A medical birth registry at Kilimanjaro Christian Medical Centre

OBJECTIVE: To establish a medical birth registry intended to serve clinical, administrative and research purposes. METHODS: Starting in July 2000, every birth at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania has been recorded in a separate database. The information is obtained through personal interviews with each mother, conducted by specially trained midwives, and supplied with data from the medical records. A secretary enters the data into the electronic file. Data are collected about the mother and father: education, occupation and living conditions, mother's health before and during present pregnancy, expected date of delivery, smoking and drinking (alcohol) habits, use of drugs, plus HIV and syphilis status (if known). This is followed by particulars on the delivery: spontaneous or induced, and complications; the child or children: weight, height and Apgar score, malformations and other diagnoses. Mode of birth: spontaneous or operative intervention. If perinatal death: when? Transfer to intensive neonatal unit? The mother's reproductive history (births, miscarriages, ectopic pregnancies) is also recorded, with outcomes. RESULTS: We describe the process based on more than six years' experience, including obstacles and how they were overcome. The registry serves as a monitoring tool, with a set of key activities and events being issued monthly, indicating changes and trends in, e.g., bleeding complications, caesarean section rates and perinatal mortality, as early warning signs. Monthly reports on key issues are presented. Confidentiality and data protection are key issues. Day-to-day recording of births is vulnerable to personnel shortage, whether from disease or holidays. CONCLUSIONS: Validation and quality checks leave the overall impression that the database is largely accurate and credible. There are plenty of opportunities for research. Clinicians and epidemiologists will profit from using the database to test hypotheses and clarify problem issues, to the ultimate benefit of labouring women and their children.     

Cost efficient sampling design for quality control of a birth defects registry

Quality control studies of registries are frequently conducted. We employed a cost effective sampling scheme for assessing the quality of case identification and abstracting in one birth defects registry. The general sampling method was a stratified two-stage design, and the optimal sample size for each stratum was chosen to minimize cost, which was defined as time for data collection. The resulting sample sizes depended on the variability in the number of abstracts between and within data collection facilities, and the amount of time needed to complete each data collection step. The most time effective scheme was to visit several facilities each for a short period of time rather than fewer facilities for a longer period of time. Cost efficient sampling strategies, such as the method used here, can be applied to ensure precision in registry quality control analyses and other public health studies.     

Quality control of birth defect registry data: a case study.

The California Birth Defects Monitoring Program maintains a population-based registry of children born with congenital malformations. Trained data collectors routinely visit hospitals and genetics centers to identify cases and abstract information. These data are provided to the public health, medical, and lay communities and are used for conducting prevalence and case-control studies. A stratified sample of each data collector''s work for one data year was reevaluated to assess the quality of case ascertainment and record abstraction. The sample included data from 109 facilities (37 percent) and 729 abstracts (5 percent). There are three steps in data collection: case-finding, the process of identifying potential cases; culling, the process of reviewing the charts of potential cases to determine which are reportable; and abstracting, the process of recording information from the charts of reportable cases. The probability that a potential case is missed during casefinding is 7 percent for small facilities, 4 percent for medium facilities, and 1 percent for large facilities. The probability that a reportable case is mistakenly classified as not reportable during culling is 3 percent for small and medium facilities and 1 percent for large facilities. The probabilities of incorrectly abstracting selected diagnoses and demographic items are slightly higher (8 percent for small and medium facilities and 6 percent for large facilities) because these are more complex processes than are casefinding and culling. Finally, the overall probability of missing a case from the registry is 3 percent. Therefore, these data indicate that the information collected by this registry are both reliable and complete.     

药物及手术流产史与早产关联的出生队列研究

目的 探讨既往药物及手术流产史与早产的关联。方法 参与马鞍山市优生优育队列的3 474名孕妇于孕14周前收集一般人口学资料、既往药物及手术流产史资料,以单胎活产儿3 256人为分析样本。根据是否有药物及手术流产史以及流产次数进行分组,采用logistic回归分析既往药物及手术流产史对随后妊娠早产发生率的影响。结果 早产发生率为4.12%（n=134）,自发性早产发生率为2.49%（n=81）。控制可能的混杂因素后,有过1次药物流产史（RR=2.00,95%CI：1.04～3.85）或2次及以上药物流产史（RR=3.58,95%CI：1.04～12.30）会增加总早产发生风险,药物流产史（RR=2.51,95%CI：1.23～5.15）亦会增加自发性早产风险。有过1次手术流产史（RR=0.67,95%CI：0.42～1.01）或2次及以上手术流产史（RR=0.97,95%CI：0.51～1.85）与总早产或自发性早产（RR=0.72,95%CI：0.43～1.22）关联无统计学意义。结论 既往药物流产史是早产或自发性早产的独立危险因素。     

医学人才素质评估方法研究

文章以医学人才基本素质为切入点，研究医学人才基本素质群体与群体、群体与个体、个体与个体之间的差异，且从差异中寻找与其成才的关系，以期建立一种医学人才基本素质较为客观的评估方法。同时，通过此项研究揭示医学人才成长的一般规律和相关影响因素，为有的放矢地设计育才方案提供依据。     

Induced abortion in relation to breast cancer among parous women: a birth certificate registry study

We wished to assess the relation of induced abortion to the subsequent incidence of breast cancer among parous women, using a design that would prevent the possibility of differentially complete reporting of abortion history by women with breast cancer and controls. Our study was conducted within a cohort of women who gave birth to a child during 1984-1994 while residing in 13 counties of western Washington. Cases were women from the cohort diagnosed with breast cancer between 1984 and 1994. From the remaining cohort members, five controls were matched to each woman with breast cancer by year of index birth (ie, the last child born before breast cancer diagnosis) and by age at delivery. We categorized 463 cases and 2,201 controls according to history of induced abortion as recorded on the index birth certificate. The risk of breast cancer was not found to be associated with a prior induced abortion (estimated relative risk (RR) = 0.9, 95% confidence interval (CI) 0.7-1.2). These results suggest that an induced abortion, if followed at some later time by pregnancy and childbirth, does not increase a woman's risk of breast cancer.     

Exactness of the birth registry of Barcelona regarding birth weight and weeks of gestation

OBJECTIVE: The aim of the study is to know the accuracy of the variables birth weight and gestational age in the Barcelona Birth Registry. Hospital medical records are used as gold standard. METHODS: A representative sample (n = 1,932) was selected from all the residents born in the city of Barcelona between 1st of May and 31st of December of 1996. The variables birth weight and gestational age were evaluated. Exhaustivity, sensitivity, specificity and predictive value for these variables were calculated. RESULTS: The Registry shows a high exhaustivity for the study variables. The lowest value of sensitivity corresponds to premature births (65.1%) and the lowest value of specificity to term births (63.9%). The predictive value positive was 77.5% for preterm births and 76.7% for term births. CONCLUSIONS: In general, exhaustivity and accuracy of the Barcelona Birth Registry are high, but sensitivity for preterm births in the Registry is lower. However, the corresponding maternal and child health indicators do not vary in an important manner.     

某市社区诊所灭菌医疗用品质量的调查

近几年的一些调查报道显示，现阶段我国某些较大的医疗机构在消毒工作方面尚存在一些不足之处。社区诊所相对于省市级医疗单位来说，规模小，医疗及消毒灭菌设施有限，而且，社区医务人员消毒知识结构和业务水平参差不齐，消毒观念淡薄，这些导致社区诊所院内感染隐患更为严     

建立医疗质量评价指标的研究

在研究病例诊疗质量的基础上，应用国际疾病分类系统ICD-10编码统计分析59713份出院病历首页信息，应用计算机自动分型方法，把每一个病例分为单纯普通型(A)、单纯急症型(B)、疑难复杂型(C)和危重抢救型(D)4个型。在此基础上对“病种病例数量”、“临床医师诊疗质量”、“临床科室医疗质量”进行了评价。建立了具有选择性、实用性、可操作性强的医疗质量评价指标体系。     

医用直线加速器质量控制中星形片分析的初步研究

目的研究医用直线加速器质量控制中星形片分析的影响因素。材料和方法在西门子医用直线加速器质量控制过程中．使用FilmQA软件和KODAK慢感光胶片对准直器的旋转中心进行星形片分析。分别研究辐照时不同准直器宽度、加速器机架角的偏移、准直器偏心、照射能量以及扫描分辨率对星形片分析结果的影响。结果本研究中．准直器偏心对分析结果有影响,偏心距离与分析结果呈线性关系。能量和扫描分辨率对分析结果影响较小．最大的影响小于0.2mm。4°机架角对分析结果的影响稍大．而2°机架角对分析结果影口向小于0．1mm。准直器宽度对射野的影响比较大．而且两次测试的影响方向柜反。结论临床工作中,当星形片分析结果超标时,需要仔细分析诸多因素．再做出最后的判断。     

Managing the introduction of expensive medical procedures: use of a registry

OBJECTIVES: To explore how the adoption of medical innovations challenges tax-financed health systems, drawing from the case of sirolimus eluting stents, a promising and costly innovation for percutaneous coronary interventions. METHODS: The coverage decisions for the new stents adopted in Emilia-Romagna, an Italian region, are described. The innovation was adopted through a process combining the development of clinical guidelines targeting their use to selected clinical indications, negotiation with the manufacturer for reducing price, and the organization of a registry for monitoring its patterns of utilization and assessing its effectiveness. RESULTS: Overall, 17% of the 6276 patients included in the registry over a 12-month period had the new stent. Wide differences between published trials on sirolimus eluting stents and actual clinical practice emerged. The new stents were frequently (23%) used in combination with traditional bare metal stents, and for indications (acute myocardial infarction and multivessel coronary disease) never included in clinical experiments (25% and 8% of the cases, respectively). Patients' outcomes were also different, the overall rate of major adverse cardiac events being relatively higher (12%) than that shown in clinical trials. CONCLUSIONS: The actions undertaken for the new stents allowed a timely, and at the same time targeted and monitored, adoption of the innovation. This experience highlights how policy decisions related to new medical products could benefit from the availability of clinical databases providing key information on how innovations are actually used and on their impact on clinical practice.     

Mobility and aircraft noice: A registry study

In a search for an alternative to the rather expensive interview technique, data obtained from existing population registries were used to study whether migration out of a certain area could serve as an indicator of the existence and extent of annoyance due to aircraft noise exposure. Since the results show only insignificant differences with respect to mobility from areas with high aircraft noise exposure compared to those with less noise, and register studies such as this do not bring out any information about the individual reasons for moving, the conclusion is that mobility cannot be regarded as a relevant indicator of annoyance caused by aircraft noise exposure.     

现行医疗质量评价指标体系的缺陷问题刍议

目的 明确现行医疗质量评价指标体系的缺陷问题.方法　以现行医疗质量评价指标体系主要包括中国医院协会(CHA)<医院管理与质量评价标准>(2007年)和卫生部<医院管理评价指南>(2005年)为主要研究对象.以北京市卫生局<北京地区医院管理考核评价标准实施细则>(2007年)、JCI<国际医院评审标准>(第2版)(2003年)和<台湾地区新制医院评鉴标准>(2005年、2006年)作为对照.应用文献分析法研究分析.结果　主要缺陷包括指标可操作性不强,病人诊疗过程角度的评价指标不足.结论 围绕病人就诊过程梳理指标,立足国情,增加病人诊疗过程指标比例,量化并突出指标的可操作性,及时总结逐步优化.     

现行医疗质量评价指标体系的缺陷问题刍议

目的 明确现行医疗质量评价指标体系的缺陷问题.方法　以现行医疗质量评价指标体系主要包括中国医院协会(CHA)<医院管理与质量评价标准>(2007年)和卫生部<医院管理评价指南>(2005年)为主要研究对象.以北京市卫生局<北京地区医院管理考核评价标准实施细则>(2007年)、JCI<国际医院评审标准>(第2版)(2003年)和<台湾地区新制医院评鉴标准>(2005年、2006年)作为对照.应用文献分析法研究分析.结果　主要缺陷包括指标可操作性不强,病人诊疗过程角度的评价指标不足.结论 围绕病人就诊过程梳理指标,立足国情,增加病人诊疗过程指标比例,量化并突出指标的可操作性,及时总结逐步优化.

Abstract：

Objective To identify shortcomings in the current evaluation index system of medical quality. Methods The documentary analysis focused on the existing index system comprises the Hospital Management and Quality Evaluation Standards (2007) by China Hospital Association, Hospital Management Evaluation Guidelines (2005) by the Ministry of Health, and Implementation Rules of Hospital Management Evaluation Standards for Beijing (2007). JCI Accreditation Standards for Hospitals (edition 2) (2003), and New Hospital Accreditation Standards for Taiwan (2005, 2006) were referred to in the study. Results The shortcomings found include the weak operability of indexes, and the deficiency of evaluation indexes from the point of hospital visiting process by patients. Conclusion In view of the hospital visiting process of patients, add more indexes for patients' hospital visiting process,and quantize and highlight the operability of indexes, with summary and optimization of experiences in time by steps.     

现行医疗质量评价指标体系的缺陷问题刍议

目的 明确现行医疗质量评价指标体系的缺陷问题.方法　以现行医疗质量评价指标体系主要包括中国医院协会(CHA)<医院管理与质量评价标准>(2007年)和卫生部<医院管理评价指南>(2005年)为主要研究对象.以北京市卫生局<北京地区医院管理考核评价标准实施细则>(2007年)、JCI<国际医院评审标准>(第2版)(2003年)和<台湾地区新制医院评鉴标准>(2005年、2006年)作为对照.应用文献分析法研究分析.结果　主要缺陷包括指标可操作性不强,病人诊疗过程角度的评价指标不足.结论 围绕病人就诊过程梳理指标,立足国情,增加病人诊疗过程指标比例,量化并突出指标的可操作性,及时总结逐步优化.     

Productivity and quality of public hospital medical staff: A dominican case study

Medical care personnel constitute a major portion of health-care costs and are an important determinant of quality. Personnel policy, especially regarding physicians and nurses, is central to the level and type of care provided, and ultimately to the resources expended. There is increasing evidence that state health systems in many Latin American countries face the apparently paradoxical situation of oversupply of physicians coupled with the undersupply of physician services. Yet, productivity of medical staff in public facilities in Latin America is a relatively unexplored area. Further, little is known about the relationship between productivity of medical staff and quality of services provided in developing countries. Taking the case of a large public hospital in the Dominican Republic, this study examines the quality of hospital structure and process as it relates to the functions and performance of physicians, and to a lesser extent, nurses. Based on a patient-based survey, data were collected on physician and nurse time allocations in outpatient, emergency, surgery and inpatient wards, the types of services provided, and the time costs of providing them. The analysis focuses on medical staff performance according to the professional levels of physicians and nurses providing care, and the time spent attending to patients and conducting supervisory tasks. The gap between contracted and expended physician hours is examined. The paper concludes with a discussion of the policy implications for hospital management, particularly as they relate to incentives for medical personnel.     

Health related quality of life after extremely preterm birth: a matched controlled cohort study

Background  

The majority of infants born before the last trimester now grow up. However, knowledge on subsequent health related quality of life (HRQoL) is scarce. We therefore aimed to compare HRQoL in children born extremely preterm with control children born at term. Furthermore, we assessed HRQoL in relation to perinatal and neonatal morbidity and to current clinical and sociodemographic characteristics.     

医院医疗质量实时控制研究概述

目的：探索先进、有效的医疗质量的管理方法，提高医疗环节质量。方法：前瞻性方法，结合文献综述、过程分析、统计学和计算机网络技术等。结果：建立了医疗质量实时控制的要素管理、过程管理、监测控制管理模式；确定了医院病种质量与费用实时控制方法；确定了临床路径对住院诊疗质量实时控制的作用；确定了病案质量实时控制 的方法。结论：医疗质量实时控制是一种有效的新的医疗质量监管方法。