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PubMedDate not supplied

Do HMOs make a difference? Data and methods.

This paper describes the common data source and methods used in this study. Data come from the Community Tracking Study Household Survey, a nationally representative survey of individuals conducted in 1996-1997. Focusing on the privately insured, nonelderly population, the study examines the effect of health maintenance organizations (HMOs) on access, service use, and consumer assessments, as well as how these effects differ across population subgroups. Multivariate models control for population characteristics and location differences between HMO and non-HMO enrollees. Tests for endogeneity of plan type (selection bias) indicated that this did not pose a threat to the analysis.

Adolescent↗

PubMed1993

The UPA score and teenage pregnancy.

Teenage motherhood is often said to be the result of deficient contraceptive and abortion services. Using data from the Public Health Common Data Set (PH CDS) we demonstrate two important effects in a Regional Health Authority: higher rates of conception are related to a live birth rather than an abortion pregnancy outcome; District Health Authorities (DHAs) with high underprivileged area scores (UPA) are more likely to have high rates of conception in the teenage years than those districts with low scores.

Abortion, Induced↗

PubMed1999

Is it better to leave or restore carious deciduous molar teeth? A preliminary study.

INTRODUCTION: The objective of this study was to compare the extraction and exfoliation experience of filled and unfilled carious deciduous molar teeth. METHOD: The study was carried out in 1997 in four general dental practices in south Cheshire, UK and involved a longitudinal retrospective review of case notes. A quota sample of 20 case notes of children from each practice was selected according to strict criteria. Subjects had to: Have had experience of approximal caries in one or more of the deciduous molar teeth. Have a date of birth between 1st January 1984 and 31st December 1985. Be a regular attender and in continuous contact with the practice. Data were collected on a common data abstraction form. Variables measured included: Base-line dmft. Site and number of filled teeth. Site and number of unfilled carious teeth. Number of courses of antibiotics. Site and number of pulp therapies. Site, number, method (local or general anaesthetic) of extractions. Reasons for extraction. All teeth not recorded as being extracted were assumed to have exfoliated. In addition, information was collected on the dentists' treatment philosophies. A series of group discussions revealed that the four dentists fitted into two groups according to treatment philosophies; two dentists shared a philosophy of minimal intervention, the other two shared the same views of treating more radically. RESULTS: There was no significant difference between the proportion of filled teeth and the proportion of carious unfilled teeth that were extracted (chi-square 0.05 P = 0.83). A logistic regression showed that for each course of antibiotics administered the odds of having an extraction was multiplied by 5.5 and children who were patients of the interventionist dentists were five times more likely to have an extraction than patients of non-interventionist dentists. CONCLUSION: Although the study was preliminary in nature no clear benefit could be found in filling deciduous molar teeth against leaving carious teeth unfilled, if avoidance of extraction was the desired outcome. The treatment philosophy of dentists was a major factor in determining extraction or exfoliation outcomes. This issue is complex with many interacting factors to be accounted for and will require multiple well-designed studies to provide an answer.

Anti-Bacterial Agents↗

PubMed1996

The use of administrative data as the first step in the continuous quality improvement process.

Billing or claims data, commonly referred to as administrative data, can be a valuable tool as the first step in a continuous quality improvement process. It is an inexpensive source of information which allows providers to identify opportunities for improvement in the process and the outcomes of health care delivery. The All Patient Refined/Diagnosis-Related Group case mix or severity-adjusted data represents one tool. The Practice Review System of Value Health Sciences is another. Comparative information is the first step, and the first step only in the quality improvement process. As such, to meet the needs of all continuous quality improvement customers, it is necessary to make this first step as reliable, yet inexpensive, as possible. Completing all the steps requires the use of a several measures over time.

Comorbidity↗

PubMed2002

Collaboration by use of the Internet yields data of high quality and detects non-uniform management of patients with Helicobacter pylori infection.

BACKGROUND: The benefits of new technology steadily being introduced in medicine should be documented. In this study, remote entry of a set of data from the daily routine was submitted via the Internet to a common database. The usefulness and quality of the information are evaluated. METHODS: Fourteen hospitals reported a common data set on consecutive Hp+ve patients handled in accordance with daily practice. Participants submitted their data via the Internet to a database. There was no monitoring or other surveillance. No audit was planned or expected, but was nevertheless possible. Doctor compliance with the common agreement was checked, differences in medical practice were noted and quality was assessed comparing the most important source data with the data in the final database. RESULTS: Four-hundred-and-forty patients were included. The quality of the reported data was high, only 1.3% showing a discrepancy between source data and the database. Overall treatment success was 89%, with no significant differences between hospitals. There were significant differences in clinical practice between the centres, the proportion of patients treated for ulcer disease varying from 36% to 96% (P < 0.001). Doctor compliance with the agreed collaboration varied significantly (P < 0.001). CONCLUSION: Internet collaboration through remote data entry in a common database yields data of high quality without monitoring, and is a powerful and resource economic tool for clinical multicentre trials and quality assurance.

Clinical Trials as Topic↗

PubMed1995

Telemedicine system evaluation and a collaborative model for multi-centered research.

Evaluating telemedicine systems and services is a complex task. Safety and efficacy must be measured in a relatively controlled laboratory environment, while measurement of clinical utility and medical effectiveness requires extensive field testing. The need for large clinical trials to demonstrate utility and effectiveness presents a dilemma. Substantial numbers of cases are needed to achieve statistically valid results, yet most telemedicine programs are based in rural settings with small patient populations. One potential solution is to pool data from multiple programs by using common data collection instruments and protocols. A promising model for the performance of multi-centered collaborative telemedicine research is described. The Clinical Telemedicine Cooperative Group (CTCG) is based on the successful use of collaborative research by clinical oncology research groups such as the Southwest Oncology Group (SWOG).

Cost-Benefit Analysis↗

PubMed2001

Estimating log models: to transform or not to transform?

Health economists often use log models to deal with skewed outcomes, such as health utilization or health expenditures. The literature provides a number of alternative estimation approaches for log models, including ordinary least-squares on ln(y) and generalized linear models. This study examines how well the alternative estimators behave econometrically in terms of bias and precision when the data are skewed or have other common data problems (heteroscedasticity, heavy tails, etc.). No single alternative is best under all conditions examined. The paper provides a straightforward algorithm for choosing among the alternative estimators. Even if the estimators considered are consistent, there can be major losses in precision from selecting a less appropriate estimator.

Delivery of Health Care, Integrated↗

PubMed2003

Multipoint and single point non-parametric linkage analysis with imperfect data.

We used simulation to explore the impact of common data imperfections (i.e., missing parents, genotyping error, map error, and missing genotypes) upon the performance of multipoint and single point linkage analysis in the analyses of linkage data from pairs of siblings affected with an idealized complex trait. The performance of single point and multipoint linkage was similar under an unrealistic best case scenario; however, when four data imperfections were combined, the performance of single point linkage analysis appeared to be superior to multipoint. The absence of parental genotypes in the presence of 1% genotype error led to marked degradation of linkage signal, particularly for multipoint analyses.

Computer Simulation↗

PubMed2001

Osmotic perturbations induce differential movements in the core and periphery of proteins, membranes and micelles.

Polymeric structures, namely, micelles, membranes and globular proteins share the property of two distinct regions: a hydrophobic core and a hydrophilic exterior. The dynamics of these regions of the polymeric structures were probed using selective fluorophores 1,6-diphenyl-1,3,5-hexatriene (DPH) and 1-anilinonaphthalene-8-sulfonate (ANS), respectively. Perturbation of the polymers by external osmotic pressure, ionic strength and temperature was monitored in the two regions using steady state measurements of fluorescence intensity and anisotropy. While the fluorescence lifetime of DPH and ANS did not change significantly, parallel change in steady state anisotropy values and the rotational correlation time indicated mobility in the probe/probe-domain. Osmotic perturbation of the polymers in electrolyte media led to decreased DPH mobility. Enhanced ellipticity at 222 nm in bovine serum albumin was observed in 1.5 M NaCl and sucrose media. ANS exhibited a decreased anisotropy with progressive dehydration in proteins in NaCl media, in dimyristoylphosphatidylcholine (DMPC) vesicles in sucrose media, and in neutral laurylmaltoside micelles in both NaCl and sucrose media. Thus, ANS showed responses opposite to that of DPH in these systems. A comparison with several domain selective probes indicated that DPH reported findings common to depth probes while ANS reported data common to interfacial probes used for voltage monitoring.

Anilino Naphthalenesulfonates↗

PubMed2001

[Quality assurance of data collection and data processing in epidemiologic study data].

Quality assurance of the data generating processes in epidemiologic studies is a prerequisite for the internal validity of study results. This paper presents practical aspects of such a quality assurance system pertaining to the planning, data gathering, data entry and data processing phase of a study. It is concerned with data obtained in the framework of a project rather than with data accumulating continuously in private practices, research institutes or veterinary faculties. During the planning phase of a project, standard operating protocols should be developed that assure a reliable performance of observation, coding and data entry. The data base structure, consisting of tables, input validation rules and queries, should be predefined and well documented. A data safety concept will provide the necessary integrity, physical safety and availability of the data. The paper presents technical solutions to common data processing problems with emphasis on re-coding and relational data base facilities (Microsoft-ACCESS) using a hypothetical study on risk factors for mastitis.

Animals↗

PubMed1977

Accelerographic, temporal, and distance gait factors in below-knee amputees.

Gait characteristics of 19 patients with a unilateral below-knee amputation were studied. The accelerographic and foot placement method used in this study allowed for simultaneous acquisition of data commonly obtained in the experimental laboratory (acceleration) and data easily gathered in the physical therapy clinic (temporal and distance factors). The following results may be of interest to the clinician: 1) measures of cadence, stride length, and velocity were highly related and the magnitude of these measures was below commonly accepted values for normal; 2) the below-knee amputees spent more time in stance phase on their uninvolved lower extremity than on their involved (prosthetic) extemity; 3) the step length from heel strike of the uninvolved lower extremity to heel strike of the involved (prosthetic) lower extremity was greater and accomplished in less time than the opposite step; and 4) smoothness of the gait pattern and any single temporal and distance factor exhibited low statistical relationships.

Acceleration↗

PubMed1999

The effects of socioeconomic status and dental attendance on dental caries' experience, and treatment patterns in 5-year-old children.

OBJECTIVE: To compare the dental caries' experience and treatment received by 5-year-old children registered with a GDP. DESIGN: Retrospective case note review of all 5-year-old children registered with seven GDPs. SETTING: The study was carried out in 1996/7 in Wirral and North Cheshire in the north west of England. SUBJECTS AND MATERIALS: Clinical, demographic and attendance data were collected from each practice using a common data abstraction form. Subjects were categorised according to regular/irregular attenders, and into five groups ranging from affluent to deprived using the Super Profiles geodemographic classification. The relationships between disease experience, treatment, attendance and socioeconomic status were compared using cross-tabulations, t-tests and multiple linear regression. RESULTS: The dental records of 430 5-year-old children were available for analysis. Irregular attenders had significantly higher dmft, dt and mt, and fewer filled teeth. Only 29% of disease experience of regular attenders was treated by restoration. Both socioeconomic status and visiting behaviour exerted significant independent effects on dmft, but dental attendance alone had a significant effect on ft. CONCLUSIONS: Significant inequalities remain in the disease experience and service use of young children. Regularly attending children have less than a third of their diseased teeth restored. Consensus is needed across the profession on the care of the diseased deciduous dentition.

Child, Preschool↗

PubMed2000

Benchmarking medical group practices using claims data: methodological and practical problems.

As claims data for physicians and groups of physicians has improved in quality and quantity, health information vendors have begun marketing information about medical groups' productivity, utilization, and quality. Based on interviews with product developers and our understanding of the evolution of their products, several methodological and practical issues remain. For now and the immediate future, health information vendors will continue to face the limitations of physicians' claims data. Vendors and purchasers should be aware of common data shortcomings such as inadequate monthly enrollment figures, possible physician upcoding to circumvent utilization management restrictions, and incorrect coding when a test is used to rule out a disease. In the longer term, several avenues seem likely to make medical groups' data better and richer because of computer-based medical records and efficiencies possible from the Internet. The field of benchmarking products for group practices is still an immature market. However, several trends suggest such products are highly desirable. Provider organizations which bear medical risk need benchmarking data to help improve their efficiency. There are many important nonprovider organizations that need good information on group practices' utilization patterns and outcomes to help them plan new products and negotiate with physicians.

Benchmarking↗

PubMed1997

[Target population for hypertensive therapy].

The efficacy of treatment may be demonstrated globally but, in some patients, treatment can be either inappropriate or harmful because of undesirable secondary effects. Ideally, treatment should be limited to patients who respond, but this is impossible with the published data from clinical trials. This could become possible by creating a data base containing all published results and carrying out meta analyses on individual parameters. Using the most powerful methods of analysis this could allow identification of patients responding to treatment by taking into account not only the benefits but also the risks of a given treatment (the principle is to identify and estimate factors--demographical, sociological, generic, which interfere with the size of the effect). In order to identify responders to antihypertensive treatment, a meta analysis of individual data was started, the INDANA project. With a common data base of all the preventive trials of antihypertensive therapy, this study should contribute to improved identification of responders and therefore to individualization of treatment of hypertension.

Antihypertensive Agents↗

PubMed1992

Clinical semiology of common cervicobrachial neuralgia. Data from 50 hospital cases.

Common cervicobrachial neuralgia is less frequent than sciatica and its aetiological profile is more varied: men and women are equally affected, triggering factors or previous history are less often found and patients with anxiety or depression are relatively numerous. Clinically, signs of C7 lesion are present in half the patients. Acroparesthesias are frequent and may be the initial signs. Nocturnal pain is present in 50% of the cases. Signs of neurological deficit are rare, except for abolition of a reflex. The association of cervicobrachial neuralgia with tendinitis of the upper limb or algodystrophy of the shoulder is too frequent to be fortuitous. Left to itself, the syndrome usually lasts several months and sometimes one year. Recurrences are rare. The most frequent sequela is a painful neck.

Brachial Plexus Neuritis↗

PubMed1998

Zopiclone. An update of its pharmacology, clinical efficacy and tolerability in the treatment of insomnia.

Zopiclone is a non-benzodiazepine hypnotic which was first reviewed in Drugs in 1986. At that time, zopiclone had shown hypnotic efficacy superior to that of placebo, but had not been extensively compared with benzodiazepine hypnotics in patients with insomnia. A much larger body of clinical data is now available, allowing a more detailed evaluation than was previously possible. Together with results from earlier studies, subsequent clinical trials have shown that zopiclone is generally at least as effective as the benzodiazepines (regardless of duration of action) in the treatment of insomnia, although comparisons between zopiclone and flurazepam have produced inconsistent results. Tolerance to the effects of zopiclone was not seen in short term clinical trials (< or = 4 weeks); data from longer term studies are conflicting and the potential for tolerance during long term zopiclone treatment is therefore unclear. Zopiclone has a relatively low propensity to cause residual clinical effects (such as difficulty in waking or reduced morning concentration). Rebound of insomnia to a level below that at baseline can occur after withdrawal of zopiclone, but, on the basis of data from short term studies, does not appear to be common. Data from prescription-event monitoring suggest that zopiclone does not have a high dependence potential (at least in those who are not regular drug abusers/addicts). Zopiclone is well tolerated in both the elderly and younger patients with insomnia. A bitter aftertaste is usually the most common adverse event, but is relatively infrequent (3.6% in the largest available postmarketing study). Thus, zopiclone is now firmly established as an effective and well tolerated hypnotic agent. Although the available data on rebound insomnia and dependence liability are encouraging, potential differences between zopiclone and the benzodiazepines in these respects may have little clinical relevance in the context of short term intermittent use of hypnotics, as it currently recommended. A low propensity for rebound insomnia and dependence might prove valuable during long term hypnotic therapy (which, although not recommended, is a clinical reality). However, the risk-benefit profile of zopiclone in this context remains unknown. Nevertheless, zopiclone is clearly a suitable alternative to the benzodiazepines for the short term treatment of insomnia.

Azabicyclo Compounds↗

PubMed1999

The European Childhood Obesity Group (ECOG) project: the European collaborative study on the prevalence of obesity in children.

During the European Congress on Obesity held in Barcelona in 1996, the European Childhood Obesity Group (ECOG) proposed a study designed to estimate the prevalence of obesity by country. An overview of existing systems revealed that most countries have no suitable structure in place for the determination of obesity in children and that the most practical sources of samples would be the school systems. A protocol was drawn up for these countries, whereas for those countries already collecting data, guidelines were defined to clarify the criteria allowing inclusion in the common analysis. The target population is 7-9-y-old children. The study design consists of separate cross-sectional population studies by country with a cluster probability sample of 2000 children attending primary school. The minimum common data will be age, weight, height, and hip, thigh, and waist circumferences. The participating countries will be encouraged to collect harmonized data on social indicators, lifestyle, diet, physical activity, and anthropometric measures of the parents. Children will be measured either by centrally based traveling examiners or, in countries with limited resources, by local staff. Each country will computerize its own data and send a copy to a center responsible for the common analysis. The main analysis will be of body mass index distribution in children from the different populations and determination of the proportion of children with a BMI above the 90th percentile of a common reference population. Members of the ECOG in 14 European countries have confirmed their interest in the project.

Journal Article↗

PubMedDate not supplied

Assessing the quality of project data by means of a data sufficiency categorization scheme.

Improving the quality of gathered or abstracted data is often an important part of a quality improvement project's early stages. This is especially so if indicators will be compared across providers or if various data elements will be used for severity adjustment. One common data problem is missing data. This paper describes a flowchart-based approach for assessing the magnitude of missing data problems. The approach is demonstrated by means of two indicators currently used in multihospital cooperative improvement projects. The approach results in assigning each observation (e.g., patient record) in a sample into one of five data categories. These categories follow standard definitions advanced by the Joint Commission on Accreditation of Healthcare Organizations. Two of the categories tally observations with missing data problems. Assessment of missing data can be viewed as one component of reliability assessment, and its relationship to other forms of reliability assessment is discussed, with emphasis on the relationship to interrater agreement.

Abstracting and Indexing↗