Dissertations / Theses on the topic 'Routinely Collected Health Data'
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Hockin, James Charles. "A case-control study of risk factors for ectopic pregnancy using routinely collected administrative data." Thesis, University of Ottawa (Canada), 1990. http://hdl.handle.net/10393/5628.
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The potential for using the case-control design with only hospital separation records was explored in a study of ectopic pregnancy. The Saskatchewan Hospital Services Commission hospital morbidity database was used. Cases were women hospitalized for ectopic pregnancy in the years 1984 through 1986. Controls were women hospitalized for any other pregnancy condition. In a case-control study using pregnant controls, the odds ratio is an appropriate estimator of relative risk, conditional on conception. Among the potential risk factors (exposures) represented in the data were tubal surgery, prior ectopic pregnancy, pelvic inflammatory disease, and infertility. Of these, the first two are completely ascertained during the time a woman was resident in Saskatchewan. Under representation of exposures should be non-differential, leading to odds ratios which are biased towards the null. Multiple logistic regression analysis yielded estimates of the odds ratios for acute PID, chronic PID or pelvic adhesions, prior ectopic pregnancy, tubal sterilization, and tubal repair. Of particular interest was the association between ectopic pregnancy and tubal surgery performed in the hope of maintaining or restoring normal tubal function. The attributable risk proportion of ectopic pregnancy due to such surgery was 8.1%. This study design can be used to follow trends in surgical causes of ectopic pregnancy in Canada. (Abstract shortened by UMI.)
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Xu, Yan. "Using data to answer questions of public health importance for ACT Health, with an emphasis on routinely-collected linked data." Master's thesis, Canberra, ACT : The Australian National University, 2017. http://hdl.handle.net/1885/144601.
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My field placement was with the Epidemiology Section in the Population Health Protection and Prevention Division at ACT Health. Within this placement, I have completed four projects for this thesis: an analysis of Emergency Department (ED) data; a gastroenteritis outbreak investigation; an evaluation of a population health survey and, for my main project, a study of unplanned hospital readmissions. One of the motivations for undertaking these projects was to promote better use of the routinely-collected linked data to answer questions of public health importance for ACT Health. My data analysis project was an analysis of frequent ED use in the Australian Capital Territory (ACT). This is the first study to quantify and characterise ED frequent users in the ACT. The results support existing evidence that frequent users tend to be older, female, and/or single, and commonly present with pain-related conditions. The data also showed that compared to non-frequent ED users, frequent users were more likely to be referred by police, corrective or community services; arrive by ambulance, not wait to be assessed, or leave at their own risk. In addition, we investigated visit intervals, rarely reported on in other studies. This study found around one third of frequent users returned within 7 days, with 41% of their visits having the same diagnosis as the last visit. Early identification and follow-up in the community for frequent users will assist in the development of targeted strategies to improve health service delivery to this vulnerable group. Unexpected return to hospital has negative impacts on families and healthcare systems. We examined which conditions have the highest rates of readmission and contribute most to 30-day unplanned readmissions in the ACT, and which patient characteristics are associated with readmissions. The study identified a 30-day unplanned readmission rate of 6.2%, with admission rates highest for alcohol-related liver disease (19.2%), and heart valve disorders (17.4%). Older age and comorbidities are strong predictors for 30-day unplanned readmissions. For some conditions the rates were relatively high, suggesting areas to target for reducing readmissions. Therefore, when developing preventative strategies and post-discharge plans, particular consideration should be given to patients at older age or with underlying comorbidities. As part of the ACT Health Survey Program (HSP), the ACT General Health Survey (GHS) is a computer-assisted telephone interviewing survey conducted every year among ACT residents. My evaluation of the GHS found that it is a useful tool to monitor trends of overweight, obesity, nutrition and physical activity for adults and children in the ACT. The data collected are used to provide evidence to understand and analyse overweight and obesity patterns in the ACT and create awareness of unhealthy lifestyles. However, improvements could be made in a few areas, including: developing a proper evaluation plan and a data quality statement, increasing the sample size and the proportion of young people in the sample population. I also carried out an outbreak investigation of foodborne gastroenteritis that occurred among staff and public members at a large national institution in Canberra. I conducted two studies for this outbreak – a retrospective cohort study and a case control study. The epidemiological, environmental and laboratory evidence suggested the outbreak was caused by C. perfringens toxin Type A, with the likely vehicles of transmission being butter chicken and rice. The findings of this investigation suggest that a breakdown in temperature control and good food handling practices may have resulted in C. perfringens bacterium growing rapidly and producing a toxin which caused the illness. This project also indicated that the value of a second epidemiological study was questionable given the limited time and resources available.
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King, Carina. "Can routinely collected electronic health data be used to develop novel healthcare associated infection surveillance tools?" Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/17759.
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Background: Healthcare associated infections (HCAI) pose a significant burden to health systems both within the UK and internationally. Surveillance is an essential component to any infection control programme, however traditional surveillance systems are time consuming and costly. Large amounts of electronic routine data are collected within the English NHS, yet these are not currently exploited for HCAI surveillance. Aim: To investigate whether routinely collected electronic hospital data can be exploited for HCAI surveillance within the NHS. Methods: This thesis made use of local linked electronic health data from Imperial College Healthcare NHS Trust, including information on patient admissions, discharges, diagnoses, procedures, laboratory tests, diagnostic imaging requests and traditional infection surveillance data. To establish the evidence base on surveillance and risks of HCAI, two literature reviews were carried out. Based on these, three types of innovative surveillance tools were generated and assessed for their utility and applicability. Results: The key findings were firstly the emerging importance of automated and syndromic surveillance in infection surveillance, but the lack of investigation and application of these tools within the NHS. Syndromic surveillance of surgical site infections was successful in coronary artery bypass graft patients; however it was an inappropriate methodology for caesarean section patients. Automated case detection of healthcare associated urinary tract infections, based on electronic microbiology data, demonstrated similar rates of infection to those recorded during a point prevalence survey. Routine administrative data demonstrated mixed utility in the creation of simplified risk scores or infection, with poorly performing risk models of surgical site infections but reasonable model fit for HCA UTI. Conclusion: Whilst in principle routine administrative data can be used to generate novel surveillance tools for healthcare associated infections; in reality it is not yet practical within the IT infrastructure of the NHS.
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Rouamba, Toussaint. "Optimal use of routinely collected data among pregnant women to improve malaria surveillance in Burkina Faso: Contribution of Bayesian spatiotemporal modelling." Doctoral thesis, Universite Libre de Bruxelles, 2020. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/314119.
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Background: The control of malaria in pregnancy remains a large challenge in Burkina Faso, despite the adoption of control measures known to be effective. Known effective programs include individual measures, such as intermittent preventive treatment during pregnancy, and the use of long lasting insecticide nets and daily supplementation of ferrous sulphate (200 mg) along with folic acid. Besides these measures, health programs that aim at enhancing the well-being of the population and improve maternal and child health have emerged, including results-based financing (in 2014), a project promoting health in 130 communities (implemented in 2015), and free health care (implemented in 2016). This thesis attempts to assess the effects of health programs on the space–time patterns of malaria (morbidity and mortality) through routinely collected data in pregnancy and explore the various prediction approaches to address challenges in routine health data reporting. Methods: We utilized a substantial range of data and applied advanced quantitative approaches while considering the specific distribution of the data. Our thesis is based on the valorization (analyses) of malaria surveillance data (aggregated by space and time units) recorded in the health information system of Burkina Faso between 2011 and 2019. These analyses also integrate environmental remote sensing data, data from periodic surveys, and data from other sources. These data were coupled into a database. After performing appropriate descriptive analyses considering the complexity of the data design, we performed spatio-temporal Bayesian modeling to determine areas with high risk and assess the effect of health programs on the space–time patterns of malaria incidence among pregnant women at the community-level; to explore an approach to estimate health facility readiness from survey data designed to be regionally representative (and then quantify the effect of this readiness on severe-malaria cases and case fatality); and to explore the prediction approaches used to address challenges in routine health data reporting, thereby supporting a malaria early warning system. Results: Our results show spatial and temporal heterogeneity and indicate that the annual incidence of malaria increased between 2013 and 2018, while the mortality rate decreased significantly. Some communities with a high malaria burden experienced a reduction in their risk through the deployment of the health programs mentioned above. The risk of a pregnant woman dying from severe malaria was 2.5 times higher in districts with low operational capacity. Finally, our thesis proposed an approach to respond to crisis situations that would affect data collection and could be used to set the target or provide early warnings for epidemics or other notifications. Conclusion: Our thesis provides useful tools for disease surveillance in developing countries to help optimize the scarce resources in malaria high burden areas. The results of our thesis could be used by the Ministry of Health to strengthen the capacity of existing surveillance tools and to develop rational strategies and/or new tools for monitoring malaria cases and associated deaths in communities.Contexte :La lutte contre le paludisme pendant la grossesse reste un grand défi au Burkina Faso, malgré l'adoption de mesures de contrôle dont l'efficacité est reconnue. Les programmes dont l'efficacité est reconnue comprennent des mesures individuelles, telles que le traitement préventif intermittent pendant la grossesse, l'utilisation de moustiquaires imprégnées d'insecticide de longue durée et la supplémentation quotidienne en sulfate ferreux (200 mg) ainsi qu'en acide folique. Outre ces mesures, des programmes de santé visant à accroître le bien-être de la population et à améliorer la santé maternelle et infantile ont vu le jour, notamment le financement basé sur les résultats (en 2014), le projet de promotion de la santé dans 130 communes (mis en œuvre en 2015) et la gratuité des soins de santé (mise en œuvre en 2016). Cette thèse tente d'évaluer les effets des programmes de santé sur les caractéristiques spatio-temporelles du paludisme (morbidité et mortalité) par le biais de données de routine collectées pendant la grossesse et d'explorer les différentes approches de prévision pour relever les défis de la rapportage systématique des données de santé. Méthodes :Nous avons utilisé un large éventail de données et appliqué des approches quantitatives avancées tout en tenant compte de la distribution spécifique des données. Notre thèse est basée sur la valorisation (analyses) des données de surveillance du paludisme (agrégées par unités spatiales et temporelles) enregistrées dans le système d'information sanitaire du Burkina Faso entre 2011 et 2019. Ces analyses intègrent également des données de télédétection environnementale, des données issues d'enquêtes périodiques et des données provenant d'autres sources. Ces données ont été couplées pour constituer une base de données. Après avoir effectué des analyses descriptives appropriées en tenant compte de la complexité de la conception des données, nous avons procédé à une modélisation bayésienne spatio-temporelle pour déterminer les zones à haut risque et évaluer l'effet des programmes de santé sur les tendances spatio-temporelles de l'incidence du paludisme chez les femmes enceintes au niveau communautaire ;pour explorer une approche permettant d'estimer la capacité opérationnelle des établissements de santé à partir de données d'enquête conçues pour être représentatives au niveau régional (et ensuite quantifier l'effet de cette capacité opérationnelle sur les cas de paludisme grave et la mortalité) ;et pour explorer les approches de prévision utilisées pour relever les défis relatifs au rapportaga systématique des données de santé, pouvant aussi servir à un système d'alerte précoce du paludisme. Résultats :Nos résultats montrent une hétérogénéité spatiale et temporelle et indiquent que l'incidence annuelle du paludisme a augmenté entre 2013 et 2018, tandis que le taux de mortalité a diminué de manière significative. Certaines communes où la charge du paludisme est élevée ont connu une réduction de leur risque grâce au déploiement des programmes de santé mentionnés ci-dessus. Le risque qu'une femme enceinte meure d'un paludisme grave était 2,5 fois plus élevé dans les districts ayant une faible capacité opérationnelle. Enfin, notre thèse a proposé une approche pour répondre aux situations de crise qui affecterait la collecte de données et pourrait être utilisée pour fixer l'objectif ou fournir des alertes précoces pour les épidémies ou autres notifications. Conclusion :Notre thèse fournit des outils utiles pour la surveillance des maladies dans les pays en développement afin de contribuer à optimiser les ressources limitées dans les zones à forte incidence de paludisme. Les résultats de notre thèse pourraient être utilisés par le ministère de la santé pour renforcer la capacité des outils de surveillance existants et pour développer des stratégies rationnelles et/ou de nouveaux outils de surveillance des cas de paludisme et des décès associés dans les communautés.
Doctorat en Sciences de la santé Publique
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Vallance, Abigail Ella. "Using routinely collected national data to describe the surgical management and outcomes of patients with colorectal cancer liver metastases in the English National Health Service." Thesis, University of Leeds, 2017. http://etheses.whiterose.ac.uk/20576/.
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Colorectal cancer (CRC) is the fourth most common cancer in the United Kingdom. Up to half of patients with CRC will develop liver metastases. For selected patients with liver metastases, liver resection can offer a chance of long-term cure. The aim of this thesis was to investigate the management and outcomes associated with the surgical treatment of patients with CRC liver metastases in England in an attempt to identify areas where care may be improved. Four separate studies were performed describing i) the impact of centralisation of hepatobiliary surgical services on liver resections rates for patients with CRC liver metastases and patient survival, ii) the effect of socioeconomic deprivation on rates of liver resection in patients with CRC liver metastases ,and the impact on survival, iii) the timing of liver resection in relation to CRC resection in patients with synchronous CRC liver metastases and iv) the impact of advancing age on outcomes following liver resection. These studies were conducted by linking three national databases: the National Bowel Cancer Audit, Hospital Episode Statistics data and Office for National Statistics mortality data. The results of these studies highlight that firstly, amongst patients with synchronous CRC liver metastases, those diagnosed at hospital sites with no on-site hepatobiliary services and those of higher socioeconomic deprivation have poorer survival than would be expected. This appears to relate to inequalities in provision of liver resection. Secondly, there is wide inter-hospital variation in the timing of liver resection in relation to CRC resection in England. Thirdly, although elderly patients are at increased risk of post-operative mortality following liver resection, cancer-specific and overall survival in patients between 65 and 74 years are comparable to younger patients. This thesis also discusses methodological issues associated with using national routine data for the analyses in this patient cohort.
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Holm, Hansen Christian. "Analysis of routinely collected repeated patient outcomes." Thesis, University of Edinburgh, 2014. http://hdl.handle.net/1842/9556.
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Clinical practice should be based on the best available evidence. Ideally such evidence is obtained through rigorously conducted, purpose-designed clinical studies such as randomised controlled trials and prospective cohort studies. However gathering information in this way requires a massive effort, can be prohibitively expensive, is time consuming, and may not always be ethical or practicable. When answers are needed urgently and purpose-designed prospective studies are not feasible, retrospective healthcare data may offer the best evidence there is. But can we rely on analysis with such data to give us meaningful answers? The current thesis studies this question through analysis with repeated psychological symptom screening data that were routinely collected from over 20,000 outpatients who attended selected oncology clinics in Scotland. Linked to patients’ oncology records these data offer a unique opportunity to study the progress of distress symptoms on an unprecedented scale in this population. However, the limitations to such routinely collected observational healthcare data are many. We approach the analysis within a missing data context and develop a Bayesian model in WinBUGS to estimate the posterior predictive distribution for the incomplete longitudinal response and covariate data under both Missing At Random and Missing Not At Random mechanisms and use this model to generate multiply imputed datasets for further frequentist analysis. Additional to the routinely collected screening data we also present a purpose-designed, prospective cohort study of distress symptoms in the same cancer outpatient population. This study collected distress outcome scores from enrolled patients at regular intervals and with very little missing data. Consequently it contained many of the features that were lacking in the routinely collected screening data and provided a useful contrast, offering an insight into how the screening data might have been were it not for the limitations. We evaluate the extent to which it was possible to reproduce the clinical study results with the analysis of the observational screening data. Lastly, using the modelling strategy previously developed we analyse the abundant screening data to estimate the prevalence of depression in a cancer outpatient population and the associations with demographic and clinical characteristics, thereby addressing important clinical research questions that have not been adequately studied elsewhere. The thesis concludes that analysis with observational healthcare data can potentially be advanced considerably with the use of flexible and innovative modelling techniques now made practicable with modern computing power.
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Almashrafi, Ahmed. "Optimising cardiac services using routinely collected data and discrete event simulation." Thesis, Imperial College London, 2016. http://hdl.handle.net/10044/1/43388.
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Background: The current practice of managing hospital resources, including beds, is very much driven by measuring past or expected utilisation of resources. This practice, however, doesn't reflect variability among patients. Consequently, managers and clinicians cannot make fully informed decisions based upon these measures which are considered inadequate in planning and managing complex systems. Aim: to analyse how variation related to patient conditions and adverse events affect resource utilisation and operational performance. Methods: Data pertaining to cardiac patients (cardiothoracic and cardiology, n=2241) were collected from two major hospitals in Oman. Factors influential to resource utilisation were assessed using logistic regressions. Other analysis related to classifying patients based on their resource utilisation was carried out using decision tree to assist in predicting hospital stay. Finally, discrete event simulation modelling was used to evaluate how patient factors and postoperative complications are affecting operational performance. Results: 26.5% of the patients experienced prolonged Length of Stay (LOS) in intensive care units and 30% in the ward. Patients with prolonged postoperative LOS had 60% of the total patient days. Some of the factors that explained the largest amount of variance in resource use following cardiac procedure included body mass index, type of surgery, Cardiopulmonary Bypass (CPB) use, non-elective surgery, number of complications, blood transfusion, chronic heart failure, and previous angioplasty. Allocating resources based on patient expected LOS has resulted in a reduction of surgery cancellations and waiting times while overall throughput has increased. Complications had a significant effect on perioperative operational performance such as surgery cancellations. The effect was profound when complications occurred in the intensive care unit where a limited capacity was observed. Based on the simulation model, eliminating some complications can enlarge patient population. Conclusion: Integrating influential factors into resource planning through simulation modelling is an effective way to estimate and manage hospital capacity.
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Badriyah, Tessy. "Developing risk of mortality and early warning score models using routinely collected data." Thesis, University of Portsmouth, 2013. https://researchportal.port.ac.uk/portal/en/theses/developing-risk-of-mortality-and-early-warning-score-models-using-routinely-collected-data(88353bb6-9b5d-4bca-ba60-78e33bd8e085).html.
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Aim. The aim of this study was to contribute to the building of effective and efficient methods to predict adverse clinical outcome. It has been done by developing risk of mortality and early warning score models using routinely collected data that are available from hospital computer systems. Methods. To predict risk of mortality, firstly we used logistic regression using (Biochemistry and Haematology Outcome Model - BHOM dataset) to generate a model, and the performance of each model was then compared using discrimination (AUROC or c-index) and calibration (the Hosmer- Lemeshow test). Secondly, we focused on decision trees (DT) to be compared with logistic regression (LR). In addition, we used cross validation to compare LR with other various machine learning methods. We developed early warning score algorithmically using decision trees (DTEWS) using vital sign dataset and compared the performance of DTEWS with other EWSs based on clinical expertise using c index, early warning score efficiency curve and distribution score. We also compared DTEWS with another EWS based on statistics and applied DTEWS to BHOM dataset. Results. In BHOM dataset, there were 9497 adult hospital discharges, and it was divided into four subsets. A model was built using one training set and then applied to three other testing data sets. The model in logistic regression satisfied both discrimination and calibration value when the c-index in the range 0.700-0.800 is reasonable discrimination and the p-value > 0.05 indicates there is no evidence of significant lack of fit. We also found that decision trees gave a satisfactory result followed by some other machine learning methods.Using a large vital signs dataset (n = 198,755 observation sets) from acute medical admissions, DTEWS can provide a discrimination (c-index) as good as other EWSs, has a better c-index, and also is better in other measurements including EWS efficiency curve, and distribution of score. We found DTEWS can also be applied to BHOM dataset with satisfactory results. Conclusion. The results of this study support the idea that decision trees can be applied to medical problems. When we produced a model for risk of mortality, we have shown that the decision trees model has reasonable discrimination and could be considered as an alternative technique to logistic regression. We have shown that a structured methodology using decision trees to develop early warning score has satisfactory result and contributes additional evidence that suggests an algorithmical method can be employed to quickly produce EWSs for employment in particular types of medical purpose.
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Fear, Nicola Townsend. "Paternal occupation and childhood cancer : an analysis of routinely collected death certification data." Thesis, University of Oxford, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.390489.
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Kingkeow, Chamnong. "The use of routinely collected epidemiological data to improve malaria control in northwestern Thailand." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.263726.
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Kirby, Bradley. "Data linkage for pharmacovigilance using routinely acquired electronic health data." Thesis, University of Aberdeen, 2014. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=215567.
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Introduction: Despite the establishment of pharmacovigilance systems, there is a recognised paucity of information specifically on the safety of paediatric medicines. Data linkage techniques offer real potential for linking routinely collected population based primary and secondary care datasets, using the Community Health Index (CHI) as a patient linkage key, to monitor the safety of new drugs and treatments. Aim: To explore the validity of routinely acquired NHS data and the utility of linking this data to support a routine mechanism for post-marketing surveillance of paediatric medicines. Methods: The internal and external validity of the Scottish national Prescribing Information System (PIS) was assessed using retrospective cohort studies combined with data linkage techniques. This PhD programme assesses the consistency of unique patient identifiers; the completeness and accuracy of the data; and the extent to which well established associations between drugs and adverse events can be reproduced using routinely collected NHS data. Results: For routine prescribing data a CHI number was found present on nearly 95% of dispensed items. In the first cohort study, insulin prescriptions within PIS were identified for 96% (95% CI 0.96-0.97) of children hospitalised for type 1 diabetes (SMR01). The rates of newly prescribed insulin were concordant with published rates in both Scottish and non-Scottish populations. In the second study asthma prescribing in children was observed to be complete (sensitivity 0.96 (95% CI 0.95-0.98)) and accurate (PPV 0.87 (95% CI 0.83-0.9)) when compared with a gold standard patient registry. Finally, patients newly prescribed NSAID therapy were observed to be 1.51 (95% CI 1.24-1.85) to 3.97 (95% CI 1.27 – 12.46) times more likely to experience first time hospitalisation for a gastrointestinal event than unexposed. Significant risk factors for a GI event were age and concurrent use of antiplatelet and anticoagulant therapy. These results are concordant with the published literature. Conclusions: Routine Scottish prescribing data is consistent, complete and accurate; however several key variables such as indication, dose and frequency, which are essential for robust pharmacovigilance, are currently missing from routinely collected data.
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Kozinetz, Claudia A., Kathryn Royse, Sarah c. Graham, Xiaoying Yu, Jack Moye, Beatrice J. Selwyn, Michele R. Forman, and Chantal Caviness. "Consenting Postpartum Women for Use of Routinely Collected Biospecimens and/or Future Biospecimen Collection." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/1494.
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The National Children’s Study (NCS) Harris County, Texas Study Center participated in the NCS Provider Based Sampling (PBS) substudy of the NCS Vanguard Phase pilot. As part of the hospital-based birth cohort component of the PBS substudy, we conducted a secondary data analysis to evaluate the proportion of postpartum women who consented to future biospecimen collection alone and to both future collection and use of residual birth biospecimens. In phase 1, 32 postpartum women at one hospital were asked to consent only to maternal future biospecimen collection. In phase 2, 40 other postpartum women from the same hospital were asked for an additional consent to use residual clinical biospecimens from the birth event that otherwise would be discarded, including cord blood and maternal blood and urine. Among 103 eligible women, a total of 72 participated. They were 28.3 ± 5.9 years old on average; 58 % were Hispanic; 63 % consented in English, and 37 % in Spanish; 39 % had some college education; 42 % were married; 60 % had an annual family income <$30,000; and 51 % were employed. In phase 1, 59 % consented to future biospecimen collection, and in phase 2, 95 % consented to both future collection and use of at least one residual birth biospecimen, with a difference between phases of 36 % [95 % CI 17–54 %]. Demographic characteristics did not differ among those who did and did not consent. Postpartum women were significantly more likely to grant consent for use of future and residual hospital-obtained biospecimens than future biospecimen collection alone.
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Knight, H. E. "Using routinely collected data to evaluate the performance and quality of English NHS maternity services." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2018. http://researchonline.lshtm.ac.uk/4650762/.
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This 'publication style' thesis comprises a collection of research papers, each of which seeks to address a different element of the overall aim: to determine the extent to which electronic data, captured routinely as part of clinical care and hospital administration, can be used to evaluate the performance and quality of English NHS maternity services. These routine data sources present opportunities for research groups to examine whether current practice and outcomes in NHS maternity services meet guidelines and standards, and to guide research and initiatives to improve the quality of maternity care at a regional and national level. However, the difficulty faced by clinicians, managers and service users in interpreting some of the currently available maternity statistics highlights the need to improve the usefulness of the information being produced to evaluate NHS maternity services. The first part of this thesis comprises a review of the advantages and limitations of existing routinely collected data sources for these purposes. The review identifies three key challenges relating to 1) the handling of missing or inconsistent information, 2) the definition of key exposure, outcome and confounding variables relevant to maternity care and 3) adjustment for confounding variables. In the second part, novel techniques are developed to address current weaknesses in the secondary analysis of these data. The findings show that these new methods can be used to derive accurate information on two key data items: 1) the method of delivery and 2) the parity status of women, although misclassification rates are higher for some subgroups of women. This section demonstrates that overall the quality of administrative data is sufficient to support the evaluation of maternity care but that some organisational-level statistics are sensitive to inconsistencies in the data. Consequently, it is recommended that publications of quality indicators should describe how data were prepared and analysed, in order for results to be replicable. In the third part, a series of retrospective cohort studies are described that illustrate how these new methodological techniques can be used to overcome the three challenges identified in the part 1. The first study calculated rates of attempted and successful vaginal birth after caesarean section, which had not previously been done using administrative data at national and provider-level basis (Chapter 6), and found that among women who attempted a trial of labour for their second birth, almost two-thirds successfully achieved a vaginal delivery. A second study evaluated a clinical intervention (induction of labour) designed to prevent rare outcomes such as perinatal mortality which are impractical to investigate by experimental methods (Chapter 7); it found that bringing forward the routine offer of induction of labour from the current recommendation of 41±42 weeks to 40 weeks of gestation in nulliparous women aged >=35 years might reduce overall rates of perinatal death. A third study examined an important health policy question about when staff should be present on the labour ward (Chapter 8) and involved the linkage of administrative, staffing and clinical datasets. The study found no difference in the rate of maternal and neonatal morbidity according to the presence of consultants on the labour ward. A final study examined whether administrative data provided a cost effective way of monitoring perinatal outcomes using a composite indicator of adverse outcomes. The study found that a measure developed in Australia could be adapted to English data, and had good concurrent and predictive ability (Chapter 9). The thesis concludes that hospital administrative datasets, linked with other sources of clinical data where necessary, are a valuable resource for population-based service evaluations. Taken together, the novel techniques developed, validated and applied as part of this programme of work, advance our understanding of the ways in which routinely collected maternity data can and cannot be used to support the evaluation of maternity services. Whilst these data are not perfect and there is certainly a need to improve their completeness and consistency, this research demonstrates that it is possible to develop techniques to identify and manage data errors, and methods to clearly define key exposure, outcome and confounding variables. Together, these allow answers to be found to many potential questions about maternity care.
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Tsang, Carmen. "Patient safety in English general practice : the role of routinely collected data in detecting adverse events." Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/14712.
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The use of routinely collected, or administrative, data for measuring and monitoring patient safety in primary care is a relatively new phenomenon. With increasing availability of data from different sources and care settings, their application for adverse event surveillance needs evaluation. In this thesis, I demonstrated that data routinely collected from primary care and secondary care can be applied for internal monitoring of adverse events at the general practice-level in England, but these data currently have limited use for safety benchmarking in primary care. To support this statement, multiple approaches were adopted. In the first part of the thesis, the nature and scope of patient safety issues in general practice were defined by evidence from a literature review and informal consultations with general practitioners (GPs). Secondly, using these two methods, measures of adverse events based on routinely collected healthcare data were identified. Thirdly, clinical consensus guided the selection of three candidate patient safety indicators for investigation; the safety issues explored in this thesis were recorded incidents with designated adverse event diagnostic codes and complications associated with two common diseases, emergency admissions for diabetic hyperglycaemic emergencies (diabetic ketoacidosis, DKA and hyperglycaemic hyperosmolar state, HHS) and cancer. In the second part of the thesis, the contributions of routinely collected data to new knowledge about potentially preventable adverse events in England were considered. Data from a primary care trust (NHS Brent), national primary care data (from the General Practice Research Database, GPRD) and secondary care data (Hospital Episode Statistics, HES) were used to explore the epidemiology of, and patient characteristics associated with, coded adverse events and emergency admissions for diabetic hyperglycaemic emergencies and cancer. Low rates of adverse events were found, with variation by individual patient factors. Finally, recommendations were made on extending the uses of routinely collected data for patient safety monitoring in general practice.
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Powell, Helen. "Quantifying important risk factors and survival following treatment in people with lung cancer using routinely collected national data." Thesis, University of Nottingham, 2014. http://eprints.nottingham.ac.uk/14092/.
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Background: Survival for people with lung cancer is poor and inequalities in access to care have been demonstrated. Methods: Primary care data from The Health Improvement Network, secondary care data from Hospital Episodes Statistics and the National Lung Cancer Audit, and death records from the Office for National Statistics, were used to investigate clinical questions in lung cancer. Matched case-control methodology was used to investigate the association between sex, smoking quantity, chronic obstructive lung disease (COPD), and lung cancer. Case control and cohort studies were performed to investigate early mortality after lung cancer surgery and treatment decisions in small cell lung cancer (SCLC). Multivariate logistic regression was used to generate a predictive score for early mortality after lung cancer surgery. Results: Sex significantly modified the effect of smoking on lung cancer with women at higher risk for the same quantity smoked. COPD was strongly associated with lung cancer in univariate analysis however this was heavily confounded by smoking and strongly related to timing of diagnosis. For people with non-small cell lung cancer, 90-day mortality after surgery was 5.9%. Age, co-morbidity index, performance status, procedure type and stage were significantly associated with this outcome and therefore make up the predictive score. 70% of people with SCLC were treated with chemotherapy however this varied according to several factors including referral method and socioeconomic status. Survival after chemotherapy for people with SCLC was similar to that reported in clinical trials. Conclusions: The work in thesis provides further evidence that women are at higher risk of lung cancer per quantity of cigarettes smoked, and challenges the commonly held belief that COPD is a strong independent risk factor for lung cancer. In addition it produced a predictive score for early mortality following lung cancer surgery, and provides information on treatment decisions and outcomes for SCLC.
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Mcallister, Katherine. "Coronary revascularisation in the UK : using routinely collected data to explore case trends, treatment effectiveness and outcome prediction." Thesis, University of Manchester, 2015. https://www.research.manchester.ac.uk/portal/en/theses/coronary-revascularisation-in-the-uk-using-routinely-collected-data-to-explore-case-trends-treatment-effectiveness-and-outcome-prediction(f894406c-e5e3-40a1-8fde-29be3310a293).html.
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Background: Coronary artery disease is a common cause of morbidity and mortality in the UK. Interventional revascularisation procedures for addressing the disease include percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), which respectively seek to open up or bypass blocked arteries to restore blood flow to heart muscle. Rates at which these procedures are carried out have changed in recent years, as have clinical indications for referral. PCI is delivered by interventional cardiologists, while CABG is carried out by cardiothoracic surgeons, necessitating multi-disciplinary decision making. There is both within- and cross-speciality debate as to the optimal treatment strategy in some case types. Evaluation of the care provided is of clinical and political importance, and requires information about how post-procedure event rates per operator and hospital compare with those expected given the composition of patient populations. Methods: Two UK-wide audit databases of PCI and CABG procedures were used to explore a range of clinical outcome questions. The patient populations contained within each database were compared to see how they differed, and also how each had changed in recent years. In CABG patients, comparative effectiveness of two different surgical techniques (single vs bilateral mammary artery grafting) was assessed with respect to both short-term and long-term mortality outcomes. In PCI patients, a risk model to predict 30-day mortality was developed for use in clinical appraisal. Results: In both patient populations there had been changes to the relative frequencies of many characteristics over time. In the CABG population, multivariable analysis showed that patients undergoing single mammary artery grafting had lower odds of all-cause mortality within 30 days of procedure than those receiving bilateral mammary artery grafting, but had worse overall survival in the long term. In the PCI population, the developed risk model demonstrated good calibration and discrimination at predicting 30-day all-cause mortality. Discussion: The studies described above demonstrate that large-scale routinely collected data can be used to gain insights into clinical care quality and delivery. These resources are under-utilised at present; correcting this requires an understanding of the limitations of the data and how the information contained therein relates to actual clinical care.
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Massicotte-Azarniouch, David. "The Risks Associated with Blood Transfusion in Kidney Transplant Patients: A Retrospective Cohort Study Using Routinely Collected Data." Thesis, Université d'Ottawa / University of Ottawa, 2020. http://hdl.handle.net/10393/40651.
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A blood transfusion may have important immunomodulatory effects and may carry certain risks which could be detrimental to the kidney transplant patient. The aim of this project is to examine the potential risks associated with post-transplant blood transfusions in kidney transplant recipients. We carried out a retrospective cohort study of all adult kidney transplant recipients at The Ottawa Hospital from 2002 to 2018 inclusive. We examined the risks for kidney transplant rejection, graft loss, death, infections and venous thromboembolic events (VTE) associated with the receipt of red blood cell transfusions (RBCTs) administered after kidney transplant. We calculated hazard ratios (HR) using Cox proportional hazards model with RBCT as a cumulative, time-varying exposure. Out of a total study population of 1,258 kidney transplants recipients, 37% received at least one RBCT. The receipt of a RBCT was not significantly associated with the risk for rejection, however it was associated with an increased risk for graft loss, death, infection and VTE. Important biases such as reverse causation and unmeasured confounding may account for some of these findings. That being said, our findings suggest clinicians should be judicious in their use of RBCT in kidney transplant patients.
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Saunders, Patrick Joseph. "Investigating the public health impact of contaminated land using routinely available health data." Thesis, University of Birmingham, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.410601.
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Steventon, A. "Evaluating complex interventions using routinely collected data : methods to improve the validity of randomised controlled trials and observational studies." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2015. http://researchonline.lshtm.ac.uk/2212900/.
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This thesis addresses the evaluation of complex interventions using routinely collected data, specifically the internal validity of observational studies and the generalisability of Randomised Controlled Trials (RCTs). Following a literature review, this thesis has four main objectives: to estimate the effect of telephone health coaching on hospital utilisation in an observational study; to assess optimal choices of control area in observational studies; to estimate the effect of telehealth within a large RCT; and to develop methods to assess aspects of the generalisability of RCTs empirically. The first paper compares health-coached patients with matched controls. Controls were selected from areas of England that were first matched to the characteristics of the intervention area. Health coaching did not reduce hospital admissions in this study. A second paper uses simulations to assess the relative bias and statistical precision in the treatment effects estimated under alternative approaches to selecting control areas. Lower bias is reported when using local controls than when selecting controls from matched areas, except when there is little unexplained area-level variation in outcomes, when the opposite is true. The third paper reports that, in the RCT, telehealth patients had fewer hospital admissions than controls, but admissions increased unexpectedly among controls after recruitment, leading to concerns about generalisability. Placebo tests find that control patients in the RCT experienced more admissions than matched non-participants receiving usual care. To address the concern that the control group did not receive ‘usual care’, sensitivity analyses are presented that contrast outcomes between the telehealth patients in the RCT and matched non-participants. In this comparison, telehealth is associated with a trend towards more admissions than usual care. The thesis concludes that careful control matching and placebo tests can address important aspects of the validity of observational studies and RCTs, but that further development of evaluation methods is warranted.
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Thorne, Kymberley. "An independent evaluation of the NHS Modernisation Agency's 'Modernising Endoscopy Services' project using routinely collected, service-related endoscopy data." Thesis, Swansea University, 2008. https://cronfa.swan.ac.uk/Record/cronfa43103.
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Aim: To independently evaluate the NHS Modernisation Agency’s “Modernising Endoscopy Services” (MES) project using routinely collected, service-related endoscopy data. Methods: A random selection of 10 sites who had participated in the MES project (called MES sites) were compared to a random selection of 10 sites who were unsuccessful applicants for the MES project but had indicated their intention to redesign independently (called Non-MES sites). Data on Referral numbers, Number of patients waiting, Number of lost appointment slotsand Activity werecollected from all 20 sites for eight specific time periods ranging from January 2003 to April 2006 to evaluate the endoscopy services of MES and Non-MES sites and to compare both site types at specific points in time using various statistical tests. Activitydata were validated where appropriate using an equivalent HES dataset. Details of innovations introduced were collected to explore possible trends. Results: Data were not routinely collected by endoscopy units. NHS Trust datasets were subsequently included to ensure a full dataset for analysis. The accuracy of the Activitydata was successfully validated. There were relatively few statistically significant results to report. Consequently, this study found that the MES project did not significantly improve the endoscopy services of the MES sites over time. It also found that there was no significant difference between the MES sites and the Non-MES sites in the improvement of their endoscopy services over time and that the Non-MES sites appeared to implement changes that led to improvements to their services, although they were not statistically significant. Conclusions: Data was not routinely collected by most NHS endoscopy units participating in this study. Based on the data analysed, the MES project did not appear to have significantly improved NHS endoscopy services over and above what could have been achieved independently with only the intention to redesign.
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Stenhouse, Elizabeth Ann. "The effect of maternal glycaemia in pregnancy on birth weight, infant and childhood growth : a study using routinely collected data." Thesis, University of Exeter, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.410393.
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Harper, Gill. "A study of the use of linked, routinely collected, administrative data at the local level to count and profile populations." Thesis, City, University of London, 2017. http://openaccess.city.ac.uk/18244/.
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There is increasing evidence that official population statistics are inaccurate at the local authority level, the fundamental administrative unit of the UK. The main source of official population statistics in the UK comes from the decennial census, last undertaken in 2011. The methodology and results of official population counts have been criticised and described as unfit for purpose. The three main purposes of population statistics are resource allocation, population ratios, and local planning and intelligence. Administrative data are data that is routinely collected for administrative purposes by organisations, government departments or companies and not for statistical or research purposes. This is in contrast with surveys which are designed and carried out as a specific information gathering exercise. This thesis describes a methodology for linking routinely collected administrative data for counting and profiling populations and other purposes at the local level. The benefits of this methodology are that it produces results more quickly than the decennial census, in a format that is more suitable for accurate and detailed analyses. Utilising existing datasets in this way reduces costs and adds value. The need and the evolution of this innovative methodology are set out, and the success and impact it has had are discussed, including how it has helped shape thinking on statistics in the UK. This research preceded the current paradigm shift in the UK for research and national statistics to move towards the use of linked administrative data. Future censuses after 2021 may no longer be in the traditional survey format, and the Office for National Statistics are exploring using a similar administrative data method at the national level as an alternative. The research in this thesis has been part of this inevitable evolution and has helped pave the way for this.
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Dall'Ora, Chiara. "The association of nurses' shift characteristics, missed vital signs observations and sickness absence : retrospective observational study using routinely collected data." Thesis, University of Southampton, 2017. https://eprints.soton.ac.uk/417870/.
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When organising shift work, healthcare managers are required to cover the service across 24 hours in a way that maximises job performance – which includes minimising sickness absence related to work, and creating conditions that allow nursing staff to perform their scheduled tasks. This study aimed to investigate the association between characteristics of shift work in acute hospital wards and nursing staff job performance, in terms of sickness absence and compliance with vital signs observations. This was a retrospective longitudinal observational study using routinely collected data on nursing staff shifts, missed vital signs observations and sickness absence. The study took place in all acute inpatient general wards at a large teaching hospital in the South of England over a three years period. Shift and sickness data were extracted from the electronic shift system and overtime shifts datasets, which are both linked to the hospital payroll. These contain individual records of shifts worked, dates, start and end time, ward and grade for all nurses employed by the hospital. Vital signs observations data were extracted from a database of records made using the VitalPAC™ system. Generalised linear mixed models were used to model the association between shift work characteristics, sickness absence episodes and compliance with vital signs observations. This doctoral research provides new knowledge regarding the association of shift characteristics and job performance outcomes. It found that working high proportions of 12 hours or more shifts is associated with higher sickness absence, regardless of how many days nursing staff had worked in the previous seven days. An association between working 12 hours or more shifts and delaying vital signs observations was found for health care assistants. Drawing on a large and diverse sample size and using objective data, this study is the first in nursing to demonstrate that there is an association between long shifts and job performance.
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Stenhouse, E. A. "The effect of maternal glycaemia in pregnancy on birth weight, infant, & childhood growth : a study using routinely collected data." Thesis, Exeter and Plymouth Peninsula Medical School, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.701309.
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Asiimwe, Alex. "Morbidity and mortality in patients with stable and unstable COPD : construction and validation of a prediction model using routinely collected data." Thesis, University of Portsmouth, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.478895.
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Palmer, William. "Measuring the quality and safety of hospital care using specialty-specific indicators based on routinely collected administrative data : a feasibility study." Thesis, Imperial College London, 2014. http://hdl.handle.net/10044/1/24697.
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Using administrative data to measure the quality and safety of hospital care offers many opportunities. However, progress has been limited to few countries and predominantly to a small subset of broad measures, such as Hospital Standardised Mortality Rates. In this thesis, I investigate the potential advantages and feasibility - in terms of validity and applicability - of specialty-specific indicators. In the first part of my PhD work, I examine the case for specialty-specific indicators. I also present potential applications which overcome some of the existing shortcomings of previous uses of indicators based on administrative data. In the next stage of the project I focus on assessing feasibility by focusing on two specialties - stroke and obstetric care - conducting systematic reviews and consulting with experts to develop two indicator sets. As part of this, I identified the shortcomings in current use of indicators in these specialties. To investigate the limitations of these indicators, I applied the indicator definitions to English hospital administrative data (Hospital Episode Statistics, HES) and evaluated whether they can be used to discriminate between hospitals based on their performance and, importantly, to understand the effect of differences in coding practice. The final aspect of the research was to investigate alternative applications for the indicators which can overcome some of the shortcomings highlighted in both the prior analyses and existing literature. In doing so, I raise serious, robust shortcomings on the quality and safety of weekend care.
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Hegenberg, Kathrin [Verfasser], and Bernhard [Akademischer Betreuer] Zwißler. "Utilization of pre-hospital emergency medical services : analysis of trends and patient characteristics using routinely collected data / Kathrin Hegenberg ; Betreuer: Bernhard Zwißler." München : Universitätsbibliothek der Ludwig-Maximilians-Universität, 2020. http://d-nb.info/1221761439/34.
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Ryan, Ronan Paul. "Can routinely collected primary care data be used to predict future risk of morbidity and mortality in newly-diagnosed type 2 diabetes mellitus?" Thesis, University of Birmingham, 2014. http://etheses.bham.ac.uk//id/eprint/5397/.
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Background/clinical context: Type 2 diabetes (T2DM) is associated with an increased risk of adverse outcomes. Data routinely recorded in general practice electronic patient records could be used to develop risk prediction models to identify those at higher risk and target preventative treatment. Objective: To develop models to predict the 5-year risk of coronary heart disease (CHD), stroke, chronic kidney disease (CKD), and all-cause mortality following a diagnosis of T2DM. Methods: Newly diagnosed T2DM patients registered at a practice contributing data to a large UK general practice database were included in the analyses. The models included clinical predictors routinely recorded following diabetes diagnosis plus cardiovascular preventative treatments. Results: 20041 patients diagnosed with T2DM were included. The proportion of variation explained by each model (R2) was: CHD 0.09; stroke 0.35; CKD 0.34; and mortality 0.58. Hazard ratios for modifiable risks in the mortality model were: current smoking 1.65; blood pressure (high/treated) 1.07; and glycaemic control (HbA1C/%) 1.09 (p<0.01 apart from BP). Conclusion: The models were predictive, particularly for mortality, and suggest that older, male, smokers, those with poor blood pressure and glycaemic control and those with cardiovascular co-morbidity are at highest risk and should be targeted at the point of diagnosis.
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Gkaravella, Antigoni. "A study of patients referred following an episode of self-harm, a suicide attempt, or in a suicidal crisis using routinely collected data." Thesis, University of East London, 2014. http://roar.uel.ac.uk/4593/.
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Self-harm and suicide prevention remain a priority of public health policy in the UK. Clinicians conducting psychosocial assessments in Accident and Emergency Departments are confronted with a complex and demanding task. There is a paucity of research into the content of psychosocial assessments and the experiences of clinicians conducting psychosocial assessments in Accident and Emergency Departments. This study examines the experiences of people who presented in an Accident and Emergency Department following self-harm or with suicidal ideation, as those are documented in the psychosocial assessments. Furthermore, the study explores the attitudes, feelings and experiences of clinicians working in a Psychiatric Liaison Team, as well as the process of making decisions about aftercare plans. In order to achieve this, qualitative methods were employed. A sample of sixty-one psychosocial assessments was collected and analysed using thematic analysis. The coding of the data was done inductively and deductively with the use of the categories of the Orbach and Mikulincer Mental Pain Scale. Two focus groups with clinicians were conducted and analysed with a grounded theory oriented approach. Stevens’ framework was applied in order to analyse the interactional data in the focus groups. Key themes emerging from the focus groups were shared with serviceusers who offered their own interpretation of the data and findings. The study draws on psychodynamic theories to explore the experiences of clinicians assessing and treating patients with self-harm and suicidal ideation in an Accident and Emergency Department and to make sense of the needs of the patients. The findings are that suicidal ideation and self-harm were assessed and treated in similar ways. Difficulties in relationships and experiences of loss or trauma in childhood and/or adulthood were the two most common themes emerging in the psychosocial assessments. Decisions about aftercare plans were guided by patients’ presentation and needs in conjunction with available resources. Clinicians were found to have various emotional responses to patients’ painful experiences with limited space to reflect upon these at work. Clinicians and service-users commented upon the therapeutic aspect of psychosocial assessments, which in light of the painful experiences reported in the psychosocial assessments could be used to generate more sensitive and meaningful approaches to the care of this population. Providing support and a space for clinicians to be able to think of their task and their responses seems important.
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Hasselback, Paul. "Native mortality in Canada: An epidemiological study using computerized record linkage of native administrative files with the Canada mortality database and two sources of routinely collected mortality statistics." Thesis, University of Ottawa (Canada), 1990. http://hdl.handle.net/10393/5619.
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Natives in Canada suffer from high rates of morbidity and mortality in comparison to the Canadian population. Investigation of this inequity has been hampered by a lack of valid health statistics on native populations. This thesis assesses native mortality through a study of three potential sources of native mortality statistics using routinely collected data. Objectives were to: (1) Measure mortality indicators using a computerized record linkage of government Indian administrative records with the Canada Mortality Database. (2) Compare native mortality indicators based on the linked files, on-reserve deaths, and Medical Services Branch native client files. (3) Relate mortality amongst natives with respect to the Canadian population. (4) Determine if there is a contribution of "rural" living to native mortality. The record linkage includes deaths recorded with DIAND as occurring in 1981. The average annual mortality rate for the two other native files and comparison populations are derived from 1979-1983 records. (Abstract shortened by UMI.)
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Jain, Poorva. "Can routinely collected primary care data determine the prevalence of chronic kidney disease and predict clinical events in patients with stages 3 of the disease?" Thesis, University of Birmingham, 2015. http://etheses.bham.ac.uk//id/eprint/5552/.
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Introduction Chronic Kidney Disease (CKD) is common and associated with cardiovascular morbidity and mortality. Few studies have assessed the real prevalence of CKD and the predictors of morbidity and mortality in this cohort. Methods Using THIN data, the prevalence of CKD 1-5 was ascertained .This was compared to the prevalence on the practice register using QOF Read codes in 2009. Cox proportional hazard models using routinely collected primary care were used identify predictors of i) all-cause mortality and ii) the composite of cardiovascular disease and all-cause mortality. Results The prevalence of CKD 1-5 was 5.01%. Patients with CKD not on the practice register were associated with worse management than those on the practice register. Increasing age and co-morbidity were associated with worse outcomes. Continuous variables such as hypertension, BMI, haemoglobin and cholesterol were associated with an inverse J shaped relationship with log relative hazard ratio. Antihypertensives and lipid lowering drug usage, and non white ethnicity was associated with improved outcomes. Blood thinning agents and diuretics were associated with worse outcomes. Conclusions CKD is common in UK. Many practices mis-label CKD which impacts upon management. Some predictors of mortality and morbidity is different to previous reports and this requires further investigation.
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Gates, Peter J. "Analyzing categorical traits in domestic animal data collected in the field /." Uppsala : Swedish Univ. of Agricultural Sciences (Sveriges lantbruksuniv.), 1999. http://epsilon.slu.se/avh/1999/91-576-5473-5.pdf.
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O'Donnell, Amy Jane. "A mixed-methods investigation of the extent to which routinely collected information can help evaluate the implementaion of screening and brief alcohol interventions in primary health care." Thesis, University of Newcastle upon Tyne, 2014. http://hdl.handle.net/10443/2463.
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Background: UK health policy has sought to encourage alcohol screening and brief intervention (ASBI) delivery in primary care, including via pay-for-performance (P4P) schemes. To measure the impact of such policies, a range of data exist, including General Practitioner (GP) Read codes, which record all clinical activity. However, previous studies have highlighted the difficulties of using Read code data for evaluation purposes, with concerns around the distorting effect of P4P on healthcare recording. Against this background, this research investigated whether Read code data can be used to provide a meaningful measure of ASBI implementation in primary care. Methods: Sequential mixed methods design, comprising: (1) systematic literature review to identify what factors influence the recording of routine clinical data by UK primary care physicians; (2) analysis of ASBI Read code data from 16 GP practices in North East England; (3) 14 GP interviews to explore the barriers and facilitators affecting their ASBI recording. Results: (1) Multiple factors shape primary care physicians’ recording of routine data, including structural influencers (such as the design and resourcing of the coding system), and psychosocial factors (including patient characteristics and physicians’ perspectives on their role as care-givers). (2) 287 Read codes exist to record alcohol- related activity however only a small minority are used regularly, generally relating to the identification of alcohol use disorders. Whilst many unused Read codes are associated with relatively rare alcohol conditions, a significant number relate to duplicate or outmoded terminology. Overall, practices associated with higher recorded rates of key ASBI service indicators were signed up to P4P schemes. (3) GP interviews suggested that across all practices, nurse-administered ASBI components were most likely to be provided and coded consistently, with GP-delivery and recording activity far more ad hoc. Conclusion: Whilst routine data may be a valid indicator of more successfully embedded ASBI activity in UK primary healthcare following the introduction of P4P schemes, measuring the impact on delivery at GP level remains challenging due to the deficiency of the available Read code data across a number of quality dimensions.
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Mizen, Amy R. "Investigating the impact of GIS modelled daily exposures to the retail food environment on routinely linked child health data." Thesis, Swansea University, 2018. https://cronfa.swan.ac.uk/Record/cronfa40669.
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Obesity continues to be a huge public health concern around the globe, and numbers are projected to continue to increase. There is particular concern around the issue of obesity in children because obese children are far more likely to become obese adults than children who are a healthy weight. We have so far been ineffective in developing successful public health policies and interventions that report population level reductions in obesity. In order to tackle obesity on a large scale, we need to be creative and develop interventions and policies that drive societal change. The cause of obesity has been found to be not a linear relationship of cause and effect but a complex and multifaceted system. Geographic Information Systems (GIS) are being used to more fully understand the role of the environment on obesity. There has been a particular focus on exposure to the ‘retail food environment’ (RFE) and how this may be linked with obesity. Currently, GIS modelled exposures to the RFE along routes to and from school are not adequate to make reliable predictions about exposure. Instead, GPS data are used to obtain accurate exposures. This thesis has developed a GIS method to generate population level exposures to the RFE. In order to advise policies and interventions that will effectively cause societal change, population level research must be undertaken. A novel way that this type of research can be undertaken is through data linkage. This study has calculated exposures to the RFE for school children aged 13-14 years in south Wales and linked these exposures to individual level health data held within the Secure Anonymised Information Linkage Databank (SAIL). These results contribute to the evidence base and shed light on new aspects of the built environment that can be altered to encourage healthy lifestyles.
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Hoskins, Gaylor. "Defining and Assessing Symptom Control of Asthma in "UK Primary Care : Use of routinely collected data to determine appropriateness of a variety of control assessment models and to identify the factors associated with poor control." Thesis, University of Dundee, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.521678.
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Reed, R. J. "A mathematical model to determine optimum cadence for an individual cyclist using power output, heart rate and cadence data collected in the field." Thesis, University of Salford, 2013. http://usir.salford.ac.uk/30698/.
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We aim to develop a methodology to determine individual optimum cadences for competitive cyclists using field data. Cadence is the number of pedal crank revolutions per minute or pedalling rate. Currently athletes tend to select a cadence intuitively (choosing a gear that permits a cadence that feels comfortable), with some advice from coaches. Literature defines optimum cadence based on gross efficiency. However only power output, heart rate and cadence measurements from the field are available to us. Hence we determine an optimum cadence as the cadence that minimises heart rate for a given power output. In so doing we consider heart rate a reasonable proxy for gross efficiency. We fit statistical models of power output, heart rate amd cadence, with heart rate lagged behind changes in power output, at various lags (though we believe 30 seconds is appropriate). We consider the effect of fatigue on optimum cadence through calculation of training impulses or TRIMPs, but do not consider the effects of fitness, gradient, or whether athletes are standing or sitting. Optimum cadences are found for two athletes (83 and 70 revolutions per minute respectively); these cadences are similar to athletes’ preferred cadences (82-92 and 65-75 rpm respectively). Optimum cadences do not vary by power output or heart rate in our study, and are relatively insensitive to TRIMP. Power output reduces by approximately 2% for cadences 10 rpm above or below optimum. The methodology we propose can be implemented by a wide range of competitive cyclists to calculate optimum cadence; cyclists need to collect power output, heart rate and cadence measurements from training sessions over an extended period (>6 months), and ride at a range of cadences within those sessions. Cyclists and their coaches can re-calculate optimum cadence, say every 6 months, to take account of possible changes in fitness.
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Halstead, Holly. "ARG-MATEE Automated Pipeline for Detection of Antimicrobial Resistance in WGS Data Collected from Pig Farms and Surrounding Communities." Thesis, Uppsala universitet, Institutionen för biologisk grundutbildning, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-414587.
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As part of recognizing the interconnected nature of different sectors in relation to health, AMR (antimicrobial resistance) has emerged as an issue of high global importance. E. coli isolates were taken from pig farms in Thailand, which serves as a point of interest in the study of ARGs (antimicrobial resistance genes) in emerging economies. The fecal samples were collected from pigs, humans who came in contact with the pigs, and humans who did not have contact with pigs to be analyzed for ARGS, virulence genes, and plasmids. Data was analyzed with an automated pipeline in the form of ARG-MATEE, the Antimicrobial Resistance Gene Multi-Analysis Tool for Enteric E. coli, a tool designed in this study to be used here and in future investigations. ARG-MATEE regulates and records internal software versions in a produced report which also includes data tables for all non phylogeny results in Boyce–Codd normal form and data visualizations for plasmids, ARGs, virulence genes, and phylogeny. Through the use of ARG-MATEE, the iss virulence gene was seen to be significantly different between testing groups as it is present in only human testing groups, suggesting the loss of function of the iss gene in pigs, showing host specialization.
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Goodfellow, Stephanie Anne. "Having a baby in the Isle of Man : the analysis and interpretation of data collected as part of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC)." Thesis, University of Bristol, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.319138.
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Molefi, Zachariah Modise. "Exploring the understanding of routinely collected data by the health practitioners in a primary health care setting." Diss., 2014. http://hdl.handle.net/10500/18841.
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Health practitioners collect health data on a daily basis at health facility levels in order to monitor and evaluate the performance of priority national health programmes (District Health Plan 2012:6). Routine data quality for health programmes monitoring need a collective intervention to ensure clear understanding for what data to be collected at primary health care setting. The aim of the study is to explore the understanding of routine health data, determine the use of routine data and feedback mechanism at primary health care clinic setting. Quantitative descriptive research design was used to answer the research question on this research study. Structured data collection questionnaire was used for the study to accomplish the research purpose and reach the study objectives. A total of 400 participants was sampled, and 247 responded. One of the findings was that the understanding of routine health data by Health Practitioners was at 82.6% (% = f/n*100, f= 3242 and n= 3926).Health Studies
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Lawton, R., J. K. O'Hara, L. Sheard, C. Reynolds, K. Cocks, Gerry R. Armitage, and J. Wright. "Can staff and patient perspectives on hospital safety predict harm-free care? An analysis of staff and patient survey data and routinely collected outcomes." 2015. http://hdl.handle.net/10454/9261.
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NoPatients have the potential to provide feedback on the safety of their care. Recently, tools have been developed that ask patients to provide feedback on those factors that are known to contribute to safety, therefore providing information that can be used proactively to manage safety in hospitals. The aim of this study was to investigate whether the safety information provided by patients is different from that provided by staff and whether it is related to safety outcomes. Data were collected from 33 hospital wards across 3 acute hospital Trusts in the UK. Staff on these wards were asked to complete the four outcome measures of the Hospital Survey of Patient Safety Culture, while patients were asked to complete the Patient Measure of Safety and the friends and family test. We also collated publicly reported safety outcome data for 'harm-free care' on each ward. This patient safety thermometer measure is used in the UK NHS to record the percentage of patients on a single day of each month on every ward who have received harm-free care (i.e. no pressure ulcers, falls, urinary tract infections and hospital acquired new venous thromboembolisms). These data were used to address questions about the relationship between measures and the extent to which patient and staff perceptions of safety predict safety outcomes. The friends and family test, a single item measure of patient experience was associated with patients' perceptions of safety, but was not associated with safety outcomes. Staff responses to the patient safety culture survey were not significantly correlated with patient responses to the patient measure of safety, but both independently predicted safety outcomes. The regression models showed that staff perceptions (adjusted r(2)=0.39) and patient perceptions (adjusted r(2)=0.30) of safety independently predicted safety outcomes. When entered together both measures accounted for 49% of the variance in safety outcomes (adjusted r(2)=0.49), suggesting that there is overlap but some unique variance is also explained by these two measures. Based on responses to the Patient Measure of Safety it was also possible to identify differences between the acute Hospital Trusts. The findings suggest that although the views of patients and staff predict some overlapping variance in patient safety outcomes, both also offer a unique perspective on patient safety, contributing independently to the prediction of safety outcomes. These findings suggest that feedback from patients about the safety of the care that they receive can be used, in addition to data from staff to drive safety improvements in healthcare. TRIAL REGISTRATION NUMBER: ISRCTN07689702.
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Marsh, Celeste. "Harnessing routinely collected data for effective control of vaccine preventable disease in Australia." Master's thesis, 2021. http://hdl.handle.net/1885/222856.
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The primary goal of the Australian Government Department of Health's (DoH) Immunisation Branch (IB) is to protect Australians from vaccine preventable diseases (VPDs) primarily via the administration of the National Immunisation Program (NIP). The NIP has, since its birth in 1998 been credited with significant gains in childhood immunisation coverage across Australia. Despite this, there remain under-vaccinated pockets of the population vulnerable to outbreaks of VPDs. Good quality data and its appropriate use is key to informing policies and programs aimed at lifting vaccination uptake and in the control of VPDs. In the projects of this thesis, each of which was conducted to achieve core requirements of the Master of Philosophy in Applied Epidemiology (MAE), routinely collected data are leveraged to answer immunisation policy and programming questions and to investigate an epidemic of a VPD. Australia has a valuable central repository for vaccination-related information for its residents, the Australian Immunisation Register (AIR). The dataset has long been used for administrative and social service purposes by the Department of Human Services (DHS); however it is also an important surveillance and public health instrument. The DoH recently received a subset of the register in order to allow the IB to undertake real-time analytics to better support program and policy-making decisions and prescribed bodies on data related matters.This project (AIR data access reform) is poised to undertake its second phase, the roll-out of the DoH AIR data to States/Territories which sets the stage for the evaluation requirement of the MAE. I evaluate the usefulness of the health AIR dataset for States/Territories to meet their immunisation and public health goals (Chapter 5). The evaluation finds a need for a transparent, consistent approach to the use of AIR data and a community of practice that offers ongoing technical support. AIR data access has enabled a further two projects included in this thesis. The first is an historical review of immunisation medical exemptions (IMEs) registered in the AIR in which trends overtime particularly around key policy changes are explored (Chapter 3). We find evidence that policies linking financial incentives to immunisation status do impact IME rates which reflects responses both by immunisation providers and families. We also discover that the observed rise in IME rates following one policy change is curbed by tighter rules around IME granting. In Chapter 4, AIR-derived routine immunisation coverage data is used to evaluate the impact of a national education campaign aimed at increasing childhood vaccination demand, particularly in areas of low coverage. Using an interrupted-time-series design we find a positive impact in several targeted areas and discover that success of the campaign did not vary by small-area-level socioeconomic rating, vaccination objection level or remoteness. Continuing the theme of VPD prevention, for the outbreak requirement (Chapter 2), I investigate together with New South Wales (NSW) Health the factors associated with influenza infection in a summer epidemic (2018-2019) by utilising the NSW notifiable disease database as a platform for the distribution of a survey via text message. This case control study reveals that international travel and/or contact with an ill traveller in the week prior to becoming ill was strongly associated with influenza in the first two months of summer. This thesis focuses on immunisation in Australia; the projects hinge on the optimal use of large datasets and database platforms to help inform the control of VPDs at a time in which the DoH is expanding data access and analytic capabilities. Findings may assist with DoH understanding of the impacts of key immunisation interventions and policies, contribute to the relevant literature, feed discussion on pre-travel vaccination practices and help guide further steps in immunisation data sharing.
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Springmann, Vicky. "The Hygiene Hypothesis and the risk of Crohn’s disease : a case-control study utilizing prospectively-collected exposure data from an administrative database." Thèse, 2013. http://hdl.handle.net/1866/12759.
Full textAbstract:
La maladie de Crohn (MC) pédiatrique a des conséquences majeures sur la qualité de vie des patients atteints (troubles de croissance, absentéisme scolaire, etc). L’étiologie de la MC est inconnue. La théorie de l’hygiène (TH) stipule que les conditions de vie sanitaires des pays industrialisés préviennent l’exposition antigénique et empêchent le développement de la tolérance immunitaire chez les enfants. Ceci mènerait à une réaction excessive du système immunitaire lors d’expositions subséquentes et engendrerait le développement de maladies inflammatoires chroniques telles la MC.
Objectif: Analyser l’association entre la fréquence, la temporalité et le type d’infections infantiles (indicateurs d’environnements pourvus d’antigènes) et le risque de MC pédiatrique.
Une étude cas-témoin fût réalisée, les cas de MC provenant d’un centre hospitalier tertiaire montréalais. Les témoins, provenant des registres de la Régie d’assurance maladie du Québec (RAMQ), furent appariés aux cas selon leur âge, sexe et lieu de résidence. L’exposition aux infections fût déterminée grâce aux codes de diagnostic ICD-9 inscrits dans la base de données de la RAMQ. Un modèle de régression logistique conditionnelle fût construit afin d’analyser l’association entre infections et MC. Des ratios de cotes (RC) et intervalles de confiance à 95% (IC 95%) furent calculés.
Résultats: 409 cas et 1621 témoins furent recrutés. Les résultats de l’analyse suggèrent un effet protecteur des infections infantiles sur le risque de MC (RC: 0,67 [IC: 0,48-0,93], p=0,018), plus particulièrement au cours des 5 premières années de vie (RC: 0.74 [IC: 0,57-0,96], p=0,025). Les infections rénales et urinaires, ainsi que les infections des voies orales et du système nerveux central (virale), semblent particulièrement associées à l’effet protecteur. Les résultats de l’étude appuient la théorie de l’hygiène: l’exposition aux infections infantiles pourrait réduire le risque de MC pédiatrique.Crohn’s disease (CD) poses specific challenges in the paediatric population (growth failure, depression, etc). The environmental contributors to CD aetiology remain largely unknown. There are suggestions that sanitary living conditions prevailing in developed countries prevent antigen exposure and impede the development of immunological tolerance amongst children, resulting in abnormally heightened immunological responses with subsequent exposures (hygiene hypothesis). Evidence for the hygiene hypothesis in CD aetiology remains unclear. Objectives: To assess the role of the frequency, timing and type of childhood infections (measures of antigen exposure) on the risk of paediatric CD. A case-control study was carried out. Confirmed cases of CD were recruited from a tertiary care paediatric hospital. Controls matched to the cases on calendar age, gender, and area of residence, were selected using the provincial health insurance files. Infection exposure was ascertained using ICD-9 diagnostic codes provided by the provincial insurer’s administrative databases. Conditional logistic regression analysis was used to assess the relationship between childhood infections and CD. Odds ratios (OR) and corresponding 95% confidence intervals (95% CI) were estimated. 409 cases and 1621 controls were recruited. A diagnosis of infection was associated with reduced risks for paediatric CD (OR=0.67, 95% CI:[0.48-0.93], p=0.018), attributable to infection exposures primarily during the first 5 years since birth [OR=0.74, 95% CI=0.57-0.96, p=0.025]. Infections affecting the kidney and urinary tract, oral tract and viral CNS infections, were most significantly associated with protective effects. Our study provides support for the hygiene hypothesis in CD whereby exposure to infections in early childhood could potentially reduce risks for CD.
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Otwombe, Lucy Andere. "Spatial distribution and analysis of factors associated wiyh HIV infection among young people in Eastern Africa: applied to the MEASURE demographic and health survey data collected between 2007 and 2011." Thesis, 2014.
Find full textAbstract:
Assessing risk of HIV amongst young people requires knowledge of the spatial distribution of the disease and its association with demographic, socioeconomic, behavioural, and biological factors. The objective of this study was to press forward with such knowledge by analyzing the spatial distribution of HIV prevalence in relation to the demographic, social and behavioural factors reported in the MEASURE Demographic and Health Surveys conducted in four Eastern Africa countries from 2007-2011.
Methods: The study was a cross-sectional study design where data were obtained from MEASURE DHS databases of Ethiopia (2011) Kenya (2008-2009), Tanzania (2007-2008) and Uganda (2011). Statistical analysis employed Stata TM 12 software to perform descriptive analysis for overall characteristics of the study sample. Bivariate analytical tests compared statistical significant differences between the covariates and outcome. Univariate and multiple variable logistic regression models were used to explore factors that were significantly associated with HIV prevalence in young people. Spatial logistic regression analysis was aided by the Bayesian Software BayesX version 2.1 to perform spatial random effect modelling which was used to account for any unexplained spatial autocorrelation in the study area results. Spatial analyses was performed to examine the spatial distribution of the disease using geostatistical techniques such as; spatial autocorrelation and spatial. Final outputs were visualised using Geographical Information Systems techniques (GIS).
Results: The results showed variations of HIV prevalence not only within countries but also across the countries. Each country was characterised by different factors that were associated with HIV prevalence among young people. Across the study area, behavioural factors were significantly associated with HIV. Presence of an STI, a proxy for high-risk sexual behaviour, {(Kenya: POR=13.46; 95% BCI; 2.92-64.41, Uganda: POR=6.83; 95% BCI; 4.14-16.34)} and an early coital debut were significantly associated with HIV in the study area. On the other hand, circumcision (Uganda: POR=0.30; 95% BCI; 0.12-0.80) and condom use provided a protective effect on HIV among The young people. Spatial distribution of HIV in Eastern Africa was mapped at a regional level in aspects of crude prevalence estimates, excess risk and spatial risk. The spatial distribution of HIV was non-random and clustered with significant Moran’s I for Kenya (0.189, p<0.001) and Tanzania (0.056, p=0.04). Cluster analysis revealed a number of significant geo-spots of HIV in Ethiopia (n=53, p<0.001), Kenya (n=34, p<0.001), Tanzania (n=4, p<0.001), and Uganda (n=32, p<0.001).
Conclusions: Since majority of the significant associations were observed in the behavioural category, HIV prevention interventions should be aimed at behavioural change amongst young people. The use of spatial risks maps can help policy makers target interventions in areas where they are greatly needed. A future study which focuses on the distribution of HIV/AIDS in East Africa over space and time is recommended to understand how behavioural change will affect the spread of the disease.
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Horne, Maria, G. McCracken, A. Walls, P. J. Tyrrell, and C. J. Smith. "Organisation, practice and experiences of mouth hygiene in stroke unit care: a mixed methods study." 2015. http://hdl.handle.net/10454/7373.
Full textAbstract:
noAims and objectives To (1) investigate the organisation, provision and practice of oral care in typical UK stroke units; (2) explore stroke survivors', carers' and healthcare professionals' experiences and perceptions about the barriers and facilitators to receiving and undertaking oral care in stroke units. Background Cerebrovascular disease and oral health are major global health concerns. Little is known about the provision, challenges and practice of oral care in the stroke unit setting, and there are currently no evidence-based practice guidelines. Design Cross-sectional survey of 11 stroke units across Greater Manchester and descriptive qualitative study using focus groups and semi-structured interviews. Methods A self-report questionnaire was used to survey 11 stroke units in Greater Manchester. Data were then collected through two focus groups (n = 10) with healthcare professionals and five semi-structured interviews with stroke survivors and carers. Focus group and interview data were recorded, transcribed verbatim and analysed using framework approach. Results Eleven stroke units in Greater Manchester responded to the survey. Stroke survivors and carers identified a lack of oral care practice and enablement by healthcare professionals. Healthcare professionals identified a lack of formal training to conduct oral care for stroke patients, inconsistency in the delivery of oral care and no set protocols or use of formal oral assessment tools. Conclusion Oral care post-stroke could be improved by increasing healthcare professionals' awareness, understanding and knowledge of the potential health benefits of oral care post-stroke. Further research is required to develop and evaluate the provision of oral care in stroke care to inform evidence-based education and practice.