scholarly journals Commentary: does the selective inversion approach demonstrate bias in the results of studies using routinely collected data?

BMJ ◽  
2018 ◽  
pp. k3259
Author(s):  
Jonathan Sterne
Keyword(s):  
Routinely Collected Data ◽  
Selective Inversion

scholarly journals Outcomes of Victorian Prevention and Recovery Care Services: A matched pairs comparison

2021 ◽  
pp. 000486742098347
Author(s):  
John Farhall ◽  
Lisa Brophy ◽  
John Reece ◽  
Holly Tibble ◽  
Long Khanh-Dao Le ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Service Use ◽  
Inpatient Unit ◽  
Index Admission ◽  
Personal Recovery ◽  
Short Term ◽  
Care Services ◽  
Routinely Collected Data ◽  
Treatment Order ◽  
Do So

Objective: In Victoria, Prevention and Recovery Care Services have been established to provide a partial alternative to inpatient admissions through short-term residential mental health care in the community. This study set out to determine whether Prevention and Recovery Care Services are achieving their objectives in relation to reducing service use and costs, fostering least restrictive care and leading to positive clinical outcomes. Methods: We matched 621 consumers whose index admission in 2014 was to a Prevention and Recovery Care (‘PARCS consumers’) with 621 similar consumers whose index admission in the same year was to an acute inpatient unit and who had no Prevention and Recovery Care stays for the study period (‘inpatient-only consumers’). We used routinely collected data to compare them on a range of outcomes. Results: Prevention and Recovery Care Services consumers made less subsequent use of acute inpatient services and, on balance, incurred costs that were similar to or lower than inpatient-only consumers. They were also less likely to spend time on an involuntary treatment order following their index admission. Prevention and Recovery Care Services consumers also experienced positive clinical outcomes over the course of their index admission, but the magnitude of this improvement was not as great as for inpatient-only consumers. This type of clinical improvement is important for Prevention and Recovery Care Services, but they may place greater emphasis on personal recovery as an outcome. Conclusion: Prevention and Recovery Care Services can provide an alternative, less restrictive care option for eligible consumers who might otherwise be admitted to an acute inpatient unit and do so at no greater cost.

Using population-based routinely collected data from the Sentinel Stroke National Audit Programme to investigate factors associated with discharge to care home after rehabilitation

2017 ◽  
Vol 32 (8) ◽  
pp. 1108-1118 ◽  
Author(s):  
Dipankar Dutta ◽  
Daniel Thornton ◽  
Emily Bowen
Keyword(s):  
Care Home ◽  
Univariate Analysis ◽  
Population Based ◽  
National Institutes Of Health ◽  
National Audit ◽  
Factors Associated ◽  
Routinely Collected Data ◽  
Early Supported Discharge ◽  
Research Findings ◽  
First Time

Objectives: We investigated factors associated with Care Home (CH) discharge following stroke using routinely collected data in unselected patients and assessed the relevance of previous research findings to such patients seen in routine clinical practice. Design: Retrospective analysis of data from the Sentinel Stroke National Audit Programme using univariate analysis and logistic regression. Setting: A large acute and rehabilitation UK stroke unit with access to early supported discharge. Subjects: All patients with stroke treated from 1 January 2014 to 1 January 2017. Main measures: National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Results: Of 2584 patients (median age 78 years, interquartile range (IQR) 69–86; 50.6% male; 86.7% infarcts; median admission NIHSS 4, IQR 2–9), 401 (15.5%) died in hospital and 203 patients (7.9%) were permanently discharged to CH for the first time. Most had pre-discharge mRS scores of 4/5. Factors (odds ratios; 95% confidence intervals) associated with CH discharge included age (1.07; 1.05–1.10), incontinence (11.5; 7.13–19.25), dysphagia (2.13; 1.39–3.29), severe weakness (1.93; 1.28–2.92), pneumonia (1.68; 1.13–2.50), urinary tract infection (UTI) (1.70; 1.04–2.75) and depression (1.65; 1.00–2.72). In a subgroup of all patients with a pre-discharge mRS of 4/5, age (1.04; 1.02–1.06), incontinence (4.87; 2.39–11.02), UTI (2.0; 1.09–3.71) and pneumonia (1.59; 1.02–2.50) were the only factors associated with CH discharge. Conclusion: Potentially modifiable variables like incontinence, UTI and pneumonia were associated with CH discharge, particularly in the severely disabled.

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