Accuracy of injury coding in Victorian hospital morbidity data

In Victoria injury surveillance data are drawn from hospital morbidity data. The accuracy and reliability of these data are often questioned. We aimed to ascertain the reliability of injury data in the Victorian inpatient minimum database. A random sample of 546 public hospital separations with principal diagnosis ICD-9-CM codes 800-999 was selected from four metropolitan hospitals. Medical records were reviewed, and the hospital coding was compared with the record content. The frequency of error in any coding field was 73 per cent (349/480); of diagnosis error, 61 per cent (292/480); of procedure error, 45 per cent (168/370); of error in the principal diagnosis, 19 per cent (93/480); and of error in external-cause codes (E-codes), 16 per cent (75/480). Ninety-four per cent of errors (87/93) in the principal diagnosis involved recoding within the same group of codes. Only 6 per cent (6/93) were recoded to principal diagnoses other than injury. Sixty-two per cent (181/292) were errors of omission of codes for comorbid conditions. Nearly half the errors in the principal diagnosis were minor, involving the last two digits. E-codes were more complete than diagnosis codes. The best predictors of error in the principal diagnosis were greater length of stay, type of injury code (poisonings and toxic effects were associated with lower error rates) and death as the outcome. While selection of data from secondary diagnosis fields may not provide complete data, the use of the principal-diagnosis code and E-codes for injury surveillance is feasible and reliable. The database is a valuable source of injury surveillance data, bearing in mind the limitations of coded hospital morbidity data.     

Age- and sex-differentials in morbidity at the start of an epidemiological transition: returns from the 1880 U.S. Census

This paper uses a new data set, the Public Use file of the 1880 U.S. Census of the Population, to examine national point prevalence rates of adult morbidity over the early phase of the United States epidemiologic transition. These historical data report health status at the individual level and allow the analysis of age and sex differentials in morbidity. Point prevalence rates of morbidity by major cause show that males generally had higher rates of morbidity and long-term disability than females, especially at mid-life and in old age. But large sex differences in the distribution of conditions by major cause occurred over two portions of the life course: in early adulthood and in old age. Age and sex differences in the distribution of adult morbidity reflected the health status divide of the communicable and degenerative conditions.     

Errors in handbook data regarding the magnetic properties of steel

Errors in current handbook data regarding the magnetic properties of steels are reported, along with their origins and means of preventing the use of erroneous data in practice.     

Real data simulation of a two-stage statistical diagnostic system.

Explored the usefulness of a 2-stage diagnostic system. In Stage 1, 72 psychiatric inpatients and 228 student clients at a psychological center were classified into 7 categories by means of a Q-factor analytical procedure used on data from the MMPI and Differential Personality Inventory. The classification rate was 81%. In Stage 2, 185 of the Ss and 185 random data records were subjected to a sequential Bayesian identification procedure. Of the 159 initially classified Ss, 53% were correctly identified using an average of 33 items. This suggests that the proposed diagnostic system warrants trial application in a real-life setting, although 85% of the initially unclassified Ss and 70% of the random data records were also identified. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Errors in copy typewriting.

An analysis of the errors made by a skilled female typist led to the identification of error factors that often act conjointly. Substitution errors indicated that she had acquired a cognitive map of the keyboard and then controlled her fingers by spelling the to-be-typed words covertly. Accordingly, some typographical errors were attributed in part to errors of inner speech. Intrusion errors revealed both habit factors and a response perseveration tendency. A handedness effect and omission errors indicated response error factors, and transpositions indicated temporal error factors. The skilled typist was thus viewed as having learned to inhibit error tendencies, and errors such as antedating response and doubling were interpreted in terms of disinhibition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of four types of data on diagnostic conceptualization in psychological testing.

"… judges were called upon to specify certain behaviors, characteristics and interests of a subject (a) on the basis of biographical facts alone and then (b) on the basis of either observation of roleplaying situations, interpretation of a Rorschach protocol, or study of a battery of objective and projective tests… . The judges… did not differ significantly in over-all accuracy regardless of the type of information on which their judgments were based… [and] roleplaying situations, and… the subject's Rorschach protocol… [permitted of] no greater accuracy… than had been achieved by study of biographical facts alone." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Causes, management and morbidity of acute hypoglycaemia in adults requiring hospital admission

In the community, acute hypoglycaemia is commonly caused by therapies for diabetes mellitus or the excessive consumption of alcohol. Although most episodes do not require admission to hospital, little information is available on the causes and outcome of those that do. We retrospectively surveyed adult patients admitted to a large urban teaching hospital with acute hypoglycaemia in a 12-month period, identifying 56 admissions of 51 patients. Forty-one had diabetes mellitus, 33 (80%) of whom were receiving treatment with insulin. The others had hypoglycaemia induced by excessive consumption of alcohol or by deliberate self-poisoning with insulin. A history of psychiatric illness and/or chronic alcoholism was common. Neurological manifestations of hypoglycaemia were the principal reason for admission, observed on 50 occasions (89%), and 11 events (20%) had precipitated convulsions. Although many patients (59%) had received treatment for hypoglycaemia before admission, hypoglycaemia recurred in 16% of patients in hospital. Four patients (7%) died following admission, but in only one case was this the direct result of hypoglycaemia. However, within 15 months of the index hypoglycaemia event, a further six patients (11%) had died, mostly of causes unrelated to hypoglycaemia. Patients who require hospital admission for treatment of hypoglycaemia have a high incidence of neurological manifestations, a high rate of mental illness and other medical disorders, and may represent a high-risk subgroup with a poor long-term prognosis.     

Pharmacist influence on economic and morbidity outcomes in a tertiary care teaching hospital

The influence of pharmacist participation on economic and morbidity outcomes at a tertiary care teaching hospital was studied. Patients admitted to internal medicine wards during a nine-month period were assigned to either a treatment team or a control team. Each team consisted of an attending physician, senior and junior medical residents, and medical students; the treatment team included a pharmacist who reviewed all patient charts, made rounds with the team, and recommended modifications of drug therapy. Pharmacy interaction with the control team was limited to contacting physicians about potentially dangerous orders, answering questions from the medical team, and handling orders for items not on the formulary or otherwise unavailable. After discharge, data from patient records were analyzed for pharmacy costs and total hospital costs and length of stay (as markers of the pharmacist's effect on economics and morbidity, respectively). Analysis of baseline characteristics showed that the two groups of patients were statistically comparable. Treatment team patients who were included in the data analysis (414) had significantly shorter stays (by a mean of 1.3 days) and lower pharmacy and total hospital costs (by a mean of $301 and $1654, respectively) than those included in the control team analysis (453). The direct participation of a pharmacist on a patient care team significantly decreased pharmacy and hospital costs, as well as length of stay, compared with minimal participation of a pharmacist.     

Combined MMPI and demographic data in predicting length of neuropsychiatric hospital stay.

Data available on 316 psychiatric patients, soon after admission to a hospital, were used in a multiple regression formula and in less formal statistical techniques to predict length of stay. Demographic and MMPI predictors made possible early identification of long stay patients at greater than base rate frequency. The asymptote of prediction was reached when 6 of 24 variables had been included, suggesting that further search in the area would be redundant. Prediction with the 5 prediction schema was stable on a cross-validation sample of 352. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Errors in 1973 Biographical Directory..

Calls for a retabulation of productivity ranks of graduate programs in psychology. W. M. Cox and V. Catt (see record 1978-21651-001) used the 1973 rather than the 1975 edition of the Biographical Directory of the American Psychological Association in their tabulation, which contained several errors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring morbidity of children in the community: a comparison of interview and diary data

We investigated mechanisms for enhancement of peroxynitrite (OONO-; 5 microM)-evoked [3H] gamma-aminobutyric acid (GABA) release. Hydroxyl radical scavengers such as N,N'-dimethylthiourea (DMTU), mannitol, and uric acid, significantly increased OONO--evoked [3H]GABA release, whereas urea showed no effects on the release. Removal of Ca2+ from incubation buffer abolished the enhancement of the release by DMTU, although DMTU showed no effects on the basal release with and without Ca2+ in extracellular space. These results indicate that hydroxyl radical scavengers facilitate OONO--evoked [3H]GABA release dependent on Ca2+.     

Variation in the survival of women with breast cancer in Scotland. The Scottish Breast Cancer Focus Group and The Scottish Cancer Therapy Network

We have investigated factors influencing the survival of women with early breast cancer in Scotland. In a retrospective study, clinical, treatment and 'service' factors, e.g. surgical case load, deprivation and geographical area (health board of first treatment) were recorded from hospital records. A total of 2148 women with invasive breast cancer diagnosed in 1987 were identified from the Scottish Cancer Registry, of whom 1619 without metastases at diagnosis underwent surgery as part of their primary treatment. In a multivariate analysis, clinical factors (age, clinical stage, pathological tumour size, node status and oestrogen receptor status) all influenced survival. After allowing for these clinical factors, surgical case load and deprivation did not have statistically significant effects on survival. By contrast, health board did affect survival. This was explained in part by the selection of patients for surgery. There appeared, however, to be a residual effect that may be related to differences in the use of adjuvant systemic treatment among the different health boards. We conclude that, in Scotland, geographical variation in both surgical and non-surgical treatment has a greater effect on variability in survival for women with breast cancer than surgical case load and deprivation.