This quality assurance project was designed to determine the reliability, completeness and comprehensiveness of the data entered into Niday Perinatal Database.
Quality of the data was measured by comparing data re-abstracted from the patient record to the original data entered into the Niday Perinatal Database. A representative sample of hospitals in Ontario was selected and a random sample of 100 linked mother and newborn charts were audited for each site. A subset of 33 variables (representing 96 data fields) from the Niday dataset was chosen for re-abstraction.
Of the data fields for which Cohen's kappa statistic or intraclass correlation coefficient (ICC) was calculated, 44% showed substantial or almost perfect agreement (beyond chance). However, about 17% showed less than 95% agreement and a kappa or ICC value of less than 60% indicating only slight, fair or moderate agreement (beyond chance).
Recommendations to improve the quality of these data fields are presented.
Access to health care services in Canada has been identified as an urgent priority, and chronic disease has been suggested as the most pressing health concern facing Canadians. Access to services for Canadians living with chronic disease, however, has received little emphasis in the research literature or in health policy reform documents. A systematic review of research into factors impeding or facilitating access to formal health services for people in Canada living with chronic illness is presented. The review includes 31 studies of Canadian populations published between 1990 and 2002; main results were analyzed for facilitators and barriers to access for people experiencing chronic disease. An underlying organizing construct of symmetry between consumers, providers, and the larger Canadian system is suggested as a relevant lens from which to view the findings. Finally, a discussion of the relationship between identified factors and the principles of primary health care is offered.
Research in traumatic brain injury (TBI) is challenging for several reasons; in particular, the heterogeneity between patients regarding causes, pathophysiology, treatment, and outcome. Advances in basic science have failed to translate into successful clinical treatments, and the evidence underpinning guideline recommendations is weak. Because clinical research has been hampered by non-standardised data collection, restricted multidisciplinary collaboration, and the lack of sensitivity of classification and efficacy analyses, multidisciplinary collaborations are now being fostered. Approaches to deal with heterogeneity have been developed by the IMPACT study group. These approaches can increase statistical power in clinical trials by up to 50% and are also relevant to other heterogeneous neurological diseases, such as stroke and subarachnoid haemorrhage. Rather than trying to limit heterogeneity, we might also be able to exploit it by analysing differences in treatment and outcome between countries and centres in comparative effectiveness research. This approach has great potential to advance care in patients with TBI.
Case-control studies of fatal cancers often rely on proxy respondents. Therefore, it is important to determine the completeness and accuracy of proxy-reported information. We evaluated proxy reports using the Ontario Familial Colon Cancer Registry epidemiology questionnaire. A proxy questionnaire was completed by spouses or relatives identified by a sample of participating cases. Item non-response and percentage agreement (between case and proxy reports) were assessed. More than 30% of proxies were unable to report on physical activity, gynecological surgery, alcohol intake, weight 20 years ago, and oral contraceptive use. Proxy reports of medical history and bowel screening varied, the percentage missing ranging from 5% for diabetes to 44% for familial polyposis in the case of medical history, and from 4% for colonoscopy to 27% for hemoccult tests in the case of screening. Agreement between case and proxy report was good to excellent for colonic screening, most medical history, and for reproductive, medication and vitamin use variables (74% to 100%). It is useful to collect proxy information on such variables as medical history, parity, colonic screening and vitamin use, whereas oral contraceptive use and previous weight are not well reported.
There is little agreement on the philosophy of measuring clinical quality in health care. How data should be analyzed and transformed to healthcare information is an ongoing discussion. To accept a difference in quality between health departments as a real difference, one should consider to which extent the selection of patients, random variation, confounding and inconsistency may have influenced results. The aim of this article is to summarize aspects of clinical healthcare data analyses provided from the national clinical quality databases and to show how data may be presented in a way which is understandable to readers without specialised knowledge of statistics.
With the growing reliance on large health care data bases, the need to verify data quality increases as well. Because of the considerable costs involved in checks using primary data collection, a computerized methodology for performing such checks is suggested. The technique seems appropriate for any situation where two data collection systems (i.e. hospital discharge abstracts and physician claims for payment) relate to the same event, such as a patient's hospitalization. After reviewing other approaches, this paper suggests linking physician claims for performing particular surgical procedures with hospital discharge abstracts for the stay in which the surgery took place. Physician and hospital data for adults age 25 and over in Manitoba from 1 April, 1979 to 31 March, 1984 were used to address the questions: 1. How well can the two data sets be linked? 2. Given linkage of the two data sets, how much agreement is there as to procedure and diagnosis? Linkage between hospital and physician data was excellent (over 95%) for 5 out of 11 surgical procedures (hysterectomy, prostatectomy, total hip replacement, coronary artery bypass surgery, and heart valve replacement); there was over 90% perfect agreement for three other procedures (cholecystectomy, cataract surgery and total knee replacement). Problems with matching the Manitoba Health Services Commission tariffs (on physician claims) with ICD-9-CM operation codes (on hospital data) led to only 77% perfect agreement for vascular surgery and 84% for gallbladder and biliary tract operations other than cholecystectomy; over 10% of the cases linked on surgeon and date but not on the designated procedures.(ABSTRACT TRUNCATED AT 250 WORDS)