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The Concept of ‘Intent’ within Australian Coronial Data: Factors Affecting the National Coronial Information System's Classification of Mortality Attributable to Intentional Self-Harm 澳大利亚冠状数据中的“意图”概念:影响国家冠状信息系统对故意自残死亡率分类的因素
IF 3.2 3区 医学 Q2 HEALTH POLICY & SERVICES Pub Date : 2014-10-01 DOI: 10.1177/183335831404300302
Leonie Dodds, Kerin Robinson, Leanne Daking, Lindsay Paul
within Australia all unexpected deaths are investigated by the Coroners Court; specifically, the coroner investigates the identity of the deceased and the cause and circumstances of death. This ‘unexpected death’ category inevitably includes cases of self-harm and suicide. Concerns regarding the accurate reporting of national suicide statistics resulted in a review of the coding process undertaken by the Australian Bureau of Statistics (ABS), which produces the national statistics, and a formal Commonwealth Government Senate Inquiry in 2009. This article reflects data and opinions collected prior to the Senate Inquiry or the adjustment of the ABS coding processes, and explores the role of the Coroner in determining the intent of the deceased person and the role the National Coronial Information System (NCIS) 1 database plays in the provision of this information. At the Case Notification and Case Closure stages of the coronial process, administrative coders abstract from the coronial file the ‘intent’ of the deceased and enter the data into relevant administrative systems (which upload to the NCIS). The relevant intent code in the NCIS is ‘Intentional Self-Harm’, which incorporates deliberate actions of self-harm and suicide. A mixed-method study was employed to investigate anecdotal reports of a problematic coronial coding process surrounding this category of cases. A sample of Australian coroners (n=16), and of the national population of NCIS coders (n=36), were surveyed using separate instruments, and an unobtrusive case review of sampled NCIS cases (n= 127) reflecting nine key mechanisms-of-death, was undertaken. Each Australian state and territory has its own Coroners Act, none of which provides legislative direction regarding the determination of intent by the coroner. Neither the coroner-respondents nor the coders favoured a standard proforma to record ‘intent’. In order to inform their classificatory decision-making regarding the deceased's ‘intent’, the coders need to abstract extensively from the entire case file, scrutinising documentary materials from different investigators. They rely primarily on the police report at Case Notification and the coroner's finding at Case Completion. Coders do not generally perceive the classification of ‘intent’ to be problematic; however, despite NCIS-provided coder (technical) support materials, there exist inconsistent coder work practices and, sometimes, absent documentary evidence reflecting lack of information for ascertainment and interpretation by the coroner, investigators, and forensic experts on the ‘intent’ of the deceased. The gap between what a coroner is legally required to document regarding ‘intent’ and what society needs to know for statistical and preventive purposes, seems problematic to bridge.
在澳大利亚,所有意外死亡都由验尸法庭调查;具体来说,验尸官调查死者的身份、死因和死亡情况。这种“意外死亡”不可避免地包括自残和自杀。对国家自杀统计数据准确报告的担忧导致澳大利亚统计局(ABS)对编码过程进行了审查,并于2009年进行了正式的联邦政府参议院调查。本文反映了在参议院调查或ABS编码过程调整之前收集的数据和意见,并探讨了验尸官在确定死者意图方面的作用,以及国家验尸信息系统(NCIS) 1数据库在提供这些信息方面所起的作用。在验尸程序的案件通知和结案阶段,行政编码员从验尸文件中提取死者的“意向”,并将数据输入相关的行政系统(上传到NCIS)。NCIS中相关的意图代码是“故意自残”,它包含了自残和自杀的故意行为。一项混合方法研究被用于调查围绕这类病例的有问题的冠状编码过程的轶事报告。使用不同的工具对澳大利亚验尸官样本(n=16)和NCIS编码员全国人口样本(n=36)进行了调查,并对NCIS样本病例(n= 127)进行了不引人注目的病例回顾,反映了九种关键的死亡机制。澳大利亚每个州和地区都有自己的《验尸官法》,但没有一项法律规定验尸官确定意图的立法方向。验尸官和编码员都不喜欢用标准形式来记录“意图”。为了为他们关于死者“意图”的分类决策提供信息,编码员需要从整个案件档案中广泛提取,仔细审查来自不同调查员的文件材料。他们主要依靠警方在案件通报时的报告和验尸官在案件结案时的调查结果。编码员通常不会认为“意图”的分类有问题;然而,尽管ncis提供了编码器(技术)支持材料,但存在不一致的编码器工作实践,有时缺乏书面证据,反映出验尸官、调查人员和法医专家对死者的“意图”缺乏确定和解释的信息。法律上要求验尸官记录的“意图”与社会为了统计和预防目的需要知道的东西之间的差距,似乎很难弥合。
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引用次数: 3
Impact of Documentation Errors on Accuracy of Cause of Death Coding in an Educational Hospital in Southern Iran 文献错误对伊朗南部某教育医院死亡原因编码准确性的影响
IF 3.2 3区 医学 Q2 HEALTH POLICY & SERVICES Pub Date : 2014-06-01 DOI: 10.1177/183335831404300205
Mohammad Hossein Hayavi Haghighi, M. Dehghani, Saeid Hoseini Teshizi, H. Mahmoodi
Accurate cause of death coding leads to organised and usable death information but there are some factors that influence documentation on death certificates and therefore affect the coding. We reviewed the role of documentation errors on the accuracy of death coding at Shahid Mohammadi Hospital (SMH), Bandar Abbas, Iran. We studied the death certificates of all deceased patients in SMH from October 2010 to March 2011. Researchers determined and coded the underlying cause of death on the death certificates according to the guidelines issued by the World Health Organization in Volume 2 of the International Statistical Classification of Diseases and Health Related Problems-10th revision (ICD-10). Necessary ICD coding rules (such as the General Principle, Rules 1–3, the modification rules and other instructions about death coding) were applied to select the underlying cause of death on each certificate. Demographic details and documentation errors were then extracted. Data were analysed with descriptive statistics and chi square tests. The accuracy rate of causes of death coding was 51.7%, demonstrating a statistically significant relationship (p=.001) with major errors but not such a relationship with minor errors. Factors that result in poor quality of Cause of Death coding in SMH are lack of coder training, documentation errors and the undesirable structure of death certificates.
准确的死亡原因编码可以使死亡信息有组织和可用,但有一些因素会影响死亡证明上的文件,从而影响编码。我们回顾了在伊朗阿巴斯港的Shahid Mohammadi医院(SMH),文件错误对死亡编码准确性的影响。我们研究了2010年10月至2011年3月SMH所有死亡患者的死亡证明。研究人员根据世界卫生组织在《疾病和健康相关问题国际统计分类第十次修订版》(ICD-10)第2卷中发布的指南,确定死亡证明上的潜在死因并对其进行编码。采用必要的ICD编码规则(如一般原则、规则1-3、关于死亡编码的修改规则和其他说明)来选择每个证书上的潜在死亡原因。然后提取人口统计细节和文件错误。数据分析采用描述性统计和卡方检验。死亡原因编码的准确率为51.7%,与严重错误有统计学意义(p= 0.001),与轻微错误无统计学意义(p= 0.001)。导致SMH死亡原因编码质量差的因素是编码人员缺乏培训、文档错误和死亡证明结构不理想。
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引用次数: 22
A Process Mining-Based Investigation of Adverse Events in Care Processes 基于流程挖掘的护理过程不良事件调查
IF 3.2 3区 医学 Q2 HEALTH POLICY & SERVICES Pub Date : 2014-03-01 DOI: 10.1177/183335831404300103
Filip Caron, J. Vanthienen, K. Vanhaecht, E. van Limbergen, Jochen Deweerdt, B. Baesens
This paper proposes the Clinical Pathway Analysis Method (CPAM) approach that enables the extraction of valuable organisational and medical information on past clinical pathway executions from the event logs of healthcare information systems. The method deals with the complexity of real-World clinical pathways by introducing a perspective-based segmentation of the date-stamped event log. CPAM enables the clinical pathway analyst to effectively and efficiently acquire a profound insight into the clinical pathways. By comparing the specific medical conditions of patients with the factors used for characterising the different clinical pathway variants, the medical expert can identify the best therapeutic option. Process mining-based analytics enables the acquisition of valuable insights into clinical pathways, based on the complete audit traces of previous clinical pathway instances. Additionally, the methodology is suited to assess guideline compliance and analyse adverse events. Finally, the methodology provides support for eliciting tacit knowledge and providing treatment selection assistance.
本文提出了临床路径分析方法(CPAM)方法,该方法能够从医疗信息系统的事件日志中提取有关过去临床路径执行的有价值的组织和医疗信息。该方法通过引入基于视角的日期戳事件日志分割来处理现实世界临床路径的复杂性。CPAM使临床路径分析师能够有效和高效地获得对临床路径的深刻见解。通过比较患者的具体医疗条件与用于表征不同临床途径变异的因素,医学专家可以确定最佳治疗方案。基于流程挖掘的分析可以基于之前临床路径实例的完整审计跟踪,获得对临床路径的有价值的见解。此外,该方法适用于评估指南遵守情况和分析不良事件。最后,该方法为隐性知识的获取和治疗选择提供支持。
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引用次数: 43
The Quality of Medical Record Documentation and External Cause of Fall Injury Coding in a Tertiary Teaching Hospital 某三级教学医院病案文件质量与摔伤外因编码
IF 3.2 3区 医学 Q2 HEALTH POLICY & SERVICES Pub Date : 2014-03-01 DOI: 10.1177/183335831404300102
J. Cunningham, D. Williamson, Kerin Robinson, Rhonda Carroll, Ross Buchanan, Lindsay Paul
This paper reviews the documentation and coding of External causes of admitted fall cases in a major hospital. Intensive analysis of a random selection of 100 medical records included blind re-coding in the International Statistical Classification of Diseases and Related Health Problems, Tenth revision, Australian Modification (ICD-10-AM), Fifth Edition for External causes to ascertain whether: (i) the medical records contained sufficient information for assignment of specific External cause codes; and (ii) the most appropriate External cause codes were assigned per available documentation. Comparison of the hospital data with the state-wide Victorian Admitted Episodes Database (VAED) data on frequency of use of External cause codes revealed that the index hospital, a major trauma centre, treated comparatively more falls involving steps, stairs and ladders. The hospital sample reflected lower usage, than state-wide, of unspecified External cause codes and Other specified activity codes; otherwise, there was similarity in External cause coding. A comparison of researcher and hospital codes for the falls study sample revealed differences. The ambulance report was identified as the best source of External cause information; only 50% of hospital medical records contained sufficient information for specific code assignation for all three External cause codes, mechanism of injury, place of occurrence and activity at time of injury. Whilst all medical records contained mechanism of falls injury information, 16% contained insufficient details, indicating a deficiency in medical record documentation to underpin external cause coding. This was compounded by flaws in the ICD- 10-AM classification.
本文回顾了某大医院住院跌倒病例外因的记录和编码。对随机选择的100份医疗记录进行深入分析,包括在《国际疾病和相关健康问题统计分类第十版澳大利亚修订版》(ICD-10-AM)第五版中对外因进行盲法重新编码,以确定:(i)医疗记录是否包含足够的信息来分配特定的外因代码;(ii)根据现有文件分配最合适的外因代码。将医院数据与全州维多利亚州住院病例数据库(VAED)关于使用外因代码频率的数据进行比较后发现,索引医院是一家主要的创伤中心,相对而言,治疗涉及台阶、楼梯和梯子的跌倒较多。医院样本反映出,与全州相比,未指明的外因代码和其他指定活动代码的使用率较低;否则,外因编码存在相似性。对瀑布研究样本的研究人员和医院代码的比较揭示了差异。救护车报告被认为是外因信息的最佳来源;只有50%的医院医疗记录包含足够的信息,以便对所有三种外因代码、伤害机制、发生地点和受伤时的活动进行具体代码分配。虽然所有医疗记录都包含跌倒损伤信息机制,但16%的记录细节不足,这表明医疗记录文件缺乏支撑外因编码的能力。ICD- 10-AM分类的缺陷使情况更加复杂。
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引用次数: 9
A Generic Quality Assurance Model (GQAM) for Successful E-Health Implementation in Rural Hospitals in South Africa 南非农村医院成功实施电子健康的通用质量保证模式(GQAM
IF 3.2 3区 医学 Q2 HEALTH POLICY & SERVICES Pub Date : 2014-03-01 DOI: 10.1177/183335831404300104
N. Ruxwana, M. Herselman, D. Pottas
Although e-health can potentially facilitate the management of scarce resources and improve the quality of healthcare services, implementation of e-health programs continues to fail or not fulfil expectations. A key contributor to the failure of e-health implementation in rural hospitals is poor quality management of projects. Based on a survey 35 participants from five rural hospitals in the Eastern Cape Province of South Africa, and using a qualitative case study research methodology, this article attempted to answer the question: does the adoption of quality assurance (QA) models add value and help to ensure success of information technology projects, especially in rural health settings? The study identified several weaknesses in the application of QA in these hospitals; however, findings also showed that the QA methods used, in spite of not being formally applied in a standardised manner, did nonetheless contribute to the success of some projects. The authors outline a generic quality assurance model (GQAM), developed to enhance the potential for successful acquisition of e-health solutions in rural hospitals, in order to improve the quality of care and service delivery in these hospitals.
尽管电子医疗可以潜在地促进稀缺资源的管理并提高医疗保健服务的质量,但电子医疗计划的实施仍然失败或没有达到预期。农村医院未能实施电子保健的一个关键因素是项目质量管理不善。基于对来自南非东开普省五家农村医院的35名参与者的调查,并使用定性案例研究方法,本文试图回答以下问题:质量保证(QA)模式的采用是否增加了价值并有助于确保信息技术项目的成功,特别是在农村卫生机构中?本研究确定了这些医院在质量保证应用中的几个弱点;然而,调查结果也表明,所使用的QA方法,尽管没有以标准化的方式正式应用,但确实有助于一些项目的成功。作者概述了一种通用质量保证模型(GQAM),开发该模型是为了提高农村医院成功获得电子卫生解决方案的可能性,从而提高这些医院的护理和服务质量。
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引用次数: 14
Clustering in Northern Territory Perinatal Data for 2003–2005: Implications for Analysis and Interpretation 2003-2005年北领地围产期数据的聚类:分析和解释的含义
IF 3.2 3区 医学 Q2 HEALTH POLICY & SERVICES Pub Date : 2014-03-01 DOI: 10.1177/183335831404300105
M. Steenkamp
Clustering in perinatal data can violate assumptions of independence, an important consideration for data analysis. Few published studies report on the extent of repeat births in routinely collected Australian perinatal data and the implications thereof for analysis and interpretation. This paper reports on a case study that examined the extent and implications of clustering in the Northern Territory Midwives Collection (NTMC) for the period 2003–2005. Data were obtained on 7,741 individual mothers giving birth to 8,707 babies in public hospitals during 2003–2005. Clusters of multiple pregnancies and repeat births were identified and the design effects for birth weight of Aboriginal and non-Aboriginal newborns were calculated. Of the mothers, 46.1% were Aboriginal. Of these, 13.2% had repeat singleton births; 0.4% had multiple pregnancies, and 0.3% had both. Of non-Aboriginal mothers, 8.7% had repeat singleton births; 1.2% had multiple pregnancies; and 0.3% had both. The design effect was 1.07 for Aboriginal newborns and 1.04 for non-Aboriginal newborns. The design effects indicate that the correct variance accounting for clustering is 4–7% larger than the incorrect variance ignoring clustering when three consecutive years of NT data are considered and an intracluster correlation coefficient of 0.48 is assumed for birth weight between twin and non-twin siblings. Depending on the outcome of interest, the impact of clustering should be considered in multivariate analysis of perinatal data, especially when such analyses involve more than one year's data, include large proportions of Aboriginal mothers and newborns, and groups with different rates of repeat births.
围产期数据的聚类可能会违反独立性假设,这是数据分析的一个重要考虑因素。很少有已发表的研究报告在常规收集的澳大利亚围产期数据中重复分娩的程度及其对分析和解释的影响。本文报告了一个案例研究,该研究检查了2003-2005年期间北领地助产士收集(NTMC)聚集的程度和影响。获得了2003-2005年期间在公立医院分娩8,707名婴儿的7,741名母亲的数据。确定多胎妊娠和重复分娩集群,并计算原住民和非原住民新生儿出生体重的设计效应。46.1%的母亲是原住民。其中,13.2%是重复单胎;0.4%有多胎妊娠,0.3%两者都有。在非土著母亲中,8.7%有重复单胎;1.2%为多胎妊娠;0.3%的人两者都有。原住民新生儿的设计效应为1.07,非原住民新生儿的设计效应为1.04。设计效果表明,当考虑连续三年的NT数据时,考虑聚类的正确方差比不考虑聚类的不正确方差大4-7%,并且假设双胞胎和非双胞胎兄弟姐妹之间的出生体重的聚类内相关系数为0.48。根据结果的不同,在围产期数据的多变量分析中应考虑聚类的影响,特别是当这种分析涉及超过一年的数据,包括大比例的土著母亲和新生儿,以及不同重复分娩率的群体时。
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引用次数: 4
Does the PCEHR Mean a New Paradigm for Information Security? Implications for Health Information Management PCEHR意味着信息安全的新范式吗?对卫生信息管理的影响
IF 3.2 3区 医学 Q2 HEALTH POLICY & SERVICES Pub Date : 2013-06-01 DOI: 10.1177/183335831304200205
Patricia A. H. Williams
Australia is stepping up to the new e-health environment. With this comes new legislation and new demands on information security. The expanded functionality of e-health and the increased legislative requirements, coupled with new uses of technology, means that enhancement of existing security practice will be necessary. This paper analyses the new operating environment for Australian healthcare and the legislation governing it, and highlights the changes that are required to meet this new context. Individuals are now more responsible for security and organisations should be prompted to review their security measures in light of the new demands of legislative compliance.
澳大利亚正在加紧适应新的电子卫生环境。随之而来的是新的立法和对信息安全的新要求。电子保健功能的扩大和立法要求的增加,再加上技术的新用途,意味着必须加强现有的安全实践。本文分析了澳大利亚医疗保健的新运营环境和管理它的立法,并强调了满足这种新环境所需的变化。现时,个人对保安的责任更大,而机构亦应根据遵守法例的新要求,检讨其保安措施。
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引用次数: 5
Book Review: Health Law in Australia 书评:澳大利亚的卫生法
IF 3.2 3区 医学 Q2 HEALTH POLICY & SERVICES Pub Date : 2011-10-01 DOI: 10.1177/183335831104000306
Andrew Took
Review(s) of: Health law in Australia, by Edited by Ben White Fiona McDonald and Lindy Willmott, Publisher: Thomson Reuters Australia, July 2010. Price: $115.
回顾:澳大利亚的卫生法,本·怀特编辑,菲奥娜·麦克唐纳和林迪·威尔莫特,出版商:汤森路透澳大利亚,2010年7月。价格:115美元。
{"title":"Book Review: Health Law in Australia","authors":"Andrew Took","doi":"10.1177/183335831104000306","DOIUrl":"https://doi.org/10.1177/183335831104000306","url":null,"abstract":"Review(s) of: Health law in Australia, by Edited by Ben White Fiona McDonald and Lindy Willmott, Publisher: Thomson Reuters Australia, July 2010. Price: $115.","PeriodicalId":55068,"journal":{"name":"Health Information Management Journal","volume":"40 1","pages":"38 - 39"},"PeriodicalIF":3.2,"publicationDate":"2011-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/183335831104000306","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65605182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 18
Book Review: Health Care and the Law (5th Ed.) 书评:医疗保健和法律(第5版)
IF 3.2 3区 医学 Q2 HEALTH POLICY & SERVICES Pub Date : 2011-03-01 DOI: 10.1177/183335831104000108
J. Mair
Review(s) of: Health Care and the Law (5th Ed.), by Janine McIlwraith and Bill Madden, Thomson Reuters (Professional), 2010 ISBN 9780455 227030, 735 pp. Price $98.00 (softbound).
回顾:医疗保健和法律(第5版),由Janine McIlwraith和Bill Madden,汤森路透(专业版),2010 ISBN 9780455 227030, 735页。价格98.00美元(软装本)。
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引用次数: 1
Book Review: The Globalization of Managerial Innovation in Health Care 书评:医疗保健管理创新的全球化
IF 3.2 3区 医学 Q2 HEALTH POLICY & SERVICES Pub Date : 2010-03-01 DOI: 10.1177/183335831003900115
D. O'Bryan
{"title":"Book Review: The Globalization of Managerial Innovation in Health Care","authors":"D. O'Bryan","doi":"10.1177/183335831003900115","DOIUrl":"https://doi.org/10.1177/183335831003900115","url":null,"abstract":"","PeriodicalId":55068,"journal":{"name":"Health Information Management Journal","volume":"39 1","pages":"66 - 66"},"PeriodicalIF":3.2,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/183335831003900115","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65604267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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