scholarly journals Validation study of German inpatient administrative health data for epidemiological surveillance and measurement of quality of care for sepsis: the OPTIMISE study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e035763
Author(s):  
Daniel Schwarzkopf ◽  
Carolin Fleischmann-Struzek ◽  
Peter Schlattmann ◽  
Heike Dorow ◽  
Dominique Ouart ◽  
...  
Keyword(s):  
Risk Factors ◽  
Quality Of Care ◽  
Gold Standard ◽  
Medical Records ◽  
Risk Model ◽  
Predictive Accuracy ◽  
Health Data ◽  
Epidemiological Surveillance ◽  
Administrative Health Data

IntroductionSepsis is a major cause of preventable deaths in hospitals. This study aims to investigate if sepsis incidence and quality of care can be assessed using inpatient administrative health data (IAHD).Methods and analysisDesign: Retrospective observational validation study using routine data to assess the diagnostic accuracy of sepsis coding in IAHD regarding sepsis diagnosis based on medical record review. Procedure: A stratified sample of 10 000 patients with an age ≥15 years treated in between 2015 and 2017 in 10 German hospitals is investigated. All available information of medical records is screened by trained physicians to identify true sepsis cases (‘gold standard’) both according to current (‘sepsis-1’) definitions and new (‘sepsis-3’) definitions. Data from medical records are linked to IAHD on patient level using a pseudonym. Analyses: Proportions of cases with sepsis according to sepsis-1 and sepsis-3 definitions are calculated and compared with estimates from coding of sepsis in IAHD. Predictive accuracy (sensitivity, specificity) of different coding abstraction strategies regarding the gold standard is estimated. Predictive accuracy of mortality risk factors obtained from IAHD regarding the respective risk factors obtained from medical records is calculated. An IAHD-based risk model for hospital mortality is compared with a record-based risk model regarding model-fit and predicted risk of death. Analyses adjust for sampling weights. The obtained estimates of sensitivity and specificity for sepsis coding in IAHD are used to estimate adjusted incidence proportions of sepsis based on German national IAHD.Ethics and disseminationThe study has been approved by the ethics commission of the Jena University Hospital (No. 2018-1065-Daten). The results of the study will be discussed in an expert panel to write a memorandum on improving the utility of IAHD for epidemiological surveillance and quality management of sepsis care.Trial registration numberDRKS00017775; Pre-results.

Clinical Presentation, Quality of Care, Risk Factors and Outcomes in Women with Acute ST-Elevation Myocardial Infarction (STEMI): An Observational Report from Six Middle Eastern Countries

2019 ◽  
Vol 17 (4) ◽  
pp. 388-395 ◽  
Author(s):  
Abdulla Shehab ◽  
Khalid F. AlHabib ◽  
Akshaya S. Bhagavathula ◽  
Ahmad Hersi ◽  
Hussam Alfaleh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Quality Of Care ◽  
Middle East ◽  
Clinical Presentation ◽  
Middle Eastern ◽  
High Morbidity ◽  
Inhospital Mortality ◽  
Acute Stemi

Background: Most of the available literature on ST-Elevated myocardial infarction (STEMI) in women was conducted in the developed world and data from Middle-East countries was limited. Aims: To examine the clinical presentation, patient management, quality of care, risk factors and inhospital outcomes of women with acute STEMI compared with men using data from a large STEMI registry from the Middle East. Methods: Data were derived from the third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps), a prospective, multinational study of adults with acute STEMI from 36 hospitals in 6 Middle-Eastern countries. The study included 2928 patients; 296 women (10.1%) and 2632 men (89.9%). Clinical presentations, management and in-hospital outcomes were compared between the 2 groups. Results: Women were 10 years older and more likely to have diabetes mellitus, hypertension, and hyperlipidemia compared with men who were more likely to be smokers (all p<0.001). Women had longer median symptom-onset to emergency department (ED) arrival times (230 vs. 170 min, p<0.001) and ED to diagnostic ECG (8 vs. 6 min., p<0.001). When primary percutaneous coronary intervention (PPCI) was performed, women had longer door-to-balloon time (DBT) (86 vs. 73 min., p=0.009). When thrombolytic therapy was not administered, women were less likely to receive PPCI (69.7 vs. 76.7%, p=0.036). The mean duration of hospital stay was longer in women (6.03 ± 22.51 vs. 3.41 ± 19.45 days, p=0.032) and the crude in-hospital mortality rate was higher in women (10.4 vs. 5.2%, p<0.001). However, after adjustments, multivariate analysis revealed a statistically non-significant trend of higher inhospital mortality among women than men (6.4 vs. 4.6%), (p=0.145). Conclusion: Our study demonstrates that women in our region have almost double the mortality from STEMI compared with men. Although this can partially be explained by older age and higher risk profiles in women, however, correction of identified gaps in quality of care should be attempted to reduce the high morbidity and mortality of STEMI in our women.

scholarly journals Detection of adverse drug events in e-prescribing and administrative health data: a validation study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bettina Habib ◽  
Robyn Tamblyn ◽  
Nadyne Girard ◽  
Tewodros Eguale ◽  
Allen Huang
Keyword(s):  
Administrative Data ◽  
Gold Standard ◽  
Adverse Drug Events ◽  
Study Drug ◽  
Health Data ◽  
Diagnostic Code ◽  
Administrative Health Data ◽  
Potential Ades ◽  
Patient Reported

Abstract Background Administrative health data are increasingly used to detect adverse drug events (ADEs). However, the few studies evaluating diagnostic codes for ADE detection demonstrated low sensitivity, likely due to narrow code sets, physician under-recognition of ADEs, and underreporting in administrative data. The objective of this study was to determine if combining an expanded ICD code set in administrative data with e-prescribing data improves ADE detection. Methods We conducted a prospective cohort study among patients newly prescribed antidepressant or antihypertensive medication in primary care and followed for 2 months. Gold standard ADEs were defined as patient-reported symptoms adjudicated as medication-related by a clinical expert. Potential ADEs in administrative data were defined as physician, ED, or hospital visits during follow-up for known adverse effects of the study medication, as identified by ICD codes. Potential ADEs in e-prescribing data were defined as study drug discontinuations or dose changes made during follow-up for safety or effectiveness reasons. Results Of 688 study participants, 445 (64.7%) were female and mean age was 64.2 (SD 13.9). The study drug for 386 (56.1%) patients was an antihypertensive, and for 302 (43.9%) an antidepressant. Using the gold standard definition, 114 (16.6%) patients experienced an ADE, with 40 (10.4%) among antihypertensive users and 74 (24.5%) among antidepressant users. The sensitivity of the expanded ICD code set was 7.0%, of e-prescribing data 9.7%, and of the two combined 14.0%. Specificities were high (86.0–95.0%). The sensitivity of the combined approach increased to 25.8% when analysis was restricted to the 27% of patients who indicated having reported symptoms to a physician. Conclusion Combining an expanded diagnostic code set with e-prescribing data improves ADE detection. As few patients report symptoms to their physician, higher detection rates may be achieved by collecting patient-reported outcomes via emerging digital technologies such as patient portals and mHealth applications.

scholarly journals Widespread gaps in the quality of care for primary biliary cholangitis in UK

2021 ◽  
pp. flgastro-2020-101713
Author(s):  
Mathuri Sivakumar ◽  
Akash Gandhi ◽  
Eathar Shakweh ◽  
Yu Meng Li ◽  
Niloufar Safinia ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Medical Records ◽  
Clinical Symptoms ◽  
Primary Biliary Cholangitis ◽  
Cholestatic Liver Disease ◽  
Patient Demographics ◽  
Risk Patients ◽  
Wide Scale ◽  
The Uk

ObjectivePrimary biliary cholangitis (PBC) is a progressive, autoimmune, cholestatic liver disease affecting approximately 15 000 individuals in the UK. Updated guidelines for the management of PBC were published by The European Association for the Study of the Liver (EASL) in 2017. We report on the first national, pilot audit that assesses the quality of care and adherence to guidelines.DesignData were collected from 11 National Health Service hospitals in England, Wales and Scotland between 2017 and 2020. Data on patient demographics, ursodeoxycholic acid (UDCA) dosing and key guideline recommendations were captured from medical records. Results from each hospital were evaluated for target achievement and underwent χ2 analysis for variation in performance between trusts.Results790 patients’ medical records were reviewed. The data demonstrated that the majority of hospitals did not meet all of the recommended EASL standards. Standards with the lowest likelihood of being met were identified as optimal UDCA dosing, assessment of bone density and assessment of clinical symptoms (pruritus and fatigue). Significant variations in meeting these three standards were observed across UK, in addition to assessment of biochemical response to UDCA (all p<0.0001) and assessment of transplant eligibility in high-risk patients (p=0.0297).ConclusionOur findings identify a broad-based deficiency in ‘real-world’ PBC care, suggesting the need for an intervention to improve guideline adherence, ultimately improving patient outcomes. We developed the PBC Review tool and recommend its incorporation into clinical practice. As the first audit of its kind, it will be used to inform a future wide-scale reaudit.

scholarly journals Clinical profiles and quality of care of subjects with type 2 diabetes according to their cardiovascular risk: an observational, retrospective study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Basilio Pintaudi ◽  
Alessia Scatena ◽  
Gabriella Piscitelli ◽  
Vera Frison ◽  
Salvatore Corrao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Quality Of Care ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Cardiovascular Risk Factors ◽  
High Cardiovascular Risk ◽  
Very High

Abstract Background The European Society of Cardiology (ESC) recently defined cardiovascular risk classes for subjects with diabetes. Aim of this study was to explore the distribution of subjects with type 2 diabetes (T2D) by cardiovascular risk groups according to the ESC classification and to describe the quality indicators of care, with particular regard to cardiovascular risk factors. Methods The study is based on data extracted from electronic medical records of patients treated at the 258 Italian diabetes centers participating in the AMD Annals initiative. Patients with T2D were stratified by cardiovascular risk. General descriptive indicators, measures of intermediate outcomes, intensity/appropriateness of pharmacological treatment for diabetes and cardiovascular risk factors, presence of other complications and overall quality of care were evaluated. Results Overall, 473,740 subjects with type 2 diabetes (78.5% at very high cardiovascular risk, 20.9% at high risk and 0.6% at moderate risk) were evaluated. Among people with T2D at very high risk: 26.4% had retinopathy, 39.5% had albuminuria, 18.7% had a previous major cardiovascular event, 39.0% had organ damage, 89.1% had three or more risk factors. The use of DPP4-i markedly increased as cardiovascular risk increased. The prescription of secretagogues also increased and that of GLP1-RAs tended to increase. The use of SGLT2-i was still limited, and only slightly higher in subjects with very high cardiovascular risk. The overall quality of care, as summarized by the Q score, tended to be lower as the level of cardiovascular risk increased. Conclusions A large proportion of subjects with T2D is at high or very high risk. Glucose-lowering drug therapies seem not to be adequately used with respect to their potential advantages in terms of cardiovascular risk reduction. Several actions are necessary to improve the quality of care.

scholarly journals Delirium and Antipsychotic Medications at Hospital Intake: Screening to Decrease Likelihood of Aggression in Inpatient Settings Among Unknown Patients With Dementia

2018 ◽  
Vol 34 (2) ◽  
pp. 118-123 ◽  
Author(s):  
Tracy Wharton ◽  
Daniel Paulson ◽  
Kimberly Burcher ◽  
Heather Lesch
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Quality Of Care ◽  
Health Care Providers ◽  
Antipsychotic Medication ◽  
Care Providers ◽  
Antipsychotic Medications ◽  
Inpatient Settings ◽  
Logistic Regressions

For individuals with dementia, disorientation and both external and internal stimuli may trigger behaviors that are difficult to manage or dangerous to health-care providers. Identification of correlational risk factors to aggressive behavior in patients who are unknown to the hospital can allow providers to adapt patient care quickly. Records for patients aged 60+ who spent at least 24 hours at the hospital other than in the psychiatric unit were used (N = 14 080). The first 4000 records and every 10th person who met criteria (N = 5008) were searched for documentation of dementia (n = 505). Logistic regressions and χ2 tests were used to examine relationships between variables. Recognition of delirium ( P = .014, Exp(B) = 2.53), coupled with an existing prescription for antipsychotic medication at intake ( P < .001, Exp(B) < 4.37), may be a reliable means of screening for risk and intervening at the earliest possible contact, improving quality of care and safety in acute care for individuals with dementia.

scholarly journals Patterns of care of subjects with type 1 and type 2 diabetes according to their cardiovascular risk

2021 ◽  
Vol 24 (1) ◽  
pp. 30
Author(s):  
Pintaudi, B.
Keyword(s):  
Risk Factors ◽  
Quality Of Care ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Quality Indicators ◽  
High Cardiovascular Risk ◽  
Very High

AIM OF THE STUDY To explore the distribution by cardiovascular risk groups according to the classification promoted by the ESC (European Society of Cardiology) of subjects with type 1 (T1D) and type 2 (T2D) diabetes cared for by Italian diabetologists and to describe the quality indicators of care, with particular regard to cardiovascular risk factors. DESIGN AND METHODS The study is based on data extracted from electronic medical records of patients treated at the 258 diabetes centers participating in the Annals AMD initiative and active in the year 2018. Patients with T1D or T2D were stratified by cardiovascular risk, in accordance with the recent ESC guidelines. General descriptive indicators and measures of intermediate outcomes, intensity/appropriateness of pharmacological treatment for diabetes and cardiovascular risk factors, presence of other complications and overall quality of care were evaluated. RESULTS Overall, 29,368 adults with T1D and 473,740 subjects with T2D were evaluated. Among subjects with T1D: 64.7% were at very high cardiovascular risk, 28.5% at high risk and the remaining 6.8% at moderate risk. Among subjects with T1D at very high-risk: 54.7% had retinopathy, 29.0% had albuminuria, 7.3% had a history of major cardiovascular event, 47.3% had organ damage, 48.9% had three or more risk factors, and 70.6% had a diabetes duration of over 20 years. Among subjects with T2D: 78.5% were at very high cardiovascular risk, 20.9% at high risk and the remaining 0.6% at moderate risk. Among those with T2D at very high risk: 39.0% had organ damage, 89.1% had three or more risk factors, 18.7% had a previous major cardiovascular event, 26,4% had retinopathy, 39.5% had albuminuria. With regard to the glucose-lowering drugs: the use of DPPIV-i increased markedly as cardiovascular risk increased; the use of secretagogues also increased and, although within low percentages, also the use of GLP1-RA tended to increase. The use of SGLT2-i is also still limited, and only slightly higher in subjects with very high cardiovascular risk. In both types of diabetes, the overall quality of care, as summarized by the Q score values, tended to be lower as the level of cardiovascular riskincreased. CONCLUSIONS The analysis of a large population such as that of the AMD Annals database allowed to highlight the characteristics and quality indicators of care of subjects with T1D and T2D in relation to cardiovascular risk classes. A large proportion of subjects appear to be at high or very high risk. Glucose-lowering drug therapies seem not to be adequately used with respect to the potential advantages in terms of reduction of cardiovascular risk of some drug categories (GLP1-RA and SGLT2-i) and, conversely, with respect to the potential risks related to the use of other pharmacological classes (sulfonylureas). Several actions are necessary to optimize care and improve the quality of care for both subjects with T1D and T2D. KEY WORDS type 1 diabetes; type 2 diabetes; cardiovascular risk; quality indicators of care.

Abstract 13776: The Impact of Race on In-hospital Quality of Care Among Young Adults With Acute Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Diana Benea ◽  
Valeria Raparelli ◽  
hassan behlouli ◽  
Louise Pilote ◽  
Rachel Dryer
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Young Adults ◽  
Quality Of Care ◽  
Clinical Characteristics ◽  
Hospital Quality ◽  
P Value ◽  
White Race

Introduction: The extent to which race influences in-hospital quality of care among young adults with acute myocardial infarction (AMI) is unknown. We examined racial differences in in-hospital quality of AMI care in young adults and described the patient and/or clinical characteristics associated with potential disparities in care. Methods: Data from the GENESIS-PRAXY (Canada) and the VIRGO (U.S.) prospective cohorts of young adults with AMI were analyzed. Among a total of 4,048 adults with AMI (≤55 years) (median=49 years [IQR 44-52], 22% non-white, 58% women), we calculated an in-hospital quality of care score (QCS) for AMI (quality indicators divided by total, with higher scores indicating better care) based on AHA quality of care standards, reporting data disaggregated by race. We categorized race as white versus non-white, which included Black, Asian and North American Indigenous populations. Results: This cohort was comprised of 906 non-white individuals and 3142 white individuals. Non-white adults exhibited a clustering of adverse cardiac risk factors, psychosocial risk factors and comorbidities versus whites; they had higher rates of hypertension, diabetes, alcohol abuse and prior AMI and lower rates of physical activity. They were more likely to have a low SES and receive low social support, and were less likely to be employed, a primary earner, or married/living with a partner. Non-white individuals were also more likely to experience a NSTEMI and less likely to receive cardiac rehabilitation, smoking cessation counseling as well as dual antiplatelet therapy at discharge. Furthermore, non-white individuals had a lower crude QCS than whites (QCS=69.99 vs 73.29, P-value<0.0001). In the multivariable model adjusted for clinical and psychosocial factors, non-white race (LS Mean Difference=-1.49 95%CI -2.87, -0.11, P-value=0.0344) was independently associated with a lower in-hospital QCS. Conclusion: Non-white individuals with AMI exhibited higher rates of adverse psychosocial and clinical characteristics than white individuals yet non-white race was independently associated with lower in-hospital quality of care. Interventions are needed to improve quality of AMI care in non-white young adults.

Abstract 358: Annual Quality of Care Evaluations of Cardiac Surgery in British Columbia

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
James G Abel ◽  
Daniel R Wong ◽  
Carmen H Ng ◽  
Lillian Ding ◽  
Andrew Kmetic
Keyword(s):  
British Columbia ◽  
Cardiac Surgery ◽  
Quality Of Care ◽  
Risk Model ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Administrative Databases ◽  
Annual Review ◽  
Rbc Transfusion

Background: Cardiac Services BC (CSBC) is responsible for planning, coordinating, monitoring, and, in some cases, funding cardiac services across British Columbia (BC) in collaboration with senior administrators and physicians from five regional health authorities. CSBC maintains the BC Cardiac Registry (BCCR), a longitudinal clinical registry of all invasive cardiac procedures performed in BC. For over 10 years, CSBC has used BCCR data to evaluate annually quality of care indicators for isolated coronary artery bypass graft (CABG), isolated valve, and CABG+valve surgeries. Methods: In preparation for each annual review, CSBC meets with an established Planning Committee of representative surgeons. BCCR data is linked to provincial Vital Statistics data, to the national Discharge Abstract Database, and for the last 3 yearly analyses to the provincial Central Transfusion Registry which provides robust data on red blood cell (RBC) transfusion. At the annual review, CSBC meets with surgeons who are included in the analyses to present the indicator data. Results: In the 2012 evaluation, the following quality of care indicators were presented for the 2007-2011 period: 30-day mortality and 30-day stroke; 30-day RBC transfusion; and indicators for evidence-based medications at discharge. Risk-adjusted analyses were prepared for the 30-day mortality and 30-day stroke indicators to provide valid comparisons over time and according to hospital and surgeon. Patient characteristics and pre-procedural factors were included in the risk models. The risk-adjusted models performed well with C-statistics for the 30-day mortality models for isolated CABG, isolated valve, and CABG+valve surgeries of 0.86, 0.89, and 0.81, and for the 30-day stroke models 0.80, 0.83, and 0.74, respectively. Expected rates by hospital and by surgeon were determined from each risk model, and observed to expected (O/E) ratios were used for comparison of hospitals and surgeons. Rates of RBC transfusion varied by hospital, and a large reduction in transfusion rates from 69% (378 of 546) in 2007 to 43% (252 of 589) in 2011 was observed at one site with historically higher rates. Conclusion: Presenting quality of care indicators annually has raised awareness of outcome rates and variations which existed across the province. The annual process of engaging surgeons in the evaluation process and linkage with other administrative databases to obtain outcome data has been associated with a reduction in use of RBC transfusion and instigated further investigations into regional variation in mortality rates. The addition of new indicators and other risk-adjusted analyses in the future may further improve quality of care in cardiac surgery in BC.

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