Administrative Data Research Articles

Trends and determinants of clinical staff retention in the English NHS: a double retrospective cohort study

ObjectivesTo investigate how demographic, contractual and organisational factors are related to the retention of hospital workers in the English NHS. The study will specifically examine the trends in age-retention profiles.DesignA...

Impact of SARS-CoV-2 Infection on Long-Term Depression Symptoms among Veterans.

Prior research demonstrates that SARS-COV-2 infection can be associated with a broad range of mental health outcomes including depression symptoms. Veterans, in particular, may be at elevated risk of increased depression following SARS-COV-2 infection given their high rates of pre-existing mental and physical health comorbidities. However, few studies have tried to isolate SARS-COV-2 infection associations with long term, patient-reported depression symptoms from other factors (e.g., physical health comorbidities, pandemic-related stress). To evaluate the association between SARS-COV-2 infection and subsequent depression symptoms among United States Military Veterans. Survey-based non-randomized cohort study with matched comparators. A matched-dyadic sample from a larger, stratified random sample of participants with and without known to SARS-COV-2 infection were invited to participate in a survey evaluating mental health and wellness 18-months after their index infection date. Sampled participants were stratified by infection severity of the participant infected with SARS-COV-2 (hospitalized or not) and by month of index date. A total of 186 participants in each group agreed to participate in the survey and had sufficient data for inclusion in analyses. Those in the uninfected group who were later infected were excluded from analyses. Participants were administered the Patient Health Questionnaire-9 as part of a phone interview survey. Demographics, physical and mental health comorbidities were extracted from VHA administrative data. Veterans infected with SARS-COV-2 had significantly higher depression symptoms scores compared with those uninfected. In particular, psychological symptoms (e.g., low mood, suicidal ideation) scores were elevated relative to the comparator group (MInfected = 3.16, 95%CI: 2.5, 3.8; MUninfected = 1.96, 95%CI: 1.4, 2.5). Findings were similar regardless of history of depression. SARS-COV-2 infection was associated with more depression symptoms among Veterans at 18-months post-infection. Routine evaluation of depression symptoms over time following SARS-COV-2 infection is important to facilitate adequate assessment and treatment.

Examining How School Resources Contribute to Income Achievement Disparities Across Race and Ethnicity

Extending work documenting historical resource inequities across U.S. schools, we examined how school financial and social resources mediate the relationship between family income and student achievement, and tested how these associations varied by race and ethnicity. Merging administrative school data sources to a nationally representative sample of U.S. elementary students, and employing structural equation modeling, we found that family income selected all children into more highly socially resourced schools, with significantly stronger effects for White children relative to students of color. Contrary to expectations, school financial and social resources were not significantly associated overall with achievement.

Five-Year Post-Housing Outcomes for a Housing First Cohort in Aotearoa, New Zealand

This paper presents outcomes for a Housing First (HF) cohort in Aotearoa, New Zealand. Using integrated governmental administrative data, we analysed outcomes for a cohort of 357 people, comparing health, justice, income, and social welfare indicators the year prior to HF and five years after being housed. In the fifth year after being housed, improved outcomes across each of these sectors were noted, with particularly impressive improvements found in income levels (+38%) and mental health. These results demonstrate the efficacy of this HF programme in improving well-being. Despite such notable improvements, there is room for HF to have a greater impact in the context of wider system changes that support overall well-being, as well as the goal of making homelessness rare, brief, and non-recurring.

Can Social Media Reach Isolated Domestic Abuse Victims? Evidence from a Randomized Control Trial During the Covid-19 Lockdown

Abstract Research Questions Can social media reach isolated domestic abuse victims? Secondly, does providing victims with more information and a safer means of contacting police change their likelihood of domestic abuse reporting? Data This research is based on high-frequency and confidential administrative data on the population of domestic abuse calls during the period of the Covid-19 pandemic but also the preceding years from two police forces—the Thames Valley Police (TVP) and the Metropolitan Police Service (MPS). Methods To answer the research questions, we ran a randomized control trial (RCT) using a novel social media campaign promoting a method of reporting through Facebook and Instagram. We randomized the treatment across geographic areas in one police force and across individuals in another police force. Findings We found that while social media is an effective tool for engaging on domestic abuse topics, particularly with younger individuals, our intention-to-treat estimates between the treatment and control areas and individuals did not show any significant difference in domestic abuse reporting. One of the reasons to explain this finding was the geographically imprecise social media targeting features on Facebook. Conclusions Our research contributes to the scarce experimental literature on how to increase domestic abuse reporting among victims with, to the best of our knowledge, the first randomized test of the effects of a social media campaign on engagement and reporting. As police forces across the UK, but also worldwide, start using social media more to engage with the citizens they serve, these results provide interesting and valuable implications for their effectiveness and the role of technology in the future policing. Our results contribute to the understanding of how police forces can use social media to reach specific groups of people, such as younger cohorts.

Determinants of Referral Outcomes for Victim–Survivors Accessing Specialist Sexual Violence and Abuse Support Services

ABSTRACT Sexual violence and abuse (SVA) is highly prevalent globally, has devastating and wide-ranging effects on victim-survivors, and demands the provision of accessible specialist support services. In the UK, Rape Crisis England & Wales (RCEW), a voluntary third sector organization, is the main provider of specialist SVA services. Understanding the profile of victim-survivors who are referred to RCEW and their referral outcomes is important for the effective allocation of services. Using administrative data collected by three Rape Crisis Centres in England between April 2016 and March 2020, this study used multinomial regression analysis to examine the determinants of victim-survivors’ referral outcomes, controlling for a wide range of potentially confounding variables. The findings demonstrate that support needs, more so than the type of abuse experienced, predicted whether victim-survivors were engaged with services. Particularly, the presence of mental health, substance misuse and social, emotional, and behavioral needs were important for referral outcomes. The referral source also influenced referral outcomes, and there were some differences according to demographic characteristics and socioeconomic factors. The research was co-produced with stakeholders from RCEW, who informed interpretation of these findings. That victim-survivors’ engagement with services was determined by their support needs, over and above demographic characteristics or the type of abuse they had experienced, demonstrates the needs-led approach to service provision adopted by RCEW, whereby resources are allocated effectively to those who need them most.

Does Special Education Work? A Systematic Literature Review of Evidence From Administrative Data

Research increasingly seeks to answer the question: does special education work? This is different than asking if specific interventions have positive effects and instead aims to identify system-wide impacts. We systematically review published quantitative research on the impact of receiving special education services on student outcomes using large administrative data, as well as review the methodology used in existing research. The takeaway from the 15 included studies is that special education positively impacts student outcomes, and the growth of students receiving special education typically matched or exceeded the growth of their general education peers. Methods used in these studies were, however, quasi-experimental, so limitations to credibly causal claims remain. In addition, that relatively few studies met our inclusion criteria reflects the need for additional research, and we highlight methodological and substantive considerations for future work.

Impact of Family Group Conference Referrals at Pre-Proceedings Stage on Child Outcomes: A Randomised Controlled Trial

Abstract Previous evidence on the impact of Family Group Conferencing in the UK cannot establish causality. This article presents results from the first UK randomised controlled trial of Family Group Conferences. All families entering pre-proceedings between September 2020 and May 2022 in twenty-one local authorities in England were eligible for inclusion in the trial. In total, 1,511 families were randomised and child outcomes were collected from administrative data until up to twenty-one months post-referral. Half of the families were randomly allocated to be referred for a Family Group Conference, on top of usual practice during pre-proceedings. The (pre-registered) primary outcome is the child’s looked-after status twelve months after the pre-proceedings letter. This was 8.6 percentage points lower among referred families (36.2 percent vs 44.8 percent). Children were also less likely to have care proceedings issued (59.2 percent vs 71.7 percent) and spent less time in care (87 vs. 115 days). However, there was no significant difference in whether a child’s living arrangement remained the same or changed in the months after the decision. These findings have implications for the support given to families during pre-proceedings; they provide evidence in favour of Family Group Conferences as a way to reduce the chances of children going into care.

Accuracy of routinely collected hospital administrative discharge data and death certificate ICD-10 diagnostic coding in progressive supranuclear palsy and corticobasal syndrome: a systematic review and validation study.

We conducted a systematic review to identify existing ICD-10 coding validation studies in progressive supranuclear palsy and corticobasal syndrome [PSP/CBS]) and, in a new study, evaluated the accuracy of ICD-10 diagnostic codes for PSP/CBS in Scottish hospital inpatient and death certificate data. Original studies that assessed the accuracy of specific ICD-10 diagnostic codes in PSP/CBS were sought. Separately, we estimated the positive predictive value (PPV) of specific codes for PSP/CBS in inpatient hospital data (SMR01, SMR04) compared to clinical diagnosis in four regions. Sensitivity was assessed in one region due to a concurrent prevalence study. For PSP, the consistency of the G23.1 code in inpatient and death certificate coding was evaluated across Scotland. No previous ICD-10 validation studies were identified. 14,767 records (SMR01) and 1497 records (SMR04) were assigned the candidate ICD-10 diagnostic codes between February 2011 and July 2019. The best PPV was achieved with G23.1 (1.00, 95% CI 0.93-1.00) in PSP and G23.9 in CBS (0.20, 95% CI 0.04-0.62). The sensitivity of G23.1 for PSP was 0.52 (95% CI 0.33-0.70) and G31.8 for CBS was 0.17 (95% CI 0.05-0.45). Only 38.1% of deceased G23.1 hospital-coded cases also had this coding on their death certificate: the majority (49.0%) erroneously assigned the G12.2 code. The high G23.1 PPV in inpatient data shows it is a useful tool for PSP case ascertainment, but death certificate coding is inaccurate. The PPV and sensitivity of existing ICD-10 codes for CBS are poor due to a lack of a specific code.

Temporal and geographical variations in diagnostic imaging in Norway

BackgroundUnwarranted temporal and geographical variations are acknowledged as a profound problem for equal access and justice in the provision of health services. Even more, they challenge the quality, safety, and efficiency of such services. This is highly relevant for imaging services.ObjectiveTo analyse the temporal and geographical variation in the number of diagnostic images in Norway from 2013 to 2021.MethodsData on outpatient imaging provided by the Norwegian Health Economics Administration (HELFO) and inpatient data afforded by fourteen hospital trusts and hospitals in Norway. Data include the total number of imaging examinations according to the Norwegian Classification of Radiological Procedures (NCRP). Analyses were performed with descriptive statistics.ResultsMore than 37 million examinations were performed in Norway during 2013–2021 giving an average of 4.2 million examinations per year. In 2021 there was performed and average of 0.8 examinations per person and 2.2 examinations per person for the age group > 80. There was a 9% increase in the total number of examinations from 2013 to 2015 and a small and stable decrease of 0.5% per year from 2015 to 2021 (with the exception of 2020 due to the pandemic). On average 71% of all examinations were outpatient examinations and 32% were conducted at private imaging centres. There were substantial variations between the health regions, with Region South-East having 53.1% more examinations per inhabitant than Region West. The geographical variation was even more outspoken when comparing catchment areas, where Oslo University Hospital Trust had twice as many examinations per inhabitant than Finnmark Hospital Trust.ConclusionAs the population in Norway is homogeneous it is difficult to attribute the variations to socio-economic or demographic factors. Unwarranted and supply-sensitive variations are challenging for healthcare systems where equal access and justice traditionally are core values.

Participation in Advance Care Planning Among Medically At-Risk Rural Veterans: Protocol for a Personalized Engagement Model.

Many of the challenges in advanced care planning (ACP) conversations are linked to the waxing and waning progress of serious illnesses. Conversations with patients about future medical care decisions by a surrogate decision maker have historically been left until late in the patient's disease trajectory. These conversations often happen at a time when the patient is already very ill. The challenge in effective early ACP and serious illness conversations is to create a situation where patients appreciate the link between current and future medical care. Setting the stage to make these conversations more accessible includes using telehealth to have conversations at the patient's place of choice. The personalization used includes addressing the current medical and social needs of the patient and ensuring that expressed needs are addressed as much as possible. Engaging patients in these conversations allows the documentation of patient preferences in the electronic health record (EHR), providing guidelines for future medical care. The objective of our telehealth serious illness care conversations program was to successfully recruit patients who lacked up-to-date documentation of ACP in their EHR. Once these patients were identified, we engaged in meaningful, structured conversations to address the veterans' current needs and concerns. We developed a recruitment protocol that increased the uptake of rural veterans' participation in serious illness care conversations and subsequent EHR documentation. The recruitment protocol outlined herein used administrative data to determine those patients who have not completed or updated formal ACP documentation in the EHR and who are at above-average risk for death in the next 3-5 years. The key features of the telehealth serious illness care conversations recruitment protocol involve tailoring the recruitment approach to address current patient concerns while emphasizing future medical decision-making. As of September 2022, 196 veterans had completed this intervention. The recruitment method ensures that the timing of the intervention is patient driven, allowing for veterans to engage in ACP at a time and place convenient for them and their identified support persons. The recruitment protocol has been successful in actively involving patients in ACP conversations, leading to an uptick in completed formal documentation of ACP preferences within the EHR for this specific population. This documentation is then available to the medical team to guide future medical care. RR1-10.2196/55080.

Validating use of diagnostic codes in Canadian administrative data for identification of adverse drug events.

While diagnostic codes from administrative health data might be a valuable source to identify adverse drug events (ADEs), their ability to identify unintended harms remains unclear. We validated claims-based diagnosis codes for ADEs based on events identified in a prospective cohort study and assessed whether key attributes predicted their documentation in administrative data. This was a retrospective analysis of 3 prospective cohorts in British Columbia, from 2008 to 2015 (n = 13 969). We linked prospectively identified ADEs to administrative insurance data to examine the sensitivity and specificity of different diagnostic code schemes. We used logistic regression to assess which key attributes (e.g., type of event, symptoms and culprit medications) were associated with better documentation of ADEs in administrative data. Among 1178 diagnosed events, the sensitivity of the diagnostic codes in administrative data ranged from 3.4 to 52.6%, depending on the database and codes used. We found that documentation was worse for certain types of ADEs (dose-related: odds ratio [OR]: 0.32, 95% confidence interval [CI]: 0.15, 0.69; nonadherence events (OR: 0.35, 95% CI: 0.20, 0.62), and better for those experiencing arrhythmias (OR: 4.19, 95% CI: 0.96, 18.28). ADEs were not well documented in administrative data. Alternative methods should be explored to capture ADEs for health research.

Examining adverse childhood experiences and Black youth's engagement in a hospital-based violence intervention program using administrative data.

Stemming from poverty and systemic racism, Black youth are disproportionately represented in hospital-based violence intervention programs (HVIPs) due to greater violence exposure. HVIPs are a critical intervention that have been shown to reduce rates of reinjury in urban hospitals and trauma centers across the United States; however, they are plagued by low enrollment and engagement rates. Few studies have examined factors related to engagement, particularly among Black youth. Guided by Trauma Theory and Critical Race Theory, this study uses a retrospective cohort design. Between-group differences of adverse childhood experiences (ACEs) among engaged youth compared to nonengaged youth who were violently injured and recruited for a HVIP were examined using chi-square and logistic regression. ACEs were approximated using a novel approach with administrative data. Results indicated that the total ACE score was not significantly associated with engagement status. Individual ACEs were tested across age groups. This study highlights a novel approach to understanding ACEs among a hard-to-reach population and illuminates the significant level of ACEs faced by violence-exposed Black youth at young ages. Considering theory, Black families may be more reluctant to engage due to fear and past harms in social service systems stemming from systemic racism. Though ACEs did not predict engagement in this study, considering the high rates of ACEs experienced by Black youth and their families in the context of systemic racism suggests that HVIPs should acknowledge historical harms and foster trauma-informed and healing-centered interactions during recruitment and later stages of engagement.

Legitimacy deficits in the private higher education sector: categories in evaluating Russian universities

ABSTRACT This paper explores the regulators’ perspective and demonstrates how legitimacy deficits of private universities outweigh performance results in decisions regarding university inspections. We examined the period when the regulator had an urgent claim on Russian universities, particularly during the campaign to ‘clean the system of higher education’ announced in 2013. The Russian case of delayed regulation provides a unique natural phenomenon for studying how evaluators choose which universities to inspect. This study relies on administrative data on university inspections, which are merged with the results of annual evaluations of universities conducted by the Ministry from 2013 to 2016, encompassing 8227 cases. Our findings indicate that private universities and their branches are more likely to undergo inspection than public HEIs, even after considering information about their performance results. For state officials, private institutions exemplify market logic, which is seen as a competing rule of the game to state logic. These results suggest that organizational categories hold considerable promise for further research as they may contribute to understanding how universities are evaluated and scrutinized, a phenomenon typically considered as driven by performance-based criteria.

Mortality trend of ischemic heart disease (2008–2022): A retrospective analysis of epidemiological data

BackgroundAge-sex specific trend analyses of ischemic heart disease (IHD)-related mortality and prevalent risk factors can improve our understanding and approach to the disease. MethodsWe performed a 15-year retrospective epidemiological analysis of acute and chronic IHD-related mortality and prevalent cardiovascular risk factors using administrative data from Veneto, a socio-economically homogeneous Italian region. Standard mortality statistics using the underlying cause of death (UCOD) and deaths with any mention of IHD in death certificates (MCOD) from ICD-10 codes I20-I25 was performed between 2008 and 2022. ResultsA total of 134,327 death certificates reported IHD-related deaths, representing 18.6% of all deaths. Proportional mortality decreased from 14.6% in 2008 to 7.8% in 2022 for deaths with IHD as the UCOD and from 23.5% to 14.6% for deaths with IHD among the MCOD. A more pronounced decline of proportionate and case-specific mortality rate was seen in women. The decline in mortality over the whole study period was larger for acute (vs. chronic) IHD. The COVID-19 pandemic led to a marked increase in mortality in 2020 (+12.2%) with a subsequent further decline. IHD-related deaths displayed a typical seasonal pattern with more deaths during winter. The prevalence of cardiovascular risk factors was higher in IHD (vs. no IHD) deaths: this association appeared more pronounced in younger adults. ConclusionsWe provided an analysis of epidemiological trends in IHD-related mortality and prevalence of risk factors. Our findings indicate a change in the pattern of cardiovascular deaths and may suggest a switch in death from acute to chronic conditions.

Effects of summer schools: Who benefits the most?

This study investigates whether publicly funded summer school programs in secondary education are of substantive meaning for the math performance of students from lower socioeconomic backgrounds. More specifically, we explore whether this is the case when the summer programs are not explicitly aimed at low-SES students. In this context, we investigate whether summer schools in the Netherlands can decrease inequalities of opportunities in education. We use administrative data from Dutch secondary schools. To analyse the effect of the intervention we apply a Difference-in-Difference analysis in combination with matching estimation techniques. The results indicate that there is an overall modest effect of participation in a summer school. When analysing the SES groups separately, we observe a positive effect of participation for all three SES groups. However, the effect seems less strong for participants in the lowest and middle SES group compared to the highest SES group.

Surveillance of catheter-associated bloodstream infections: development and validation of a fully automated algorithm

BackgroundMost surveillance systems for catheter-related bloodstream infections (CRBSI) and central line-associated bloodstream infections (CLABSI) are based on manual chart review. Our objective was to validate a fully automated algorithm for CRBSI and CLABSI surveillance in intensive care units (ICU).MethodsWe developed a fully automated algorithm to detect CRBSI, CLABSI and ICU-onset bloodstream infections (ICU-BSI) in patients admitted to the ICU of a tertiary care hospital in Switzerland. The parameters included in the algorithm were based on a recently performed systematic review. Structured data on demographics, administrative data, central vascular catheter and microbiological results (blood cultures and other clinical cultures) obtained from the hospital’s data warehouse were processed by the algorithm. Validation for CRBSI was performed by comparing results with prospective manual BSI surveillance data over a 6-year period. CLABSI were retrospectively assessed over a 2-year period.ResultsFrom January 2016 to December 2021, 854 positive blood cultures were identified in 346 ICU patients. The median age was 61.7 years [IQR 50–70]; 205 (24%) positive samples were collected from female patients. The algorithm detected 5 CRBSI, 109 CLABSI and 280 ICU-BSI. The overall CRBSI and CLABSI incidence rates determined by automated surveillance for the period 2016 to 2021 were 0.18/1000 catheter-days (95% CI 0.06–0.41) and 3.86/1000 catheter days (95% CI: 3.17–4.65). The sensitivity, specificity, positive predictive and negative predictive values of the algorithm for CRBSI, were 83% (95% CI 43.7–96.9), 100% (95% CI 99.5–100), 100% (95% CI 56.5–100), and 99.9% (95% CI 99.2–100), respectively. One CRBSI was misclassified as an ICU-BSI by the algorithm because the same bacterium was identified in the blood culture and in a lower respiratory tract specimen. Manual review of CLABSI from January 2020 to December 2021 (n = 51) did not identify any errors in the algorithm.ConclusionsA fully automated algorithm for CRBSI and CLABSI detection in critically-ill patients using only structured data provided valid results. The next step will be to assess the feasibility and external validity of implementing it in several hospitals with different electronic health record systems.

Maternal and perinatal death surveillance and response in Bangladesh: A case study on measuring impact through health information systems

The health sector in Bangladesh is thriving, and the Maternal and Perinatal Death Surveillance and Response (MPDSR) program has been in place to investigate the causes of maternal and perinatal death. This study aimed to investigate the availability of information systems for measuring the status of an MPDSR program and the planning process and actions developed based on real-time information. This study delved into innovative information systems that can be used to monitor and measure the impact of health programs. The study included both the primary and secondary data. A total of six key informant interviews were conducted to explore the enablers and strengths of information systems. Secondary data were collected from government websites and MPDSR action plans. This study highlights the potential and challenges of governmental health information systems in notifying maternal and neonatal deaths. While the current notification rates are not up to national standards, it is encouraging to see health managers develop action plans and address this issue. The MPDSR information system is a valuable tool to help health managers measure changes in maternal and perinatal mortality rates and design locally targeted interventions. However, several obstacles must be addressed, such as insufficient data, lack of monitoring, and irregularities in MPDSR review meetings. By finding ways to overcome these challenges, we can unlock the full potential of MPDSR and improve maternal and neonatal health outcomes. The success of an MPDSR program relies on how the information is utilized to take action and measure the outcome. Advanced information systems, such as health dashboards, scorecards, and administrative data, can play a vital role in measuring the progress and impact of a program. The primary challenge lies in capturing all deaths, including their causes, and having the capacity to analyze the data effectively to develop action plans for health managers.

Marked by a Criminal Record? Socioeconomic Differences in the Relationship Between Early Criminal Justice Contacts and Adult Life Outcomes

Abstract This paper combines life course theory and empirical research on the collateral consequences of punishment as a backdrop to exploring the relationship between both the presence of and seriousness of a criminal record measured in early adulthood (age 25) and later life outcomes (ages 41-49), both in total and by socioeconomic status. The analysis relies on a combination of longitudinal survey data and administrative register data for 2,022 individuals who were between 12 and 20 years old when the data collection started. Results show that the criminal record is linked to both labor market and social exclusion later in life, but most systematically to (worse) labor market outcomes. Somewhat surprisingly, low SES seems to “buffer” against some of the unwanted outcomes linked to having a more serious criminal record, while high SES seems to “boost” others. Implications for future research on both deviance and stratification are discussed.

Predictions of tissue concentrations of myclobutanil, oxyfluorfen, and pronamide in rat and human after oral exposures via GastroPlusTM physiologically based pharmacokinetic modelling

ABSTRACT Heritage agrochemicals like myclobutanil, oxyfluorfen, and pronamide, are extensively used in agriculture, with well-established studies on their animal toxicity. Yet, human toxicity assessment relies on conventional human risk assessment approaches including the utilization of animal-based ADME (Absorption, Distribution, Metabolism, and Excretion) data. In recent years, Physiologically Based Pharmacokinetic (PBPK) modelling approaches have played an increasing role in human risk assessment of many chemicals including agrochemicals. This study addresses the absence of PBPK-type data for myclobutanil, oxyfluorfen, and pronamide by generating in vitro data for key input PBPK parameters (Caco-2 permeability, rat plasma binding, rat blood to plasma ratio, and rat liver microsomal half-life), followed by generation of PBPK models for these three chemicals via the GastroPlusTM software. Incorporating these experimental input parameters into PBPK models, the prediction accuracy of plasma AUC (area under curve) was significantly improved. Validation against rat oral administration data demonstrated substantial enhancement. Steady-state plasma concentrations (Css) of pronamide aligned well with published data using measured PBPK parameters. Following validation, parent-based tissue concentrations for these agrochemicals were predicted in humans and rats after single or 30-day repeat exposure of 10 mg/kg/day. These predicted concentrations contribute valuable information for future human toxicity risk assessments of these agrochemicals.