Electronic medical record systems, data quality and loss to follow-up: survey of antiretroviral therapy programmes in resource-limited settings.
Electronic medical record systems, data quality and loss to follow-up: survey of antiretroviral therapy programmes in resource-limited settings.
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DOI：
10.2471/blt.07.049908
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发表时间：
2008-12
影响因子：
11.1
通讯作者：
ART-LINC collaboration of International Epidemiological Databases to Evaluate AIDS
中科院分区：
文献类型：
--
作者：
Forster M;Bailey C;Brinkhof MW;Graber C;Boulle A;Spohr M;Balestre E;May M;Keiser O;Jahn A;Egger M;ART-LINC collaboration of International Epidemiological Databases to Evaluate AIDS
描述低收入国家抗逆转录病毒疗法方案中使用的电子医疗数据库，并评估这些方案为保持和提高数据质量以及减少患者失访而采取的措施。2006年12月至2007年2月，在非洲、南美洲和亚洲的15个国家进行了一项关于在抗逆转录病毒疗法方案中使用电子病历系统的调查。在调查时入组研究中心但在过去12个月内未就诊的患者被视为失访。通过计算缺失关键变量（年龄、性别、HIV感染的临床阶段、CD 4+淋巴细胞计数和ART开始年份）的百分比来评估数据的质量。使用多变量logit模型分析了研究中心特征（如专门负责数据管理的工作人员数量）、减少失访的措施（如专门负责追踪患者的工作人员的存在）和数据质量与失访之间的关联。共纳入了21个为50060例患者提供ART的研究中心（每个研究中心的患者中位数：1000;四分位数间距，IQR：72- 19320）。18个站点（86%）使用电子数据库保存医疗记录; 15个站点（83%）依赖于供个人或小型企业使用的软件。每个研究中心关键变量的缺失数据百分比中位数为10.9%（IQR：2.0-18.9%），并随着数据管理培训而下降（优势比，OR：0.58; 95%置信区间，CI：0.37-0.90）和每100名ART患者中职员每周在数据库上花费的时间（OR：0.95; 95% CI：0.90-0.99）。每100名接受ART治疗的患者每周需要约10小时，以将关键变量的缺失数据减少到10%以下。开始ART后1年失访患者的中位百分比为8.5%（IQR：4.2-19.7%）。减少失访的战略包括外展小组、社区组织和检查死亡登记数据。所有三种策略的实施大大减少了失访（OR：0.17; 95% CI：0.15-0.20）。在资源有限的情况下，参与扩大抗逆转录病毒疗法的许多地点，所收集数据的质量和患者在抗逆转录病毒疗法治疗方案中的保留情况不能令人满意，主要原因是没有足够的工作人员接受过管理数据和追踪失访患者的培训。
To describe the electronic medical databases used in antiretroviral therapy (ART) programmes in lower-income countries and assess the measures such programmes employ to maintain and improve data quality and reduce the loss of patients to follow-up. In 15 countries of Africa, South America and Asia, a survey was conducted from December 2006 to February 2007 on the use of electronic medical record systems in ART programmes. Patients enrolled in the sites at the time of the survey but not seen during the previous 12 months were considered lost to follow-up. The quality of the data was assessed by computing the percentage of missing key variables (age, sex, clinical stage of HIV infection, CD4+ lymphocyte count and year of ART initiation). Associations between site characteristics (such as number of staff members dedicated to data management), measures to reduce loss to follow-up (such as the presence of staff dedicated to tracing patients) and data quality and loss to follow-up were analysed using multivariate logit models. Twenty-one sites that together provided ART to 50 060 patients were included (median number of patients per site: 1000; interquartile range, IQR: 72–19 320). Eighteen sites (86%) used an electronic database for medical record-keeping; 15 (83%) such sites relied on software intended for personal or small business use. The median percentage of missing data for key variables per site was 10.9% (IQR: 2.0–18.9%) and declined with training in data management (odds ratio, OR: 0.58; 95% confidence interval, CI: 0.37–0.90) and weekly hours spent by a clerk on the database per 100 patients on ART (OR: 0.95; 95% CI: 0.90–0.99). About 10 weekly hours per 100 patients on ART were required to reduce missing data for key variables to below 10%. The median percentage of patients lost to follow-up 1 year after starting ART was 8.5% (IQR: 4.2–19.7%). Strategies to reduce loss to follow-up included outreach teams, community-based organizations and checking death registry data. Implementation of all three strategies substantially reduced losses to follow-up (OR: 0.17; 95% CI: 0.15–0.20). The quality of the data collected and the retention of patients in ART treatment programmes are unsatisfactory for many sites involved in the scale-up of ART in resource-limited settings, mainly because of insufficient staff trained to manage data and trace patients lost to follow-up.
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增强流行病学观察研究的报告（Strobe）陈述：报告观察性研究的指南。
影响因子：
15.8
作者：
通讯作者：
--
影响因子：
3.3
作者：
Keiser, Olivia;Anastos, Kathryn;Egger, Matthias
通讯作者：
Egger, Matthias
DOI：
10.2471/blt.07.044248
发表时间：
2008-07-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Brinkhof, Martin WG;Dabis, François;Anglaret, Xavier
通讯作者：
Anglaret, Xavier
影响因子：
105.7
作者：
Fraser, HSF;Jazayeri, D;Mukherjee, JS
通讯作者：
Mukherjee, JS
影响因子：
7.4
作者：
Fraser HS;Allen C;Bailey C;Douglas G;Shin S;Blaya J
通讯作者：
Blaya J