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PubMed1995

Developing national health information in Australia.

Two significant developments in the past two years have given impetus to development of health information in Australia. In March 1993, the former National Minimum Data Set was revised and published as the National Health Data Dictionary. Second, establishment of an agreement in June 1993, between the Commonwealth and State/Territory government health authorities, the Australian Bureau of Statistics, and the Australian Institute of Health and Welfare initiated a process of working cooperatively to develop national health information. Australia, like many other countries, suffers from inconsistent health data definitions, lack of timely data, poor data quality, gaps in data coverage, and barriers to accessing the data. The National Health Information Agreement [1] came into effect on June 1, 1993 and seeks to provide a national framework and processes to improve national health information, that is, information on health of the population; determinants of the population's health; provision and utilization of health promotion and disease prevention programs and health services including: outcomes and outputs, resource use and costs, access by and distribution to population groups; relationships between these elements; and the language necessary to facilitate provision of services and collection of national health information. The major implementation mechanism of the Agreement is a rolling three-year National Health Information Work Program of national health information activities. The activities range from development work on standard hospital charts of accounts, on health outcome measures, and on new collections such as outpatients to improved definitions and the enhancement of existing collections such as mental health and vital statistics. The Work Program is published annually. A first priority is to improve the data collections available. This is being achieved through the setting of national data definitions and standards. The Agreement recognizes the National Health Data Dictionary (NHDD) as the authoritative set of national definitions and is a significant initiative aimed at improving Australia's health information. The dictionary is the repository of the agreed common language, use of the definitions facilities the description and comparison of health and health services nationally [2]. The National Health Data Dictionary currently covers institutionally provided health care, the national health labor force, and is expanding to cover other major areas, including outpatient services, community care, and mental health. The NHDD is reviewed and maintained by the National Health Data Committee and the overall coordination of definition development projects and publication is undertaken by the Institute. The placement of an agreed definition in the NHDD does not automatically mean that it has a place in a national data collection. The use of the dictionary definition will allow comparison by and between service providers. In order for a data item to be eligible for inclusion in a national minimum data set, the definition of that item must be contained in the NHDD. During the first three months of 1995, the Australian Institute of Health and Welfare will conduct a national project to develop a model for the health system in Australia. The model will provide a common vocabulary and information architecture in order to facilitate better quality health information, and consequently better health for Australians. It is expected that the development of the model will bring several benefits including facilitating the more rapid and accurate assembly of appropriate clinical information to support improved customer service and outcomes, provide a mechanism for achieving better quality information, reduce the costs of data collection; provide enabling mechanisms for the integration of systems via data standards and reduce the costs of acquiring information systems through reduced development and tailoring costs for suppliers. (abst

Australia↗
PubMed2006

A survey of laboratory and statistical issues related to farmworker exposure studies.

Developing internally valid, and perhaps generalizable, farmworker exposure studies is a complex process that involves many statistical and laboratory considerations. Statistics are an integral component of each study beginning with the design stage and continuing to the final data analysis and interpretation. Similarly, data quality plays a significant role in the overall value of the study. Data quality can be derived from several experimental parameters including statistical design of the study and quality of environmental and biological analytical measurements. We discuss statistical and analytic issues that should be addressed in every farmworker study. These issues include study design and sample size determination, analytical methods and quality control and assurance, treatment of missing data or data below the method's limits of detection, and post-hoc analyses of data from multiple studies. Key words: analytical methodology, biomarkers, laboratory, limit of detection, omics, quality control, sample size, statistics.

Agriculture↗
PubMed2005

Chemotherapy, radiotherapy and combined modality for Hodgkin's disease, with emphasis on second cancer risk.

BACKGROUND: Second malignancies (SM) are a major late effect of treatment for Hodgkin's disease (HD). Reliable comparisons of SM risk between alternative treatment strategies are lacking. OBJECTIVES: Radiotherapy (RT), chemotherapy (CT) and combined chemo-radiotherapy (CRT) for newly-diagnosed Hodgkin's disease are compared with respect to SM risk, overall (OS) and progression-free (PFS) survival. Further, involved-field (IF-)RT is compared to extended-field (EF-)RT. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, PubMed, EMBASE, CancerLit, LILACS, relevant conference proceedings, trials lists and publications. SELECTION CRITERIA: RCTs accruing 30+ patients and completing accrual before/during 2000, comparing at least two treatment modalities for newly-diagnosed HD. DATA COLLECTION AND ANALYSIS: Individual patient data were collected and assessed for data quality. Trialists submitted additional information concerning methods and data quality. Peto Odds Ratios (OR) with 95% confidence intervals (CI) were calculated for OS, PFS and SM-free survival. Secondary acute leukemia (AL), non-Hodgkin's lymphoma (NHL) and solid tumours (ST) were also analysed separately. MAIN RESULTS: 37 trials (9312 patients) were analysed: 15 (3343) for RT vs. CRT, 16 (2861) for CT vs. CRT, 3 (415) for RT vs. CT and 10 (3221) for IF-RT vs. EF-RT.CRT was superior to RT in terms of OS (OR=0.76, CI=0.66 to 0.89, p=0.0004), PFS (OR=0.49, CI=0.43 to 0.56, p<0.0001) and SM (OR=0.78. CI=0.62 to 0.98, p=0.03). The superiority of CRT also applied to early and advanced stages (mainly IIIA) separately. Excess SM with RT is due mainly to ST and is apparently caused by greater need for salvage therapy after RT.CRT was superior to CT in terms of PFS (OR=77, CI 0.68 to 0.77, p<0.0001). OS was better with CRT for early stages only (OR=0.62, CI 0.44 to 0.88, p=0.006). SM risk was higher with CRT (OR=1.38, CI 1.00 to 1.89, p=0.05), although not significant for early stages alone. This effect, also seen in AL and ST separately, was due directly to first-line treatment. Data were insufficient to compare RT to CT.EF-RT was superior to IF-RT (each additional to CT in most trials) in terms of PFS (OR=81, CI 0.68 to 0.95, p=0.009) but not OS. No significant difference in SM was observed. AUTHORS' CONCLUSIONS: CRT seems to be optimal for most early stage (I-II) HD patients. For advanced stages (III-IV), CRT better prevents progression/relapse but CT alone seems to cause less SM. RT alone gives a higher overall SM risk than CRT due to increased need for salvage therapy. Reduced SM risk after IF-RT instead of EF-RT could not be demonstrated. Due to the large number of studies excluded because no IPD were received, to the inclusion of many outdated treatments and to the limited amount of long-term data, one must be cautious in applying these results to current therapies.

Antineoplastic Agents↗
PubMed1994

Using pharmacist clinical intervention data for quality improvement of medication use and physician assessment.

BACKGROUND: Patient-specific intervention data are often used for drug usage evaluation (DUE), but their use in physician assessment is less often discussed. In response to the quality assurance department's request, the pharmacy department at the Medical College of Georgia (Augusta) developed a database and a reporting system that supports quality assessment of the medical staff, identifies housestaff education needs, and directs efforts for improvement in medication use. THE REPORTING SYSTEM: In 1991 the comprehensive, concurrent screening of drug therapy by pharmacists formed the foundation of the hospital's DUE program. Each month information from the pharmacy database is sorted with use of a spreadsheet software program to generate medical department-level reports and for use in physician reappointment. Identified performance deficiencies can be used to educate individual prescribers and to develop educational programs for the department or specialty areas. Feedback from the medical staff assessment is useful for pharmacist education, such as identifying newly reported indications and dosage regimens. RESULTS: During the first six months after all pharmacists began participating in the reporting program, a mean of 224 interventions were recorded monthly. For the period January through June 1994, 400-550 interventions were recorded monthly. System improvements in medication during the first year of implementation included hospitalwide guidelines for parenteral potassium and phosphate dosing and administration and a renewed focus on patient allergies. CONCLUSION: Emphasis for use of intervention data has shifted from identifying "problem" persons to improving performance by identifying topics for corrective education and redesigning systems to promote positive patient outcomes.

Adverse Drug Reaction Reporting Systems↗
PubMed1990

Computer-assisted data collection in multicenter epidemiologic research. The Atherosclerosis Risk in Communities Study.

The Atherosclerosis Risk in Communities (ARIC) Study uses a computer-assisted data collection (CADC) system in which staff at four Field Centers directly record into microcomputers much of the data obtained from the 16,000 study participants during 4 hours of interviews and exams. A pilot study was conducted to evaluate the feasibility of training Field Center staff in the use of a CADC system and to assess study participants' reaction to such a system. When asked to compare CADC to a paper-based system, all five of the pilot study staff members preferred the CADC system. The 16 pilot study participants either had no preference (63%) or preferred CADC (37%). With respect to data quality, no systematic differences between the two methods of data collection were evident in the pilot study. The CADC system required approximately 10% longer for data collection, keying, and editing than the paper-based system took for collection alone. Immediate data entry in a CADC system may improve data quality by eliminating a transcription step and by allowing prompt detection of suspicious values while the participant is still available to provide confirmation or correction. CADC simplifies data collection by automating complex branching questions and can enhance data completeness. The ARIC CADC system is based on commercially available software customized by the study's Coordinating Center. The microcomputer-based CADC system described in this report may serve as the prototype for future epidemiologic studies that collect standardized data on large numbers of participants at a small number of sites.

Arteriosclerosis↗
PubMed2005

Calibration and validation of multiple regression models for stormwater quality prediction: data partitioning, effect of dataset size and characteristics.

Two main issues regarding stormwater quality models have been investigated: i) the effect of calibration dataset size and characteristics on calibration and validation results; ii) the optimal split of available data into calibration and validation subsets. Data from 13 catchments have been used for three pollutants: BOD, COD and SS. Three multiple regression models were calibrated and validated. The use of different data sets and different models allows viewing general trends. It was found mainly that multiple regression models are case sensitive to calibration data. Few data used for calibration infers bad predictions despite good calibration results. It was also found that the random split of available data into halves for calibration and validation is not optimal. More data should be allocated to calibration. The proportion of data to be used for validation increases with the number of available data (N) and reaches about 35% for N around 55 measured events.

Calibration↗
PubMed2005

Experimental aspects of asynchronous rapid-scan fourier transform infrared imaging.

In the asynchronous, rapid-scan approach to Fourier transform infrared (FT-IR) imaging, data sampling is not correlated with the zero crossings of the interference fringes of the HeNe reference laser. The success of this data collection scheme depends on the reproducibility of the clock signals driving the interferometer mirror and focal plane array data collection. In previous studies, it was shown that this implementation provides for markedly faster data acquisition without sacrificing data quality, as compared with stepscan imaging. This approach to data collection introduces some unique peculiarities to the acquisition and processing of imaging data. The purpose of this paper is to address a few of these concerns in terms of their effect on final data quality. Also, the practical aspects of implementing such an acquisition scheme are described in detail.

Calibration↗
PubMed2000

[Autopsy in peri- and neonatology--an essential step in quality control. Data on autopsy frequency in Saxony].

In the framework of a general quality assurance compaign the working group for peri- and neonatology at the General Medical Council of Saxony has investigated the frequency, conclusiveness and development of autopsies in Saxony between 1992 and 1997/98. There were observable different autopsy rates depending on the degree of neonate maturity. Thus, the autopsy rate of stillbirths having birth weights from 500 to 999 g amounted to 79.7%, and that of stillbirths above 1000 g birth weight to only 59.4%. The abduction rate of neonates dying before day 7 of life was 65.7%. It is remarkable that the abduction rates declines from 79.1 to 62.9% in all weight classes of premature and full-term neonates from 1992 to 1997. The possible reasons for the decline of autopsies and the problems emerging for quality assurance are discussed.

Autopsy↗
PubMed2005

Interpretation of high-throughput liquid chromatography mass spectrometry data for quality control analysis and analytical method development.

An approach to rapidly process and interpret high-throughput liquid chromatography mass spectrometry data is presented. This approach applies an in-house developed computer application to process LC-MS report files containing spectral and chromatographic data from four different detectors (i.e. electrospray positive ionization, electrospray negative ionization mass spectrometry, UV absorption, and evaporative light scattering detection). Properties characteristic of detection and chromatographic retention are extracted and populated into a database. Approaches to applying this analytical information database for quality control analysis of ca. 400,000 samples are presented. Compound quality assessment methods employing average purity and detection data fields are compared to methods employing multiple quality control criteria (e.g. detection, purity, retention, and signal to noise). Structural similarity searches were applied with the analytical information database to identify compounds that may be undetectable by electrospray mass spectrometry. In addition, an approach to applying the database to aid in the selection of analytical detection and chromatography conditions for rapid analytical method development is also discussed.

Chromatography, Liquid↗
PubMed2005

An integrated platform for automated analysis of protein NMR structures.

Recent developments provide automated analysis of NMR assignments and three-dimensional (3D) structures of proteins. These approaches are generally applicable to proteins ranging from about 50 to 150 amino acids. In this chapter, we summarize progress by the Northeast Structural Genomics Consortium in standardizing the NMR data collection process for protein structure determination and in building an integrated platform for automated protein NMR structure analysis. Our integrated platform includes the following principal steps: (1) standardized NMR data collection, (2) standardized data processing (including spectral referencing and Fourier transformation), (3) automated peak picking and peak list editing, (4) automated analysis of resonance assignments, (5) automated analysis of NOESY data together with 3D structure determination, and (6) methods for protein structure validation. In particular, the software AutoStructure for automated NOESY data analysis is described in this chapter, together with a discussion of practical considerations for its use in high-throughput structure production efforts. The critical area of data quality assessment has evolved significantly over the past few years and involves evaluation of both intermediate and final peak lists, resonance assignments, and structural information derived from the NMR data. Methods for quality control of each of the major automated analysis steps in our platform are also discussed. Despite significant remaining challenges, when good quality data are available, automated analysis of protein NMR assignments and structures with this platform is both fast and reliable.

Data Interpretation, Statistical↗
PubMed2005

A knowledge audit of the managers of primary care organizations: top priority is how to use routinely collected clinical data for quality improvement.

Technology has provided improved access to the rapidly expanding evidence base and to computerized clinical data recorded as part of routine care. A knowledge audit identifies from within this mass of information the knowledge requirements of a professional group or organization, enabling implementation of an appropriately tailored knowledge-management strategy. The objective of the study is to describe perceived knowledge gaps and recommend an appropriate knowledge-management strategy for primary care. The sample comprised 18 senior managers of Primary Care Trusts: the Chairman, Chief Executive Officer, or Research and Development Lead. A series of interviews were recorded verbatim, transcribed and analysed. Knowledge requirements were broad, suggesting that a broadly based knowledge-management strategy is needed in primary care. The biggest gap in current knowledge identified is how to perform needs assessment and quality improvement using aggregated routinely collected, general practice computer data.

Data Collection↗
PubMed1998

[Changes in blood pressure 24 hour monitoring data and quality of life in patients with systolic hypertension treated with arifon].

AIM: The study of quality of life and 24-h monitoring blood pressure data in elderly patients with isolated systolic hypertension (SH) on arifon monotherapy. MATERIALS AND METHODS: 22 patients over 65 (mean age 69.8 +/- 1.3 years) suffering from SH entered the open trial. 24-h monitoring of blood pressure was performed at least 2 weeks after discontinuation of the previous antihypertensive treatment and after 4 weeks of arifon monotherapy (2.5 mg once a day). Quality of life was evaluated according to the standard SIP questionnaire. RESULTS: Arifon 4-week treatment resulted in a significant fall of systolic pressure for 24 hours, day and night (by 16.2, 13.7 and 17.4%, respectively; p < 0.001). Variability of blood pressure did not change much. 24-h index for systolic and diastolic blood pressure increased 2-fold and by 46%, respectively. Moreover, the rate of the systolic pressure growth in the morning hours decreased by 36.7% (p < 0.05). Psychosomatic status by SIP questionnaire changed for the best. CONCLUSION: Arifon is an effective treatment of SH and improves quality of life.

Aged↗
PubMed1999

[Changes in psychophysiologic status during inpatient rehabilitation in the orthopedics service--a preliminary study].

OBJECTIVES: Assessment of non-operative treatment of orthopaedic diseases is sometimes considered difficult. The purpose of this retrospective longitudinal study on the one hand is to evaluate the formal quality of questionnaire data under routine conditions in an in-patient rehabilitation hospital and on the other hand to study the impact of additional psychologic treatment on the outcome of patients who received conservative treatment for chronic orthopaedic diseases. PATIENTS AND METHODS: During a 7-month period, a total of 900 patients received a standardized questionnaire at the beginning and the end of a 4-week inhouse treatment for chronic orthopaedic diseases. A questionnaire handed out to the patients at arrival includes 33 items of psychophysiologic interest. At discharge, a modified questionnaire was used, focussing on the course of complaints during the treatment period, and including additional control-questions for consistency. Return of the questionnaires was voluntary, no pressure was applied, no effort was made to correct inconsistent or missing data. The results presented here are based on 105 orthopaedic patients who returned both questionnaires complete with consistent data. Of these, 44 received additional psychologic treatment by a psychologist, while 61 did not. Participation or non-participation in the psychologic treatment was the grouping variable in this study. RESULTS: For only 189/900 (21%) of the patients taking part in the study complete and consistent questionnaires were available for analysis. For the 105 orthopaedic patients, no significant score differences at arrival between the groups were detected (p = 0.38) using the Mann-Whitney U-test. At discharge, the mean rank sums for the psychological intervention group was 45.7, while it amounted to 58.3 in the control group, indicating significantly stronger improvement of symptoms in the intervention group (p = 0.04). CONCLUSIONS: Under routine conditions without any arrangements to ensure data quality a great amount of incomplete and/or inconsistent data has to be expected. For subsequent studies, this fact has to be taken into account. Irrespective of this aspect, complementary psychologic treatment of certain orthopaedic diseases seems to lead to significantly better results of treatment, as assessed by a psychophysiological questionnaire.

Adult↗
PubMed2001

The nature of collision-induced dissociation processes of doubly protonated peptides: comparative study for the future use of matrix-assisted laser desorption/ionization on a hybrid quadrupole time-of-flight mass spectrometer in proteomics.

Comparative MS/MS studies of singly and doubly charged electrospray ionization (ESI) and matrix-assisted laser desorption/ionization (MALDI) precursor peptide ions are described. The spectra from these experiments have been evaluated with particular emphasis on the data quality for subsequent data processing and protein/amino acid sequence identification. It is shown that, once peptide ions are formed by ESI or MALDI, their charge state, as well as the collision energy, is the main parameter determining the quality of collision-induced dissociation (CID) MS/MS fragmentation spectra of a given peptide. CID-MS/MS spectra of singly charged peptides obtained on a hybrid quadrupole orthogonal time-of-flight mass spectrometer resemble very closely spectra obtained by matrix-assisted laser desorption/ionization post-source decay time-of-flight mass spectrometry (MALDI-PSD-TOFMS). On the other hand, comparison of CID-MS/MS spectra of either singly or doubly charged ion species shows no dependence on whether ions have been formed by ESI or MALDI. This observation confirms that, at the time of precursor ion selection, further mass analysis is effectively decoupled from the desorption/ionization event. Since MALDI ions are predominantly formed as singly charged species and ESI ions as doubly charged, the associated difference in the spectral quality of MS/MS spectra as described here imposes direct consequences on data processing, database searching using ion fragmentation data, and de novo sequencing when ionization techniques are changed.

Animals↗
PubMed2000

[Evaluation of inpatient satisfaction. Comparison of different survey methods].

OBJECTIVES: To assess the impact of patient satisfaction survey method on response rate, data quality and satisfaction. PATIENTS AND METHODS: Four modes of data collection were assessed during a randomized trial that included 400 inpatients discharged from a teaching hospital. RESULTS: The response rate was 58% within the mail survey group (72% with follow-up letter) versus 73% and 81% within the home and telephone interview group (p < 0.01). 69% of the mailed questionnaires contained no missing values versus 94% and 96% for home and telephone interview modes (p < 0.01). The global satisfaction scale score was greater within the mail survey groups (8.1/10 without follow-up letter and 7.9 with follow-up letter) than within the telephone interview group (7.8) and the face to face interview group (7.3), (p < 0.05). CONCLUSION: Mail survey with follow-up letter constitutes an operational method despite lower data quality and overestimation of patients' satisfaction scores.

Adult↗
PubMed2003

Improving nursing home quality of care through outcomes data: the MDS quality indicators.

BACKGROUND: The quality of care provided to nursing home residents is a continuing source of concern throughout the world. In the United States, the Health Care Financing Administration mandated the use of a standardised resident assessment instrument, called the Minimum Data Set (MDS) which facilitated the development of a set of nursing home quality of care indicators. METHODS: The MDS Quality Indicators were developed by a team of researchers at the University of Wisconsin-Madison and covered 12 domains, as well as associated risk factors. This initial set of indicators then went through an iterative process of review by national clinical panels, further empirical analysis, validation studies, and pilot tests, to confirm whether they were accurate, reliable and useful tools for identifying quality problems. RESULTS: The final set of MDS Quality Indicators includes 24 variables that include both processes and outcomes of care and prevalence and incidence measures. They are defined at both the resident and facility level. Four of the indicators are risk-adjusted. CONCLUSION: The indicators have several possible applications: a source of consumer information; to help guide policy makers; and to assist providers in conducting quality improvement initiatives and to evaluate the impact of these efforts.

Humans↗
PubMed1998

The development of a statewide continuous evaluation system for the Texas Children's Mental Health Plan: a total quality management approach.

The article presents a description of processes involved in developing and implementing a statewide continuous evaluation system for the Texas Children's Mental Health Plan (TCMHP) and quality management tools used to approach implementation challenges. Implementation issues are discussed relating to stakeholder involvement, evaluation design evolution, measurement method modification, evaluation integration, staff training, data quality control, communication of results, and use of results in decision making. A review of implementation processes suggests evaluation design and activities should be seen as constantly evolving in response to ongoing stakeholder input. Involving stakeholders in design and implementation can result in increased data quality, data-informed decision making to improve service delivery, and increased public accountability. The TCMHP evaluation system development demonstrates that quality management tools can provide a useful framework to work through design and implementation problems, and a continuous evaluation system can provide an infrastructure for meeting data needs in a managed care environment.

Adolescent↗