Use of narrative analysis for comparisons of the causes of fatal accidents in three countries: New Zealand, Australia, and the United States.

OBJECTIVES: To investigate the utility of narrative analysis of text information for describing the mechanism of injury and to compare the patterns of the mechanism of injury for work related fatalities in three countries. METHODS: Three national collections of data on work related fatalities were used in this study including those for New Zealand, 1985-94 (n=723), for Australia, 1989-92 (n=1,220), and for the United States, 1989-92 (16,383). The New Zealand and Australian collections used the type of occurrence standard code for the mechanism of injury, however the United States collection did not. All three databases included a text description of the circumstances of the fatality so a text based analysis was developed to enable a comparison of the mechanisms of injury in each of the three countries. A test set of 200 cases from each country dataset was used to develop the narrative analysis and to allow comparison of the narrative and standard approaches to mechanism coding. RESULTS: The narrative coding was more useful for some types of injury than others. Differences in coding the narrative codes compared with the standard code were mainly due to lack of sensitivity in detecting cases for all three datasets, although specificity was always high. The pattern of causes was very similar between the two coding methods and between the countries. Hit by moving objects, falls, and rollovers were among the five most common mechanisms of workplace fatalities for all countries. More common mechanisms that distinguished the three countries were electrocutions for Australia, drowning for New Zealand, and gunshot for the United States. CONCLUSION: Narrative analysis shows some promise as an alternative approach for investigating the causes of fatalities.

Comparison of work related fatal injuries in the United States, Australia, and New Zealand: method and overall findings.

OBJECTIVES: To compare the extent, distribution, and nature of fatal occupational injury in New Zealand, Australia, and the United States. SETTING: Workplaces in New Zealand, Australia, and the United States. METHODS: Data collections based on vital records were used to compare overall rates and distribution of fatal injuries covering the period 1989-92 in Australia and the United States, and 1985-94 in New Zealand. Household labour force data (Australia and the United States) and census data (New Zealand) provided denominator data for calculation of rates. Case definition, case inclusion criteria, and classification of occupation and industry were harmonised across the three datasets. RESULTS: New Zealand had the highest average annual rate (4.9/100,000), Australia an intermediate rate (3.8/100,000), and the United States the lowest rate (3.2/ 100,000) of fatal occupational injury. Much of the difference between countries was accounted for by differences in industry distribution. In each country, male workers, older workers, and those working in agriculture, forestry and fishing, in mining and in construction, were consistently at higher risk. Intentional fatal injury was more common in the United States, being rare in both Australia and New Zealand. This difference is likely to be reflected in the more common incidence of work related fatal injuries for sales workers in the United States compared with Australia and New Zealand. CONCLUSIONS: The present results contrasted with those obtained by a recent study that used published omnibus statistics, both in terms of absolute rates and relative ranking of the three countries. Such differences underscore the importance of using like datasets for international comparisons. The consistency of high risk areas across comparable data from comparable nations provides clear targets for further attention. At this stage, however, it is unclear whether the same specific occupations and/or hazards are contributing to the aggregated industry and occupation group rates reported here.

An instrument for collecting problem oriented, problem linked data in primary medical care.

AIM: To describe a new form for collecting problem oriented, problem linked data from primary care. METHOD: A novel form is described which has been used to collect these data. These data were validated against secondary data collections. RESULTS: The form has been used to record 10,937 encounters in a variety of primary care settings. The form was acceptable to general practitioners (GPs) and was completed on 87% of eligible patients in a one week data collection. Data captured provide descriptive data about the problems encountered and services provided during the consultation. These elements of the medical record are linked so that it is possible to address questions about patterns of service provision. Uncomplicated lower urinary tract infection is used as an example of how data from the form can be used to examine clinical practice and resource utilisation. CONCLUSION: A method has been demonstrated to collect problem oriented, problem linked data which may be used for clinical costing and to demonstrate compliance with clinical practice guidelines.

Information technology and general practice. A survey of general practitioner attitudes towards computerisation.

AIM: General practitioners in the central Sydney area were surveyed to quantify the extent of, and attitudes towards, computerisation in Australian general practice. METHOD: Two surveys were mailed to all GPs in the central Sydney area, first in 1994, and again in 1996. The majority of questions in both surveys were identical. The results were collated and descriptive and comparative statistics calculated. RESULTS: There was an increase in the use of computers for clinical tasks and, GPs' attitudes towards computerised prescribing systems became more positive. There was a persistent negative attitude towards the actual costs of computerisation. CONCLUSION: Methods are now required to transform the increased use of computers by GPs into improved outcomes for them and their patients.

A model for the evaluation of computerised codes. The Gabrieli Medical Nomenclature as an example.

The objective of this article was to evaluate the Gabrieli Medical Nomenclature (GMN) as a coding system for primary care, using a system of five criteria. These were: the infrastructure supporting the coding system; the code structure; ease of use of the codes; the reproducibility of coding; the usefulness of the codes to Australian GPs. The performance of the GMN was evaluated as being at, or below the level of other coding systems in each of the assessment areas. It was found that the GMN has no advantages over other, existing coding systems. Evaluation of coding systems should include an assessment of the reproducibility of coding and its usefulness to Australian general practice.

The changing pattern of fetal death, 1961-1988.

The aim of this study was to assess any changes in cause-specific fetal death rates in the nonreferred population of a tertiary care unit. The fetal death rate (per 1000 births) among 88,651 births diminished from 11.5 in the 1960s to 5.1 in the 1980s. Fetal death due to intrapartum asphyxia and Rh isoimmunization has almost disappeared. Toxemia and diabetes continue to make similar and small contributions to fetal death rates. There has been a significant decline in unexplained antepartum fetal deaths and in those caused by fetal growth retardation, but no significant change in the death rate due to intrauterine infection or abruptio placentae. During the 1960s, the risk of fetal death was increased in women with hypertension, diabetes, or a history of stillbirth; during the 1980s, only women with a history of insulin-dependent diabetes were at risk. Improved application of current knowledge may help decrease the fetal death rate caused by fetal growth retardation. Reduction in deaths due to abruptio placentae, intrauterine infections, or lethal malformations, as well as unexplained antepartum deaths, appears to depend on better understanding of the etiology of these disorders.