The importance of defining periods of complete mortality reporting for research using automated data from primary care
The importance of defining periods of complete mortality reporting for research using automated data from primary care
复制标题
DOI：
10.1002/pds.1688
复制
发表时间：
2009-01-01
影响因子：
2.6
通讯作者：
Thompson, Mary
中科院分区：
文献类型：
--
作者：
Maguire, Andrew;Blak, Betina T.;Thompson, Mary
目的为了定义可接受的死亡率报告在初级保健期间，并通过例子证明研究使用自动化的医疗data.Methods每年的死亡人数为每个初级保健实践参与健康改善网络“THIN”（英国）的含义。预期计数是根据国家死亡率计算的，考虑到实践的年龄/性别结构。计算标准化死亡率（SMR）和95%置信区间（CI）。进行了目视审查过程，以指定该实践具有可接受死亡率报告（AMR）的年份。该过程涉及对彼此的决定不知情的评审员对。检查了死亡报告的模式。AMR年作为一个过滤器应用于THIN数据，以评估其对SMR.Results的影响，对于大多数做法的SMR是相对稳定的，AMR年很容易识别与86%的协议之间的盲审对。将AMR应用于THIN消除了对死亡的低报。然而，计算机化随访的总时间从3700万患者年减少到3200万患者年。有问题的死亡记录模式，包括一些做法，只保留活的病人记录时，转换他们的软件系统，从而创建“不朽的时期”之前，这一刻，和高峰时发生的做法更新了他们的病人的记录的重要地位。结论这是第一次，外部标准已被用于评估死亡率的完整性，在自动化的初级保健数据。由此产生的AMR年度为研究提供了一个自然的过滤器，并避免了与“不朽时期”，记录更新和低报相关的偏见。版权所有（C）2008约翰威利父子有限公司
Purpose To define periods of acceptable mortality reporting in primary care and to demonstrate through examples the implication for research using automated medical data.Methods Annual death counts were obtained for each primary care practice participating in The Health Improvement Network "THIN" (UK). Expected counts were calculated from national death rates, accounting for the practice's age/sex structure. The standardized mortality ratio (SMR) was calculated with 95% confidence intervals (CI). A visual review process was undertaken to assign the year from which the practice had acceptable mortality reporting (AMR). The process involved reviewer pairs who were blinded to each other's decisions. Patterns of death reporting were checked. The AMR year was applied as a filter to THIN data to assess its impact on the SMR.Results For most practices the SMR was relatively stable and the AMR year was easily identified with 86% agreement between the blinded reviewer pairs. Applying the AMR to THIN removed under-reporting of death. However, the total computerized follow-up reduced from 37 to 32 million patient-years. Problematic death recording patterns included some practices keeping only live patient records when converting their software systems thereby creating 'immortal periods' prior to this moment, and peaks occurring when practices updated the vital status of their patients' records.Conclusions This is the first time that an external standard has been used to assess completeness of mortality in automated primary care data. The resulting AMR year provides a natural filter for research and avoids biases associated with 'immortal periods', record updating and under-reporting. Copyright (C) 2008 John Wiley & Sons, Ltd.