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Washington State's Medical Assistance Program personnel conducted a retrospective review of medical records assigned to DRG 468 to determine the reasons for incorrect/improper DRG 468 assignment. The results of their coding validation review provide insight into the origins of lapses in data quality.
Immunoassay test kits are promising technologies for measuring analytes under field conditions. Frequently, these field-test kits report the analyte concentrations as falling in an interval between minimum and maximum values. Many project managers use field-test kits only for screening purposes when characterizing waste sites because the results are presented as semiquantitative intervals. However, field-test kits that report results as intervals can also be used to make project-related decisions in compliance with false-rejection and false-acceptance decision error rates established during a quantitative data quality objective process. Sampling and analysis plans can be developed that rely on field-test kits to meet certain data needs of site remediation projects.
A method for initiating quality assurance in cardiac surgery was developed multicentrically by a commission of the German Society for Thoracic and Cardiovascular Surgery (QUADRA Study). To appraise the quality of cardiosurgical action, variables were compiled from the preoperative, intraoperative, and postoperative treatment course. The data collection was carried out at the same time as treatment. On the basis of unicentric data profiles, multicentric hospital profiles, and problem profiles, a quality comparison could be carried out and the variability of cardiosurgical action which may occasion interventions could be identified. A reduction of perioperative blood consumption during the study period could be observed in four out of five hospitals as the first result. The data collection also revealed epidemiological features. On average, women were older than men at the time of the heart-valve and coronary operations. To ensure data validity and the organization of quality assurance, a documentation assistant and a specially trained physician are necessary at every cardiovascular surgery center. The multicentric external comparison is indispensable and must be carried out by means of a central data collection, for which intrumental and staff capacities are also to be provided. With modern methods of data processing, an additional and new approach to the improvement of quality in cardiac surgery can thus be made.
BACKGROUND AND OBJECTIVES: Health status measures, used to measure the subjective functioning and well-being of respondents, are increasingly being used in trials of treatments that are undertaken in a variety of countries. To assess comparability of results gained from such cross-cultural studies, it is important for researchers to know the comparability of instruments across cultures. One measure widely used in cross-cultural studies is the Parkinson's Disease Questionnaire (PDQ-39). We evaluated response rate, data quality, score reliability, and scaling assumptions of the instrument in the United States, Canada, Spain, Italy, and Japan. METHODS: Our data were gained from the Global Parkinson's Disease Survey, a cross-national survey, in which the PDQ-39 was interviewer administered to respondents. RESULTS: Our data suggest that the PDQ-39 is, for the most part, a valid and reliable measure that can be appropriately and meaningfully used in cross-cultural studies. However, one of the dimensions of the measure, Social Support, may not be sufficiently reliable to be used as a primary endpoint in trials. CONCLUSION: The PDQ-39 seems to be sufficiently robust to be used in trials and surveys in cross-cultural studies.
A rapidly increasing number of health care provider institutions is dealing with data architecture design issues that directly affect the quality of data within their heterogeneous information systems. These problems result from a failure to recognize that they are actually managing a loosely distributed yet integrated database among their many information system platforms. Understanding the issues surrounding data integration, the application available interface standards, and the tools available for implementation is critical to operating a successful distributed health care information systems environment today.
The correlation between genomic G+C content and optimal growth temperature in prokaryotes has gained renewed interest after Musto et al. [H. Musto, H. Naya, A. Zavala, H. Romero, F. Alvarex-Valin, G. Bernardi, Correlations between genomic GC levels and optimal growth temperatures in prokaryotes, FEBS Lett. 573 (2004) 73-77], reported that positive correlations exist in 15 families studied. We have reanalyzed their data and found that when genome size and data quality were adjusted for, there was no significant evidence of relationship between optimal temperature and GC content for two of the families that had previously shown strongly significant correlations. Using updated temperature optima for Halobacteriaceae species we found the correlation is insignificant in this family. For the family Enterobacteriaceae when genome size and optimal temperature are included in a multiple linear regression, only genome size is significant as a predictor of GC content. We showed that more profound statistical methods than simple two factor correlation analysis should be used for analyzing complex intrinsic and extrinsic factors that affect genomic GC content. We further found that a positive correlation between temperature and genomic GC is only evident in free-living species of low optimal growth temperatures.
This final rule with comment period revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system, and to implement certain related provisions of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 and the Deficit Reduction Act (DRA) of 2005. In this final rule with comment period, we describe changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2007. In addition, this final rule with comment period implements future CY 2009 required reporting on quality measures for hospital outpatient services paid under the prospective payment system. This final rule with comment period revises the current list of procedures that are covered when furnished in a Medicare-approved ambulatory surgical center (ASC), which are applicable to services furnished on or after January 1, 2007. This final rule with comment period revises the emergency medical screening requirements for critical access hospitals (CAHs). This final rule with comment period supports implementation of a restructuring of the contracting entities responsibilities and functions that support the adjudication of Medicare fee-for-service (FFS) claims. This restructuring is directed by section 1874A of the Act, as added by section 911 of the MMA. The prior separate Medicare intermediary and Medicare carrier contracting authorities under Title XVIII of the Act have been replaced with the Medicare Administrative Contractor (MAC) authority. This final rule continues to implement the requirements of the DRA that require that we expand the "starter set" of 10 quality measures that we used in FY 2005 and FY 2006 for the hospital inpatient prospective payment system (IPPS) Reporting Hospital Quality Data for the Annual Payment Update (RHQDAPU) program. We began to adopt expanded measures effective for payments beginning in FY 2007. In this rule, we are finalizing additional quality measures for the expanded set of measures for FY 2008 payment purposes. These measures include the HCAHPS survey, as well as Surgical Care Improvement Project (SCIP, formerly Surgical Infection Prevention (SIP)), and Mortality quality measures.
Nerve cell signals are different in form from the stimuli that evoke them and they exhibit complex spatio-temporal characteristics. This defines a neural coding problem which is addressed by two current theories: Multiple Meaning Theory holds that neural signals contain patterns that make statements about combinations of stimulus properties; the Task Dependence Hypothesis suggests that different features of identical neural signals mediate performance in different behavioral tasks. These coding issues were addressed by investigating the representation of sensory information in the distal nervous system after transduction of visual stimuli into bio-electric signals. The objects of study were light-evoked neural responses which had been intracellularly recorded from single retinula (photoreceptor) cells in Limulus lateral eyes. The efficacies with which sensory information was represented by various candidate neural codes were calculated using receiver operating characteristic (ROC) analyses to provide objective indices. The specific visual problem under investigation was discrimination between light flashes whose intensities differed by a very small amount. A wide range of light adaptation states and relative stimulus intensities were explored. Extremely stringent data quality standards were applied which restricted the investigation to cells whose potentials did not exhibit any statistically significant drift during the hours required for data collection. Seven cellular characterizations were simultaneously monitored to detect drift in a given cell's potentials; these characterizations included the value of the membrane potential and the values of six candidate codes. These codes were: the area under the light-evoked receptor potential (RP), the mean value of the RP, the peak height of the RP, the slope of the onset of the RP, the duration required for the RP to drop from its peak by a given amount, and the duration required for the RP to end. The results were: (1) Light adaptation increases efficacy. (2) Thus, light adaptation trades sensitivity for acuity (as characterized by ROC discriminations). (3) Increasing relative light flash intensity also increases efficacy. (4) The efficacies of the various codes are significantly different and fall in the following order: area > or = peak = mean > or = duration-end = slope = duration-drop. These findings further demonstrate that arbitrary characterizations of stimulus-response relationships are very likely to be incomplete. They particularly indicate that many commonly used and quite conventional neural analysis strategies may substantially under-estimate system performance.
This paper discusses methodology in developing exposure data for the water supply contaminant dibromochloropropane (DBCP) in Fresno County, California. There are 532 drinking water systems (49 large and 483 small) within Fresno County plus 14,000 private wells. We determined the number of wells per system, the output per well, and the population served by each system. The task of deriving water quality estimates for each census tract was complicated by the fact that a single census tract can be served by more than one system; each system usually has more than one well; and a single well can have several episodes of testing for various contaminants. We calculated a series of weighted averages for concentrations of DBCP, arsenic, and nitrates for each census tract, using water production figures for each well as the weighting factor. Water quality data were derived from a total of 14,861 laboratory reports, although the majority did not report on all contaminants. Mean DBCP levels ranged from 0.0041 ppb to 5.7543 ppb among the census tracts. We found no correlation between DBCP levels per census tract compared to either arsenic or nitrates. We believe that we made as complete an exposure assessment as practically feasible.
The application of genome-wide linkage scans to uncover susceptibility loci for complex diseases offers great promise for the risk assessment, treatment, and understanding of these diseases. However, for most published studies, linkage signals are typically modest and vary considerably from one study to another. The multicenter Family Blood Pressure Program has analyzed genome-wide linkage scans of over 12 000 individuals. Based on this experience, we developed a protocol for large linkage studies that reduces two sources of data error: pedigree structure and marker genotyping errors. We then used the linkage signals, before and after data cleaning, to illustrate the impact of missing and erroneous data. A comprehensive error-checking protocol is an important part of complex disease linkage studies and enhances gene mapping. The lack of significant and reproducible linkage findings across studies is, in part, due to data quality.
Time-resolved crystallography is a powerful technique that allows structural transitions to be followed in real time during the course of a chemical reaction. The extension of the time resolution of this technique to nanosecond and picosecond time scales require a short laser pulse to initiate the transition and a rapid polychromatic X-ray pulse to probe the structural perturbations. Unfortunately, polychromatic diffraction patterns are quite sensitive to subtle crystal movements that can occur from laser pulses used to trigger the structural transition. The immobilization of crystals within capillary tubes dramatically improves data quality and allows the utilization of more intense laser pulses for the initiation step. This leads to an increase in the signal to noise present in the electron density maps.
Gene expression studies using cDNA arrays require robust and sensitive detection methods. Being extremely sensitive, radioactive detection suffers from the influence of signals positioned in each other's vicinity, the 'neighbourhood' effect. This limits the gene density of arrays and the quality of the results obtained. We have investigated the quantitative influence of different parameters on the 'neighbourhood' effect. By using a model experimental system, we could show that the effect is linear and depends only on the intensity of the hybridisation signal. We identified a common factor that can describe the influence of the neighbour spots based on their intensities. This factor is <1%, but it has to be taken into account if a high dynamic range of gene expression is to be detected. We could also derive the factor, although with less precision, from comparison of duplicate spots on arrays of 4565 different clones and replication of the hybridisation experiments. The calculated coefficient applied to our actual experimental results not only revealed previously undetected tissue or cell-specific expression differences, but also increased the dynamic range of detection. It thus provides a relatively simple way of improving DNA array data quality with few experimental modifications.
Clinical decision support system (CDSS) performance may vary with the quality of the input data. We assessed the impact of medical record completeness and accuracy on a CDSS that provides risk assessment for gastrointestinal bleeding and recommends therapy when prescribing NSAIDs. We examined the documentation of six data elements in the medical record and the impact on the performance of the CDSS. We reviewed 178 transcribed clinical encounters from standardized patients with predefined clinical histories. Results showed that the mean completeness score across all encounters was .34. The mean correctness score for those elements present was .94. When the available data was input into the CDSS, the missing data elements resulted in inappropriate and unsafe recommendations in almost 77% of the encounters. The results show that important gaps in the medical record can affect the accuracy of a CDSS designed to improve safe prescribing.
BACKGROUND: The use of quality of life (QoL) questionnaires in clinical medicine must be based on instruments that are reliable and valid. The aim of this study was to describe the translation of the Inflammatory Bowel Disease Questionnaire (IBDQ) into Norwegian, its scaling assumptions and the psychometric properties of the translated questionnaire. METHOD: All patients included were recruited from an ongoing epidemiological study started in 1990 (the IBSEN trial), based on the registration of undiagnosed cases of Crohn disease (CD) or ulcerative colitis (UC) in subjects permanently residing in the study area the year before registration. At the 5-year follow-up visit in the hospital, all patients between 18 and 75 years of age were invited to participate in this QoL study, and those willing were interviewed and asked to complete the two QoL questionnaires, IBDQ and SF-36, on two different occasions separated by 6 months. The IBDQ was tested for validity, reliability and responsiveness. RESULTS: In total, 497 patients (93%) completed the IBDQ questionnaire at visit 1, and 493 (92%) completed SF-36. The mean age was 43.3 years, 48% were female. We found that the Norwegian version of the IBDQ (N-IBDQ) consists of five underlying dimensions in contrast to the four dimensions previously reported. Psychometric testing of the N-IBDQ indicates that the questionnaire is valid, reliable, has a high degree of responsiveness and that the results are comparable to those reported from other groups, even though our findings are based on a different factorial structure than the original McMaster version. CONCLUSION: The N-IBDQ consists of five different dimensions in contrast to the four dimensions previously reported. Good item internal consistency, validity, reliability and responsiveness were demonstrated.
INTRODUCTION: The paper and electronic medical record (EMR) have evolved with little scientific inquiry into what effect the informant (clinician or patient) has on the validity of the recorded information. We have previously reported on an electronic interview program that facilitated parents' direct reporting of past medical history data. We sought to define additional data elements that parents could report electronically and to compare parents' electronically entered data to that charted by physicians using the current EMR system. METHODS: A convenience sample of parents was recruited to enter data on history of present illness (HPI) and review of systems (ROS) elements using an electronic interview. Data from the electronic parental interview and information abstracted from the physician EMR were compared to data derived from a face-to-face criterion standard interview. Validity, sensitivity and specificity of each mode of data entry were calculated. RESULTS: 100 of 140 eligible parents (71.4%) participated. Validity of information from the electronic interview was comparable to that charted by emergency physicians for HPI regarding fever and ROS questions. Sensitivity of parents' electronic interview was superior to physicians' charting for ROS elements specific to hydration status. CONCLUSIONS: Improved sensitivity for detection of historical risk factors for illness can be achieved by augmenting the pediatric EMR with a section for direct parental direct data input. Direct parental data input to the EMR should be considered to improve the quality of documentation for medical histories.
Waterwatch is a national community-based monitoring network that aims to involve community groups and individuals in the protection and management of waterways. Waterwatch Victoria has the dual objectives of catchment education and water quality monitoring. The educational outcomes are evident, with the Waterwatch programme facilitating over 9,000 students to monitor more than 2,000 sites in waterways in 2000. This paper aims to assess the scientific value of community-collected data, through examining differences between Waterwatch data and professionally collected data. The study looked at all aspects of volunteer data collection, including data confidence protocols, equipment, and data analysis. All professional data was collated by the Victorian Water Quality Monitoring Network (VWQMN). The parameters examined in this study were turbidity, electrical conductivity (EC), pH and total phosphorus. The level of agreement between community-collected data and professional data varied temporally and spatially. Waterwatch data for EC and pH appeared to be very similar to professionally collected data. Equipment used by Waterwatch volunteers for turbidity and total phosphorus appeared to be limited in accuracy to moderate ranges. Overall the VWQMN professionally collected data showed less variance, suggesting greater variability, potentially due to inaccuracies, in volunteer collected data
Simulation models must be tested against measurements before their predictions can be viewed as reliable. However, having data to test all pathways in a model is rare, and finding data that were collected for the purpose of model testing is even rarer. Thus modelers must take every opportunity to test portions of their models with data obtained under less than ideal circumstances. With careful preparation of the data and a thorough understanding of the data requirements of the model, the success of the test can be assured. Monitoring data collected after the Chernobyl reactor accident were used for model testing in two international studies, the Biospheric Model Validation Study and the Validation of Environmental Model Predictions. Based on these experiences, this paper describes the data requirements of validation, the validation of models with less than ideal data, the value of good data, the role of modeling in improving the quality of data and, most importantly, ways to improve collection and preparation of data to assist further validation. Although the examples are specific to radiological assessment models, the principles of data collection and preparation herein may be applied to testing all simulation models.
OBJECTIVE: To assess patient recruitment and quality of data in a randomized database study. STUDY DESIGN AND SETTING: A randomized database study was conducted in the Integrated Primary Care Information (IPCI) general practice research database. Software was built to allow for automated patient identification and recruitment, and randomization. As an application, we compared gastrointestinal tolerability in persons treated with diclofenac and celecoxib for osteoarthritis. The outcomes were assessed in the IPCI database. To assess accuracy of exposure and outcome, we also collected information by self-administrated patient questionnaires. For all eligible subjects, we assessed the main reason for noninclusion. Physicians were interviewed to evaluate the study and to identify the major obstacles. RESULTS: Forty-two general practice physicians collaborated with the study and 7,127 potential study subjects were identified. Among these subjects, 170 were eligible for recruitment and 20 (11.8%) were randomized. Of the eligible patients, 96 (56.5%) were not recruited because the physician was too busy or the patient was treated by another healthcare provider and 54 (31.8%) were not recruited because of exclusion criteria. CONCLUSION: Concordance between questionnaires and IPCI data and the outcome was good (kappa=0.7; SD=0.14). The physicians reported that recruitment during routine visits was too time-consuming, in particular because of the need for informed consent. Although a randomized database study is feasible, patient recruitment during routine consultations should be avoided.