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Background: Administrative hospital discharge data are widely used to assess quality of care in patients undergoing certain procedures. However, little is known about the validity of administrative coding of procedure data. We conducted a detailed chart review to evaluate the accuracy and completeness of information on procedures in administrative data.Methods: We randomly selected 1200 hospital separations in the period April 1, 1996, to March 31, 1997, from administrative discharge data of 3 acute adult hospitals in Calgary, Alberta, Canada. Each separation record in administrative data contains up to 10 procedure coding fields. The corresponding medical charts were reviewed for recording presence or absence of procedures. We then determined sensitivity to quantify the accuracy of coding presence of procedures in administrative data when these are present in the chart data (criterion standard).Results: The agreement between the 2 databases varied greatly across 35 procedures studied. The sensitivity ranged from 0% to 94%. Of 6 major procedures studied, validity of coding was generally good, with 5 procedures having coding sensitivity of 69% and over and only 1 (lysis of peritoneal adhesion) with a low sensitivity of 41%. In contrast, many minor procedures had low sensitivities. Of 29 minor procedures studied, sensitivity was lower than 50% for 15 procedures, between 50% and 79% for 10, and 80% and over for 4.Conclusion: Validity of information on procedures in administrative discharge data appears to be related to type of procedures. Major procedures that are usually performed in operating rooms are reasonably well-coded. Meanwhile, minor procedures that are routinely performed on wards or in radiology departments are generally undercoded. [ABSTRACT FROM AUTHOR]

Objective: The goal of this study was to assess the validity of the International Classification of Disease, 10th Version (ICD-10) administrative hospital discharge data and to determine whether there were improvements in the validity of coding for clinical conditions compared with ICD-9 Clinical Modification (ICD-9-CM) data., Methods: We reviewed 4,008 randomly selected charts for patients admitted from January 1 to June 30, 2003 at four teaching hospitals in Alberta, Canada to determine the presence or absence of 32 clinical conditions and to assess the agreement between ICD-10 data and chart data. We then re-coded the same charts using ICD-9-CM and determined the agreement between the ICD-9-CM data and chart data for recording those same conditions. The accuracy of ICD-10 data relative to chart data was compared with the accuracy of ICD-9-CM data relative to chart data., Results: Sensitivity values ranged from 9.3 to 83.1 percent for ICD-9-CM and from 12.7 to 80.8 percent for ICD-10 data. Positive predictive values ranged from 23.1 to 100 percent for ICD-9-CM and from 32.0 to 100 percent for ICD-10 data. Specificity and negative predictive values were consistently high for both ICD-9-CM and ICD-10 databases. Of the 32 conditions assessed, ICD-10 data had significantly higher sensitivity for one condition and lower sensitivity for seven conditions relative to ICD-9-CM data. The two databases had similar sensitivity values for the remaining 24 conditions., Conclusions: The validity of ICD-9-CM and ICD-10 administrative data in recording clinical conditions was generally similar though validity differed between coding versions for some conditions. The implementation of ICD-10 coding has not significantly improved the quality of administrative data relative to ICD-9-CM. Future assessments like this one are needed because the validity of ICD-10 data may get better as coders gain experience with the new coding system.

Background: Psychosocial factors, including social support, affect outcomes of cardiovascular disease, but can be difficult to measure. Whether these factors have different effects on mortality post-acute myocardial infarction (AMI) in men and women is not clear., Objective: To examine the association between living alone, a proxy for social support, and mortality postdischarge AMI and to explore whether this association is modified by patient sex., Design: Historical cohort study., Participants/setting: All patients discharged with a primary diagnosis of AMI in a major urban center during the 1998-1999 fiscal year., Measurements: Patients' sociodemographic and clinical characteristics were obtained by standardized chart review and linked to vital statistics data through December 2001., Results: Of 880 patients, 164 (18.6%) were living alone at admission and they were significantly more likely to be older and female than those living with others. Living alone was independently associated with mortality [adjusted hazard ratio (HR) 1.6, 95% confidence interval (CI) 1.0-2.5], but interacted with patient sex. Men living alone had the highest mortality risk (adjusted HR 2.0, 95% CI 1.1-3.7), followed by women living alone (adjusted HR 1.2, 95% CI 0.7-2.2), men living with others (reference, HR 1.0), and women living with others (adjusted HR 0.9, 95% CI 0.5-1.5)., Conclusions: Living alone, an easily measured psychosocial factor, is associated with significantly increased longer-term mortality for men following AMI. Further prospective studies are needed to confirm the usefulness of living alone as a prognostic factor and to identify the potentially modifiable mechanisms underlying this increased risk.

Background: Previous studies have indicated that sex differences may exist in the pharmacological management of acute myocardial infarction (AMI), with female patients being treated less aggressively., Objectives: To determine if previously reported sex differences in AMI medication use were also evident among all AMI patients treated at hospitals in an urban Canadian city., Methods: All patients who had a primary discharge diagnosis of AMI from all three adult care hospitals in Calgary, Alberta, in the 1998/1999 fiscal year were identified from hospital administrative records (n=914). A standardized, detailed chart review was conducted. Information collected from the medical charts included sociodemographic and clinical characteristics, comorbid conditions, and cardiovascular medication use during hospitalization and at discharge., Results: Similar proportions of female and male patients were treated with thrombolytics, beta-blockers, angiotensin-converting enzyme inhibitors, nitrate, heparin, diuretics and digoxin. Among patients aged 75 years and over, a smaller proportion of female patients received acetylsalicylic acid in hospital than did male patients (87% versus 95%; P=0.026). Multivariable logistic regression analysis revealed that, after correction for age, use of other anticoagulants/antiplatelets and death within 24 h of admission, sex was no longer an independent predictor for receipt of acetylsalicylic acid in hospital. Medications prescribed at discharge were similar between male and female patients., Conclusion: The results from this Canadian chart review study, derived from detailed clinical data, indicate that the pattern of pharmacological treatment of female and male AMI patients during hospitalization and at discharge was very similar. No sex differences were evident in the treatment of AMI among patients treated in an urban Canadian centre.

Objective: Canadian administrative hospital discharge data contain a diagnosis-type indicator for each coded diagnosis that allows researchers to distinguish complications from pre-existing diagnoses. Given that the validity of diagnosis-type indicators is unknown, we conducted a detailed chart review to evaluate the accuracy of diagnosis-type indicators for flagging complications., Study Design and Setting: We obtained administrative hospital discharge data for 1,200 randomly selected adult inpatient separations in Calgary, Alberta, occurring between April 1, 1996 and March 31, 1997. Each discharge record contains up to 16 diagnoses and 16 corresponding diagnosis-type indicators (value of "2"=complication). The corresponding medical charts were reviewed for evidence of diagnoses and complications. A complication was defined as a new diagnosis arising after the start of hospitalization. We determined the extent to which the diagnosis-type indicator in the administrative data agreed with the chart reviewer's assessment (criterion standard) of whether a diagnosis was a complication or not., Results: The agreement for complications between the two databases varied greatly across 12 conditions studied (kappa range: 0-0.72) and was often low (kappa <0.20 for six conditions). Sensitivity ranged from 0 to 57.1% (higher than 50% for only two conditions), indicating a tendency for complications to often be miscoded as baseline comorbidities. In contrast, specificity was generally high (range: 99.0-100%), suggesting that pre-existing conditions were usually appropriately coded as such in the administrative data., Conclusion: The validity of diagnosis-type indicators in Canadian administrative discharge data appears to be poor for some types of complications. This is likely to be of greatest concern in studies that rely solely on diagnosis-type indicators to define complications as outcomes.

A retrospective review of 8 cases of millipede 'burns' (caused by Polyconoceras sp. [= Salpidobolus sp.]) of the eye and periorbital tissues seen in a specialist ophthalmology unit over 6 years at Madang General Hospital, Papua New Guinea, was conducted. Such cases comprised 0.06% of the 14,000 patients seen in the same period. All cases were seen in the rainy season. Apart from one adult, all cases were children (age range 9 months-7 years). Clinical manifestations included a 'burn' of periorbital skin (all 8 cases), marked periorbital oedema (3 cases), conjunctivitis (2 cases), and keratitis (one case). All patients recovered fully with standard topical ophthalmic therapy. Despite anecdotal reports that blindness is a likely sequela of millipede 'burns' of the eye, it did not occur in this, the only published series of the condition.

This review is a composite of quarterly reports from an ophthalmologist's clinic in Madang over a ten-year period. The aim was to encompass ophthalmological practice in this situation quantitatively and qualitatively. It reflects, in the author's opinion, the state of ophthalmological services at present offered including ancillary services, and comments are made on some of the pathology encountered and surgery performed.

A series of 22 cases of unilateral proptosis at Angau Hospital, Lae, presenting over a 22-month period are analysed. The cases are discussed individually with emphasis on aetiology, treatment and prognosis. The differential diagnosis of unilateral proptosis is outlined.

Primary eye malignancy presenting in Papua New Guinea over a twelve-year period is surveyed. Subsequent cases presenting at Angau Memorial Hospital, Lae, are mentioned. Primary malignancies of the eye and orbit in general are discussed with particular emphasis on retinoblastoma.

An ocular survey was done on 6,153 children in 30 community schools in the Madang Province of Papua New Guinea over a two year period. Trachoma was diagnosed in 19.6% of subjects but was mild and asymptomatic in most. 9.6% of trachoma patients had moderate to severe disease, but only 5.3% required treatment. A significant refractive error was noted in 1.4% of subjects, and colour perception deficiency was found in 4.7% of boys and 0.5% of girls. 1.2% of subjects had other ocular abnormalities most of which were minor. Training paramedical workers and students in screening methods for ocular disease is one of the most important aspects of ocular surveys as many will be posted to remote areas of provinces which cannot be visited by an ophthalmologist or ocular survey teams.