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1.
The Impact of Electronic Health Record Implementation and Use on Performance of the Surgical Care Improvement Project Measures
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Caroline Pinto Thirukumaran M.B.B.S. M.H.A. James G. Dolan M.D. Patricia Reagan Webster Ph.D. Robert J. Panzer M.D. Bruce Friedman Ph.D. M.P.H. 《Health services research》2015,50(1):273-289
Objective
To examine the impact of electronic health record (EHR) deployment on Surgical Care Improvement Project (SCIP) measures in a tertiary-care teaching hospital.Data Sources
SCIP Core Measure dataset from the CMS Hospital Inpatient Quality Reporting Program (March 2010 to February 2012).Study Design
One-group pre- and post-EHR logistic regression and difference-in-differences analyses.Principal Findings
Statistically significant short-term declines in scores were observed for the composite, postoperative removal of urinary catheter and post–cardiac surgery glucose control measures. A statistically insignificant improvement in scores for these measures was noted 3 months after EHR deployment.Conclusion
The transition to an EHR appears to be associated with a short-term decline in quality. Implementation strategies should be developed to preempt or minimize this initial decline. 相似文献2.
3.
Jawali Jaranilla Thomas E. Kottke Courtney J. Baechler 《Online Journal of Public Health Informatics》2013,5(1)
Objective
The objective of this project was to identify criteria that accurately categorize acute coronary and heart failure events exclusively with electronic health record data so that the medical record can be used for surveillance without manual record review.Introduction
Surveillance to track the incidence, prevalence and treatment of disease is a fundamental task of public health. The advent of universal health care coverage in the United States and electronic health records could make the medical record a valuable disease surveillance tool. This can only happen, however, if the necessary data can be extracted from the medical record without manual review.Methods
We serially compared 3 different computer algorithms to manual record review. The first two algorithms relied on ICD9CM codes, troponin levels, ECG data and echocardiographic data. The 3rd algorithm relied on a very detailed coding system, IMO statements, troponin levels and echocardiographic data.Results
Cohen’s Kappa for the initial algorithm was 0.47 (95%CI 0.41–0.54). Cohen’s Kappa was 0.61 (95%CI 0.55–0.68) for the second algorithm. Cohen’s Kappa for the third algorithm was 0.99 (95%CI 0.98–1.00).Conclusions
We conclude that electronic medical record data are sufficient to categorize coronary heart disease and heart failure events without manual record review. However, only moderate agreement with medical record review can be achieved when the classification is based on 4-digit ICD9CM codes because ICD9CM 410.9 includes myocardial infarction with ST elevation (STEMI) and myocardial infarction without ST elevation (nSTEMI). Nearly perfect agreement can be achieved using IMO statements, a more detailed coding system that tracks to ICD9, ICD10 and SnoMED-CT. IMO statements are available in many electronic medical record systems. 相似文献4.
Doyin Oluwole John Kraemer for Pink Ribbon Red Ribbon 《Bulletin of the World Health Organization》2013,91(9):691-696
Problem
In low- and middle-income countries, breast and cervical cancer have a poor prognosis, partly owing to barriers to treatment. To redress this situation, health systems must be strengthened.Approach
Pink Ribbon Red Ribbon (PRRR) is an innovative partnership designed to leverage public and private investments in global health and to build on the successful United States President’s Emergency Plan for AIDS Relief (PEPFAR) platform to combat cancers of the breast and cervix in sub-Saharan Africa and Latin America. By supporting a comprehensive set of country-owned and country-driven interventions, PRRR seeks to reduce deaths from cervical cancer among women screened and treated through the programme and to reduce deaths from breast cancer by promoting early detection.Local setting
In its initial phase, PRRR is supporting the governments of Botswana, Zambia and other countries in expanding cervical cancer prevention, screening and treatment coverage – especially to high-risk women with human immunodeficiency virus infection – and in strengthening breast cancer education and control services.Relevant changes
PRRR has introduced a diagonal strategy based on the life course and continuum of care approaches to cancer control. Its work has resulted in the delivery of the human papillomavirus vaccine to young girls in several settings and in the strengthening of prevention, screening and treatment delivery systems from the community to the tertiary level.Lessons learnt
This paper outlines the approach PRRR has taken as a country-aligned public–private partnership and the preliminary lessons learnt, including the need for flexible implementation, effective country coordination mechanism and regular communication with all stakeholders. 相似文献5.
6.
Helen Hogan Frances Healey Graham Neale Richard Thomson Nick Black Charles Vincent 《Journal of the Royal Society of Medicine》2014,107(9):365-375
Objective
To determine if applying change analysis to the narrative reports made by reviewers of hospital deaths increases the utility of this information in the systematic analysis of patient harm.Design
Qualitative analysis of causes and contributory factors underlying patient harm in 52 case narratives linked to preventable deaths derived from a retrospective case record review of 1000 deaths in acute National Health Service Trusts in 2009.Participants
52 preventable hospital deaths.Setting
England.Main outcome measures
The nature of problems in care and contributory factors underlying avoidable deaths in hospital.Results
The change analysis approach enabled explicit characterisation of multiple problems in care, both across the admission and also at the boundary between primary and secondary care, and illuminated how these problems accumulate to cause harm. It demonstrated links between problems and underlying contributory factors and highlighted other threats to quality of care such as standards of end of life management. The method was straightforward to apply to multiple records and achieved good inter-rater reliability.Conclusion
Analysis of case narratives using change analysis provided a richer picture of healthcare-related harm than the traditional approach, unpacking the nature of the problems, particularly by delineating omissions from acts of commission, thus facilitating more tailored responses to patient harm. 相似文献7.
A Binagwaho CM Wagner M Gatera C Karema CT Nutt F Ngabo 《Bulletin of the World Health Organization》2012,90(8):623-628
Problem
Virtually all women who have cervical cancer are infected with the human papillomavirus (HPV). Of the 275 000 women who die from cervical cancer every year, 88% live in developing countries. Two vaccines against the HPV have been approved. However, vaccine implementation in low-income countries tends to lag behind implementation in high-income countries by 15 to 20 years.Approach
In 2011, Rwanda’s Ministry of Health partnered with Merck to offer the Gardasil HPV vaccine to all girls of appropriate age. The Ministry formed a “public–private community partnership” to ensure effective and equitable delivery.Local setting
Thanks to a strong national focus on health systems strengthening, more than 90% of all Rwandan infants aged 12–23 months receive all basic immunizations recommended by the World Health Organization.Relevant changes
In 2011, Rwanda’s HPV vaccination programme achieved 93.23% coverage after the first three-dose course of vaccination among girls in grade six. This was made possible through school-based vaccination and community involvement in identifying girls absent from or not enrolled in school. A nationwide sensitization campaign preceded delivery of the first dose.Lessons learnt
Through a series of innovative partnerships, Rwanda reduced the historical two-decade gap in vaccine introduction between high- and low-income countries to just five years. High coverage rates were achieved due to a delivery strategy that built on Rwanda’s strong vaccination system and human resources framework. Following the GAVI Alliance’s decision to begin financing HPV vaccination, Rwanda’s example should motivate other countries to explore universal HPV vaccine coverage, although implementation must be tailored to the local context. 相似文献8.
Bernadette O'Hare Innocent Makuta Naor Bar-Zeev Levison Chiwaula Alex Cobham 《Journal of the Royal Society of Medicine》2014,107(4):148-156
Objectives
This paper sets out to estimate the cost of illicit financial flows (IFF) in terms of the amount of time it could take to reach the fourth Millennium Development Goal (MDG) in 34 African countries.Design
We have calculated the percentage increase in gross domestic product (GDP) if IFFs were curtailed using IFF/GDP ratios. We applied the income (GDP) elasticity of child mortality to the increase in GDP to estimate the reduction in time to reach the fourth MDG in 34 African countries.Participants
children aged under five years.Settings
34 countries in SSA.Main outcome measures
Reduction in time to reach the first indicator of the fourth MDG, under-five mortality rate in the absence of IFF.Results
We found that in the 34 SSA countries, six countries will achieve their fourth MDG target at the current rates of decline. In the absence of IFF, 16 countries would reach their fourth MDG target by 2015 and there would be large reductions for all other countries.Conclusions
This drain on development is facilitated by financial secrecy in other jurisdictions. Rich and poor countries alike must stem the haemorrhage of IFF by taking decisive steps towards improving financial transparency. 相似文献9.
Agnes Binagwaho Fidele Ngabo Claire M Wagner Cathy Mugeni Maurice Gatera Cameron T Nutt Sabin Nsanzimana 《Bulletin of the World Health Organization》2013,91(9):697-703
Problem
Although it is highly preventable and treatable, cervical cancer is the most common and most deadly cancer among women in Rwanda.Approach
By mobilizing a diverse coalition of partnerships, Rwanda became the first country in Africa to develop and implement a national strategic plan for cervical cancer prevention, screening and treatment.Local setting
Rwanda – a small, landlocked nation in East Africa with a population of 10.4 million – is well positioned to tackle a number of “high-burden” noncommunicable diseases. The country’s integrated response to infectious diseases has resulted in steep declines in premature mortality over the past decade.Relevant changes
In 2011–2012, Rwanda vaccinated 227 246 girls with all three doses of the human papillomavirus (HPV) vaccine. Among eligible girls, three-dose coverage rates of 93.2% and 96.6% were achieved in 2011 and 2012, respectively. The country has also initiated nationwide screening and treatment programmes that are based on visual inspection of the cervix with acetic acid, testing for HPV DNA, cryotherapy, the loop electrosurgical excision procedure and various advanced treatment options.Lessons learnt
Low-income countries should begin to address cervical cancer by integrating prevention, screening and treatment into routine women’s health services. This requires political will, cross-sectoral collaboration and planning, innovative partnerships and robust monitoring and evaluation. With external support and adequate planning, high nationwide coverage rates for HPV vaccination and screening for cervical cancer can be achieved within a few years. 相似文献10.
Jin Hyuk Choi Yunhwan Kim Seoyun Choe Sunmi Lee 《Osong Public Health and Research Perspectives》2014,5(2):101-107
Objectives
It is critical to implement effective multiple countermeasures to mitigate or retain the spread of pandemic influenza. We propose a mathematical pandemic influenza model to assess the effectiveness of multiple countermeasures implemented in 2009.Methods
Age-specific parameters, including the transmission rate, the proportion of asymptomatic individuals, the vaccination rate, the social distancing rate, and the antiviral treatment rate are estimated using the least-square method calibrated to the incidence data.Results
The multiple interventions (intensive vaccination, social distancing, antivrial treatment) were successfully implemented resulting in the dramatic reduction in the total number of incidence.Conclusion
The model output is sensitive to age-specific parameters and this leads to the fact that a more elaborate age group model should be developed and extensive further studies must be followed. 相似文献11.
Everton Faccini Augusto Larissa Silva dos Santos Ledy do Horto dos Santos Oliveira 《Revista latino-americana de enfermagem》2014,22(1):100-107
Objectives
to survey the prevalence of human papillomavirus, associated risk factors and genotype distribution in women who were referred to cervical cancer screening when attended in a Family Health Program.Method
we conducted a cross-sectional survey, investigating 351 women. Polymerase chain reaction for DNA amplification and restriction fragment length polymorphism analysis were used to detect and typify the papillomavirus.Results
virus infection was detected in 8.8% of the samples. Among the 21 different genotypes identified in this study, 14 were high risk for cervical cancer, and the type 16 was the most prevalent type. The infection was associated with women who had non-stable sexual partners. Low risk types were associated with younger women, while the high risk group was linked to altered cytology.Conclusion
in this sample attended a Family Health Program, we found a low rate of papillomavirus infection. Virus frequency was associated to sexual behavior. However, the broad range of genotypes detected deserves attention regarding the vaccine coverage, which includes only HPV prevalent types. 相似文献12.
Luis Rogério Cosme Silva Santos Ada ávila Assun??o Eduardo de Paula Lima 《Revista de saúde pública》2014,48(5):750-757
OBJECTIVE
To analyze the factors associated with back pain in adults who live in quilombola territories.METHODS
A population-based survey was performed on quilombola communities of Vitória da Conquista, state of Bahia, Northeastern Brazil. The sample (n = 750) was established via a raffle of residences. Semi-structured interviews were conducted to investigate sociodemographics and employment characteristics, lifestyle, and health conditions. The outcome was analyzed as a dichotomous variable (Poisson regression).RESULTS
The prevalence of back pain was of 39.3%. Age ≥ 30 years and being a smoker were associated with the outcome. The employment status was not related to back pain.CONCLUSIONS
The survey identified a high prevalence of back pain in adults. It is suggested to support the restructuring of the local public service in order to outline programs and access to healthy practices, assistance, diagnosis, and treatment of spine problems. 相似文献13.
Satoyo Hosono Takakazu Kawase Keitaro Matsuo Miki Watanabe Hiroaki Kajiyama Kaoru Hirose Takeshi Suzuki Kumiko Kidokoro Hidemi Ito Toru Nakanishi Yasushi Yatabe Nobuyuki Hamajima Fumitaka Kikkawa Kazuo Tajima Hideo Tanaka 《Journal of epidemiology / Japan Epidemiological Association》2010,20(4):295-301
Background
We conducted a case-control study to examine the relationship between human leukocyte antigen-A (HLA-A) allele polymorphism and the pathogenesis of cervical neoplasia among Japanese women.Methods
A total of 119 patients with invasive cervical squamous cell carcinoma were compared to 119 age- and menopausal status-matched non-cancer controls. Blood samples were taken from all cases and controls and lifestyle information was collected by means of a self-administered questionnaire. The estimated impact of HLA-A alleles on cervical cancer risk was evaluated by unconditional logistic regression models.Results
The frequency of HLA-A*0206 among cases was significantly lower than among controls (P = 0.006). There was an inverse association between A*0206 and cervical cancer risk (odds ratio [OR] = 0.31, 95% confidence interval [95% CI] = 0.15 to 0.65, P = 0.002), and a positive association for HLA-A*2402 (OR = 1.76, 95% CI = 1.00 to 3.09, P = 0.048). After correction for multiple comparisons, A*0206 was significantly associated with reduced cervical cancer risk (corrected P = 0.036). Furthermore, the inverse association between A*0206 and cervical cancer risk was independent of smoking status (never smoker: OR = 0.37, 95% CI = 0.15 to 0.90; ever smoker: OR = 0.23, 95% CI = 0.06 to 0.89).Conclusions
There was an inverse association between HLA-A*0206 and cervical cancer risk among Japanese women, which suggests that HLA-A polymorphism influences cervical cancer risk. Further investigation in other populations is thus warranted.Key words: cervical cancer, human leukocyte antigen, case-control study 相似文献14.
Shinya Kimura Toshihiko Sato Shunya Ikeda Mitsuhiko Noda Takeo Nakayama 《Journal of epidemiology / Japan Epidemiological Association》2010,20(5):413-419
Background
Health insurance claims (ie, receipts) record patient health care treatments and expenses and, although created for the health care payment system, are potentially useful for research. Combining different types of receipts generated for the same patient would dramatically increase the utility of these receipts. However, technical problems, including standardization of disease names and classifications, and anonymous linkage of individual receipts, must be addressed.Methods
In collaboration with health insurance societies, all information from receipts (inpatient, outpatient, and pharmacy) was collected. To standardize disease names and classifications, we developed a computer-aided post-entry standardization method using a disease name dictionary based on International Classification of Diseases (ICD)-10 classifications. We also developed an anonymous linkage system by using an encryption code generated from a combination of hash values and stream ciphers. Using different sets of the original data (data set 1: insurance certificate number, name, and sex; data set 2: insurance certificate number, date of birth, and relationship status), we compared the percentage of successful record matches obtained by using data set 1 to generate key codes with the percentage obtained when both data sets were used.Results
The dictionary’s automatic conversion of disease names successfully standardized 98.1% of approximately 2 million new receipts entered into the database. The percentage of anonymous matches was higher for the combined data sets (98.0%) than for data set 1 (88.5%).Conclusions
The use of standardized disease classifications and anonymous record linkage substantially contributed to the construction of a large, chronologically organized database of receipts. This database is expected to aid in epidemiologic and health services research using receipt information.Key words: database, administrative data, health insurance claims, record linkage, health services research 相似文献15.
16.
Vania Reis Girianelli Carmen Justina Gamarra Gulnar Azevedo e Silva 《Revista de saúde pública》2014,48(3):459-467
OBJECTIVE
To analyze cervical and breast cancer mortality in Brazil according to socioeconomic and welfare indicators.METHODS
Data on breast and cervical cancer mortality covering a 30-year period (1980-2010) were analyzed. The data were obtained from the National Mortality Database, population data from the Brazilian Institute of Geography and Statistics database, and socioeconomic and welfare information from the Institute of Applied Economic Research. Moving averages were calculated, disaggregated by capital city and municipality. The annual percent change in mortality rates was estimated by segmented linear regression using the joinpoint method. Pearson’s correlation coefficients were conducted between average mortality rate at the end of the three-year period and selected indicators in the state capital and each Brazilian state.RESULTS
There was a decline in cervical cancer mortality rates throughout the period studied, except in municipalities outside of the capitals in the North and Northeast. There was a decrease in breast cancer mortality in the capitals from the end of the 1990s onwards. Favorable socioeconomic indicators were inversely correlated with cervical cancer mortality. A strong direct correlation was found with favorable indicators and an inverse correlation with fertility rate and breast cancer mortality in inner cities.CONCLUSIONS
There is an ongoing dynamic process of increased risk of cervical and breast cancer and attenuation of mortality because of increased, albeit unequal, access to and provision of screening, diagnosis and treatment. 相似文献17.
Paula Renata Amorim Lessa Samila Gomes Ribeiro Priscila de Souza Aquino Paulo Cesar de Almeida Ana Karina Bezerra Pinheiro 《Revista latino-americana de enfermagem》2015,23(5):971-978
Objectives:
the aim was to translate and culturally adapt the Adherence Determinants Questionnaire scale for the Portuguese language in the Brazilian context, and to check its reliability and validity to analyze the elements of the adherence of patients to the clinical treatment for breast and cervical cancer.Method:
this was a methodological study, carried out in two oncology reference centers. The sample consisted of 198 participants, with 152 being treated for breast cancer and 46 being treated for cervical cancer. The content validation was performed by a committee of experts. The construct validation was demonstrated through factor analysis and the reliability was analyzed using Cronbach''s alpha.Results:
the committee of experts made the necessary adjustments so that the scale was adapted to the Brazilian context. The factor analysis suggested a reduction from seven to five factors and the maintenance of 38 items similar to those of the original scale. The reliability, investigated through Cronbach''s alpha, was .829, showing high internal consistency.Conclusion:
it was concluded that the Brazilian version of the Adherence Determinants Questionnaire scale is a valid and reliable instrument that is able to measure the elements of adherence to the treatment for breast and cervical cancer. 相似文献18.
Changhong Yang Jun Yang Xiangshu Luo Peng Gong 《Bulletin of the World Health Organization》2009,87(8):619-623
Problem
Quick detection and response were essential for preventing outbreaks of infectious diseases after the Sichuan earthquake. However, the existing public health communication system in Sichuan province, China, was severely damaged by the earthquake.Approach
The Chinese Center for Disease Control and Prevention set up a mobile phone emergency reporting system. In total, 495 light-powered mobile phones were delivered to local health-care agencies in earthquake affected areas. All phones were loaded with software designed for inputting and transmitting cases of infectious disease directly to a national database for further analysis.Local setting
The emergency reporting system was set up in 14 counties hit hardest by the earthquake in Sichuan province, China.Relevant changes
One week after delivering mobile phones to earthquake-affected areas, the number of health-care agencies at the township level that had filed reports returned to the normal level. The number of cases reported by using mobile phones accounted for as much as 52.9% of the total cases reported weekly from 19 May to 13 July in those areasLessons learned
The mobile phone is a useful communication tool for infectious disease surveillance in areas hit by natural disasters. Nevertheless, plans must be made ahead of time and be included in emergency preparedness programmes. 相似文献19.
Objective
To investigate the role of smoking cessation in body weight.Data Sources
2004–2005 and 2009–2010 Behavioral Risk Factor Surveillance Surveys (BRFSS) (N = 349,000), Centers for Disease Control and Prevention; Tax Burden on Tobacco (Orzechowski and Walker 2010).Study Design
The Gaussian treatment effect model is estimated for three age categories by gender. Treatment effects of quitting smoking on body mass index (BMI) by quit length are calculated.Principal Findings
Quitting is found to be endogenous. Differentiated effects of quitting smoking on BMI are found among quitters by gender, between age groups, and by length of time since quitting smoking, and positive association between smoking cessation and body weight confirmed. Declining smoking rates have only a modest effect in the overweight population. The effects of quitting on BMI are considerably lower among younger men and women.Conclusion
The price that must be paid, in terms of weight gain, to enjoy the health benefits of smoking cessation is trivial even for the obese population. 相似文献20.
Marjorie A. Pett D.S.W Susan L. Beck Ph.D. A.P.R.N. F.A.A.N. A.O.C.N. Jia‐Wen Guo M.S. R.N. Gail L. Towsley Ph.D. N.H.A. Jeannine M. Brant Ph.D. A.P.R.N. A.O.C.N. Ellen M. Lavoie Smith Ph.D. A.P.R.N. A.O.C.N. Gary W. Donaldson Ph.D. 《Health services research》2013,48(3):1018-1038