Data linkage errors in hospital administrative data when applying a pseudonymisation algorithm to paediatric intensive care records.

OBJECTIVES: Our aim was to estimate the rate of data linkage error in Hospital Episode Statistics (HES) by testing the HESID pseudoanonymisation algorithm against a reference standard, in a national registry of paediatric intensive care records. SETTING: The Paediatric Intensive Care Audit Network (PICANet) database, covering 33 paediatric intensive care units in England, Scotland and Wales. PARTICIPANTS: Data from infants and young people aged 0-19 years admitted between 1 January 2004 and 21 February 2014. PRIMARY AND SECONDARY OUTCOME MEASURES: PICANet admission records were classified as matches (records belonging to the same patient who had been readmitted) or non-matches (records belonging to different patients) after applying the HESID algorithm to PICANet records. False-match and missed-match rates were calculated by comparing results of the HESID algorithm with the reference standard PICANet ID. The effect of linkage errors on readmission rate was evaluated. RESULTS: Of 166,406 admissions, 88,596 were true matches (where the same patient had been readmitted). The HESID pseudonymisation algorithm produced few false matches (n=176/77,810; 0.2%) but a larger proportion of missed matches (n=3609/88,596; 4.1%). The true readmission rate was underestimated by 3.8% due to linkage errors. Patients who were younger, male, from Asian/Black/Other ethnic groups (vs White) were more likely to experience a false match. Missed matches were more common for younger patients, for Asian/Black/Other ethnic groups (vs White) and for patients whose records had missing data. CONCLUSIONS: The deterministic algorithm used to link all episodes of hospital care for the same patient in England has a high missed match rate which underestimates the true readmission rate and will produce biased analyses. To reduce linkage error, pseudoanonymisation algorithms need to be validated against good quality reference standards. Pseudonymisation of data 'at source' does not itself address errors in patient identifiers and the impact these errors have on data linkage.Economic and Social Research Council (ESRC) National Centre for Research Methods (NCRM), grant number ES/F035098/1

Paying for the quantity and quality of hospital care : the foundations and evolution of payment policy in England

Prospective payment arrangements are now the main form of hospital funding in most developed countries. An essential component of such arrangements is the classification system used to differentiate patients according to their expected resource requirements. In this article we describe the evolution and structure of Healthcare Resource Groups (HRGs) in England and the way in which costs are calculated for patients allocated to each HRG. We then describe how payments are made, how policy has evolved to incentivise improvements in quality, and how prospective payment is being applied outside hospital settings

Acceptance of Health Information System for Public Health Centre in North Borneo, Indonesia

This study sought the factor associated with own acceptance of HIS for PHC by using the modification of Technology Acceptance Model (TAM) in the Sebengkok PHC, Central Tarakan Subdistrict, Tarakan City, North Borneo, Indonesia. A cross-sectional approach was conducted through a survey on the 37 of PHC\u27s user. A set of questionnaires which was adopted from the previous research was used to collect the information from the participant. The model was developed by involving job relevance, output quality, result demonstrability, screen design, terminology, facilitating condition, perceived of usefulness, perceived ease of use, intention to use and system use (actual usage) as the construct. According to the hypothesis testing, perceived usefulness predicted by terminology, perceived ease of use is significantly predicted by screen design and terminology, perceived usefulness significantly predicts the intention of use and perceived ease of use, while system use which predicted considerably by the intention of use and facilitating condition. This study may have a contribution to the future improvement of HIS for PHC and guide the next coming research to dig the difference acceptance among the user

What next for Shared Lives? Family-based support as a potential option for older people

With an ageing population and limited resources the challenge for policy makers and practitioners is how best to provide for the care and support needs of older people. This article draws on findings from two studies, a scoping study of the personalisation of care services and another which aimed to generate evidence about the potential use of family-based support schemes (Shared Lives, SL) for certain groups of older people. Forty-three schemes participated in a survey to gather information about services provided and the extent to which this included older people and their carers, and six staffs were interviewed across two schemes about issues for expanding provision for older people in their local areas. It was evident that SL schemes were already supporting a number of older people and there was support for expansion from both schemes and local authorities. Adequate resources, awareness raising, management commitment, and a pool of suitable carers would be needed to support any expansion effort. There is also still a need for SL to be more widely known and understood by care managers if it is to be considered part of mainstream provision for older people

Harm-reduction approaches for self-cutting in inpatient mental health settings:development and preliminary validation of the Attitudes to Self-cutting Management (ASc-Me) Scale

IntroductionHarm-reduction approaches for self-harm in mental health settings have been under-researched.AimTo develop a measure of the acceptability of management approaches for self-cutting in mental health inpatient settings.MethodsStage one: scale items were generated from relevant literature and staff/service user consultation. Stage two: A cross-sectional survey and statistical methods from classical test theory informed scale development.Results/FindingsAt stage one N=27 staff and service users participated. At stage two N=215 people (n=175 current mental health practitioners and n=40 people with experience of self-cutting as a UK mental health inpatient) completed surveys. Principal components analysis revealed a simple factor structure such that each method had a unique acceptability profile. Reliability, construct validity, and internal consistency were acceptable. The harm-reduction approaches 'advising on wound-care' and 'providing a first aid kit' were broadly endorsed; 'providing sterile razors' and 'maintaining a supportive nursing presence during cutting' were less acceptable but more so than seclusion and restraint.DiscussionThe Attitudes to Self-cutting Management scale is a reliable and valid measure that could inform service design and development.Implications for practiceNurses should discuss different options for management of self-cutting with service users. Harm reduction approaches may be more acceptable than coercive measures. This article is protected by copyright. All rights reserved.</p

Real world evaluation of three models of NHS smoking cessation service in England

<p>Abstract</p> <p>Background</p> <p>NHS Stop Smoking Services provide various options for support and counselling. Most services have evolved to suit local needs without any retrospective evaluation of their efficiency.</p> <p>Three local service evaluations were carried out at Bournemouth & Poole Teaching Primary Care Trust (PCT) (PCT1), NHS South East Essex (PCT2) and NHS Warwickshire (PCT3) to describe the structure and outcomes associated with different services.</p> <p>Result</p> <p>Standardised interviews with key personnel in addition to analysis of data from 400 clients accessing the service after 1^stApril 2008 in each PCT. The PCTs varied in geography, population size and quit rate (47%-63%). Services were delivered by PCT-led specialist teams (PCT1), community-based healthcare providers (PCT3) and a combination of the two (PCT2) with varying resources and interventions in each.</p> <p>Group support resulted in the highest quit rates (64.3% for closed groups v 42.6% for one-to-one support (PCT1)). Quit rates were higher for PCT (75.0%) v GP (62.0%) and pharmacist-delivered care (41.0%) where all existed in the same model (PCT2). The most-prescribed therapy was NRT (55.8%-65.0%), followed by varenicline (24.5%-34.3%), counselling alone (6.0%-7.8%) and bupropion (2.0%-4.0%).</p> <p>Conclusion</p> <p>The results suggest that service structure, method of support, healthcare professional involved and pharmacotherapy all play a role in a successful quit. Services must be tailored to support individual needs with patient choice and access to varied services being key factors.</p

Arrival by ambulance explains variation in mortality by time of admission : retrospective study of admissions to hospital following emergency department attendance in England

BACKGROUND: Studies finding higher mortality rates for patients admitted to hospital at weekends rely on routine administrative data to adjust for risk of death, but these data may not adequately capture severity of illness. We examined how rates of patient arrival at accident and emergency (A&E) departments by ambulance-a marker of illness severity-were associated with in-hospital mortality by day and time of attendance. METHODS: Retrospective observational study of 3 027 946 admissions to 140 non-specialist hospital trusts in England between April 2013 and February 2014. Patient admissions were linked with A&E records containing mode of arrival and date and time of attendance. We classified arrival times by day of the week and daytime (07:00 to 18:59) versus night (19:00 to 06:59 the following day). We examined the association with in-hospital mortality within 30 days using multivariate logistic regression. RESULTS: Over the week, 20.9% of daytime arrivals were in the highest risk quintile compared with 18.5% for night arrivals. Daytime arrivals on Sundays contained the highest proportion of patients in the highest risk quintile at 21.6%. Proportions of admitted patients brought in by ambulance were substantially higher at night and higher on Saturday (61.1%) and Sunday (60.1%) daytimes compared with other daytimes in the week (57.0%). Without adjusting for arrival by ambulance, risk-adjusted mortality for patients arriving at night was higher than for daytime attendances on Wednesday (0.16 percentage points). Compared with Wednesday daytime, risk-adjusted mortality was also higher on Thursday night (0.15 percentage points) and increased throughout the weekend from Saturday daytime (0.16 percentage points) to Sunday night (0.26 percentage points). After adjusting for arrival by ambulance, the raised mortality only reached statistical significance for patients arriving at A&E on Sunday daytime (0.17 percentage points). CONCLUSION: Using conventional risk-adjustment methods, there appears to be a higher risk of mortality following emergency admission to hospital at nights and at weekends. After accounting for mode of arrival at hospital, this pattern changes substantially, with no increased risk of mortality following admission at night or for any period of the weekend apart from Sunday daytime. This suggests that risk-adjustment based on inpatient administrative data does not adequately account for illness severity and that elevated mortality at weekends and at night reflects a higher proportion of more severely ill patients arriving by ambulance at these times

Measuring change in health care equity using small-area administrative data - evidence from the English NHS 2001-2008

This study developed a method for measuring change in socio-economic equity in health care utilisation using small-area level administrative data. Our method provides more detailed information on utilisation than survey data but only examines socio-economic differences between neighbourhoods rather than individuals. The context was the English NHS from 2001 to 2008, a period of accelerated expenditure growth and pro-competition reform. Hospital records for all adults receiving non-emergency hospital care in the English NHS from 2001 to 2008 were aggregated to 32,482 English small areas with mean population about 1500 and combined with other small-area administrative data. Regression models of utilisation were used to examine year-on-year change in the small-area association between deprivation and utilisation, allowing for population size, age-sex composition and disease prevalence including (from 2003 to 2008) cancer, chronic kidney disease, coronary heart disease, diabetes, epilepsy, hypertension, hypothyroidism, stroke, transient ischaemic attack and (from 2006 to 2008) atrial fibrillation, chronic obstructive pulmonary disease, obesity and heart failure. There was no substantial change in small-area associations between deprivation and utilisation for outpatient visits, hip replacement, senile cataract, gastroscopy or coronary revascularisation, though overall non-emergency inpatient admissions rose slightly faster in more deprived areas than elsewhere. Associations between deprivation and disease prevalence changed little during the period, indicating that observed need did not grow faster in more deprived areas than elsewhere. We conclude that there was no substantial deterioration in socio-economic equity in health care utilisation in the English NHS from 2001 to 2008, and if anything, there may have been a slight improvement

A five year longitudinal study investigating the prevalence of childhood obesity: comparison of BMI and waist circumference.

Objective: The purpose of this study was to examine the prevalence of obesity over time in the same individuals comparing body mass index (BMI), waist circumference (WC) and waist to height ratio (WHtR). Study design: Five year longitudinal repeated measures study (2005–2010). Children were aged 11–12 (Y7) years at baseline and measurements were repeated at age 13–14 (Y9) years and 15–16 (Y11) years. Methods: WC and BMI measurements were carried out by the same person over the five years and raw values were expressed as standard deviation scores (sBMI and sWC) against the growth reference used for British children. Results: Mean sWC measurements were higher than mean sBMI measurements for both sexes and at all assessment occasions and sWC measurements were consistently high in girls compared to boys. Y7 sWC = 0.792 [95% confidence interval (CI) 0.675–0.908], Y9 sWC = 0.818 (95%CI 0.709–0.928), Y11 sWC = 0.943 (95%CI 0.827–1.06) for boys; Y7 sWC = 0.843 (0.697–0.989), Y9 sWC = 1.52 (95%CI 1.38–0.67), Y11 sWC = 1.89 (95%CI 1.79–2.04) for girls. Y7 sBMI = 0.445 (95%CI 0.315–0.575), Y9 sBMI = 0.314 (95%CI 0.189–0.438), Y11 sBMI = 0.196 (95%CI 0.054–0.337) for boys; Y7 sBMI = 0.353 (0.227–0.479), Y9 sBMI = 0.343 (95%CI 0.208–0.478), Y11 sBMI = 0.256 (95%CI 0.102–0.409) for girls. The estimated prevalence of obesity defined by BMI decreased in boys (18%, 12% and 10% in Y 7, 9 and 11 respectively) and girls (14%, 15% and 11% in Y 7, 9 and 11). In contrast, the prevalence estimated by WC increased sharply (boys; 13%, 19% and 23%; girls, 20%, 46% and 60%). Conclusion: Central adiposity, measured by WC is increasing alongside a stabilization in BMI. Children appear to be getting fatter and the additional adiposity is being stored centrally which is not detected by BMI. These substantial increases in WC are a serious concern, especially in girls

The E-health Strategic Research Orientation at the Centre for Telematics and Information Technology

This report gives an overview of research themes, research groups and research partners of the E-Health Strategic Research Orientation (SRO) at the University of Twente