bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Canadian data linkage to investigate the socioeconomic patterning of hospital burden for childbirth
Authors: Mah Sarah M. , Sanmartin Claudia , Rotermann Michelle , Khan Saeeda , Harper Sam , Ross Nancy A. 
Published: April 2017

ABSTRACTObjectivesBirth and delivery in hospital is one of the most common medical procedures in Canadian hospitals, and can be used to assess equity in the delivery of health care. This study investigates the association between socioeconomic status and hospital burden for childbirth using linked Canadian survey and administrative databases, accounting for a wide array of other individual and health-care related characteristics.
ApproachA population-based record linkage between national health survey data and the Canadian Discharge Abstract Database (a census of all Canadian hospital separations) allowed the tracking of hospital utilization between 2005 and 2009 for which individual-level socioeconomic and demographic factors were also available. Length of stay for delivery, risk of pre-delivery hospitalization within 30 days of admission for delivery, and risk of maternal readmission within 30 days of discharge for delivery were the three measures of hospital utilization modeled.
ResultsComplete information for 7,163 deliveries of 5,568 women was available and used in the models of length of stay and risk of maternal admission pre- and post-delivery. In fully adjusted models, predicted length of stay was graded by household income with longest stays for lowest income women (2.79 days, 95% CI 2.61-2.92), followed by middle income women (2.63 days, 95% CI 2.50-2.76) and high income women (2.56 days, 95% CI 2.49-2.63). Factors intrinsic to routine hospital care and protocol such as province and vaginal versus Cesarean section delivery were stronger predictors of length of stay than income. Additionally, Aboriginal status, compounded with residing in a rural setting was associated with higher predicted probability of maternal readmission.
ConclusionsLow income women have marginally longer stays in hospital following birth events than do middle and high-income women in Canada that persist after adjustment for strong drivers of length of stay (parity and birth mode). While this may suggest that more complicated cases are benefiting from longer stays in hospital, it provokes the question as to whether there may be additional reductions in length of stay that could be achieved through resource redistribution to the prenatal period. Overall, the results suggest that equity goals of the Canadian health care system are being achieved for birth-related hospitalizations, and the availability of these linked data will be key for further comprehensive evaluation of population health status.
Long term health effects of NEET experiences: evidence from a longitudinal analysis of young people in Scotland
Authors: Feng Zhiqiang , Ralston Kevin , Everington Dawn , Dibben Chris 
Published: April 2017

ABSTRACTBackgroundThis paper examines whether experiences of young people who are not in employment, education or training (NEET) are associated with adverse long-term outcomes in health. We used the Scottish Longitudinal Study (SLS), which includes information from the 1991, 2001, and 2011 censuses as well as from vital events, for a 5.3% representative sample of the Scottish population. Linked health data such as hospital admissions and prescribing in general practice are also available. We followed around 14,000 young people who were aged 16-19 in 1991 up to 2011.
MethodWe explored whether NEET young people in 1991 displayed higher risks of poor physical and mental health in the follow-up period. Poor physical health is measured by any admission into hospital and poor mental health is measured by prescription of anti-depressant and anti-anxiety medicine. We used descriptive and modelling approaches in our analysis. Covariates include a number of individual socioeconomic characteristics and local area characteristics in the models.
ResultsOur research found that over 40% of the cohort members have been admitted into hospital, while over 30% have been prescribed with anti-depressant and anti-anxiety drugs. The NEET status in 1991 appears to be associated with hospitalisation with adjusted odds ratio (OR) of 1.24 (95% Confidence Intervals (CIs): 1.08 – 1.42). Also the NEET experiences are associated with poor mental health with OR of 1.47 (95% CI: 1.27 – 1.71). Policy intervention is necessary in assisting NEET young people to re-engage in education or employment.
Political and Policy Arguments for Integrated Data
Authors: Brown Adalsteinn D , Boozary Andrew S , Henry David , Marchildon Greg , Schull Michael 
Published: April 2017

ABSTRACT
IntroductionThere is little argument that integrated data can provide a valuable resource for improved health system management, planning, and accountability as well as discovery and commercial use, but policies to enable and support integrated data fall short of the potential represented by integrated data. To understand the current level of progress on policy for integrated data, we looked at two successful and two unsuccessful efforts to support the creation and use of integrated data in health systems.
Methods/ApproachWe used document and literature analysis to develop descriptions of the Icelandic Health Sector Database Act, the creation of the Institute for Clinical Evaluative Sciences in Ontario (Canada), the care.data initiative in the United Kingdom, and the Health Datapalooza initiative in the US and used an Ideas, Institutions and Actors framework to compare the experience with integrated data policy and politics.
Results and discussionOur analysis suggests that institutions around integrated data remain under-developed and largely focused on specific aspects of integrated data policy or use. There are at least two sets of dominant ideas around integrated data – data as a tool for economic development and health system performance and data as a threat to privacy and liberty – that are often diametrically opposed in different jurisdictions. To a great extent, powerful actors remain disengaged from integrated data discussions and leadership engaged in integrated data policy and politics remains isolated from larger policy and political discussions. The medical profession along with civil society groups can mount effective opposition to integrated data initiatives, although potentially for different reasons (accountability and privacy concerns respectively).
ConclusionsOur analysis suggests several key issues around successful integrated data policy and politics that support the importance of strong leadership, an incremental approach to institution building that focuses on public benefits, strongly alignment to missions that are congruent with societal values, and stronger attention to effective and rapid implementation of policy. In addition to the cases studied here, the success of smaller sub-national (e.g. state or provincial) efforts suggests that smaller efforts tend to work better although their success may not receive the attention that could support larger efforts to integrate data on the national level. Further work should focus chiefly on the extension of these arguments to non-health sectors to realize the full value of integrated data.
Improving primary care prescribing safety using routine data for intervention and evaluation: four trials in 500+ practices
Authors: Guthrie Bruce , Bennie Marion , Macbride-Stewart Sean , Dreischulte Tobias 
Published: April 2017

ABSTRACTObjectivesHigh-risk prescribing in primary care is common and causes considerable harm, with for example, ~6% of emergency hospital admissions caused by adverse drug effects. Our aim is to rigorously develop and evaluate complex interventions to improve primary care prescribing safety using routine clinical and administrative data.
ApproachCo-design of interventions by joint academic and clinical teams with implementation embedded in NHS Scotland information and contractual systems. Routine data from general practice electronic medical records (EMRs) or from the NHS Scotland prescribing payment system are used to both underpin the interventions and allow evaluation. Two cluster-randomised trials in 295 general practices have been completed (EFIPPS and DQIP), and two trials in 298 practices are in progress (EPIPP and POEMS), involving ~55% of Scottish general practices in total. The completed EFIPPS trial was a three-arm cluster randomised trial of a routine data feedback intervention +/- a theory-informed behaviour intervention involving 262 (~95%) of practices in three health boards. The completed DQIP trial was a stepped-wedge cluster randomised trial in 33 (50%) practices in one Health Board, the intervention comprising a web-based informatics tool to identify patients needing review from practice EMRs and to facilitate and structure review, an educational outreach visit, and financial incentives to review patients. EPIPP is evaluating a more complex feedback intervention, where both arms receive an active intervention on a different topic, involving all 242 practices in one Health Board. POEMS is evaluating an ‘enhanced medication summary’ to support contractually required-polypharmacy reviews in older people taking 10 or more regular medications, involving all 56 practices in one Health Board.
ResultsThe simpler EFIPPS intervention reduced high-risk prescribing by 12% by 15 months after feedback started. We are currently examining what happened in the year after feedback ceased. The more intensive DQIP intervention reduced high-risk prescribing by 37% at 12 months. This effect was sustained in the 12 months after the financial incentives ceased because the intervention reduced new high-risk prescribing. The DQIP intervention also led to large reductions in related emergency hospital admissions with gastrointestinal bleeding, acute kidney injury and heart failure.
ConclusionWe have shown that informatics-based interventions using routine data and co-designed with clinicians and managers are effective in improving primary care prescribing safety. The presentation will describe our approach to intervention development and implementation, show examples of the interventions, and present outcomes and process evaluation data from the two completed trials.
Under-coding of secondary conditions in coded hospital health data: impact of co-existing conditions, death status and number of codes in a record
Authors: Peng Mingkai , Southern Danielle , Williamson Tyler , Quan Hude 
Published: April 2017

ABSTRACTObjectivesAdministrative health data including hospital discharge abstract data have been widely collected and analyzed for various purposes, including disease surveillance, case-mix costing, tracking healthcare system performance, policy-making and research. This study examined the coding validity of hypertension, diabetes, obesity and depression related to the presence of their co-existing conditions, death status and number of diagnosis codes in hospital discharge abstract data (DAD).
ApproachWe randomly selected around 4000 DAD records from four teaching hospitals in Alberta, Canada and reviewed their charts to extract 31 conditions listed in Charlson and Elixhauser comorbidity indices. Conditions associated with the four study conditions were identified through multivariable logistic regression. We examined the coding validity of the four study conditions related to whether their co-existing conditions were coded, whether the patient died in hospital and the total number of diagnosis codes recorded in a DAD record.Results Hypertension, diabetes, obesity and depression are generally secondary diagnosis and their validity are affected by the coding of their co-existing conditions. The sensitivity for the four conditions increased as the total number of diagnosis codes in the record increased. The impact of death status on coding validity for the four conditions was minimal.ConclusionThe coding validity of conditions is closely related to its clinical importance and complexity of patients’ case mix. We recommend mandatory coding of certain secondary diagnosis to meet the need of health research based on administrative health data.
Comparing a primary care dataset with a questionnaire based health survey
Authors: Atkinson Mark , Kennedy Jonathan , Brophy Sinead 
Published: April 2017

ABSTRACTObjectivesThe Welsh Health Survey (WHS) has been carried out annually since 2003. Approximately 15000 adults and 3000 children are interviewed each year on a wide range of health related questions. From 2013, adult participants were asked to consent to their data being linked and incorporated into the SAIL databank, allowing linkage to the SAIL datasets. Here we focus on linkage to primary care, General Practitioner (GP), data.
This provides a unique opportunity to compare some clinical concepts which are represented in both datasets. The questionnaires in the WHS are taken at a set moment in time and are standardised for everyone questioned, and are more complete. In comparison the GP data collects responses over the patients’ interactions with the GP, but the information may have been elicited in different ways and data are much more likely to be missing.
ApproachWe have chosen a small number of variables scored in both datasets for comparison. BMI and its core variables height and weight are the principal numeric variables found in both datasets. Smoking behaviour is coded for 96% of people in the GP data, alcohol consumption for 79% and exercise for 62%. In contrast, in the WHS data, coding is for 99% (smoking), 99% (alcohol) and 97% (exercise).
ResultsThe 2013 WHS had 4362 participants linked to the SAIL databank, and 7332 from the 2014 WHS. Of these, 95 % had either an exact match or a probabilistic match of 0.9 or above, with 6869 people (63 %) of the combined WHS dataset having linked GP data.
Of those with GP data, 5997 (87%) have weights in the GP data at any date. But only 2429 (35%) have weights within 1 year before and 1 year after the questionnaire date. Of the 2429, 135 have no weight in the WHS data.
ConclusionsFor those using WHS data, the data can be enhanced with a temporal dimension, while the GP data user can augment missing values from the WHS. Both the GP and WHS can gain confirmation from each other. This allows the non-randomness of missingness in the GP dataset to be assessed.
Developing and Validating Electronic Medical Record Based Case Definitions for Liver Diseases and Comorbidities
Authors: Xu Yuan , Li Ning , Lu Mingshan , Myers Robert , Dixon Elijah , Walker Robin , Quan Hude 
Published: April 2017

ABSTRACTObjectiveChina has collected high volume of electronic health record (EMR) data. The rich information in EMR data could be used for health services research. The first challenge is developing methods for extracting study variables. Our study aimed to develop and validate data extraction methods for defining clinical conditions.
ApproachThe EMRs were from Beijing You-An Hospital, a leading liver diseases specialized teaching hospital affiliated with Capital Medical University in China. We developed EMR based case definitions for extracting common liver diseases and comorbidities in Charlson and Elixhauser comorbidity algorithms. We developed the EMR case definitions based on the fundamental EMR structure and clinical expertise. To determine validity of the EMR case definitions, we calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each case definition based on the “gold standard”: randomly selected 450 charts review conducted by two hepatologists. The agreement between the two reviewers was assessed by kappa value.
ResultsIn total, 69,864 EMRs for adult patients with liver disease admitted between 2010 and 2015 were included in this study. Among these patients, we identified 13,763 (19.7%) PLC, 18,654 (26.7%) Hepatitis B Virus (HBV), 4681 (6.7%) Hepatitis C Virus (HCV), 18,933 (27.1%) cirrhosis, 7,964 (11.4%) diabetes, 8,523 (12.2%) hypertension, 3,283 (4.7%) Fluid and Electrolyte Disorder (FED), 3,563 (5.1%) renal disease and 1,258 (1.8%) Cerebrovascular Disease (CEVD). Between the two reviewers, the Kappa values fell between 0.65 and 1.00. Of the 450 EMRs reviewed, the two reviewers identified 95 (21.1%) PLC, 197 (43.8%) HBV, 40 (8.9%) HCV, 146 (32.4%) cirrhosis, 39 (8.7%) diabetes, 45 (10.0%) hypertension, 25 (5.6%) FED, 26 (5.8%) renal disease and 8 (1.8%) CEVD. Compared to chart review, the sensitivity, specificity, PPV and NPV of the algorithms for above conditions are respectively: (PLC) 100%, 99.44%, 97.94%, 100%; (HBV) 61.93%, 99.21%, 98.39%, 76.99%; (HCV) 72.50%, 99.51%, 93.55%, 97.37%; (cirrhosis) 78.77%, 98.36%, 95.83%, 90.61%; (diabetes) 97.44%, 98.05%, 82.61%, 99.75%; (hypertension) 95.00%, 99.72%, 97.44%, 99.45%; (FED) 71.43%, 100.00%, 100.00%, 99.09%; (renal disease) 96.15% 100.00% 100.00% 99.76%; (CEVD) 100.00%, 99.77%, 88.89%, 100.00%.
ConclusionOur EMR case definitions of above conditions had high validity and could be applied to extract clinical variables including major liver diseases and comorbidities from Chinese EMR. This extracting method could be modified slightly for extracting other medical conditions from Chinese EMRs.
Early onset preeclampsia: using population data to assess recurrence risk and adverse pregnancy outcomes
Authors: Roberts Christine L. , Seeho Sean K. , Algert Charles S. , Ford Jane B. 
Published: April 2017

ABSTRACTObjectiveUse linked perinatal data to determine the subsequent pregnancy rate after a pregnancy with early onset preeclampsia and, among those who have a subsequent pregnancy, the risk of recurrence and adverse pregnancy outcomes.
ApproachPreeclampsia is a hypertensive disorder of pregnancy associated with adverse outcomes for the mother and baby. Although rare, when preeclampsia occurs before 34 weeks of gestation, the risk of adverse outcomes is markedly increased primarily due to prematurity. Despite the desire for another child, many women are anxious about becoming pregnant again because of concerns of recurrent complications in a next pregnancy but information for counselling is sparse. We undertook a population-based record linkage cohort study using longitudinally-linked birth and hospital records from New South Wales (Australia) to create medical and obstetric histories. The study population included nulliparous women with a singleton pregnancy and early onset preeclampsia who gave birth between 2001 and 2010 (the index pregnancy), with follow-up for a subsequent birth through 2012. Early onset preeclampsia was defined as a hospital record (antenatal and/or delivery hospitalisations) with a diagnosis of preeclampsia and delivery before 34 weeks gestation. Outcomes included subsequent pregnancy, and among women with a consecutive subsequent birth, the preeclampsia recurrence rate and adverse pregnancy outcome rates.
ResultsOf 1473 (4.0/1000) nulliparous women who had early onset preeclampsia in the index pregnancy, 60% had evidence of any subsequent pregnancy compared to 66% for women without preeclampsia (P<0.001). Of 758 women with early onset preeclampsia and a subsequent singleton birth ≥20 weeks gestation, 256 (33.8%) had preeclampsia in the subsequent pregnancy but only 57 (7.5%) had recurrent early onset preeclampsia. Most women (717, 94.6%) progressed to a later gestational age in their subsequent pregnancy. The median overall increase in gestational age at delivery was 6 weeks (interquartile range [IQR] 4 to 8) and among the women with recurrent preeclampsia the median increase in gestation in the subsequent pregnancy was 5 weeks (IQR 2 to 7). Outcomes in the subsequent pregnancy included 4.2% postpartum haemorrhage, 3.4% severe maternal morbidity, 2.6% Apgar <7 at 5 minutes, 16.2% small-for gestational-age and 1.7% perinatal deaths.
ConclusionsMost women with early onset preeclampsia had good outcomes in their subsequent pregnancy. For rare conditions, linked population data with accurately recorded information can provide robust estimates of outcomes that can inform clinical counselling.
Previous hospital admissions in risk adjustment for mortality of elderly patients admitted with hip fracture
Authors: Machareth Helen , Coeli Cláudia , Pinheiro Rejane 
Published: April 2017

ABSTRACTIntroductionThe Hospital Information System of the Brazilian Unified Health System (SIH-SUS) can be an important tool in evaluating care through comparisons of mortality rates among hospitals. However, the SIH-SUS has limited availability of data on comorbidities, which are needed in order to measure the severity of patients' condition for risk adjustment when comparing mortality among hospitals.
ObjectivesTo analyze previous hospital admissions as an indicator of severity of patients' condition using as an example hip fracture admissions.
ApproachWe analyzed 1984 patients with 62 years of age or older with hip fracture who were admitted to the public health system in Rio de Janeiro City between 2010 and 2011. The causes of previous hospital admissions were obtained through probabilistic record linkage with the SIH-SUS for all causes of admissions between 2008 and 2010. We analyzed the association between the patient having had a any previous admission, adjusted by sex and age, with hospital death, through a logistic regression model. We also analyzed the association between groups of causes of admission with hospital death.
ResultsHaving had at least one previous hospital admission due to any cause before the admission for hip fracture was associated with a 77% increase in the odds of hospital death (CI 95% = 1.06 – 2.94). Among comorbidities, the most relevant were severe or moderate kidney disease with OR = 20.196 (CI 95% = 3.042 – 134.092), ischemic diseases with OR = 9.099 (CI 95% = 0.973 – 85.106), pneumonia with OR = 3.619 (CI 95% = 0.977 – 13.401) and diverse fractures and lesions with OR = 2.041 (CI 95% = 0.900 – 4.627). We were not able to analyze the association for some comorbidities due to an absence in outcome variability in some groups.
ConclusionResults point to a promising use of previous hospital admissions in the Hospital Information System as a proxy for patient's risk adjustment.
De la problematización social a la problematización pública del derecho educativo de migrantes indígenas en contextos urbanos: la educación de los niños y niñas qom (toba) en Rosario, Santa Fe, Argentina (1986-1990)
Authors: Corbetta Silvina 
Published: April 2017

La migración qom que recepciona la ciudad de Rosario, Santa Fe (Argentina) constituyó avanzados los años 80 aquello que desde el análisis de políticas públicas se denomina problema público, originado desde un problema social de progresivo dinamismo, producto de los flujos continuos de migrantes indígenas a la ciudad, y con ellos, la llegada de los niños y niñas indígenas a las escuelas criollas instaladas en cercanía de lo que fue el primer asentamiento qom. El artículo se realiza con base al marco teórico-conceptual que aportan los estudios de política pública con eje en las tres primeras fases del ciclo de la política pública: (i) surgimiento y percepción del problema, (ii) el ingreso a la agenda pública y (iii) la formulación y decisión del programa de la política. ¿Cómo se enuncia entre los actores el problema social? ¿Cuál fue el proceso que permitió – por primera vez- convertir en problema público, la educación de los niños migrantes e indígenas de Rosario a fines de los años 80 y de principios de los 90? ¿Cómo surgieron en ese contexto los actores indígenas? ¿Qué luchas, intereses de actores privados y factores colaborativos diversos confluyeron en las primeras fases del emergente ciclo de vida de la citada política? El artículo pretende analizar el modo en que se configura, fundamentalmente, la demanda educativa de migrantes internos indígenas a través de la educación. La estrategia metodológica es de corte cualitativo. La información se construyó con base a entrevistas, revisión bibliográfica y análisis de normativas. Palabras clave: Migración Urbana Indígena. Educación Intercultural Bilingüe. Comunidad Qom.