Biomedical subjects

S M Cageorge

Publications and source records attributed to S M Cageorge.

3 recordsLinked to original sources

PubMed1987

Using administrative data for longitudinal research: comparisons with primary data collection.

This paper discusses the advantages and disadvantages of using administrative data for longitudinal research, focusing on loss to follow-up. Comparisons between research relying on primary data collection and that using data bases are made. After development of a suitable framework, follow-up in several well-known projects based on primary data collection (the Seven Countries project on coronary heart disease, the Massachusetts research on long-term care and the Pittsburgh clinical trial of tonsillectomy) is compared with follow-up using the Health Services Commission data base in Manitoba, Canada. Overall follow-up in the Manitoba research compares favorably with participation and follow-up rates in other studies based on primary data collection. Initial nonresponse and nonlocation are major problems with studies using primary data; failure to locate earlier respondents in subsequent waves results in a wide range of overall response rates. Data bases do not require researchers to contact individuals and hence follow-up is simplified. Eight year follow-up rates in the Manitoba data base are almost always over 80% and often over 90%. Because records can be flexibly summarized for each individual over time, data bases facilitate certain types of longitudinal studies which would be difficult, if not impossible, to perform using other methodologies. If the desired data are available and recorded with acceptable accuracy, administrative data banks hold considerable promise for the health care researcher.

Adolescent↗

PubMed1986

Centralization, certification, and monitoring. Readmissions and complications after surgery.

Research on adverse outcomes following common surgical procedures has suggested the importance of hospital and surgeon variables. Policy directions depend on which factors are important in influencing patient outcomes and what sorts of policies are feasible. Focusing on where a given procedure is performed highlights a concern for centralization; emphasizing who should perform a particular operation implies physician certification. Finally, monitoring involves identifying particular hospitals that appear to have relatively poor (or relatively good) results. This paper analyzes patient, surgeon, and hospital characteristics associated with serious postdischarge complications of hysterectomy, cholecystectomy, and prostatectomy in patients age 25 and over in Manitoba, Canada, following surgery during 1974 through 1976. The three procedures differ markedly in the ease of prediction of the probability of complications and in the predictive importance of patient, hospital, and physician variables. The predictors worked fairly well for cholecystectomy, somewhat less well for hysterectomy, and not well at all for prostatectomy. Hospital variables were not generally important in the multiple logistic regressions. After controlling for case mix and type of surgery, physician surgical experience was found to account for relatively large differences (almost two to one) in the probability of patient complications following cholecystectomy. Cholecystectomy might be a candidate for certification because of the epidemiology of the operation. As of the mid-1970s, a substantial proportion of the cholecystectomies were being performed by physicians with comparatively little ongoing experience with this type of procedure. Moreover, a monitoring perspective identified one hospital with a significantly higher postcholecystectomy complication rate, even after physician experience was taken into account. Both identifying which procedures should be attended to and focusing on problems following surgery are important beyond Manitoba and highly relevant to such American requirements as Peer Review Organizations. Methods of increasing the efficiency of using claims data for quality assurance studies are outlined.

Cholecystectomy↗

PubMed1985

Using computers to identify complications after surgery.

We used the Health Services Commission data from Manitoba, Canada to identify complications resulting from hysterectomy, cholecystectomy, and prostatectomy which led to hospital readmissions. For each procedure, two specialists independently judged whether the readmissions were for surgery-related complications on the basis of liberally interpreted literature guidelines. Then, each pair of physicians met to resolve differences; only complications agreed upon by physicians were retained in our computer-based analysis. The analysis was done in three steps: algorithms were developed using guidelines from the literature, physician input, and 1974 hospital claims; these were then modified using 1975 data; finally, the algorithms were tested with 1976 data. The computerized algorithms developed were compared with the clinical decisions of physician panels. The results showed high specificity, sensitivity, and predictive value. Given the increasing availability of routinely collected data bases, the possibilities for inexpensively monitoring the outcomes of different providers and institutions are appealing. More extensive validation and application of the methodology to a greater number of procedures are necessary to implement such a program.

Cholecystectomy↗