis codes are assigned centrally to preserve uniformity and distributed periodically to all 8 clinical genetic centers. Diagnosis codes are assigned in numerical order of inclusion, enabling quick and easy updates. It is possible to include subclassifications of disorders according to pattern of inheritance, gene location, and gene mutations and to cover all disorders and disorder subtypes which are not clearly distinguished by the 2 pre-existing classification systems. The architecture of the coding system is suitable for international use. It offers a practical solution for clinical geneticists in need of a coding system suitable for clinical use. The use of the diagnosis code will also facilitate reliable comparison of data and nationwide genetic epidemiological studies.

[Characteristics of patients during their stay in a nursing home and at discharge]. / Kenmerken van patiënten tijdens verblijf in het verpleeghuis en bij ontslag.

OBJECTIVE: To determine the characteristics of patients during stay in nursing homes, and at the moment of discharge or death. DESIGN: Cross-sectional study. METHOD: Data were collected concerning September 30th 1991 using the National Nursing Home Registration System SIVIS, in which over 80% of the nursing homes participate. There were 45,471 patients (23,395 somatic and 22,076 psychogeriatric patients). RESULTS: Frequent morbidity consisted of stroke, neurological disorders, locomotor disorders and dementia. There was a high degree of disability regarding the activities of daily life and mobility. The average length of stay for somatic patients was just over one year, that for psychogeriatric patients almost two and a half years. After rehabilitation, one-third of the patients could be discharged to their homes or to a home for the aged. (Most of the remaining patients eventually died in the nursing home.) CONCLUSION: Residing nursing home patients are mainly characterised by chronic disorders. Consequently, disabilities and handicaps occur in many areas, such as self-care, mobility and psychological functioning. For a number of patients the distinction between somatic or psychogeriatric nursing becomes irrelevant. For all categories of patients the utilisation of care resources is increasing.

[Characteristics of nursing home patients at initial admission: age, sex and morbidity]. / Kenmerken van verpleeghuispatiënten bij eerste opname: leeftijd, geslacht en morbiditeit.

INTRODUCTION: Some 35,000 new patients are admitted yearly to 'verpleeghuizen' or Dutch nursing homes. This paper describes some characteristics of these patients. METHOD: Data were collected using the national Nursing Home Registration System SIVIS of the Dutch centre for health care information. The response rate to the registration by the nursing homes is over 80%. RESULTS: Newly admitted nursing home patients are characterised by a (very) high age (over 50% of the patients are 80 years and over), a distribution of twice as many women as men and a morbidity pattern of chronic somatic and psychogeriatric, as well as orthopaedic disorders. CONCLUSION: Among elderly patients the nursing home patients constitute of a heterogeneous purpose of admission and morbidity pattern. Nursing home care focuses on rehabilitation, long-term care and terminal care.

[Recalculation of bed occupancy ratio of short- and long-stay nursing home patients]. / Het beddenaandeel van kort- en langverblijvende verpleeghuispatiënten herberekend.

The authors present a revised equation by which the ratio of beds occupied by short- and long-term patients can be calculated. In 1984, 8.2% of the beds were occupied by short-stay somatic patients, compared to 2.17% occupied by short-stay psychogeriatric patients, the dividing line between short-stay and long-stay patients being 6 months. These data are also compared with those in 1985. In the latter year a distinction is made between somatic short-stay patients who died, and other somatic short-stay patients.

[Length of stay in nursing homes. Arrangements in short- and long-term stays]. / Verblijfsduur in verpleeghuizen. Een ordening in kort en lang verblijf.

For general and specific planning purposes in nursing homes it is necessary to know the number of beds available for the different groups of patients. The length of stay of patients, however, varies substantially. This makes it difficult to calculate the numbers and types of beds which will be available at any given moment. By drawing the dividing line between a short and a long stay at six months we are able to discuss factors concerning length of stay more lucidly. According to this criterion, 64.9% of the somatic patients discharged in 1984 were short-stay patients, compared with 31.3% short-stay psychogeriatric patients. The total number of beds needed for short-stay patients in 1984 amounted to 34.4% of the total number of beds available for somatic patients and 12.5% of the beds available for psychogeriatric patients. The precise figures vary considerably between nursing homes. This variation is greater for somatic than for psychogeriatric patients.