Data Infrastructure for a Poisoning Registry with Designing Data Elements and a Minimum Data Set

Background: The prevalence of poisoning is on the rise in Iran. A poisoning registry is a key source of information about poisoning patterns used for decision-making and healthcare provision, and a minimum dataset (MDS) is a prerequisite for developing a registry. Objectives: This study aimed to design a MDS for a poisoning registry. Methods: This applied study was conducted in 2021. A poisoning MDS was developed with a four-stage process: (1) conducting a systematic review of the Web of Science, Scopus, PubMed, and EMBASE, (2) examining poisoning-related websites and online forms, (3) classification of data elements in separate meetings with three toxicology specialists, and (4) validating data elements using the two-stage Delphi technique. A researcher-made checklist was employed for this purpose. The content validity of the checklist was examined based on the opinions of five health information management and medical informatics experts with respect to the topic of the study. Its test-retest reliability was also confirmed with the recruitment of 25 experts (r = 0.8). Results: Overall, 368 data elements were identified from the articles and forms, of which 358 were confirmed via the two-stage Delphi technique and classified into administrative (n = 88) and clinical data elements (n = 270). Conclusions: The creation of a poisoning registry requires identifying the information needs of healthcare centers, and an integrated and comprehensive framework should be developed to meet these needs. To this end, a MDS contains the essential data elements that form a framework for integrated and standard data collection.

Design and Implementation of a Guideline-Based Workflow Software System for Improving the Chemotherapy Process

Background: While chemotherapy is an effective modality for the treatment of patients with cancer, it is a complex, multidisciplinary, and error-prone process. Paper-based protocols are commonly applied in chemotherapy; however, they fail to eliminate the complexity of this process. Therefore, a new guideline-based workflow software (GWS) system is needed to improve the workflow and quality of chemotherapy process. Methods: Planning was initiated 11 months before the system implementation and it involved a multidisciplinary group to analyze the current chemotherapy workflow and protocols for identifying the workflow components, analyzing paper-based protocols, developing computer-based protocols, and designing of systems based on an object-oriented analysis. To implement the GWS, we applied a system based on Python programming language and SQL language. Results: The conceptual model was developed based on need assessments and chemotherapy steps. A minimum dataset was developed for the electronic health records. We established examination forms for the patient management system (PMS), as well as specific standard forms for chemotherapy ordering, prescription verification and administration templates. Finally, developed GWS system consisted of a PMS, computerized provider order entry (CPOE), prescription verification system (PVS), and nursing administration system (NAS). Conclusions: A PMS, a PVS, a NAS, and a protocol-based clinical decision support system were integrated into the CPOE system to improve the chemotherapy process. Elimination of iterations and unnecessary steps in old chemotherapy workflow, increase of patient safety, improvement of communication and coordination between healthcare providers, and use of updated evidence-based medicine in direct chemotherapy orders justify the integration of GWS in the cancer care settings.

P-L06 Establishing minimum datasets and disease specific forms for cancer patients in multidisciplinary team meetings

Background Multidisciplinary team (MDT) meetings aim to ensure standardised access to cancer pathways and treatment. It is thus important that minimum datasets are established and provided to the MDT clinicians to facilitate thorough discussion and encourage shared decision making. To determine the effectiveness of pre-established minimum dataset proformas for periampullary tumours, hepatocellular carcinoma (HCC), colorectal cancer with liver metastases (CRLM) and hilar cholangiocarcinoma in cancer MDT meetings. Methods Cancer specific minimum dataset forms were developed by consultants to be implemented in MDTs for the four types of hepatobiliary pancreatic cancers: HCC, periampullary cancer, hilar cholangiocarcinoma and CRLM. 189 MDT reports and 184 referral letters were analysed from three weekly MDT meetings to determine the outcomes reported against those outlined in the proformas. The proformas were then implemented by consultants leading the weekly MDT meetings for three consecutive weeks. 128 MDT reports and 126 referral letters were re-audited from these MDT meetings to determine if there was a change in the outcomes reported. Results In this quality improvement project, 21.25% (11/52) of outcomes in MDT and 19.23% (10/52) of outcomes in the referral letters had a statistically significant difference in the reporting of outcomes from Cycle 1 to Cycle 2 across all four cancers. Greater changes in reporting were observed for outcomes that may carry higher prognostic value, such as tumour size and vascular invasion. Despite the notable difference in reporting seen for datasets consisting of smaller cohorts, the change was not statistically significant due to the insufficient statistical power proving the need for trialling such proformas in a wider population. Conclusions The minimum dataset proformas were associated with a limited gain in compliance with data reporting. Further work, with particular focus on user acceptability and attitudes is required to improve use of minimum dataset proformas in MDT.

Developing Minimum Dataset For Electronic Health Record In Iran

Background: Health information system is an integral part of the health system that has a vital role in increasing the efficiency of the health system, especially in primary health care settings. This study was conducted to determine the minimum dataset required in the electronic health record within the health system of Iran as a lower middle income country.Method: This study combines qualitative and quantitative methods. It includes three main stages: reviewing the theoretical foundations of research, designing the main framework for interview questions, conducting a qualitative study by interviewing 42 managers of the health system across the country to determine the minimum dataset in the electronic health. Interviews were carried out from 2020 to 2021. The validity of data was assessed by Delphi method using SPSS 15 software.Results: After reviewing the minimum dataset in the electronic health records of seven countries, 7 main concepts and 23 sub-concepts were extracted from the interviews with experts across the country. Accordingly, 159 information elements were surveyed and a two-round Delphi provided 145 information elements in seven categories of children's program, mothers' program, mental health, elderly, paraclinical services, drug program, and vaccination.Conclusion: Health systems in different countries determine the minimum dataset required in health care setting based on their demographic and epidemiological needs, which can facilitate access to accurate and unambiguous information.

Funnel Plots for Assessing Institutional Performance

<p>This thesis presents a comparison of maternal outcomes for births in New Zealand District Health Boards (DHBs).This is carried out through analysis of the National Minimum Dataset collected by the Ministry of Health for 2007. The outcome compared is postpartum haemorrhage (PPH) the results are displayed using funnel plots, a useful tool for displaying unbiased information on performance outcomes when comparing institutions. Exploration of the data found that there are differences in the demographics, maternal and birth characteristics among DHBs. The rates of PPH are different and the population mixes are made up of a range of different proportions of ethnic groups, ages and deprivation indexes. The exploratory analysis found that a large number of factors are associated with PPH. And that birth weight, parity and gestation had a large number of missing observations. These factors are not missing at random and require imputing prior to constructing the funnel plots. Results show that there is divergence amongst DHBs in the postpartum haemorrhage rate. First a raw PPH rate was plotted and the results indicated there were differences among DHBs. As there are many potential predictors for PPHa logistic regression model was applied to find the most important factors related to PPH. This allows us to apply an adjusted rate for the funnel plot. The risk adjusted funnel plot also indicated differences among DHBs. Two approaches are taken to account for the overdispersion. A winsorised estimate and a winsorised estimate with a random effects term are applied to the data. The approaches produced different results. The winsorised estimate widened the control limits and the random effects term narrowed the control limits. All four plots identified an extreme outlier and this was later removed from the analysis and the winsorisation funnel plots were rerun. The influential outlier made a difference and from this we can concluded that 2 out 20 DHBs lie outside the 95% control limits. These two DHBs could be stated as having a very low rate of PPH.</p>

Funnel Plots for Assessing Institutional Performance

<p>This thesis presents a comparison of maternal outcomes for births in New Zealand District Health Boards (DHBs).This is carried out through analysis of the National Minimum Dataset collected by the Ministry of Health for 2007. The outcome compared is postpartum haemorrhage (PPH) the results are displayed using funnel plots, a useful tool for displaying unbiased information on performance outcomes when comparing institutions. Exploration of the data found that there are differences in the demographics, maternal and birth characteristics among DHBs. The rates of PPH are different and the population mixes are made up of a range of different proportions of ethnic groups, ages and deprivation indexes. The exploratory analysis found that a large number of factors are associated with PPH. And that birth weight, parity and gestation had a large number of missing observations. These factors are not missing at random and require imputing prior to constructing the funnel plots. Results show that there is divergence amongst DHBs in the postpartum haemorrhage rate. First a raw PPH rate was plotted and the results indicated there were differences among DHBs. As there are many potential predictors for PPHa logistic regression model was applied to find the most important factors related to PPH. This allows us to apply an adjusted rate for the funnel plot. The risk adjusted funnel plot also indicated differences among DHBs. Two approaches are taken to account for the overdispersion. A winsorised estimate and a winsorised estimate with a random effects term are applied to the data. The approaches produced different results. The winsorised estimate widened the control limits and the random effects term narrowed the control limits. All four plots identified an extreme outlier and this was later removed from the analysis and the winsorisation funnel plots were rerun. The influential outlier made a difference and from this we can concluded that 2 out 20 DHBs lie outside the 95% control limits. These two DHBs could be stated as having a very low rate of PPH.</p>

Verschuivingen in formele zorg en mantelzorg voor thuiswonende ouderen in Nederland van 2009 tot 2013

Achtergrond Om de snel stijgende Nederlandse zorgkosten te beperken, zijn verzorgingshuizen vervangen door goedkopere thuiszorg (formele zorg) of mantelzorg (informele zorg). Het langer thuis wonen leidde tot een groeiende vraag naar formele en mantelzorg. Het doel van dit artikel is inzicht krijgen in: 1) de trends in geleverde formele en mantelzorg; 2) dekking van zorgbehoeften van thuiswonende ouderen, en 3) associaties tussen zorgbehoeften en kwaliteit van leven (KvL). Methoden Cross-sectionele basismetinggegevens werden gebruikt van ‘The Older Persons and Informal Caregivers Survey – Minimum DataSet’ bestaande uit 54 studies uitgevoerd in 2008-2014. 12.735 deelnemers werden geïncludeerd (leeftijd ≥65 jaar, thuiswonend en hulp nodig met wassen, aankleden, medicatie of huishouden). Percentages formele en/of mantelzorg werden beschreven en de associatie met KvL werd onderzocht met ordinale (zelf-gerapporteerde KvL) en lineaire (EQ-5D) regressiemodellen. Resultaten Het percentage formele zorg daalde van 75% naar 63% en het percentage mantelzorg steeg van 16% naar 28% van de geïncludeerde ouderen tussen 2009 en 2013 (p<0.001). Ongeveer één op de vier thuiswonende ouderen had één of meer onvervulde zorgbehoeften. Het niet ontvangen van formele zorg is geassocieerd met een hogere KvL (zelf-gerapporteerde KvL: OR=1,39, CI=[1,251-1,544]; EQ-5D: regressiecoëfficiënt=0,038 CI=[0,023-0,053]). Conclusie De verschuiving van formele naar mantelzorg samen met de lage dekking van zorgbehoeften onderstreept de noodzaak tot meer ondersteuning van thuiswonende ouderen in Nederland en hun mantelzorgers.

Developing a Minimum Dataset for a Mobile-based Contact Tracing System for the COVID-19 Pandemic

Context: Contact tracing is a cornerstone community-based measure for augmenting public health response preparedness to epidemic diseases such as the current coronavirus disease 2019 (COVID-19). However, there is no an agreed data collection tool for the unified reporting of COVID-19 contact tracing efforts at the national level. Objectives: The purpose of this research was to determine the COVID-19 Contact Tracing Minimal Dataset (COV-CT-MDS) as a prerequisite to develop a mobile-based contact racing system for the COVID-19 outbreak. Methods: This study was carried out in 2020 by a combination of literature review coupled with a two-round Delphi survey. First, the probable data elements were identified using an extensive literature review in scientific databases, including PubMed, Scopus, ProQuest, Science Direct, and Web of Science (WOS). Then, the core data elements were validated using a two-round Delphi survey. Results: Out of 388 articles, 24 were eligible to be included in the study. By the full-text study of the included articles and after the Delphi survey, the designed COV-CT-MDS was categorized into two clinical and administrative data sections, nine data classes, and 81 data fields. Conclusions: COV-CT-MDS is an efficient and valid tool that could provide a basis for collecting comprehensive and standardized data on COVID-19 contact tracing. It could also provide scientific teamwork for health care authorities, which may lead to the enhanced quality of documentation, research, and surveillance outcomes.

Costs of inpatient hospitalisations in the last year of life in older New Zealanders: a cohort study

Background Rapidly ageing populations means that many people now die in advanced age. This paper investigated public hospital and long-term care home costs in the 12 months before death in Māori and non-Māori of advanced age in New Zealand. Methods Data from an existing longitudinal study (LiLACS NZ) was used, in which 937 older New Zealanders were enrolled in 2010. At the time of this study, 213 Māori and 241 non-Māori in the cohort had died. National Health Index numbers were linked to the hospitalisation National Minimum Dataset to ascertain public hospitalisation and care home costs in the last year of life. Results The average total publicly funded hospital and long-term care home costs in the 12 months prior to death were $16,211 and $17,351 for Māori and non-Māori respectively. Non-Māori tended to have long lengths of stay in their last year of life, and non-Māori men had the highest proportion with high costs and long lengths of stay in care homes. Costs in the last year of life were 8.1 times higher in comparison to costs for individuals who did not die in the same time period. Conclusion Despite New Zealand’s commitment to providing an equitable level of healthcare, this study illustrated that ethnic and gender disparities are still apparent at the end of life. This raises questions as to whether money at the end of life is being spent appropriately, and how it could potentially be more equitably targeted to meet the diverse needs of older people and their families.