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Purpose: Describe the relative frequency and joint effect of missing and misreported fetal death certificate (FDC) data and identify variations by key characteristics., Methods: Stillbirths were prospectively identified during 2006-2008 for a multisite population-based case-control study. For this study, eligible mothers of stillbirths were not incarcerated residents of DeKalb County, Georgia, or Salt Lake County, Utah, aged ≥13 years, with an identifiable FDC. We identified the frequency of missing and misreported (any departure from the study value) FDC data by county, race/ethnicity, gestational age, and whether the stillbirth was antepartum or intrapartum., Results: Data quality varied by item and was highest in Salt Lake County. Reporting was generally not associated with maternal or delivery characteristics. Reasons for poor data quality varied by item in DeKalb County: some items were frequently missing and misreported; however, others were of poor quality due to either missing or misreported data., Conclusions: FDC data suffer from missing and inaccurate data, with variations by item and county. Salt Lake County data illustrate that high quality reporting is attainable. The overall quality of reporting must be improved to support consequential epidemiologic analyses for stillbirth, and improvement efforts should be tailored to the needs of each jurisdiction., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: Successful primary bladder closure of classic bladder exstrophy sets the stage for development of adequate bladder capacity and eventual voided continence. The postoperative pathway following primary bladder closure at the authors' institution is quantitatively and qualitatively detailed., Materials and Methods: Sixty-five consecutive newborns (47 male) undergoing primary closure of classic bladder exstrophy were identified and data were extracted relating to immediate postoperative care. Overall success rate was utilized to validate the pathway., Results: Mean age at time of primary closure was 4.6 days and mean hospital stay was 35.8 days. Osteotomy was performed in 19 patients (mean age 8.8 days), and was not required in 39 infants (mean age 2.9 days). All patients were immobilized for 4 weeks. Tunneled epidural analgesia was employed in 61/65 patients. All patients had ureteral catheters and a suprapubic tube, along with a comprehensive antibiotic regimen. Postoperative total parenteral nutrition was commonly administered, and enteral feedings started around day 4.6. Our success rate of primary closure was 95.4%., Conclusions: A detailed and regimented plan for bladder drainage, immobilization, pain control, nutrition, antimicrobial prophylaxis, and adequate healing time is a cornerstone for the postoperative management of the primary closure of bladder exstrophy., (Copyright © 2011 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Objective: To measure agreement between gestational age based on maternal report of expected date of delivery (EDD) 9 months after birth and gestational age at birth in routine hospital data. Furthermore, to examine whether sociodemographic and perinatal factors influenced agreement and whether disagreement affected classification of infants in preterm groups., Study Design and Setting: The study used data on 8,058 singleton infants from the UK Millennium Cohort Study. Women were interviewed 9 months after birth and interviews were linked to routine hospital data. The infant's date of birth and EDD were used to calculate gestational age in completed weeks., Results: Agreement between maternal report and hospital data was 72% for exact number of weeks' gestation and 94% for agreement within 1 week. Disagreement was associated with the infant not being firstborn, unplanned pregnancy, late or no antenatal care, and low socioeconomic status. Maternal report of gestational age resulted in slightly more children being classified as preterm (6.4%) than gestational age based on hospital data (6.1%). Agreement was found to be poor for postterm births., Conclusion: Gestational age based on retrospective maternal reporting of EDD is reliable within 1 week or when used to assign infants to broad gestational groups., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background and Objectives: Validation of health administrative data for identifying patients with different health states (diseases and conditions) is a research priority, but no guidelines exist for ensuring quality. We created reporting guidelines for studies validating administrative data identification algorithms and used them to assess the quality of reporting of validation studies in the literature., Methods: Using Standards for Reporting of Diagnostic accuracy (STARD) criteria as a guide, we created a 40-item checklist of items with which identification accuracy studies should be reported. A systematic review identified studies that validated identification algorithms using administrative data. We used the checklist to assess the quality of reporting., Results: In 271 included articles, goals and data sources were well reported but few reported four or more statistical estimates of accuracy (36.9%). In 65.9% of studies reporting positive predictive value (PPV)/negative predictive value (NPV), the prevalence of disease in the validation cohort was higher than in the administrative data, potentially falsely elevating predictive values. Subgroup accuracy (53.1%) and 95% confidence intervals for accuracy measures (35.8%) were also underreported., Conclusions: The quality of studies validating health states in the administrative data varies, with significant deficits in reporting of markers of diagnostic accuracy, including the appropriate estimation of PPV and NPV. These omissions could lead to misclassification bias and incorrect estimation of incidence and health services utilization rates. Use of a reporting checklist, such as the one created for this study by modifying the STARD criteria, could improve the quality of reporting of validation studies, allowing for accurate application of algorithms, and interpretation of research using health administrative data., (Copyright © 2011 Elsevier Inc. All rights reserved.)

In our hospital all operative procedures are coded using the OPCS 4.3 classification and in addition are entered into an independent theatre databases. Using these two databases we identified patients undergoing hip fracture surgery at this hospital between 1st November 2003 and 30th November 2006. We identified 408 cases. No single database identified all 408 cases. A quarter of cases (N=98) were not procedurally coded. Only 43.2% (N=176) of cases were recorded in both the theatre database and procedurally coded at the time of this study. Overall the coding accuracy of these 176 cases was 93.8%. Clinical coding at this hospital was unreliable and inaccurate, which has major implications for national statistics, performance analysis and most importantly Payment by Results. We discuss this further and offer possible solutions to improve the coding process.

Objectives: This research identifies the level of specificity of cause-of-injury morbidity data in Australia. The research explores reasons for poor-quality data across different causes-of-injury areas, including a lack of clinical documentation and insufficient detail in the classification system., Methods: The 2002/03 hospital morbidity dataset of 593,079 injury-related hospital admissions was analysed to examine the specificity of coded external cause-of-injury data., Results: While overall specificity appeared high, the cause of 47,660 injuries was not specifically defined according to the code assigned. Only 56% of cases for whom injury was the result of an accidental fall were assigned a specific code to identify the causal detail; 19% were assigned an 'Other Specified' fall code, suggesting a lack of specific code availability; and 25% were assigned an 'Unspecified Fall' code, suggesting a lack of clinical documentation to facilitate code selection., Conclusions: To improve the quality of injury-related hospital morbidity data, two main areas to focus resources are: 1) the development of more specific cause-of-injury codes; and 2) the provision of more detailed documentation from clinicians., Implications: Clinicians and clinical coders need to work together to improve the quality of injury-related coded data through the provision of specific codes and improved clinical documentation. Accurate and comprehensive data pertaining to the circumstances surrounding hospitalised injury events will benefit injury prevention and surveillance initiatives, provide justification for resources related to injury hospitalisation, and assist in external cause research in Australia.

Purpose: The purpose of this study was to measure the reliability of data reported on Indiana electronic birth certificates. Knowing the accuracy of birth certificate data is crucial when identifying community health needs and evaluating birth outcomes interventions., Methods: This study compared 1996 electronic birth certificate data on a random sample of 1050 Indiana hospital births to data abstracted from the hospital medical records for the same patients. Kappa scores, Pearson r correlation values, sensitivity, specificity, and positive predictive values of the birth certificate data were used to measure agreement., Results: Parents' demographic variables had the best agreement, followed by birth outcome variables. Delivery type, cesarean indications, pregnancy history, prenatal care and mother's risk variables were found to have moderate agreement. Agreement was poor for variables measuring labor and delivery complications, obstetric procedures, concurrent illnesses, pregnancy complications, congenital anomalies, and abnormal conditions., Conclusions: The results of this study clearly show that some important descriptive and outcome data are reliable while infrequent events are generally not. The results indicate a need to improve the quality of data reported on birth certificates.

Background and Objective: The accuracy of comorbidity data within the Western Australian Data Linkage System was evaluated by means of comparison with hospital charts and a general practitioner (GP) survey., Methods: Patients (n=2,037) with a hospital admission from 1991 to 1996 were selected. Linked data were extracted for 100 comorbidities, categorized into 16 diagnostic chapters, for each hospital admission within a 5-year period. Clinical chart review and a GP survey were performed. Comorbidity occurrence in each data source and false-positive and false-negative diagnoses were ascertained., Results: Administrative data contained 45.5% of comorbidity recorded in hospital charts and underascertained secondary conditions for all 16 diagnostic chapters. False-positive diagnoses were low for most conditions (range: 0-1.5%); however, a high occurrence of false negatives existed for all comorbidity chapters (range: 16.3-91.3%). GP-identified comorbidity was 20.0% greater than that found using administrative data but, with the exceptions of injury-poisoning and cutaneous-subcutaneous diseases, was less (42.0%) than that observed from hospital charts., Conclusion: Our results indicate that when accurate comorbidity data are crucial to health outcome research, hospital chart review (as opposed to using administrative data) may be required. Furthermore, surveying GPs, at least in Australia, appears an unsatisfactory alternative to hospital charts for obtaining retrospective comorbidity information.

Background: The district hospital is considered essential for delivering basic, cost-effective health care to children in resource poor countries. We aimed to investigate the performance of these facilities in Kenya., Methods: Government hospitals providing first referral level care were prospectively sampled from 13 Kenyan districts. Workload statistics and data documenting the management and care of admitted children were obtained by specially trained health workers., Findings: Data from 14 hospitals were surveyed with routine statistics showing considerable variation in inpatient paediatric mortality (range 4-15%) and specific case fatality rates (eg, anaemia 3-46%). The value of these routine data is seriously undermined by missing data, apparent avoidance of a diagnosis of HIV/AIDS, and absence of standard definitions. Case management practices are often not in line with national or international guidelines. For malaria, signs defining severity such as the level of consciousness and degree of respiratory distress are often not documented (range per hospital 0-100% and 9-77%, respectively), loading doses of quinine are rarely given (3% of cases) and dose errors are not uncommon. Resource constraints such as a lack of nutritional supplements for malnourished children also restrict the provision of basic, effective care., Interpretation: Even crude performance measures suggest there is a great need to improve care and data quality, and to identify and tackle key health system constraints at the first referral level in Kenya. Appropriate intervention might lead to more effective use of health workers' efforts in such hospitals.

Study Objective: To determine the impact of changes in form design on the capture of administrative and clinical data elements., Design: Randomized retrospective chart review., Setting: Academic health center., Patients: Patients undergoing surgical procedures in the operating rooms at Medical College Hospital., Intervention: The principal intervention was the implementation of a newly designed anesthesiology preoperative evaluation form with the intent to improve data capture., Measurements: Charts were reviewed for the presence or absence of the following indicators: Addressograph Stamp, Proposed Surgery, Current Medications, Medication Doses/Frequency, Allergies, ASA Physical Status, Anesthesia Plan, Attending Note, and fasting (NPO) Status., Main Results: Completion of Proposed Surgery and ASA Physical Status was lower for the structured form. Completion of Attending Notes was higher with the new form. Medication Doses were more often completed, but they remained below desired levels on the new form., Conclusions: Design of a form can have a significant impact on the completion rate of form elements. Visual cues such as a labeled space for medication doses may improve the completion of these elements. Design layout can also have an influence on completion. In this case, changes to the layout may have impeded the completion rate for ASA Physical Status.

Background: The schooling of 1 of every 8 children is influenced by the Individuals with Disabilities Education Act (IDEA). The IDEA also governs, to a degree, the relationship between interdisciplinary hospital clinics that evaluate many of these children and the schools that provide educational services. Little is known about how this relationship functions or how educational personnel perceive reports from hospital settings., Objectives: To describe special education administrator and hospital evaluator perspectives on hospital assessments of children with learning problems., Methods: A survey of attendees at a 1998 meeting of the Massachusetts Association of Special Education Administrators was conducted by use of a questionnaire using closed and open-ended questions. Subsequently, focus groups were held with hospital evaluators., Results: Special education administrators describe a high level of frustration with hospital-school relations. They state that hospital reports do not meet the needs of children in the educational setting. They seek closer collaboration with medical evaluators. Evaluators working in hospital settings acknowledge frustration perceived by school personnel. They state that communication with educational personnel improves the quality of their reports and outcomes for the child., Conclusions: Hospital assessments of children with learning problems are associated with high levels of frustration among special education administrators. These assessments might be made more useful if careful attention were paid to the needs of educators. Greater communication between hospital evaluators and school personnel may increase the usefulness of hospital clinic assessments of children with learning problems.

Objective: To assess the coding accuracy of primary and secondary discharge diagnoses in the Quebec hospital discharge database for elderly persons with myocardial infarction (MI)., Design: Retrospective chart review in a convenience sample of six Montreal hospitals. The diagnoses listed in the medical chart were compared with those listed in the hospital discharge database. For each subject, the Charlson comorbidity index was calculated twice, once based on the medical chart and again based on the hospital discharge database., Patients: Subjects aged 65 years and over who had an MI coded as the primary discharge diagnosis in the hospital discharge database and who were discharged alive., Main Results: For 234 MI survivors, the positive predictive value (ie, probability that a patient with MI reported in the hospital discharge database had an MI diagnosed by the discharging physician) for coding MI was 0.96 (95% CI 0.94, 0.98). Comorbid medical conditions and complications of the MI were under-reported in the hospital discharge database, which meant that the Charlson index based on the hospital discharge database was an average of 0.71 units lower than the Charlson index based on the medical chart., Conclusions: When studying survivors of MI by using hospital discharge databases, the advantages must be weighed against potential drawbacks in the quality of the information. Hospital discharge databases are almost as reliable as medical charts for identifying MI patients, but there is substantial under-reporting of comorbid medical conditions.

Hospital medical records staff enter diagnostic codes on charts using the International Classification of Diseases (Clinically Modified), Ninth Revision (ICD-9-CM). In a downtown Toronto tertiary hospital, 209 consecutive charts coded for acute myocardial infarction as the primary diagnosis in 1987-88 were reviewed. Criteria for documentation of acute myocardial infarction included symptomatic, electrocardiographic and enzymatic elements. Forty-three (21%) false-positives, ie, charts coded acute myocardial infarction where criteria were not fulfilled, were found (95% confidence interval 15 to 26%). Physician diagnosis of acute myocardial infarction appeared on the face sheet of 30 of the false-positive cases. Common reasons for false-positive face sheet entries and chart coding were acute myocardial infarction within the previous eight weeks with transfer or readmission for coronary angiography and other procedures; and presumed acute myocardial infarction on admission subsequently unproven or disproved. The false-positive proportion was similar to a Canadian study drawing on charts from hospitals of various sizes in 1977, lower than in recent reports from various American tertiary teaching hospitals (P less than 0.0001), and higher than in five Boston area community hospitals (P = 0.0005) where procedure-related transfers or readmissions of previous acute myocardial infarction patients were less likely. This audit lends credence to arguments that changes are needed in ICD-9-CM codes for acute myocardial infarction and in the assignation of reasons for hospitalization.