Abstract:The assessment of quality of care is becoming increasingly important in healthcare, both globally and in the Netherlands. The Dutch Minister of Health declared 2015 to be the year of transparency, thereby aiming to improve quality of care by transparent reporting of outcome data. With the increasing importance of transparency, knowledge on quality measurement will be essential for a cardiologist in daily clinical care. To that end, this paper provides a comprehensive overview of the Dutch healthcare structure,… Show more
“…Our results are in line with other studies showing high completeness and correctness of AMI diagnosis in administrative registers [3, 11, 12, 26]. The Myocardial Infarction Register was found to have higher completeness than was generally found in such registers in other countries [4–8, 10]. However, a recent report from the Swedish Heart Register (RIKS-HIA) also found high completeness compared to an administrative register [27].…”
Section: Discussionsupporting
confidence: 90%
“…A systematic review of acute myocardial infarction (AMI) diagnoses in administrative registers suggests that hospitalization data have high completeness and correctness, and can be used to identify patients with AMI [3]. Medical quality registers of patients with AMI have been found to be less complete than administrative registers, however [4–10]. Few studies have investigated the correctness of AMI in medical quality registers although such registers are frequently used as a “gold standard” to investigate the completeness and correctness of administrative registers [11, 12].…”
Aims: Health registers are used for administrative purposes, disease surveillance, quality assessment, and research. The value of the registers is entirely dependent on the quality of their data. The aim of this study was to investigate and compare the completeness and correctness of the acute myocardial infarction (AMI) diagnosis in the Norwegian Myocardial Infarction Register and in the Norwegian Patient Register. Methods: All Norwegian patients admitted directly to St Olavs hospital, Trondheim University Hospital, Trondheim University Hospital from 1 July to 31 December 2012 and who had plasma levels of cardiac troponin T measured during their hospitalization ( n=4835 unique individuals, n=5882 hospitalizations) were identified in the hospital biochemical database. A gold standard for AMI was established by evaluation of maximum troponin T levels and by review of the information in the medical records. Cases of AMI in the registers were classified as true positive, false positive, true negative, and false negative according to the gold standard. We calculated sensitivity, positive predictive value (PPV), specificity, and negative predictive value (NPV). Results: The Norwegian Myocardial Infarction Register had a sensitivity of 86.0% (95% confidence interval (CI) 82.8–89.3%), PPV of 97.9% (96.4–99.3%), and specificity of 99.9% and NPV of 98.9% (98.6-99.2%) (99.8–100%). The corresponding figures for the Norwegian Patient Register were 85.8% (95% CI 82.5–89.1%), 95.1% (92.9–97.2%), and 99.7% (99.5–99.8%) and 98.9% (98.6-99.2%), respectively. Both registers had a sensitivity higher than 95% when compared to hospital discharge diagnoses. The results were similar for men and women and for cases below and above 80 years of age. Conclusions: The Norwegian Myocardial Infarction Register and the Norwegian Patient Register are adequately complete and correct for administrative purposes, disease surveillance, quality assessment, and research.
“…Our results are in line with other studies showing high completeness and correctness of AMI diagnosis in administrative registers [3, 11, 12, 26]. The Myocardial Infarction Register was found to have higher completeness than was generally found in such registers in other countries [4–8, 10]. However, a recent report from the Swedish Heart Register (RIKS-HIA) also found high completeness compared to an administrative register [27].…”
Section: Discussionsupporting
confidence: 90%
“…A systematic review of acute myocardial infarction (AMI) diagnoses in administrative registers suggests that hospitalization data have high completeness and correctness, and can be used to identify patients with AMI [3]. Medical quality registers of patients with AMI have been found to be less complete than administrative registers, however [4–10]. Few studies have investigated the correctness of AMI in medical quality registers although such registers are frequently used as a “gold standard” to investigate the completeness and correctness of administrative registers [11, 12].…”
Aims: Health registers are used for administrative purposes, disease surveillance, quality assessment, and research. The value of the registers is entirely dependent on the quality of their data. The aim of this study was to investigate and compare the completeness and correctness of the acute myocardial infarction (AMI) diagnosis in the Norwegian Myocardial Infarction Register and in the Norwegian Patient Register. Methods: All Norwegian patients admitted directly to St Olavs hospital, Trondheim University Hospital, Trondheim University Hospital from 1 July to 31 December 2012 and who had plasma levels of cardiac troponin T measured during their hospitalization ( n=4835 unique individuals, n=5882 hospitalizations) were identified in the hospital biochemical database. A gold standard for AMI was established by evaluation of maximum troponin T levels and by review of the information in the medical records. Cases of AMI in the registers were classified as true positive, false positive, true negative, and false negative according to the gold standard. We calculated sensitivity, positive predictive value (PPV), specificity, and negative predictive value (NPV). Results: The Norwegian Myocardial Infarction Register had a sensitivity of 86.0% (95% confidence interval (CI) 82.8–89.3%), PPV of 97.9% (96.4–99.3%), and specificity of 99.9% and NPV of 98.9% (98.6-99.2%) (99.8–100%). The corresponding figures for the Norwegian Patient Register were 85.8% (95% CI 82.5–89.1%), 95.1% (92.9–97.2%), and 99.7% (99.5–99.8%) and 98.9% (98.6-99.2%), respectively. Both registers had a sensitivity higher than 95% when compared to hospital discharge diagnoses. The results were similar for men and women and for cases below and above 80 years of age. Conclusions: The Norwegian Myocardial Infarction Register and the Norwegian Patient Register are adequately complete and correct for administrative purposes, disease surveillance, quality assessment, and research.
“…Proponents of confidentiality hold to the view that an environment without negative public consequences improves the likelihood of disclosure by CPs to CCEs [26, 27]. The resultant openness between agency and educator produced by this ‘safe environment’ is thought to be conducive to a collaborative working relationship that increases the chances of quality improvements [28]. However, the evidence for this is elusive.…”
Section: Discussionmentioning
confidence: 99%
“…Those who argue in favour of such transparency believe the public and students have a right in a democratic society to know of educational practice standards [29]. They also argue that the possibility of positive reports motivates educational programs to strive to improve themselves and increase their marketability [26, 28].…”
BackgroundAccreditation of educational programs involves an independent agency assessing quality against a set of defined standards. Site inspection teams are appointed by an accrediting agency and compile a report with the intention of identifying deficiencies and making recommendations for their rectification and continued improvement. For chiropractic programs accreditation is carried out by Councils on Chiropractic Education (CCEs). However, the reliability of their site inspection teams remains unknown. Recent research has suggested that variability in chiropractic practice may be partially traced back to the education provider. This raises the possibility of deficient accreditation procedures that may include unsatisfactory site inspection standards or processes or the accreditation standards by which they work to.We sought to compare the various CCEs documented standards and processes for site inspection teams for similarities and differences with the intent of making recommendations to create uniform and high quality standards. Further, we sought to compare a sample of CCEs site inspection team surveys / reports for commonly identified recommendations and quality improvements and determine if they are adequately described in their accreditation standards.MethodIn December of 2018 invitation emails were sent to 4 CCEs through their website portals outlining a proposed study investigating site inspection teams’ standards and processes. Access was requested to all appropriately redacted documentation relating to site inspection teams and their chiropractic program reports. Follow up emails were sent several weeks later.ResultsOnly one of four of the CCEs responded by providing the requested information.Conclusion and recommendationsThree CCEs did not cooperate with this educational research. The possible reasons for the non-engagement is discussed.Electronic supplementary materialThe online version of this article (10.1186/s12998-019-0270-y) contains supplementary material, which is available to authorized users.
“…Following this software structure, the information will be to-the-point to the physician, understandable to the patient and transparent to the public. Structured storage of information enables easier data extraction for quality assessment purposes [ 18 ]. Fig.…”
Although it has been possible to transfer electrocardiograms via a phone line for more than 100 years, use of internet-based patient monitoring and communication systems in daily care is uncommon. Despite the introduction of numerous health-monitoring devices, and despite most patients having internet access, the implementation of individualised healthcare services is still limited. On the other hand, hospitals have invested heavily in massive information systems offering limited value for money and connectivity. However, the consumer market for personal healthcare devices is developing rapidly and with the current healthcare-related investments by tech companies it can be expected that the way healthcare is provided will change dramatically. Although a variety of initiatives under the banner of ‘e-Health’ are deployed, most are characterised by either industry-driven developments without proven clinical effectiveness or individual initiatives lacking the embedding within the traditional organisations. However, the introduction of numerous smart devices and internet-based technologies facilitates the fundamental redesign of healthcare based on the principle of achieving the best possible care for the individual patient at the lowest possible cost.Conclusion The way healthcare is delivered will change, but to what degree healthcare professionals together with patients will be able to redesign healthcare in a structured manner is still a question.
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