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Chapter 14

Chapter 14 - Data Analysis and Use

DATA ANALYSIS AND USEHealth Care Data Created by health-related events, and are used by many different people, organizations, and agencies for multiple purposes.
Primary Data Information contained in the actual patient record.
Secondary Data Information generated form the record.
Registry A systematic collection of data specific to a type of disease (cancer, AIDS, etc.), exposure to hazardous substances or events (Agent Orange) or trauma and treatment. The data collected is used for reports and vary in usage for each registry.
Surveillance The collection, collation, analysis and dissemination of data for the registries.
Incidence Occurence measure. The number of occurences of a new or specific disease.
CASE DEFINITIONS AND ELIGIBILITYCase A person with a given disease or condition that will be included in the registry.
Epidemiologic Case Definitions Diseases that must be reported to public health agencies, Epidemiologic analysis is then undertaken on the basis of specific issues of interest regarding the disease being studies.
A Clinical Case Definition` A list of signs and symptom that establish a clinical diagnosis and may be reported as a reportable disease if it meetes the epidemiologic case criteria.
Case Finding The method by which all eligible cases to be included in the registry are identified, accessioned into the registry and abstracted. Sources include pathology department, radiology, and laboratory.
Abstracting A set of predetermined data obtained from the patient record and related sources that provides various information about patient, diagnosis, treatment data, outcome of treatment and follow-up.
Registry Quality Control Visutal and computerized checks on data to ensure that the registry database has consistant, complete and accurate data.
Confidentiality Of Registry Information Registries contain patient-idenifiable information that is derived from the primary patient record information. Confidentialy policies and procedures are required in all phases of registry operations to protect the privacy of individual patients.
CANCER REGISTRIES Cancer registries are located in all sizes of hospitals and the most common type of registry. The registry collects and maintains information on patients from initial date of diagnosis or treatment until death.
HOSPITAL CANCER REGISTRIES The primary goal of the hospital based cancer registry is to improve patient care. The cancer registry provides a system for monitoring al types of cancer diagnosed or treated in a organizagion.
Case Eligiblity Is defined as the organizations patients diagnosed or treated for an active disease on or after the reference date or beginning of the registry are eligible for inclusion.
Reference Date The date the registry began accessioning cases.
Accessioned When patients are determined eligible an dadded to the registry.
Population-Based Cancer Registries There are three types of populaton-based cancer registries, they are: incidence only, cancer control and research.
Incidence Only Most are operated by a government health agency and designed to determine cancer rates and trends in a defined population.
Cancer control This serves a broader function; often combining incidence, patient care and end results reporting with other research such as cancer screening or smoking cessation programs.
Research Conduct epidemiologic research focused on etilogy (Study of the cause of disease).
Cancer Registry Coding The coding scheme tradionally used by cancer registries is ICD-0-3. ICD-0-3 permits coding of all neoplasms topography (site), morphology (cell structure and form), grading (variation from normal tissue)and differentiation (variation from normal tissue).
Cancer Registry Staging Stage is the extend of spread of cancer at time of initial diagnosis and treatment is recorded for every cased included in the registry. The AJCC staging scheme is nationally accepted: T (tumor size) N (lymph node involvement) M (metastases).
Ouality Management of the Cancer Program and Registry Data The quality management program must be multidisciplinary and include four components: quality planning, Measurement, evaluation, and improvement.
Use of Registry Data Used for performance improvement projects, cancer conferences, administrative reports, and marketing.
The Cancer Registrar Profession The NCRA is a nonprofit professional organization representing cancer registrars. Some of its approved definitions of the cancer registry field is: individuals working in or supervising cancer registreis, research, quality management/improvments.
BIRTH DEFECTS REGISTRIES Birth defects are the leading cause of infant mortality in the US. Birth defects survelliance systems are characterized as either active or passive case reporting.
Active Case Ascertainment Surveillance Identifying cases in all hospitals, clinics, or other medical facilities through systematic review of patient records, surgery records, disases indeses, pathology records, vital records, and hospital logs.
Passive Case Ascertainment Surveillance Relies on reports submitted to the registry by hospitals, clinics or supplemented with data from vital statistics.
Birth Defects Case Definition and Coding The goal of birth defects registries is to capture data about specific types of congential anomalies and conditions.Birth defects can be classified as major or minor; Major birth defects affect survival and require medical care.
Quality Control of Birth Defects Registry Data Evaluating the completeness and accuracy of data collection, reabstracting procedures similar to those used by cancer registries.
Use of Birth Defects Registry Data Analysis of birth defects surveillance data allows health care planners and epidemiologists to monitor birth defect rates in different areas. Because birth defects are rare researchers have difficulty in obtaining enough cases for etiological studies.
DEATH REGISTRIES Mortality statistics are part of the vital statistics kept by the National Center for Health Statistics. The cause of death form death certificases are translated into medical codes through classsification contained in ICD published by WHO.
DIABETES REGISTRIES The detection and managment of diabetes can result in significant improvement in health and morbidity rates. Diabetes registries servelliance data are used to identify high-risk groups, target intervention programs, evaluate disease and control activity.
Diabetes Registry Case Finding Includes hosptial admission and discharge logs, pharmacy records, dietary records, emergency department logs, and physician surveillance and reporting.
IMPLANT REGISTREIS The main objective of the Internation Implant Registry is to be able to track patients so their whereabouts are known and to facilitate accurate communications between manufacturers, health care providers and patients.
IMMUNIZATION REGISTRIES Immunization registries collect vaccination imformation about children within a geographic area. The provide a central location to collect vaccination records of children.
Immunization Registry Case Finding and Data Use These data elements are used to establish a registry record withing 6 weeks of birth of each child born in the geographic area.
ORGAN TRANSPLANT REGISTRIES Medical advances today makes transplantation a recognized and accepted mode of treatment for patients with organ failure. Due the scarcity of organs threr have been many issues ethical, legal and economic issues raised.
Transplant Case Registration and Data Use The cancer registrar follows the whole process from the before the transplant until graft failure or death.
TRAUMA REGISTRIES Traumatic injury, accidental and intential, is the leading cause of death in the first four decades of life. Trauma registries gather data about patients wo are injured. They can be hospital based or population based.
Trauma Registry Case Finding and Data Use Case finding is performed by reviewing by emergency department logs, admitting department face sheets, patient records, and the disease indices - injury codes 800 to 959.9 and E codes listed in the ICD-9-CM.
RESEARCH AND USE OF DATA Registry data is used for many types of including organizational or population levels to prevent disease or mitigate disability; new health care programs or to sutstantiate funding for a research project.
Health Services Rearch The focus of research through scientific inquiry about resources, organization, finances, and policies relate to the provision of health services.
Medical Reserch - Comorbidity A condition that is in addition to a primary condition and that affects the course or treatment of a condition.
Role of a Data Broker in Research To facilitate the research process to meet the need of the users of health information.
PUBLIC HEALTH States that use the data from discharges to increase public safety and to research injuries. The incidence of disease is also estimated by some states through hospital discharges.
PLANNING AND ASSESSMENT Annual analysis from different registries can help determine future patient needs for expansion of facilities and services.
DATA AND HEALTH Surveillance systems use coded data to monitor possible bioterrism. The main objective is to indentify illness clusters before diagnoses are confirmed an to report cluster to public health agencies for rapid response to mitigate morbidity and mortality.
PERFORMANCE MANAGEMENT - Core Measures The Joint Commission uses data to describe core measures quality improvement process. The data transmitted to the joint commission is evaluated and the quality data provided to the public.
OUTCOMES Patients, purchasers, payers and providers are calmoring for objective informatin about what really works in health care. the outcome refers to an indicator of the results of the process that is typically related to content and delivery of health care.
Outcome Data Use Outcomes may be presented in terms of the life domains and being able to return to the activities of the living. Some managed care systems include information on life domains.
OUtcom and the Electronic Health Record All groups have to make do with information available to them. Although operational systems have comprehensive data, it is usually not available on a single patient at a time.
Outcome Indicator Outcome measures are still in the early development state. Most outcomes are conditions or process specific making it difficut to identify a single simple set of outcome data.
Outcome and Coding Issues Coding schemes may also differ by setting. To compare inpatient and outpatient surgery outcomes it is necessary to look at both CPT-4 and ICD-9 to identify all similar procedures.
Desirable Outcome Systems The outcomes data warhouse will be structures around persons, not the patient. It will include information on a population of people who have either received care in the past or who may receive care in the future.
CLINICAL DECISION SUPPORT Clinical decision suport is typically presented as a system that brings knowlegds to caregivers to assist them in making decisions about patient care. The system generates alerts to allow the caregiver the opportunity to determine the appropriate care.
DATA DICTIONARY The data dictionary is critical to the EHR and conceptually no different from any other dictionary except that it must be more precise and complete in it definitions.
Purpose of the Data Dictionary The data dictionary is a point of consensus that institutionalizes the structure and meaning of the individual elements of the information system.
Scope of the Data Dictionary The data dictionary should include all the elements that are required for a person or institution to make key decisions.
Meta-content of the Dictionary The data dictionary must have a meta-content that defines the attributes that will include the data dictonary for each element.Legal name, Physical name, category, Definition, type, Length, Decimal, Domain, Coding, and Reference.
Building the Data Dictionary Most health institutes have multiple systems for recording a great deal of information. Each application uses a set of definition appropriate to the appliaton or department.
Step 1: Inventory of an existing Enterprise Inventory the content of the exisitig system. Analyze all aspects of the data collection process and identify those that ar synonymous.
Step 2: Identifying New Data Content The process of identifying the new data content requires a great deal of planning and discipline to accomplish appropriately.
Step 3: Consensus Development It is necessary for the users of the system understand and buy into the definitions of elements that will be used in the system; otherwise the data will lack validity and integrity
Criteria for Data Element Inclusion Each data element to be included into the data dictionary should be evaluated to see whether it is appropriate for inclusion on the basis of a set of criteria.
Cataloging Standards If the content and attributes of a broadly used patient identifer are not uniform within various departmental-based systems, the ability to merge these data is thwarted.
Created by: Carol K. Rose
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