The quality of abstracting medical information from the medical record: the impact of training programmes.

OBJECTIVE: To evaluate the impact of a programme of training, education and awareness on the quality of the data collected through discharge abstracts. STUDY DESIGN: Three random samples of hospital discharge abstracts relating to three different periods were studied. Quality control to evaluate the impact of systematic training and education activities was performed by checking the quality of abstracting medical records. SETTING: The study was carried out at the Istituto Dermopatico dell'Immacolata, a research hospital in Rome, Italy; it has 335 beds specializing in dermatology and vascular surgery. MEASURES: Error rates in discharge abstracts were subdivided into six categories: wrong selection of the principal diagnosis (type A); low specificity of the principal diagnosis (type B); incomplete reporting of secondary diagnoses (type C); wrong selection of the principal procedure (type D); low specificity of the principal procedure (type E); incomplete reporting of procedures (type F). A specific rate of errors modifying classification in diagnosis related groups was then estimated. RESULTS: Error types A, B and F dropped from 8.5% to 1.3%, from 15.8% to 1.6% and from 22% to 2.6% respectively. Error type D and E were zero in the third period of analysis (September-October 1997) compared with a rate of 0.7% and 4.1% in the third quarter of 1994. Error type C showed a slight decrease from 31.8% in 1994 to 27.2% in 1997. All differences in error types except incomplete reporting of secondary diagnoses were statistically significant. Five and a half per cent of cases were assigned to a different diagnoses related group after re-abstracting in 1997 as compared to 24.3% in the third quarter of 1994 and 23.8% in the first quarter of 1995. DISCUSSION: Training and continuous monitoring, and feedback of information to departments have proved to be successful in improving the quality of abstracting information at patient level from the medical record. The effort to increase administrative data quality at hospital level will facilitate the use of those data sets for internal quality management activities and for population-based quality of care studies.     

依法加强对医疗废物的管理

论述了制定《医疗废物管理条例》的必要性和《医疗废物管理条例》的基本原则、思路,介绍了国际上医疗废物管理的状况和国务院颁发的《医疗废物管理条例》的主要内容。     

Big Data and Total Hip Arthroplasty: How Do Large Databases Compare?

Background

Use of large databases for orthopedic research has become extremely popular in recent years. Each database varies in the methods used to capture data and the population it represents. The purpose of this study was to evaluate how these databases differed in reported demographics, comorbidities, and postoperative complications for primary total hip arthroplasty (THA) patients.

Can use of an administrative database improve accuracy of hospital-reported readmission rates?

Objectives

Readmission rates after cardiac surgery are being used as a quality indicator; they are also being collected by Medicare and are tied to reimbursement. Accurate knowledge of readmission rates may be difficult to achieve because patients may be readmitted to different hospitals. In our area, 81 hospitals share administrative claims data; 28 of these hospitals (from 5 different hospital systems) do cardiac surgery and share Society of Thoracic Surgeons (STS) clinical data. We used these 2 sources to compare the readmissions data for accuracy.

Assessment of blood administration procedures: problems identified by direct observation and administrative incident reporting

BACKGROUND: Adverse events in blood administration frequently involve the identification of transfusion recipients or components. This report details the results of an investigation of the efficacy of direct observation and that of a hospital-wide incident-reporting system in detecting standard operating procedures (SOPs) for deviations in blood administration. STUDY DESIGN AND METHODS: A process-driven audit form targeting 19 blood administration steps was developed for direct observation monitoring of blood administration. Over 18 months, 202 transfusions were observed in selected hospital locations. Data from this audit were compared with data collected from the incident reporting system. RESULTS: Through direct observation, 334 events were identified for a rate of 1.65 SOP deviations per transfusion. The incident reporting system identified 52 adverse events. Deviations were categorized as being related to the patient or component information, transfusion, patient monitoring, record documentation, and ordering or delivery of the component. Fifty-five percent of the events detected with direct observation related to identification of the patient or component, compared with 17 percent of incident reports. Using direct observation, 9 percent of transfused patients had wristband identification deviations. Such SOP deviations were not detected with the incident reporting system. Transfusion SOP deviations represented 15 percent of direct observation reports and 38 percent of incident reports. Direct observation identified deviations in monitoring practices and record documentation not detected by incident reporting. CONCLUSION: Direct observation appears to be an effective means for identifying deviations related to patient identification, patient monitoring, and record documentation.     

全国省级卫生行政主管部门实验室生物安全管理能力调查及分析

目的 掌握我国省级卫生行政主管部门实验室生物安全管理现况,分析问题与不足,为继续做好我国实验室生物安全管理工作提供依据。方法 利用流行病学动态数据采集平台下的实验室生物安全管理子平台进行《全国省级卫生行政主管部门实验室生物安全管理能力调查》问卷的定制和在线发布,收集信息,对反馈信息进行整理和分析。结果 25家参与应答的省级卫生行政主管部门中,96%的实验室生物安全管理职能设置在科教部门,64%的实验室生物安全管理工作有经费支持,72%的省级卫生行政主管部门成立了生物安全专家委员会,80%的省级卫生行政主管部门开展了省内菌(毒)种或者样本运输审批工作。结论 我国实验室生物安全管理工作已走上规范化、法制化道路,但仍然存在一定的问题和困难。建议各部门重视实验室生物安全管理工作,完善管理体系与制度,提高实验室生物安全意识,提升我国实验室生物安全管理水平。     

Independent clinical validation of a Canadian FRAX tool: Fracture prediction and model calibration

A FRAX model for Canada was constructed for prediction of osteoporotic and hip fracture risk using national hip fracture data with and without the use of femoral neck bone mineral density (BMD). Performance of this system was assessed independently in a large clinical cohort of 36,730 women and 2873 men from the Manitoba Bone Density Program database that tracks all clinical dual‐energy X‐ray absorptiometry (DXA) test results for the Province of Manitoba, Canada. Linkage with other provincial health databases allowed for the direct comparison of fracture risk estimates from the Canadian FRAX model with observed fracture rates to 10 years (549 individuals with incident hip fractures and 2543 with incident osteoporotic fractures). The 10‐year Kaplan‐Meier estimate for hip fractures in women was 2.7% [95% confidence interval (CI) 2.1–3.4%] with a predicted value of 2.8% for FRAX with BMD, and in men the observed risk was 3.5% (95% CI 0.8–6.2%) with predicted value of 2.9%. The 10‐year estimate of osteoporotic fracture risk for all women was 12.0% (95% CI 10.8–13.4%) with a predicted value of 11.1% for FRAX with BMD, and in men, the observed risk was 10.7% (95% CI 6.6–14.9%) with a predicted value of 8.4%. Discrepancies were observed within some subgroups but generally were small. Fracture discrimination based on receiver operating characteristic curve analysis was comparable with published meta‐analyses with area under the curve for osteoporotic fracture prediction of 0.694 (95% CI 0.684–0.705) for FRAX with BMD and for hip fractures 0.830 (95% CI 0.815–0.846), both of which were better than FRAX without BMD or BMD alone. Individual risk factors considered by FRAX made significant independent contributions to fracture prediction in one or more of the models. In conclusion, a Canadian FRAX tool calibrated on national hip fracture data generates fracture risk predictions that generally are consistent with observed fracture rates across a wide range of risk categories. © 2010 American Society for Bone and Mineral Research.     

浅议暂停销售违法广告药品的行政强制措施

目的探索完善暂停销售违法广告药品行政强制措施的相关规定。方法采用行政强制法学研究方法和比较研究方法,归纳了药品广告行政强制措施与药品广告行政处罚的相同点、不同点,指出了我国行政强制领域、药品广告行政措施实施的情况,提出完善暂停销售违法广告药品行政强制措施的建议。结果与结论要加大对违法药品广告的打击力度;也要对药监部门实施药品广告行政强制措施加以适当限制;同时,各部门应处理好药品广告行政强制措施与行政处罚的衔接问题。     

军队老干部膳食结构及微量元素摄入15年变化分析

目的了解军队老干部在15年中膳食结构及微量元素摄入的变化情况。方法对1995、2005和2010年来我院疗养的军队老干部进行膳食调查,并对膳食中铁、锌、硒、铜、锰五种微量元素摄入情况进行分析与评价。结果 膳食结构中,谷类食物摄入逐年下降,已经接近中国居民平衡膳食宝塔推荐摄入量的低值;肉类、食盐、烹调油摄入量逐年升高并大大超过推荐量;乳类摄入量明显不足;热能、蛋白质、烟酸、VB1、VC、VE及胆固醇的摄入已超过推荐量,且呈逐渐上升趋势,VA、VB2及钙摄入量呈明显上升趋势,但还未达到推荐摄入量;脂肪供能比增长较快,2010年已达38.5%,大大超过推荐摄入量。微量元素铁、锌、硒摄入量呈逐年上升趋势,至2010年军队老干部膳食中铁、锌、硒、铜、锰五种微量元素已基本达到推荐摄入量。结论军队老干部营养状况改善明显,各种微量元素摄入量普遍得到提高,但脂肪、胆固醇、食盐摄入过高及乳类摄入不足的问题还比较严重,应继续加强营养宣传教育和正确引导。