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Background: The use of administrative databases in vascular injury research has been increasing, but the validity of the diagnosis codes used in this research is uncertain. We assessed the positive predictive value (PPV) of International Classification of Diseases, tenth revision (ICD-10), vascular injury codes in administrative claims data in Ontario. Methods: We conducted a retrospective validation study using the Canadian Institute for Health Information Discharge Abstract Database, an administrative database that records all hospital admissions in Canada. We evaluated 380 randomly selected hospital discharge abstracts from the 2 main trauma centres in Toronto, Ont., St. Michael's Hospital and Sunnybrook Health Sciences Centre, between Apr. 1, 2002, and Mar. 31, 2010. We then compared these records with the corresponding patients' hospital charts to assess the level of agreement for procedure coding. We calculated the PPV and sensitivity to estimate the validity of vascular injury diagnosis coding. Results: The overall PPV for vascular injury coding was estimated to be 95% (95% confidence interval [CI] 92.3-96.8). The PPV among code groups for neck, thorax, abdomen, upper extremity and lower extremity injuries ranged from 90.8 (95% CI 82.2-95.5) to 97.4 (95% CI 91.0-99.3), whereas sensitivity ranged from 90% (95% CI 81.5-94.8) to 98.7% (95% CI 92.9-99.8). Conclusion: Administrative claims hospital discharge data based on ICD-10 diagnosis codes have a high level of validity when identifying cases of vascular injury. Level of evidence: Observational Study Level III. Contexte: L'utilisation des bases de donnees administratives pour la recherche sur les lesions vasculaires est en hausse, mais la validite des codes diagnostiques utilises dans ces recherches est incertaine. Nous avons evalue la valeur predictive positive (VPP) des codes de lesions vasculaires de la dixieme edition de la Classification internationale des maladies (CIM-10) qui figurent dans une base de donnees administrative ontarienne. Methodes: Nous avons realise une etude de validation retrospective a partir de la base de donnees de l'Institut canadien d'information sur la sante (ICIS) sur les conges des patients, une base de donnees administrative qui enregistre toutes les hospitalisations au Canada. Nous avons evalue 380 conges hospitaliers de 2 grands centres de traumatologie de Toronto, en Ontario, soit l'Hopital St. Michael's et le Centre des sciences de la sante Sunnybrook, entre le 1er avril 2002 et le 31 mars 2010. Nous avons ensuite compare ces dossiers aux dossiers hospitaliers des patients correspondants pour verifier la concordance des codes attribues aux interventions. Nous avons calcule la VPP et la sensibilite pour estimer la validite des codes diagnostiques appliques aux lesions vasculaires. Resultats: La VPP globale pour les codes de lesions vasculaires a ete estimee a 95 % (intervalle de confiance [IC] de 95 % 92,3-96,8). Parmi les groupes de codes attribues aux lesions affectant le cou, le thorax, l'abdomen, les membres superieurs et inferieurs, la VPP a varie de 90,8 (IC de 95 % 82,2-95,5) a 97,4 (IC de 95 % 91.0-99,3), tandis que la sensibilite a varie de 90 % (IC de 95 % 81,5-94,8) a 98,7 % (IC de 95 % 92,9-99,8). Conclusion: Les donnees administratives sur les conges hospitaliers basees sur les codes diagnostiques de la CIM 10 ont un degre de validite eleve pour ce qui est des lesions vasculaires. Niveau de preuve: Etude d'observation Niveau III., Administrative claims databases are an important source of data for epidemiological research. These databases are often large and contain information on patient hospital admissions, emergency department visits, clinic visits and [...]

Objectives. We evaluated an intervention to support health workers after training in Integrated Management of Childhood Illness (IMCI), a strategy that can improve outcomes for children in developing countries by encouraging workers' use of evidence-based guidelines for managing the leading causes of child mortality. Methods. We conducted a randomized trial in Benin. We administered a survey in 1999 to assess health care quality before IMCI training. Health workers then received training plus either study supports (job aids, nonfinancial incentives, and supervision of workers and supervisors) or usual supports. Follow-up surveys conducted in 2001 to 2004 assessed recommended treatment, recommended or adequate treatment, and an index of overall guideline adherence. Results. We analyzed 1244 consultations. Performance improved in both intervention and control groups, with no significant differences between groups. However, training proceeded slowly, and low-quality care from health workers without IMCI training diluted intervention effects. Per-protocol analyses revealed that workers with IMCI training plus study supports provided better care than did those with training plus usual supports (27.3 percentage-point difference for recommended treatment; P Conclusions. IMCI training was useful but insufficient. Relatively inexpensive supports can lead to additional improvements. doi:10.2105/AJPH.2008.134411)

Objectives. We sought to ascertain the types of ethical challenges public health practitioners face in practice and to identify approaches used to resolve such challenges. Methods. We conducted 45 semistructured interviews with public health practitioners across a range of occupations (e.g., health officers, medical directors, sanitarians, nurses) at 13 health departments in Michigan. Results. Through qualitative analysis, we identified 5 broad categories of ethical issues common across occupations and locations: (1) determining appropriate use of public health authority, (2) making decisions related to resource allocation, (3) negotiating political interference in public health practice, (4) ensuring standards of quality of care, and (5) questioning the role or scope of public health. Participants cited a variety of values guiding their decision-making that did not coalesce around core values often associated with public health, such as social justice or utilitarianism. Public health practitioners relied on consultations with colleagues to resolve challenges, infrequently using frameworks for decision-making. Conclusions. Public health practitioners showed a nuanced understanding of ethical issues and navigated ethical challenges with minimal formal assistance. Decision-making guides that are empirically informed and tailored for practitioners might have some value. (Am J Public Health. 2009;99:369-374. doi: 10.2105/AJPH.2008.137588)

Objectives. Current methods to evaluate quality of care are usually limited to review of individual cases or comparisons of hospital mortality rates. We present an alternative method that compares complication rates adjusted for patient characteristics. Methods. Detailed clinical data that were specifically designed for quality comparisons of providers of revascularization procedures were abstracted from the medical records of 1998 Medicare patients, in 16 hospitals, who had coronary artery bypass surgery and 2091 patients, in 16 hospitals, who had angioplasty. Providers were ranked on the basis of an unadjusted risk, a risk adjusted for detailed clinical information, and a risk adjusted only for patient comorbidities. Results. Complication rates differed significantly and substantially among the hospital. Clinical adjustment changed the hospital rankings for the bypass surgery hospitals, but not for the angioplasty hospitals. Adjustment for comorbidities did not affect hospital rankings for either procedure. Conclusions. When sample sizes are limited, adverse outcome Rates may be a more sensitive measure of quality of care than mortality rates. Rates that are unadjusted or adjusted only for comorbidities may be inadequate for evaluating some providers of bypass surgery. (Am J Public Health. 1992;82:1631-1640)

Byline: Jochen Vollmann (1) Author Affiliation: (1) Institute for History of Medicine and Medical Ethics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany Article History: Registration Date: 18/10/2004