An evaluation of a model for the systematic documentation of hospital based health promotion activities: results from a multicentre study

BACKGROUND: The first step of handling health promotion (HP) in Diagnosis Related Groups (DRGs) is a systematic documentation and registration of the activities in the medical records. So far the possibility and tradition for systematic registration of clinical HP activities in the medical records and in patient administrative systems have been sparse. Therefore, the activities are mostly invisible in the registers of hospital services as well as in budgets and balances.A simple model has been described to structure the registration of the HP procedures performed by the clinical staff. The model consists of two parts; first part includes motivational counselling (7 codes) and the second part comprehends intervention, rehabilitation and after treatment (8 codes).The objective was to evaluate in an international study the usefulness, applicability and sufficiency of a simple model for the systematic registration of clinical HP procedures in day life. METHODS: The multi centre project was carried out in 19 departments/hospitals in 6 countries in a clinical setup. The study consisted of three parts in accordance with the objectives.A: Individual test. 20 consecutive medical records from each participating department/hospital were coded by the (coding) specialists at local department/hospital, exclusively (n = 5,529 of 5,700 possible tests in total).B: Common test. 14 standardized medical records were coded by all the specialists from 17 departments/hospitals, who returned 3,046 of 3,570 tests.C: Specialist evaluation. The specialists from the 19 departments/hospitals evaluated if the codes were useful, applicable and sufficient for the registration in their own department/hospital (239 of 285). RESULTS: A: In 97 to 100% of the local patient pathways the specialists were able to evaluate if there was documentation of HP activities in the medical record to be coded.B: Inter rater reliability on the use of the codes were 93% (57 to 100%) and 71% (31 to 100%), respectively.C: The majority of the study participants found the codes to be useful (71%), applicable (92%) and sufficient (92%). CONCLUSION: Systematic registration of HP activities is relevant in clinical day life and the suggested codes proved to be applicable for international use. HP is an essential part of the clinical pathway or the value chain. This model promises to improve the documentation and thereby facilitate analysis of records for evidence based medicine as well as cost and policy analyses

Development of a high-resolution spatial inventory of greenhouse gas emissions for Poland from stationary and mobile sources

Greenhouse gas (GHG) inventories at national or provincial levels include the total emissions as well as the emissions for many categories of human activity, but there is a need for spatially explicit GHG emission inventories. Hence, the aim of this research was to outline a methodology for producing a high-resolution spatially explicit emission inventory, demonstrated for Poland. GHG emission sources were classified into point, line, and area types and then combined to calculate the total emissions. We created vector maps of all sources for all categories of economic activity covered by the IPCC guidelines, using official information about companies, the administrative maps, Corine Land Cover, and other available data. We created the algorithms for the disaggregation of these data to the level of elementary objects such as emission sources. The algorithms used depend on the categories of economic activity under investigation. We calculated the emissions of carbon, nitrogen sulfure and other GHG compounds (e.g., CO2, CH4, N2O, SO2, NMVOC) as well as total emissions in the CO2-equivalent. Gridded data were only created in the final stage to present the summarized emissions of very diverse sources from all categories. In our approach, information on the administrative assignment of corresponding emission sources is retained, which makes it possible to aggregate the final results to different administrative levels including municipalities, which is not possible using a traditional gridded emission approach. We demonstrate that any grid size can be chosen to match the aim of the spatial inventory, but not less than 100 m in this example, which corresponds to the coarsest resolution of the input datasets. We then considered the uncertainties in the statistical data, the calorific values, and the emission factors, with symmetric and asymmetric (lognormal) distributions. Using the Monte Carlo method, uncertainties, expressed using 95% confidence intervals, were estimated for high point-type emission sources, the provinces, and the subsectors. Such an approach is flexible, provided the data are available, and can be applied to other countries