Improvement of maternal Aboriginality in NSW birth data

<p>Abstract</p> <p>Background</p> <p>The Indigenous population of Australia was estimated as 2.5% and under-reported. The aim of this study is to improve statistical ascertainment of Aboriginal women giving birth in New South Wales.</p> <p>Methods</p> <p>This study was based on linked birth data from the Midwives Data Collection (MDC) and the Registry of Births Deaths and Marriages (RBDM) of New South Wales (NSW). Data linkage was performed by the Centre for Health Record Linkage (CHeReL) for births in NSW for the period January 2001 to December 2005. The accuracy of maternal Aboriginal status in the MDC and RBDM was assessed by consistency, sensitivity and specificity. A new statistical variable, ASV, or Aboriginal Statistical Variable, was constructed based on Indigenous identification in both datasets. The ASV was assessed by comparing numbers and percentages of births to Aboriginal mothers with the estimates by capture-recapture analysis.</p> <p>Results</p> <p>Maternal Aboriginal status was under-ascertained in both the MDC and RBDM. The ASV significantly increased ascertainment of Aboriginal women giving birth and decreased the number of missing cases. The proportion of births to Aboriginal mothers in the non-registered birth group was significantly higher than in the registered group.</p> <p>Conclusions</p> <p>Linking birth data collections is a feasible method to improve the statistical ascertainment of Aboriginal women giving birth in NSW. This has ramifications for the ascertainment of babies of Aboriginal mothers and the targeting of appropriate services in pregnancy and early childhood.</p

Are women birthing in New South Wales hospitals satisfied with their care?

Abstract Background Surveys of satisfaction with maternity care among Australian women have been conducted using overnight inpatient surveys and dedicated maternity surveys in a number of Australian states and territories, however to date no information on satisfaction with maternity care has been published for women birthing in New South Wales. The aim of this study was to investigate the effects of pregnancy and birth characteristics, hospital location and type of care provision on patient satisfaction with hospital care at the time of birth. Results Analysis of responses from 5,367 obstetric patients completing overnight patient surveys between 2007 and 2011 revealed three quarters of women were satisfied with care provided in hospital. Compared with women who had previously given birth, first-time mothers were more likely to recommend their birth hospital to friends and family (60.5% versus 56.4%; P<0.05), less likely to have experienced differing messages from staff (44.8% vs 59.4%; P<0.001), and less likely to feel they had received sufficient information about feeding (58.8% vs 65.0%; P<0.001) and caring for their babies (52.4% vs 65.2%; P<0.001). Women having a caesarean birth were more likely to have a negative experience of differing messages from doctors and nurses than women giving birth vaginally (52.7% vs 44.3%; P<0.001). While metropolitan women were more likely to rate their birth hospital positively (76.0% vs. 71.3%; P<0.05) than their rural counterparts, rural women tended to rate the care they received (68.1% vs. 63.4%; P<0.05), and doctors (70.7% vs 61.1%; P<0.05) and nurses (73.5% vs. 66.9%; P<0.001) more highly than metropolitan women. Conclusions The overall picture of maternity care satisfaction in New South Wales is a positive one, with three quarters of women satisfied with care. The differences in care ratings among some subgroups of women (for instance, by parity and rurality) may assist in targeting allocation of resources to improve maternity satisfaction. Further resources could be dedicated to ensuring consistency and amount of information provided, particularly to first-time mothers.Australian Research Council Future Fellowship (#FT120100069)

Quality and complexity measures for data linkage and deduplication

Summary. Deduplicating one data set or linking several data sets are increasingly important tasks in the data preparation steps of many data mining projects. The aim of such linkages is to match all records relating to the same entity. Research interest in this area has increased in recent years, with techniques originating from statistics, machine learning, information retrieval, and database research being combined and applied to improve the linkage quality, as well as to increase performance and efficiency when linking or deduplicating very large data sets. Different measures have been used to characterise the quality and complexity of data linkage algorithms, and several new metrics have been proposed. An overview of the issues involved in measuring data linkage and deduplication quality and complexity is presented in this chapter. It is shown that measures in the space of record pair comparisons can produce deceptive quality results. Various measures are discussed and recommendations are given on how to assess data linkage and deduplication quality and complexity. Key words: data or record linkage, data integration and matching, deduplication, data mining pre-processing, quality and complexity measures

The effectiveness of an intervention in increasing community health clinician provision of preventive care: a study protocol of a non-randomised, multiple-baseline trial

<p>Abstract</p> <p>Background</p> <p>The primary behavioural risks for the most common causes of mortality and morbidity in developed countries are tobacco smoking, poor nutrition, risky alcohol use, and physical inactivity. Evidence, guidelines and policies support routine clinician delivery of care to prevent these risks within primary care settings. Despite the potential afforded by community health services for the delivery of such preventive care, the limited evidence available suggests it is provided at suboptimal levels. This study aims to assess the effectiveness of a multi-strategic practice change intervention in increasing clinician's routine provision of preventive care across a network of community health services.</p> <p>Methods/Design</p> <p>A multiple baseline study will be conducted involving all 56 community health facilities in a single health district in New South Wales, Australia. The facilities will be allocated to one of three administratively-defined groups. A 12 month practice change intervention will be implemented in all facilities in each group to facilitate clinician risk assessment of eligible clients, and clinician provision of brief advice and referral to those identified as being 'at risk'. The intervention will be implemented in a non-random sequence across the three facility groups. Repeated, cross-sectional measurement of clinician provision of preventive care for four individual risks (smoking, poor nutrition, risky alcohol use, and physical inactivity) will occur continuously for all three facility groups for 54 months via telephone interviews. The interviews will be conducted with randomly selected clients who have visited a community health facility in the last two weeks. Data collection will commence 12 months prior to the implementation of the intervention in the first group, and continue for six months following the completion of the intervention in the last group. As a secondary source of data, telephone interviews will be undertaken prior to and following the intervention with randomly selected samples of clinicians from each facility group to assess the reported provision of preventive care, and the acceptability of the practice change intervention and implementation.</p> <p>Discussion</p> <p>The study will provide novel evidence regarding the ability to increase clinician's routine provision of preventive care across a network of community health facilities.</p> <p>Trial registration</p> <p>Australian Clinical Trials Registry <a href="http://www.anzctr.org.au/ACTRN12611001284954.aspx">ACTRN12611001284954</a></p> <p>Universal Trial Number (UTN)</p> <p>U1111-1126-3465</p

Using hospital discharge data for determining neonatal morbidity and mortality: a validation study

<p>Abstract</p> <p>Background</p> <p>Despite widespread use of neonatal hospital discharge data, there are few published reports on the accuracy of population health data with neonatal diagnostic or procedure codes. The aim of this study was to assess the accuracy of using routinely collected hospital discharge data in identifying neonatal morbidity during the birth admission compared with data from a statewide audit of selected neonatal intensive care (NICU) admissions.</p> <p>Methods</p> <p>Validation study of population-based linked hospital discharge/birth data against neonatal intensive care audit data from New South Wales, Australia for 2,432 babies admitted to NICUs, 1994–1996. Sensitivity, specificity and positive predictive values (PPV) with exact binomial confidence intervals were calculated for 12 diagnoses and 6 procedures.</p> <p>Results</p> <p>Sensitivities ranged from 37.0% for drainage of an air leak to 97.7% for very low birthweight, specificities all exceeded 85% and PPVs ranged from 70.9% to 100%. In-hospital mortality, low birthweight (≤1500 g), retinopathy of prematurity, respiratory distress syndrome, meconium aspiration, pneumonia, pulmonary hypertension, selected major anomalies, any mechanical ventilation (including CPAP), major surgery and surgery for patent ductus arteriosus or necrotizing enterocolitis were accurately identified with PPVs over 92%. Transient tachypnea of the newborn and drainage of an air leak had the lowest PPVs, 70.9% and 83.6% respectively.</p> <p>Conclusion</p> <p>Although under-ascertained, routinely collected hospital discharge data had high PPVs for most validated items and would be suitable for risk factor analyses of neonatal morbidity. Procedures tended to be more accurately recorded than diagnoses.</p

What are the current barriers to effective cancer care coordination? A qualitative study

<p>Abstract</p> <p>Background</p> <p>National cancer policies identify the improvement of care coordination as a priority to improve the delivery of health services for people with cancer. Identification of the current barriers to effective cancer care coordination is needed to drive service improvement.</p> <p>Methods</p> <p>A qualitative study was undertaken in which semi-structured individual interviews and focus groups were conducted with those best placed to identify issues; patients who had been treated for a range of cancers and their carers as well as health professionals involved in providing cancer care. Data collection continued until saturation of concepts was reached. A grounded theory influenced approach was used to explore the participants' experiences and views of cancer care coordination.</p> <p>Results</p> <p>Overall, 20 patients, four carers and 29 health professionals participated. Barriers to cancer care coordination related to six aspects of care namely, recognising health professional roles and responsibilities, implementing comprehensive multidisciplinary team meetings, transitioning of care: falling through the cracks, inadequate communication between specialist and primary care, inequitable access to health services and managing scarce resources.</p> <p>Conclusions</p> <p>This study has identified a number of barriers to coordination of cancer care. Development and evaluation of interventions based on these findings is now required.</p

The trouble with clinical indicators: Intact lower genital tract following childbirth in NSW Hospitals, 2003-2005

BackgroundThe federal government wants outcomes of hospital care to be made publicly available. League tables based on single clinical indicators are misleading, largely because of their inability to take case-complexity into account.AimTo demonstrate the application of a graphical tool (the risk-adjusted funnel plot) to the comparison of clinical outcomes across hospitals; and its advantages over league tables.MethodsWe looked at publicly available data on intact lower genital tract (ILGT), for all hospitals in New South Wales at which more than 200 births occurred in 2005. The 'excess' percentage of women at each hospital with an ILGT following a vaginal birth, was calculated after adjustment for instrumental assistance, the use of epidural analgesia/anaesthesia, the use of induction/augmentation, and the number of births per annum.ResultsIn 2005, ILGT ranged from 13.1 to 55.8%. A plot of ILGT against vaginal births per annum (a funnel plot) revealed huge heterogeneity among hospitals, and an inverse association with the number of births per annum. A residual funnel plot, constructed from the differences between observed and expected ILGT identified four hospitals (three public and one private) with consistently better ILGT than expected - and four public hospitals with ILGT consistently worse than expected. Some of these hospitals were not located at the extremes of the league table.ConclusionThe risk-adjusted funnel plot is a useful graphical tool which may overcome the shortcomings of league tables. We need to become more sophisticated in our use of clinical indicators for comparing hospital performances.Peter A. Baghurs