scholarly journals Building the National Database of Health Centred on the Individual: Administrative and Epidemiological Record Linkage - Brazil, 2000-2015

2018 ◽  
Vol 3 (1) ◽  
Author(s):  
Augusto Afonso Guerra Junior ◽  
Ramon Gonçalves Pereira ◽  
Eli Iola Gurgel ◽  
Mariangela Cherchiglia ◽  
Leonardo Vinicius Dias ◽  
...  
Keyword(s):  
National Health ◽  
Record Linkage ◽  
False Negative ◽  
National Health System ◽  
Graph Algorithm ◽  
Kappa Statistic ◽  
Administrative Databases ◽  
National Database ◽  
Health Database ◽  
The Individual

IntroductionIn Brazil, the National Health System (SUS) provides healthcare to the public. The system hasmultiple administrative databases; the major databases record hospital (SIH) and outpatient (SIA)procedures. Epidemiological information is collected for all populations in subsystems, such as mor-tality (SIM), live births (SINASC) and diseases of compulsory declaration (SINAN). Each subsystemhas its own information system, which is able to provide information about consultations, clinicalinformation and medicines dispensed. However, these systems are not linked, thereby preventingindividual-centred analysis. ObjectiveTo describe the methods and results of parameter setting that are needed to execute the probabilisticdeduplication of large administrative and epidemiological databases in Brazil and to create a NationalHealth Database Centred on the individual. MethodsThis paper shows the results of a record linkage model to integrate data from SIH, SIA, SIM, andSINAN, which have different formats and attributes between them and over time. These data consistof 1.3 billion records from 2000-2015. Probabilistic and deterministic record linkages were used todeduplicate these data. The Kappa statistic and clerical review were used to ensure the quality ofthe linkage. The graph algorithm and depth-first search were used to generate the identifiers. ResultsThe deterministic deduplication process resulted in a database with 403,113,527 possible uniqueindividuals. After the probabilistic deduplication process of the former database was performed,159,703,805 unique individuals were identified. This result had an estimated a false positive errorrate of 3.3%, and the false negative error was estimated at 12.3%. ConclusionsThe National Health Database centred on the individual was generated and will allow researchersto use real-world evidence to conduct clinical, epidemiological, economic and other studies. Thisdatabase represents a significant cohort, spanning 15 years of historical data and preserving patientprivacy. The success of the process described will allow repeating and appending the data for futureyears and enable important studies to promote SUS efficiency and provide better treatments forpatients. KeywordsData linkage, record linkage, Brazilian health database, SUS deduplication

scholarly journals Oxygen-ozone therapy in arthroplasty infections

Ozone Therapy ◽  
2019 ◽  
Vol 4 (1) ◽  
Author(s):  
Alessandra Vittoria De Lisi ◽  
Marianno Franzini ◽  
Giovanni Ricevuti
Keyword(s):  
Antibiotic Resistance ◽  
Health System ◽  
National Health ◽  
National Health System ◽  
Surgical Site Infections ◽  
Negative Consequences ◽  
Ozone Therapy ◽  
National Guidelines ◽  
Duration Of Hospitalization ◽  
The Individual

The prevention of surgical site infections is a priority within the objectives of the National Health System. The negative consequences of postoperative infections (morbidity, duration of hospitalization, mortality) are particularly serious events for the individual patient and for the community, given both the welfare resources needed to treat them, and the continued growth of the phenomenon of antibiotic resistance. In a global health context in which evidence-based medicine has established itself, all medical interventions must be reconsidered in the light of what can be inferred from the literature evaluated according to strict methodological criteria, all the more so when the evidence is available and unanimously shared. The future objective will be to introduce in the national guidelines a protocol involving the use of ozone therapy alongside antibiotic therapy, both in the prevention and treatment of infections, to avoid the emergence of antibiotic resistance and thus reduce the expenditure of the national health system.

scholarly journals HOSPITAL ADMISSIONS FOR STROKE IN THE BRAZILIAN NATIONAL HEALTH SYSTEM: EPIDEMIOLOGICAL FINDINGS FROM 2019-2020

2021 ◽  
Author(s):  
Mariana Guelli ◽  
Tulio Loyola Correa
Keyword(s):  
Health System ◽  
National Health ◽  
Skin Color ◽  
Hospital Admissions ◽  
Age Groups ◽  
National Health System ◽  
National Database ◽  
Cross Sectional ◽  
Unified Health System ◽  
Time Period

Background and Aims Stroke is one of the leading causes of death and disability in adults, accounting for a high number of hospitalizations worldwide.This study aims to evaluate the epidemiology of hospitalizations for stroke in Brazil during 2019 and 2020. Methods Cross-sectional, descriptive and retrospective study, which evaluated the epidemiology of hospital admissions for stroke in the Brazilian National Health System in the years 2019 and 2020.Hospital admissions were evaluated by sex, race and age group using the national database (DATASUS – Department of Informatics of the Unified Health System). The official classification of race/skin color in Brazil is composed of five categories: White, Brown [Pardo], Black,Yellow and Indigenous. Results During this time period, there was a total of 316,859 hospitalizations for stroke in the Brazilian National Health System, with 163,120 (51.5%) hospital admissions in 2019 and 153,739 (48.5%) in 2020. Also, 166,178 (52.4%) patients were male and 150,681 (47.6%) were female. Regarding race (n=250,446); 106,998 (42.7%) patients considered themselves white, 116,601 (46.6%) brown, 17,085 (6.8%) black and 9,762 (3.9%) others. Regarding age groups; 64,939 (20.5%) were >80 years old, 163,114 (51.5%) were 60-79, 74,605 (23.5%) were 40-59 and 14,201 (4.5%) were <40. Conclusions The majority of patients hospitalized for stroke were 60-79 years old and white or brown. The similar number of hospital admissions in 2019 and 2020 may suggest that hospitalizations for stroke were not significantly impacted by hospital’s oversaturation by the COVID-19 pandemic.

scholarly journals Comparing Record Linkage methods for real-world perinatal and neonatal data without unique identifiers

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Rainer Schnell ◽  
Christian Borgs
Keyword(s):  
Clinical Practice ◽  
Real World ◽  
Record Linkage ◽  
Incomplete Data ◽  
Privacy Preserving ◽  
Administrative Databases ◽  
National Database ◽  
Linkage Methods ◽  
Standard Patient ◽  
The Impact

BackgroundData on newborns is regularly linked for epidemiological research. However, hospital data often suffers from incomplete data. We report on a linkage of two population-covering administrative health databases containing neonatal and perinatal data without unique personal identifiers and with incomplete information in standard patient identifiers. GoalTo study the effects of a policy-induced change from linking a national database without standard patient identifiers to a privacy-preserving Record Linkage method, we compare the linkage system in use to clear-text and privacy-preserving Record Linkage techniques. We expected large proportions of missing identifiers since they are not needed for clinical practice. Therefore, we expected missing links caused by missing identifiers. To study the impact of these missing identifiers on these successful links, we compared several linkage methods. Furthermore, we study the variations of linkage success between hospitals. MethodsPerinatal and neonatal data from population-covering real-world administrative databases was linked using several variants of state of the art methods, including Privacy-preserving Record Linkage (PPRL) techniques such as multiple match keys and Bloom filter methods. Results We report on the variation of linkage results between the hospitals and give possible explanations for the differences. The resulting linkage success is reported for each method. The impact of incomplete data on linkage success for each method is documented. Finally, we report on the relative performance of the modified techniques compared to standard linkage procedures used in practice. ConclusionImplementing a record linkage system based on identifiers not required for clinical practice caused a large number of missing identifiers. Since this information is essential for successful clear-text and private linkage methods, emphasizing the need for documenting patient identifiers, especially in cases where auxiliary information (such as stable addresses, date of birth or health insurance numbers) are missing, is of central importance for implementing a privacy-preserving Record Linkage system.

An automated model for forecasting non-elective hospital bed demand in the entire English National Health System: retrospective process assessment study (Preprint)

2020 ◽  
Author(s):  
Kanan Shah ◽  
Akarsh Sharma ◽  
Chris Moulton ◽  
Simon Swift ◽  
Clifford Mann ◽  
...  
Keyword(s):  
National Health ◽  
Mean Squared Error ◽  
Winter Season ◽  
National Health System ◽  
Forecast Accuracy ◽  
Occupancy Models ◽  
Bed Occupancy ◽  
Median Error ◽  
Hospital Bed ◽  
Forecasting Techniques

BACKGROUND From 2006/2007 to 2017/2018, there was a 26% increase in emergency department (ED) attendances and 32% increase in total admissions in the National Health Service in England (NHS). Growing demand puts severe strain on hospitals, resulting in bed, nursing, clinical and equipment shortages. Nevertheless, scheduling issues can still result in significant under-utilization of beds. It is imperative to optimize the allocation of existing healthcare resources, including hospital beds. More accurate and reliable long-term hospital bed occupancy rate prediction would help managers plan ahead for their population’s hospital requirements, ultimately resulting in greater efficiencies and better patient care. OBJECTIVE This study aimed to compare widely used automated time series forecasting techniques to predict short-term daily non-elective bed occupancy at all trusts in the NHS. METHODS Bed occupancy models that accounted for patterns in occupancy were created for each trust in the NHS. Daily non-elective midnight trust occupancy data from April 2011 to March 2017 for 121 NHS trusts were utilized to generate these models. Forecasts were generated using the three most widely used automated forecasting techniques: Exponential Smoothing (ES); Seasonal Autoregressive Integrated Moving Average (SARIMA); Trigonometric, Box-Cox transform, ARMA errors, Trend and Seasonal components (TBATS). The NHS Modernization Agency’s recommended forecasting method prior to 2020, was also replicated. A comparative analysis of forecast accuracy was conducted by comparing forecasted daily non-elective occupancy with actual non-elective occupancy in the out-of-sample dataset for each week forecasted. Percentage root mean squared error (RMSE) was reported. RESULTS The accuracy of the models varied based on the season during which occupancy was forecasted. For the summer season, percent RMSE values for each model remained relatively stable across six forecasted weeks. However, only the TBATS model (median error 2.45% for six weeks) outperformed the NHS Modernization Agency’s recommended method (median error 2.63% for six weeks). In contrast, during the winter season, percent RMSE values increased as we forecasted further into the future. ES generated the most accurate forecasts (median error 4.91% over four weeks), but all models outperformed the NHS Modernization Agency’s recommended method prior to 2020 (median 8.5% error over four weeks). CONCLUSIONS It is possible to create automated models, similar to those recently published by the NHS, that can be used at a hospital level for a large, national healthcare system in order to predict non-elective bed admissions and thus schedule elective procedures. CLINICALTRIAL N/A

scholarly journals Cardiovascular diseases burden in Italy, 1990–2017: the Global Burden of Disease Study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Fornari ◽  
P A Cortesi ◽  
F Madotto ◽  
S Conti ◽  
G Crotti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Diseases ◽  
National Health ◽  
Population Aging ◽  
National Health System ◽  
Total Mortality ◽  
Premature Death ◽  
Global Burden ◽  
High Systolic Blood Pressure ◽  
Life Years

Abstract Background Cardiovascular diseases (CVDs) are still the leading cause of mortality, morbidity and disability in Europe. Consequently, an exhaustive estimation of CVDs burden and cardiovascular risk factors impact is crucial for healthcare planning and resource allocation. In Italy, data on CVDs burden are sparse. This study aims to assess the global Italian CVDs burden and to analyze time changes from 1990 to 2017 within the country and in comparison to other European states. Methods We used data from the 2017 Global Burden of Diseases (GBD) study to estimate CVDs prevalence, mortality and disability-adjusted life-years (DALYs) in Italy from 1990 to 2017. We also analyzed burden attributable to CVDs-related risk factors. Finally, Italian estimations were compared to those of the other 28 European Union countries. Results CVDs were still the first cause of death (34.8% of total mortality) in Italy in 2017. A significant decrease in CVDs burden was observed since 1990: age-standardized prevalence (-12.7%), mortality rate (-53.75%), and DALYs rate (-55.54%) all decreased. Similar patterns were observed also in the majority of European countries. Despite these trends, all-ages CVDs prevalent cases increased from 5.75 million to 7.49 million. More than 80% of CVDs burden could be attributed to known modifiable risk factors such as high systolic blood pressure, dietary risks, high LDL cholesterol, and impaired kidney function. Conclusions Data showed a decline in cardiovascular mortality and DALYs, which reflects the success in terms of reducing disability, premature death and early incidence of CVDs. However, the burden of CVDs is still high, as population aging and the increased prevalent cases require more access to care and generate more years lived with disability, which in turn leads to higher costs for the National Health Service and society. More efficient prevention strategies at community and individual level are needed. Key messages Despite decreasing trends in CVDs mortality and DALYs, the burden of CVDs is still high in Italy. A joined approach of the National Health System stakeholders is needed to keep reducing the CVDs burden.

scholarly journals In utero exposure to ritodrine during pregnancy and risk of autism in their offspring until 8 years of age

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jungsoo Chae ◽  
Geum Joon Cho ◽  
Min-Jeong Oh ◽  
KeonVin Park ◽  
Sung Won Han ◽  
...  
Keyword(s):  
National Health ◽  
Screening Program ◽  
Hazard Analysis ◽  
Population Based ◽  
In Utero ◽  
National Database ◽  
Rank Test ◽  
In Utero Exposure ◽  
Exposure Group ◽  
Increased Risk

AbstractBeta-2 adrenergic receptor (B2AR) agonists, used as asthma treatments and tocolytics during pregnancy, have recently been reported to be associated with autism in their offspring. However, the particular link between autism and ritodrine, a common type of B2AR agonist used solely as tocolytics, has never been substantiated with any nationwide database. Thus, we aimed to examine the association between in utero exposure of ritodrine and the risk of autism in their offspring using a national database. This population-based cohort study was conducted by merging the Korea National Health Insurance claims database and National Health Screening Program for Infants and Children database. These databases included all women who had delivered singleton between January 2007 and December 2008 in Korea. Out of the total 770,016 mothers, 30,959 (4.02%) were exposed to ritodrine during pregnancy, and 5583 (0.73%) of their children were identified as having autism, defined until 8 years of age. According to our analysis, the overall cumulative incidence of autism up to 8 years was 1.37% in ritodrine exposure group and 0.70% in ritodrine non-exposure group (p < 0.05, log-rank test). By Cox proportional hazard analysis, use of ritodrine in preterm birth was associated with significantly higher hazard of autism [adjusted hazard ratio: 1.23, 95% CI 1.04–1.47], after adjusting for confounding variables including maternal age, parity, cesarean section, preterm labor, steroid use, birth weight, gender, and preeclampsia. Thus, in utero exposure to ritodrine was associated with an increased risk of autism in their offspring.

scholarly journals Comparing Patient and Endoscopist Perceptions of the Colonoscopy Indication

2010 ◽  
Vol 24 (11) ◽  
pp. 656-660 ◽  
Author(s):  
Maida J Sewitch ◽  
Dara Stein ◽  
Lawrence Joseph ◽  
Alain Bitton ◽  
Robert J Hilsden ◽  
...  
Keyword(s):  
Kappa Statistic ◽  
Cross Sectional Study ◽  
Routine Screening ◽  
Self Report ◽  
Administrative Databases ◽  
Screening Colonoscopy ◽  
Cross Sectional ◽  
Simple Method ◽  
Patient Questionnaires

BACKGROUND: Determining whether a colonoscopy is performed for screening or nonscreening purposes can facilitate clinical practice and research. However, there is no simple method to determine the colonoscopy indication using patient medical files or health administrative databases.OBJECTIVE: To determine patient-endoscopist agreement on the colonoscopy indication.METHODS: A cross-sectional study was conducted among staff endoscopists and their patients at seven university-affiliated hospitals in Montreal, Quebec. The study participants were 50 to 75 years of age, they were able to understand English or French, and were about to undergo colonoscopy. Self- (endoscopist) and interviewer-administered (patient) questionnaires ascertained information that permitted classification of the colonoscopy indication. Patient colonoscopy indication was defined as the following: perceived screening (routine screening, family history, age); perceived nonscreening (follow-up); medical history that implied nonscreening; and a combination of the three preceding indications. Agreement between patient and endoscopist indications was measured using concordance and Kappa statistic.RESULTS: In total, 702 patients and 38 endoscopists participated. The three most common reasons for undergoing colonoscopy were routine screening/regular check-up (33.8%), follow-up to a previous problem (30.2%) and other problem (24.6%). Concordance (range 0.79 to 0.85) and Kappa (range 0.58 to 0.70) were highest for perceived nonscreening colonoscopy. Recent large bowel symptoms accounted for 120 occurrences of disagreement in which the patient perceived a nonscreening colonoscopy while the endoscopist perceived a screening colonoscopy.CONCLUSIONS: Patient self-report may be an acceptable means for rapidly assessing whether a colonoscopy is performed for screening or nonscreening purposes. Delivery of patient-centred care may help patients and endoscopists reach a shared understanding of the reason for colonoscopy.

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