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Tests of data quality, scaling assumptions, and reliability of the Danish SF-36.

We used general population data (n = 4084) to examine data completeness, response consistency, tests of scaling assumptions, and reliability of the Danish SF-36 Health Survey. We compared traditional multitrait scaling analyses to analyses using polychoric correlations and Spearman correlations. The frequency of missing values was low, except for elderly people and people with lower levels of education. Response consistency was high and compared well with results for the U.S. SF-36. For respondents with computable scales in all eight domains, scaling assumptions (item internal consistency, item discriminant validity, equal item-own scale correlations, and equal variances) were satisfactory in the total sample and in all subgroups. The SF-36 could discriminate between levels of health in all subgroups, but there were skewness, kurtosis, and ceiling effects in many subgroups (elderly people and people with chronic diseases excepted). Concerning correlation methods, we found interesting differences indicating advantages of using methods that do not assume a normal distribution of answers as an addition to traditional methods.

Cross-Cultural Comparison↗

Formatting and presenting quality data to medical staffs and hospital boards.

A host of historical and practical precedents have made hospitals responsible for the quality of care rendered within their facilities. The medical staff and the board of trustees share in this responsibility. Increasing demands for demonstrative evidence of the quality of care in an institution have made the process data-based. There is no substitute for specific data on the performance of both the hospital and its providers in the delivery of care. The trick, however, is in presenting this information to the medical staff and the board in a fashion that will be understandable and that will still maintain confidentiality of provider and patient. The authors offer a presentation system that has met with success in their community hospital.

Computer Graphics↗

Updates to the Data Quality Review Program: the Society of Thoracic Surgeons Adult Cardiac National Database.

To ensure the credibility of this voluntary database, The Society of Thoracic Surgeons' National Database Audit and Validation Sub-Committee has been working during the past year to update and expand the group practice-based indicators used to assess the completeness, accuracy, and generalizability of the Adult Cardiac National Database. With increasing frequency, questions have been raised by third-party payors and regional/state-based groups as to the integrity of the data retained in the Adult Cardiac National Database. To work in conjunction with the Audit and Validation Sub-Committee to explicitly examine these issues, The Society of Thoracic Surgeons initiated a new Expert Advisory Panel review mechanism. This article describes the expanded data completeness and quality criteria that will be implemented in the coming year and summarizes the Expert Advisory Panel's recommendations for improvement.

Adult↗

Methodology to improve data quality from chart review in the managed care setting.

BACKGROUND: Because inherent variability may exist in data collected by multiple reviewers or from potential difficulties with data abstraction tools, we developed a standardized method of evaluating interrater reliability (IRR) for clinical studies, HEDIS effectiveness of care measures, and onsite/medical record reviews. OBJECTIVE: To demonstrate the ability of our standardized methods of data collection and analysis of results to determine the extent of agreement between multiple reviewers; identify areas for improvement in data collection procedures; and improve data reliability. STUDY DESIGN: A prospective chart review with concurrent IRR. METHODS: A subsample of patient records included in the Highmark Blue Cross Blue Shield/Keystone Health Plan West basic medical review for each HEDIS measure was selected for the IRR study. An experienced nurse ("gold standard") conducted a blinded concurrent review of these records. Using the kappa statistic (kappa) we evaluated interobserver agreement between results of the onsite reviewers and the "gold standard" from 1997 through 2000. Revised data collection methods and enhanced reviewer training were incorporated for measures showing areas for rater improvement. RESULTS: Results across years showed excellent IRR for most measures; however, each year 1 or 2 measures showed areas for rater improvement (1997 Papanicolaou kappa = 0.50; 1998 well-child visits 3 to 6 years kappa = 0.37; 1999 comprehensive diabetes kappa = 0.73; high blood pressure kappa = 0.73). After reevaluating these measures, the results of the kappa showed excellent interrater agreement in subsequent years. CONCLUSIONS: Standardized methods of data collection and evaluation of IRR results provides health plans increased confidence in data collection, statistical analyses, and in reaching conclusions and deriving relevant recommendations.

Blue Cross Blue Shield Insurance Plans↗

A summary of boron surface water quality data throughout the European Union.

The distribution of boron in rivers across European Union countries is described. The data have been collected from national and international monitoring programmes. The data show a wide range of concentrations but only in a few instances do concentrations exceed environmental quality standards. Although there is a good body of data for the analysis presented here, it is clear that there is not a full coverage of environments and for some studies there is a clear bias towards sampling of the main rivers or specific rivers where there are environmental concerns. The variations in concentration link directly to pollutant sources although assessment of the details of the spatial variations is clouded by factors such as the location of monitoring points in relation to pollutant discharges, the variation in dilution potential of the various rivers and contrasting hydrological and geological environments. The data are presented to complement more detailed studies on particular river basins as a basis for the further development of regional environmental impact water quality modelling frameworks and within the newly developing field of typological settings.

Journal Article↗

[Evaluation of data quality from the information system on live births in 1997-1998].

OBJECTIVE: To verify the concordance between data routinely collected by the Sinasc (Information System on Live Births) and data obtained by a cross-sectional survey (gold standard). METHODS: The survey was performed in a sample of 2,831 hospital deliveries in ten maternity hospitals of the municipality of São Luís, Brazil. The sample frame represented about 98% of hospital births. Sinasc's data was compared with the survey data using a computerized linkage program. Sinasc's hospital births coverage, percentage of missing or unrecorded data and consistency between Sinasc 's and the survey's data were analyzed. Concordance was measured using the kappa indicator for qualitative variables and the intraclass correlation coefficient for quantitative variables. RESULTS: The estimated Sinasc coverage was 75.8% (95% CI: 73.3%-78.2%). Five Sinasc's data fields showed good reliability: birth weight, newborn sex, hospital of birth, type of delivery and maternal age. Low birth weight rates estimated by the two data sources were similar and the concordance was high (kappa=0.94). However, preterm birth rates were higher in the survey (11.2%) than according to Sinasc 's data (1.7%) and the concordance was low (kappa=0.09). CONCLUSIONS: Estimated Sinasc coverage was low. Low birth weight rates from Sinasc's data seem to be valid and reliable. Preterm birth rates from Sinasc's data are underestimated.

Birth Rate↗

[Acoustically evoked brain stem potentials. Prerequisites for clinical use, data quality and sources of error].

Ninety patients were subjected to brain-stem auditory evoked potential (BAEP) measurements in the intensive care unit. The data are analyzed and discussed with respect to their quality, reliability, and reproducibility. BAEPs of a quality satisfactory for diagnosis were found in 90% of the patients. About 10% of the measurements were distorted by artifacts and could not be used for diagnostic purposes. Reasons for these artifacts and problems of interpretation are discussed. Examples of single BAEPs and on-line monitoring of BAEPs in the form of "compressed BAEPs" are shown.

Adolescent↗

An assessment of data quality in the Vermont-Oxford Trials Network database.

The Vermont-Oxford Trials Network is a voluntary collaborative research group of neonatologists that maintains a database for very low birthweight infants (501-1500 g). The database (1) provides core data for randomized trials, (2) serves as a resource for outcomes research in neonatology, and (3) generates quality management reports for participating sites. To assess the reliability of this database and to determine the sources of error, we reviewed 635 medical records chosen at random from among the 4341 eligible infants born at 40 participating data generating sites during an 18-month period beginning January 1, 1990. The estimated frequencies of disagreement between the medical record and database for each of the 10 data items studied and the standard errors of the estimates (in parentheses) were: date of birth 1.3% (0.4), date of admission 2.5% (0.6), date of discharge 8.8% (1.0), birthweight (difference > 50 g) 2.9% (0.6), location of birth (inborn or outborn) 2.1% (0.5), multiple birth 2.2% (0.5), cesarean section 2.5% (0.6), gender 2.1% (0.5), status 28 days after birth 3.4% (0.6), final status 2.9% (0.6). The overall proportions and mean values for items in the database were close to the estimated values based on the random sample of records. There were a total of 247 disagreements between the database and the medical records in the sample. Twenty-three were due to data keying errors. Two hundred twenty-four were due to errors in transcription or interpretation. The rate of data keying errors decreased from over 50 errors per 10,000 fields to less than 15 errors per 10,000 fields when specific quality control procedures, including visual inspection, were instituted. Data keying errors accounted for 13.7% of all disagreements between the database and medical record before improved data entry methods were introduced, and only 3.7% of all errors after they were introduced. We concluded that the Vermont-Oxford Trials Network Database is reliable. Data keying errors have been reduced by the introduction of additional quality control measures. Further reductions in database errors will require measures aimed at minimizing transcription or interpretation errors by individuals completing the data forms.

Computer Communication Networks↗

[The height census of first grade schoolchildren: data quality and cost analysis in two Brazilian municipalities].

The present study describes a first attempt in Brazil to establish a nutrition surveillance system based on the systematic collection of the height of children entering the first grade of primary school. The strategy used recognized the School District as the nuclear institution to operate the system. A quality control system showed that trained people were able to collect anthropometric data with margin of error compatible with the purposes of the system. Costs were low, around 30 cents US per child examined, and they can be further reduced since the system is operated in large scale.

English Abstract↗