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Information quality in a remote rural maternity unit in Ghana

HEALTH POLICY AND PLANNING 2000年第2期15卷 170-176页

作者： Allotey, PA Reidpath, D Univ Melbourne Key Ctr Womens Hlth Int Programs Fac Med & Dent Melbourne Vic 3053 Australia Deakin Univ Sch Hlth Sci Burwood Australia

The collection of accurate maternal outcome data enables causes of morbidity and mortality to be identified, which in turn permits interventions to be targeted appropriately. It also allows estimates to be made about the importance of various indicators in predicting birth outcome. These indicators can then be compared between health services, across time and against programme objectives, thus ensuring a management information system that informs policy and provides for real change. A review was done of data collection at the antenatal clinic and maternity ward in a remote rural hospital in northern Ghana. The data collected came from maternity ward records and participant observation, and they highlight deficiencies in the record management procedures. It is argued that exhorting staff to greater accuracy, although obvious, may not be the only solution, because of the structural impediments that often give an illusion of accuracy. The best data need to be collected within the constraints of the equipment and the people. Furthermore, to make the task more meaningful, regular feedback needs to be provided so that the process of record keeping is relevant to those who do it. Ministries of health need to conduct regular audits, like this microanalysis, so that policies are not based on data that are analyzed under a presumption of accuracy.

关键词：数据收集加纳/流行病学医院乡村/组织和管理信息管理/标准产妇卫生保健服务/组织和管理病案/标准缺医地区结果评价(卫生保健)/标准妊娠结局/流行病学女(雌)性人类妊娠

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Practical risk-adjusted quality control charts for infection control

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AMERICAN JOURNAL OF INFECTION CONTROL 2000年第6期28卷 406-414页

作者： Gustafson, TL Infect Control & Prevent Analysts Inc Austin TX 78735 USA

Background: Control chart methodology has been widely touted for monitoring and improving quality in the health care setting. P charts and U charts are frequently recommended for rate and ratio statistics, but their practical value in infection control may be limited because they (1) are not risk-adjusted, and (2) perform poorly with small denominators. The Standardized Infection Ratio is a statistic that overcomes both these obstacles. It is risk-adjusted, and it effectively increases denominators by combining data from multiple risk strata into a single value. Setting: The AICE National Database Initiative is a voluntary consortium of US hospitals ranging in size from 50 to 900 beds. The infection control professional submits monthly risk-stratified data for surgical site infections, ventilator-associated pneumonia, and central line-associated bacteremia. Methods: Run charts were constructed for 51 hospitals submitting data between 1996 and 1998. Traditional hypothesis tests (P values < .05) flagged 128 suspicious points, and participating infection control professionals investigated and categorized each flag as a "real problem" or "background variation." This gold standard was used to compare the performance of 5 unadjusted and 11 risk-adjusted control charts. Results: Unadjusted control charts (C, P, and U charts) performed poorly. Flags based on traditional 3-sigma limits suffered From sensitivity < 50%, whereas 2-sigma limits suffered from specificity < 50%. Risk-adjusted charts based on the Standardized Infection Ratio performed much better The most consistent and useful control chart was the mXmR chart. Under optimal conditions, this chart achieved a sensitivity and specificity > 80%, and a receiver operating characteristic area of 0.84 (P < .00001). Conclusions: These findings suggest a specific statistic (the Standardized Infection Ratio) and specific techniques that could make control charts valuable and practical tools for infection control.

关键词：菌血症/流行病学菌血症/病因学偏倚(流行病学) 交叉感染/流行病学交叉感染/病因学数据说明统计数据库事实型表格和记录管理/标准指导方针(主题) 医院病床数感染控制/组织和管理信息管理/标准病案/标准肺炎/流行病学肺炎/病因学质量控制问卷调查风险调节/组织和管理敏感性与特异性外科伤口感染/流行病学外科伤口感染/病因学美国/流行病学人类

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Connectivity and control in the year 2000 and beyond

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HARVARD BUSINESS REVIEW 1998年第4期76卷 148-+页

作者： Nolan, RL Harvard Business Sch Boston MA USA

By now, most executives are familiar with the famous Year 2000 problem - and many believe that their companies have the situation well in hand. After all, it seems to be such a trivial problem - computer software that interprets "00" to be the year 1900 instead of the year 2000. And yet armies of computer professionals have been working on updating code in payroll systems, distribution systems, actuarial systems, sales-tracking systems, and the like. The problem is pervasive. Not only is it in your systems, it's in your suppliers' systems, your bankers' systems, and your customers' systems. It's embedded in chips that control elevators, automated teller machines, process-control equipment, and power grids. Already, a dried-food manufacturer destroyed millions of dollars of perfectly good product when a computer counted inventory marked with an expiration date of "oo" as nearly a hundred years old. And when managers of a sewage-control plant turned the clock to January I, 2000 on a computer system they thought had been fixed, raw sewage pumped directly into the harbor. It has become apparent that there will not be enough time to find and fix all of the problems by Tanuary I, 2000. And what good will it do if your computers work but they're connected with systems that don't! That is one of the questions Harvard Business School professor Richard Nolan asks in his introduction to HBR's Perspectives on the Year 2000 issue. How will you prepare your organization to respond when things start to go wrong? Fourteen commentators offer their ideas on how senior managers should think about connectivity and control in the year zooo and beyond.

关键词：年表商业/组织和管理计算机系统/标准计算机系统/发展趋势计算机大型设备失效信息管理/标准信息管理/发展趋势管理信息系统/标准管理信息系统/发展趋势软件/标准软件/发展趋势系统综合时间美国

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Challenges in medical education - what the doctor ordered?

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POSTGRADUATE MEDICAL JOURNAL 2000年第900期76卷 599-601页

作者： Severs, M Crane, S Univ Portsmouth Queen Alexandra Hosp Postgrad Med Sch Cosham PO6 3LY Hants England

Dependable, 3 through to A Health Service of all the Talents. 1 This proposes radical changes, including that postgraduate deaneries coalesce with regional health authority boundaries, and the royal colleges participate more closely with others in workforce planning initiatives to establish wider consultation for the accreditation and location of training places. 1 It is also proposed that funding formulas for specialist registrar posts should become more flexible, reflecting the needs of service delivery and learning opportunity. Historic precedence will give way to carefully planned allocation of resources to meet workforce demands, to be driven by population needs and care pathways. [...]the relationship between service delivery and training posts is made explicit . . . those who pay the piper?

关键词：教育医学/组织和管理教育医学/发展趋势教育医学继续/经济学教育医学继续/发展趋势信息管理/教育信息管理/标准院校医学/组织和管理公费医疗/经济学公费医疗/组织和管理公费医疗/发展趋势

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The information requirements of total purchasing projects. Implications for primary care groups.

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Journal of management in medicine 1999年第1期13卷 13-22页

作者： Leese, B. Mahon, A. National Primary Care Research and Development Centre University of Manchester United Kingdom

To successfully purchase, commission and manage health services at the primary care level requires accurate, reliable, up-to-date and appropriate information for use by trusts, health authorities, and by the soon to be operational primary care groups. The national total purchasing evaluation has provided evidence which will be relevant to primary care groups, particularly in the areas of information technology (IT) and access to information. Progress in developing independent purchasing by total purchasers was slower than anticipated because of the large number of factors which had to be taken into account, of which IT and information were just two. Accurate and timely information will be crucial for primary care groups if they are to move from level 1 to level 4 without undue delay.

关键词：预算合同业务/经济学合同业务/组织和管理大不列颠联合开业/经济学联合开业/组织和管理卫生服务研究医院公立/经济学医院公立/组织和管理信息管理/标准初级卫生保健/经济学初级卫生保健/组织和管理地区卫生计划公费医疗/组织和管理

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Practice libraries: managing printed information and meeting the information needs of staff in general practice.

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Health libraries review 1997年第1期14.0卷 9-21页

作者： Bryant, S.L. Information Consultant 22 New Meadow Aylesbury Bucks HP21 7AN UK

Librarians and GPs share an interest in exploring different approaches to providing information to general practice and improving information management within it. Describing the aims, policy, collections, enquiries and services of three Practice Libraries in the Aylesbury area, this paper demonstrates that an information professional can make a significant impact on the management of printed information whilst facilitating access to external sources. A wealth of opportunities lie ahead for those willing to apply information handling skills to general practice. Medical librarians will need to strike a careful balance between providing direct access to sources and the development of information services tailored to meet the needs of primary health care workers.

关键词：视听设备教育继续评价研究家庭医学/组织和管理大不列颠信息管理/教育信息管理/组织和管理信息管理/标准图书馆医学出版物

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Informing the market: The strengths and weaknesses of information in the British National Health Service

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HEALTH CARE ANALYSIS 1997年第2期5卷 149-156页

作者： McKee, M Chenet, L UNIV LONDON LONDON SCH HYG & TROP MED HLTH SERV RES UNIT LONDON WC1E 7HT ENGLAND

Many countries are experimenting with planned (or quasi-) markets to discover if they can efficiently deliver health care in keeping with societal objectives. This paper examines the information requirements of this approach. Information is necessary in order to compare the performance of providers, to support billing, and to monitor access to care. It should be accurate, unambiguous, and resistant to manipulation. We draw on a project to find out how information on hospitalisation could be used in contracting in the British National Health Service. We conclude that the existing British system fails to provide robust measures of how many patients are treated, for what conditions, and with what treatments. We identify some promising remedies, others that are more difficult, and some which may be impossible to implement in any planned market, given the uncertainty of clinical practice. (C) 1997 by John Wiley & Sons, Ltd.

关键词：合同业务数据收集人口统计学大不列颠卫生保健改革卫生服务易得程度卫生服务研究信息管理/标准结果与过程评价(卫生保健)/统计学和数值数据社会正义公费医疗/经济学公费医疗/组织和管理公费医疗/标准税款

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Changing faces.

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Health information management : journal of the Health Information Management Association of Australia 1996年第4期26卷 222-223页

作者： Prescott, C. Stawell District Hospital Victoria

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Who benchmarks anyway? What does it really mean?

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Health information management : journal of the Health Information Management Association of Australia 1996年第4期26卷 217-217页

作者： Brosi, J.

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