Health Information System Data Research Articles

A Novel Approach to Identifying Septic Shock (SS) in Children with Acute Lymphoblastic Leukemia (ALL) Using Pediatric Health Information System (PHIS) Data: Methods Validation and Incidence Estimation in a National Cohort

Infectious complications are major contributors to morbidity and mortality in children with leukemia; however, clinical trial reporting is incomplete (Miller 2016 J Clin Oncol). Using administrative data to identify SS events could improve estimates of incidence and clinical impact. However, accurate SS determination is challenging, and the 2005 International Pediatric Sepsis Consensus Conference (IPSCC) definition is often modified for individual studies. ICD-9 codes, assigned at discharge, do not permit precise timing estimates. We hypothesized PHIS resource utilization (RU) codes could identify vasopressor exposures as proxies for IPSCC-defined SS events. We present the operating characteristics of our methods and use the approach to estimate SS incidence for a national cohort.We previously identified and validated a longitudinal cohort of children aged 0-21 with newly diagnosed ALL using PHIS billing and diagnosis codes (Fisher 2014 Med Care), expanded through 12/31/2013. PHIS RU data were used to identify distinct vasopressor exposure patterns hypothesized to represent true SS (Figure 1). Epinephrine alone with asparaginase within ± 3 days was considered anaphylaxis rather than SS. We captured vasopressor patterns occurring ≥7 days from first chemotherapy until the first of: 30 days prior to relapse, 10 days prior to stem cell transplantation, or 3 years from diagnosis.We reviewed charts of all patients with ALL diagnosed from 2004 to 2013 at the Children's Hospital of Philadelphia (CHOP) to establish the SS gold-standard. We assumed true SS events would be associated with blood cultures. Each blood culture triggered a chart review and was classified by IPSCC sepsis criteria. A PHIS RU-defined vasopressor exposure had to be within ±14 days of the chart-defined SS to be considered a true positive.We predicted a patient may meet criteria for a PHIS vasopressor exposure if vasopressors were ordered to the bedside for impending SS but ultimately not administered. For CHOP patients with available electronic medication administration record (MAR) data (1/1/2011-12/31/2013), we assessed whether using vasopressor orders marked as “given” or “given or held at bedside” resulted in different operating characteristics relative to gold standard IPSCC SS events. We calculated sensitivity and positive predictive value (PPV) of PHIS RU exposure patterns for IPSCC SS, then used them to estimate SS incidence for the entire PHIS cohort and for certain risk group subsets.We identified 360 patients common to both PHIS and CHOP chart review cohorts. Chart review revealed 38 events meeting IPSCC SS criteria. PHIS RU data identified vasopressor exposure patterns in 35 of these 38 SS events within ±14 days (sensitivity 92%). PHIS RU data identified an additional 43 vasopressor patterns that did not correlate with a chart review IPSCC SS event (PPV: 35/78, 45%). When considering chart-defined sepsis event of any severity (ie, not restricted to SS), the PPV for PHIS-defined vasopressor events increased to 88%. MAR data were available for 149 patients to delineate whether ordered vasopressors were given or held. Among these 149 patients, 10 SS events met IPSCC criteria by chart review. Restricting RU-identified vasopressor exposure events to patients who actually received vasopressors resulted in sensitivity of 70% and PPV 77%; including orders where vasopressors were given or held, the sensitivity increased to 100% and PPV decreased to 55%. Using PHIS RU vasopressor patterns, we estimated an incidence of 12.6% (95% CI 12.0 - 13.3 %) of patients ever experiencing SS in the PHIS ALL cohort. Infants, children aged ≥10 years, with public insurance, or receiving daunorubicin all had significantly higher SS rates than the cohort baseline (Table 1).PHIS RU-defined vasopressor exposure patterns have a high sensitivity for IPSCC-defined SS but a low PPV. The PPV may be the result of including patients with vasopressors ordered but not given; however, IPSCC-defined SS excludes children with fluid-responsive shock. The low PPV suggests this RU-defined approach results in “overcapture” of SS, but the gold standard definition may be too restrictive. Vasopressor exposure patterns from RU data may identify patients with SS or impending SS that can augment incomplete clinical trial data collection. PHIS RU SS incidence estimates for a national pediatric ALL cohort exceed 12%, with even higher rates in high-risk subgroups. [Display omitted] DisclosuresFisher:Merck: Research Funding; Pfizer: Research Funding.

2321. Epidemiology of Staphylococcus aureus Infections in Patients Admitted to Freestanding Pediatric Hospitals, 2009–2016

Background S. aureus causes a substantial number of pediatric infections in the United States each year, with potential for severe complications including death. Recent data suggest S. aureus infections are declining in adults, but a nationally representative and contemporary characterization of trends in pediatric S. aureus infections is lacking. Our objective was to describe recent pediatric hospitalization trends for S. aureus and associated antibiotic prescribing patterns.MethodsWe conducted a retrospective cohort study using Pediatric Health Information Systems data from 39 tertiary care freestanding children’s hospitals in the United States. All inpatient encounters for patients ages <18 hospitalized between 1/1/2009–12/31/2016 at a continuously reporting hospital were included. Analysis was limited to patients with S. aureus infection, defined as: 1) having ≥1 ICD discharge code for methicillin-resistant (MRSA) or methicillin-susceptible (MSSA) S. aureus; and 2) ≥1 anti-staphylococcal antibiotic received. Analysis for rates were per 1,000 hospital admissions, antibiotic days of therapy (DOT) per 1,000 patient-days, and trends were analyzed using Cochran-Armitage tests; significance was set at P < 0.05.ResultsFrom 2009–2016 we identified 116,152 S. aureus hospitalizations. Patients had median age 3 (interquartile range: 0–11 years); 53.7% were male, 52.5% non-Hispanic white, and 18.8% non-Hispanic African American. From 2009 to 2016, S. aureus hospitalizations declined 36% from 26.3 to 16.8 infections per 1,000 admissions (P < 0.001) (figure). MRSA infections declined 52% (14.4 in 2009 to 6.9 infections per 1,000 admissions in 2016, P < 0.001) while MSSA infections declined 17% (11.9 to 9.9 infections per 1,000 admissions, P < 0.001). DOT for anti-MRSA antibiotics declined from 38.0 to 24.5 per 1,000 patient-days.ConclusionRates of pediatric hospitalization with S. aureus infection declined substantially over time. This was largely driven by decreased rates of MRSA hospitalizations, and we observed a corresponding decline in anti-MRSA antibiotic use. Further research is needed to better understand factors driving epidemiologic changes.Figure. S. aureus hospitalization rate per 1,000 hospital admissions in 39 PHIS hospitals with continuous reporting, 2009–2016.All S. aureusinfections Disclosures R. Banerjee, Accelerate Diagnostics, Biomerieux, BioFire: Grant Investigator, Research grant and Research support. S. Patel, Merck: Grant Investigator, Grant recipient and Research grant. Pfizer: Grant Investigator, Research grant.

The Nigerian health information system policy review of 2014 : the need, content, expectations and progress.

Nigeria's national health information system (HIS) data sources are grouped into institutional and population based data that traverse many government institutions. Communication and collaboration between these institutions are limited, fraught with fragmentation and challenges national HIS functionality. The objective of this paper was to share insights from and the implications of a recent review of Nigeria's HIS policy in 2014 that resulted in its substantial revision. We also highlight some subsequent enactments. In 2013, Nigeria's Federal Ministry of Health launched an inter-ministerial and multi-departmental review of the National Health Management Information System policy of 2006. The review was guided by World Health Organization's 'Framework and Standards for Country Health Information Systems'. The key finding was a lack of governance mechanisms in the execution of the policy, including an absent data management governance process. The review also found a multiplicity of duplicative, parallel reporting tools and platforms. Recommendations for HIS Policy revisions were proposed to and implemented by the Federal Government of Nigeria. The revised HIS policy now provides for a strong framework for the leadership and governance of the HIS with early results.

Women screened for breast cancer: follow-up through Health Information Systems, Brazil, 2010-2012.

to describe the two-years follow-up of women with screening mammography showing lesions suspected or highly suspected of malignancy in the city of Rio de Janeiro, Brazil. this was a descriptive study of the care line using Health Information Systems (SIS) data on women who underwent screening mammography in the Brazilian National Health System (SUS) in the second half of 2010. of the 206 women studied, 13.1% had their mammograms requested by Primary Health Centers; during follow-up 102 (49.5%) were identified on at least one SIS; of these, 12 had biopsy information, all of which was positive for breast cancer; 93 had treatment, one of whom had benign disease; 12 died from breast cancer; the proportion of women identified as having treatment was higher among those with suspected high malignancy and palpable lesions (p<0.01). information on the breast cancer care line was partially recovered through SIS records.

Contextual factors and health service performance from the perspective of the provincial health administrators in Papua New Guinea.

The Rural Primary Health Services Delivery Project aims to improve the quality and coverage of health services to rural populations in Papua New Guinea. There are limitations in measuring performance of such projects through analysis of health information system data alone due to data quality issues and a multitude of unmeasured factors that affect performance. A mixed methods study was undertaken to understand the contextual factors that affect health service performance. A performance assessment framework was developed including service delivery indicators derived from the National Health Information System. Prior to implementation, a baseline analysis of the indicators was undertaken. Subsequently, semi-structured interviews were conducted with health administrators, in which they were asked about factors they perceived to influence health facility performance. During the interviews, key informants were provided with health indicators for their province and asked to interpret the performance of facilities. Interviews were transcribed and inductive thematic analysis performed. Performance indicators varied greatly within and between districts. Key informants cited a number of reasons for this variation. Health facilities accessible by road in urban areas, with competent and/or higher level staff and health services operated by churches or private companies, were cited as contributors to high performance. For high performing districts, key informants also discussed use of health information, planning and targeted strategies to improve performance. Inadequate numbers of staff, poorly skilled staff, funding delays and challenging geography were major contributors noted for poor performance. Analysis of quantitative indicators needs to be performed at health facility level in order to understand district level performance. Interpretation of performance through key informant interviews provided useful insight into previously undocumented contextual factors affecting health delivery performance. The sequential explanatory mixed methods design could be applied to evaluations of other health service delivery programs in similar contexts.

Lessons Learned from Introducing a Village Health Registry in Malawi.

The Village Health Registry (VHR) was a community health data collection tool introduced in 1998. It was first introduced in Mwanza district of Malawi with the objectives of collecting community-based data, analysing and taking action in a local setting. The tool was collecting and updating data such as demography, immunization status for children under one year, growth monitoring for children under five, monitoring of all pregnant women, incidence of malaria, acute respiratory infections, diarrhoea cases, water and sanitation and deaths, by visiting households in every village every month.The tool was able to collect all targeted information as required. The data collected by the tool appeared to be more reliable than that obtained through a national information system used by the Ministry of Health (MoH) for the same district and the same year. It was easy for health centres to accurately order supplies based on actual requirements, to follow-up cases during disease outbreaks and to identify deficiencies in immunisation coverage rates.Despite promising results, the VHR registry fell into disuse following the establishment of a national register. The MoH’s Health Information System (HIS) data used projections which normally did not represent the actual situation on the ground while the VHR registry gave real physical data which was representative and verifiable. The potential of the VHR outweighed that of the HIS. Although the HIS had been rolled out nationally, there were shortfalls which MoH could consider rectifying to reach its full potential. In conclusion, the VHR was worth adopting as it would give MoH realistic statistics to be effectively used at all levels.

Neuro‐fuzzy model for HELLP syndrome prediction in mobile cloud computing environments

SummaryThe exchange of information among health professionals is a common practice among clinics, laboratories, and hospitals. Cloud‐based clinical data exchange platforms enable valuable information to be available in real time and in a secure and private manner. The increasing availability of data in health information systems allows specialists to extract knowledge using pattern recognition techniques for the identification and prediction of risk situations that could lead to severe complications for a patient. Hence, this paper proposes the use of a neuro‐fuzzy machine learning technique for predicting the most complex hypertensive disorder in pregnancy called HELLP syndrome. This classifier serves as an inference mechanism for cloud‐based mobile applications, for effective monitoring through the analysis of symptoms presented by pregnant women. Results show that the proposed model achieves excellent results regarding several indicators, such as precision (0.685), recall (0.756), the F‐measure (0.705), and the area under the receiver operating characteristic curve (0.829). This technique can accurately predict situations that could lead to the death of both a mother and fetus, at any location and time.

A data quality framework, method and tools for managing data quality in a health care setting: an action case study

The effectiveness, efficiency and reliability of health services depends on the quality of data in health information systems used by health care providers, managers and decision-makers. The aim of this research-in-progress paper is to propose a data quality framework, method and set of tools to help an information management team at a health care institution to monitor data quality as part of their business intelligence process. The proposed tool has the capacity to capture and visualise different stakeholder perceptions of data quality depending on the user role and the task they are responsible for. This study uses an action case method to develop a prototype of the tool and provide an illustration of its implementation and usage by multiple stakeholders.

Challenges of DHS and MIS to capture the entire pattern of malaria parasite risk and intervention effects in countries with different ecological zones: the case of Cameroon

BackgroundIn 2011, the demographic and health survey (DHS) in Cameroon was combined with the multiple indicator cluster survey. Malaria parasitological data were collected, but the survey period did not overlap with the high malaria transmission season. A malaria indicator survey (MIS) was also conducted during the same year, within the malaria peak transmission season. This study compares estimates of the geographical distribution of malaria parasite risk and of the effects of interventions obtained from the DHS and MIS survey data.MethodsBayesian geostatistical models were applied on DHS and MIS data to obtain georeferenced estimates of the malaria parasite prevalence and to assess the effects of interventions. Climatic predictors were retrieved from satellite sources. Geostatistical variable selection was used to identify the most important climatic predictors and indicators of malaria interventions.ResultsThe overall observed malaria parasite risk among children was 33 and 30% in the DHS and MIS data, respectively. Both datasets identified the Normalized Difference Vegetation Index and the altitude as important predictors of the geographical distribution of the disease. However, MIS selected additional climatic factors as important disease predictors. The magnitude of the estimated malaria parasite risk at national level was similar in both surveys. Nevertheless, DHS estimates lower risk in the North and Coastal areas. MIS did not find any important intervention effects, although DHS revealed that the proportion of population with an insecticide-treated nets access in their household was statistically important. An important negative relationship between malaria parasitaemia and socioeconomic factors, such as the level of mother’s education, place of residence and the household welfare were captured by both surveys.ConclusionTiming of the malaria survey influences estimates of the geographical distribution of disease risk, especially in settings with seasonal transmission. In countries with different ecological zones and thus different seasonal patterns, a single survey may not be able to identify all high risk areas. A continuous MIS or a combination of MIS, health information system data and data from sentinel sites may be able to capture the disease risk distribution in space across different seasons.

Reporting of HIV-infected pregnant women: estimates from a Brazilian study.

ABSTRACTOBJECTIVE:To estimate the coverage of the reporting of cases of HIV-infected pregnant women, to estimate the increase in the coverage of the reporting with the routine search of data in other Brazilian health information systems, and to identify missed opportunities for identification of HIV-infected pregnant women in Brazilian maternity hospitals.METHODS:This is a descriptive study on the linkage of Brazilian databases with primary data from the “Nascer no Brasil” study and secondary database collection from national health information systems. The “Nascer no Brasil” is a national-based study carried out in 2011–2012 with 23,894 pregnant women, which identified HIV-infected pregnant women using prenatal and medical records. We searched for cases of HIV-infected pregnant women identified in the “Nascer no Brasil” study in the Information System of Notifiable Diseases, the Control System for Laboratory Tests of the National CD4+/CD8+ Lymphocyte Count and HIV Viral Load Network, and the Logistics Control System for Medications. We used the OpenRecLink software for the linkage of databases. We estimated the notification coverage, with the respective confidence interval, of the evaluated Brazilian health information systems.RESULTS:We estimated the coverage of the reporting of HIV-infected pregnant women in the Information System of Notifiable Diseases as 57.1% (95%CI 42.9–70.2), and we located 89.3% of the HIV-infected pregnant women (95%CI 81.2–94.2) in some of the Brazilian health information systems researched. The search in other national health information systems would result in an increase of 57.1% of the reported cases. We identified no missed opportunities for the diagnosis of HIV+ in pregnant women in the maternity hospitals evaluated by the “Nascer no Brasil” study.CONCLUSIONS:The routine search for information in other Brazilian health information systems, a procedure carried out by the Ministry of Health for cases of AIDS in adults and children, should be adopted for cases of HIV in pregnancy.

Population-based cohort study on comparative effectiveness and safety of biologics in inflammatory bowel disease

BackgroundThe comparison of effectiveness and safety of anti-tumor necrosis factor-alpha agents for the treatment of inflammatory bowel disease (IBD) is relevant for clinical practice and stakeholders.ObjectiveThe objective of this study was to compare the risk of abdominal surgery, steroid utilization, and hospitalization for infection in Crohn’s disease (CD) or ulcerative colitis (UC) patients newly treated with infliximab (IFX) or adalimumab (ADA).MethodsA retrospective population-based cohort study was performed using health information systems data from Lazio region, Italy. Patients with CD or UC diagnosis were enrolled at first prescription of IFX or ADA during 2008–2014 (index date). Only new drug users were followed for 2 years from the index date. IFX versus ADA adjusted hazard ratios were calculated applying “intention-to-treat” approach, controlling for several characteristics and stratifying the analysis on steroid use according to previous drug utilization. Sensitivity analyses were performed according to “as-treated” approach, adjusting for propensity score, censoring at switching or discontinuation, and evaluating different lengths of follow-up periods.ResultsWe enrolled 1,432 IBD patients (42% and 83% exposed to IFX for CD and UC, respectively). In both diseases, treatment effects did not differ in any outcome considered, and sensitivity analyses confirmed the results from the main analysis.ConclusionIn our population-based cohort study, effectiveness and safety data in new users of ADA or IFX with CD or UC were comparable for the outcomes we tested.

Evaluation of Nowcasting for Detecting and Predicting Local Influenza Epidemics, Sweden, 2009-2014.

The growing availability of big data in healthcare and public health opens possibilities for infectious disease control in local settings. We prospectively evaluated a method for integrated local detection and prediction (nowcasting) of influenza epidemics over 5 years, using the total population in Östergötland County, Sweden. We used routine health information system data on influenza-diagnosis cases and syndromic telenursing data for July 2009–June 2014 to evaluate epidemic detection, peak-timing prediction, and peak-intensity prediction. Detection performance was satisfactory throughout the period, except for the 2011–12 influenza A(H3N2) season, which followed a season with influenza B and pandemic influenza A(H1N1)pdm09 virus activity. Peak-timing prediction performance was satisfactory for the 4 influenza seasons but not the pandemic. Peak-intensity levels were correctly categorized for the pandemic and 2 of 4 influenza seasons. We recommend using versions of this method modified with regard to local use context for further evaluations using standard methods.

Methodological Considerations for Use of Routine Health Information System Data to Evaluate Malaria Program Impact in an Era of Declining Malaria Transmission.

.Coverage of malaria control interventions is increasing dramatically across endemic countries. Evaluating the impact of malaria control programs and specific interventions on health indicators is essential to enable countries to select the most effective and appropriate combination of tools to accelerate progress or proceed toward malaria elimination. When key malaria interventions have been proven effective under controlled settings, further evaluations of the impact of the intervention using randomized approaches may not be appropriate or ethical. Alternatives to randomized controlled trials are therefore required for rigorous evaluation under conditions of routine program delivery. Routine health management information system (HMIS) data are a potentially rich source of data for impact evaluation, but have been underused in impact evaluation due to concerns over internal validity, completeness, and potential bias in estimates of program or intervention impact. A range of methodologies were identified that have been used for impact evaluations with malaria outcome indicators generated from HMIS data. Methods used to maximize internal validity of HMIS data are presented, together with recommendations on reducing bias in impact estimates. Interrupted time series and dose-response analyses are proposed as the strongest quasi-experimental impact evaluation designs for analysis of malaria outcome indicators from routine HMIS data. Interrupted time series analysis compares the outcome trend and level before and after the introduction of an intervention, set of interventions or program. The dose-response national platform approach explores associations between intervention coverage or program intensity and the outcome at a subnational (district or health facility catchment) level.

Estimating the cost-per-result of a national reflexed Cryptococcal antigenaemia screening program: Forecasting the impact of potential HIV guideline changes and treatment goals.

IntroductionDuring 2016, the National Health Laboratory Service (NHLS) introduced laboratory-based reflexed Cryptococcal antigen (CrAg) screening to detect early Cryptococcal disease in immunosuppressed HIV+ patients with a confirmed CD4 count of 100 cells/μl or less.ObjectiveThe aim of this study was to assess cost-per-result of a national screening program across different tiers of laboratory service, with variable daily CrAg test volumes. The impact of potential ART treatment guideline and treatment target changes on CrAg volumes, platform choice and laboratory workflow are considered.MethodsCD4 data (with counts < = 100 cells/μl) from the fiscal year 2015/16 were extracted from the NHLS Corporate Date Warehouse and used to project anticipated daily CrAg testing volumes with appropriately-matched CrAg testing platforms allocated at each of 52 NHLS CD4 laboratories. A cost-per-result was calculated for four scenarios, including the existing service status quo (Scenario-I), and three other settings (as Scenarios II-IV) which were based on information from recent antiretroviral (ART) guidelines, District Health Information System (DHIS) data and UNAIDS 90/90/90 HIV/AIDS treatment targets. Scenario-II forecast CD4 testing offered only to new ART initiates recorded at DHIS. Scenario-III projected all patients notified as HIV+, but not yet on ART (recorded at DHIS) and Scenario-IV forecast CrAg screening in 90% of estimated HIV+ patients across South Africa (also DHIS). Stata was used to assess daily CrAg volumes at the 5th, 10th, 25th, 50th, 75th, 90th and 95th percentiles across 52 CD4-laboratories. Daily volumes were used to determine technical effort/ operator staff costs (% full time equivalent) and cost-per-result for all scenarios.ResultsDaily volumes ranged between 3 and 64 samples for Scenario-I at the 5th and 95th percentile. Similarly, daily volumes ranges of 1–12, 2–45 and 5–100 CrAg-directed samples were noted for Scenario’s II, III and IV respectively. A cut-off of 30 CrAg tests per day defined use of either LFA or EIA platform. LFA cost-per-result ranged from $8.24 to $5.44 and EIA cost-per-result between $5.58 and $4.88 across the range of test volumes. The technical effort across scenarios ranged from 3.2–27.6% depending on test volumes and platform used.ConclusionThe study reported the impact of programmatic testing requirements on varying CrAg test volumes that subsequently influenced choice of testing platform, laboratory workflow and cost-per-result. A novel percentiles approach is described that enables an overview of the cost-per-result across a national program. This approach facilitates cross-subsidisation of more expensive lower volume sites with cost-efficient, more centralized higher volume laboratories, mitigating against the risk of costing tests at a single site.

Community mental health services in Southern Gauteng: An audit using Gauteng District Health Information Systems data.

BackgroundCommunity mental health services (CMHS) are a central objective of the National Mental Health Policy Framework and Strategic Plan. Three core components are described: residential facilities, day care and outpatient services. Primary mental health care with specialist support is required according to an intervention pyramid. Staffing norms provide for a minimum mental health service coverage of 2.7% of the population for adults and 1.5% for children and adolescents.AimThe aim of this study was to describe the existing CMHS in Southern Gauteng in terms of the National Mental Health Policy.MethodsThe CMHS of the City of Johannesburg, Ekurhuleni, Sedibeng and West Rand districts were studied. Information regarding service organisation and staffing was obtained via the Gauteng Directorate of Mental Health. Routinely collected District Health Information Systems data for the 2014/2015 year were analysed.ResultsThe organisation of services was not consistent with that recommended by the Mental Health Policy, and specialist CMHS were inappropriately situated within primary care. Only 2.23% of clinic visits were for mental health, and 80% of these were at specialist CMHS. Overall mental health coverage was approximately 0.3% of the population for adults and 0.02% for children and adolescents. Staffing, residential facilities and day care were far below the cited norms for minimal cover.ConclusionOur audit revealed that the CMHS in Southern Gauteng did not meet any of the norms cited by the Mental Health Policy. Barriers to implementation of this aspect of the Mental Health Policy need to be explored.

Where do HIV-infected adolescents go after transfer? - Tracking transition/transfer of HIV-infected adolescents using linkage of cohort data to a health information system platform.

Introduction: To evaluate long-term outcomes in HIV-infected adolescents, it is important to identify ways of tracking outcomes after transfer to a different health facility. The Department of Health (DoH) in the Western Cape Province (WCP) of South Africa uses a single unique identifier for all patients across the health service platform. We examined adolescent outcomes after transfer by linking data from four International epidemiology Databases to Evaluate AIDS Southern Africa (IeDEA-SA) cohorts in the WCP with DoH data.Methods: We included adolescents on antiretroviral therapy who transferred out of their original cohort from 10 to 19 years of age between 2004 and 2014. The DoH conducted the linkage separately for each cohort and linked anonymized data were then combined. The primary outcome was successful transfer defined as having a patient record at a facility other than the original facility after the transfer date. Secondary outcomes included the proportion of patients retained, with HIV-RNA <400 copies/ml and CD4 > 500 cells/µl at 1, 2 and 3 years post-transfer.Results: Of 460 adolescents transferred out (53% female), 72% transferred at 10–14 years old, and 79% transferred out of tertiary facilities. Overall, 81% of patients transferred successfully at a median (interquartile range) of 56 (27–134) days following transfer date; 95% reached the transfer site <18 months after transfer out. Among those transferring successfully, the proportion retained decreased from 1 to 3 years post-transfer (90–84%). There was no significant difference between transfer and 1–3 years post-transfer in the proportion of retained adolescents with HIV-RNA <400 copies/ml and CD4 > 500 cells/µl except for HIV-RNA <400 copies/ml at 3 years (86% vs. 75%; p = 0.007). The proportion virologically suppressed and with CD4 > 500 cells/µl was significantly lower at 1 and 2 years post-transfer in those transferring at 15–19 vs. 10–14 years of age. Using laboratory data alone over-estimated time to successful transfer.Conclusions: Linking cohort data to health information system data allowed efficient assessment of post-transfer outcomes. Although >80% of adolescents transferred successfully with nearly 85% of them retained for 3 years post-transfer, the decline in the proportion virologically suppressed and poorer outcomes in older adolescents are concerns.​

Implementation of Big Data in Health Information Systems: Sample Approaches in Saudi Hospital

Implementation of Big Data in Health Information Systems: Sample Approaches in Saudi Hospital

Antithrombin Concentrate Use in Pediatric Extracorporeal Membrane Oxygenation: A Multicenter Cohort Study.

To describe antithrombin concentrate use and to compare thrombotic and hemorrhagic outcomes throughout the hospital stay in pediatric subjects who received extracorporeal membrane oxygenation in a Pediatric Health Information System-participating children's hospital. Retrospective, multi-center, cohort study. Forty-three free-standing children's hospitals participating in Pediatric Health Information System. Children older than or equal to 18 years of age who underwent extracorporeal membrane oxygenation between 2003 and 2012. Subjects were classified as receiving antithrombin if they received at least one dose of antithrombin while on extracorporeal membrane oxygenation. International Classification of Diseases, Ninth Revision, Clinical Modification codes codes were used to identify hemorrhagic and thrombotic complications during their hospitalization. Pediatric Health Information System data were analyzed to determine hospital-length of stay and in-hospital mortality. A total of 1,931 of 8,601 eligible subjects (21.5%) received at least one dose of antithrombin during their extracorporeal membrane oxygenation course. Antithrombin use during extracorporeal membrane oxygenation increased from 2.4% to 51.9% (p < 0.001) over the 10-year study period. Subjects who received antithrombin while on extracorporeal membrane oxygenation were younger (p = 0.02), had more chronic conditions (p < 0.001), and longer hospital stays (p < 0.001). On multivariate analysis, antithrombin use was associated with thrombotic events (odds ratio, 1.55; 95% CI, 1.36-1.77; p < 0.001), hemorrhagic events (odds ratio, 1.27; 95% CI, 1.14-1.42; p < 0.001), and longer hospital length of stays (slope coefficient, 1.05 d; 95% CI, 1.04-1.06; p < 0.001). No difference was observed in mortality (odds ratio, 0.99; 95% CI, 0.89-1.11; p = 0.90). In this multicenter retrospective cohort study, subjects who received antithrombin during extracorporeal membrane oxygenation had a higher number of thrombotic and hemorrhagic events throughout the hospitalization and longer length of stays without an associated difference in mortality. While limitations exist with this analysis and results should be interpreted with caution, the fact remains that over half of pediatric patients on extracorporeal membrane oxygenation are currently receiving antithrombin without clear benefit, with extra cost, and potential harms, there needs to be strong consideration for a clinical trial.

Age at presentation and management of pediatric intussusception: A Pediatric Health Information System database study

Intussusception is uncommon in children older than 3years, and use of enema reduction in older children is controversial. We sought to determine whether older children are at greater risk of requiring operative intervention and/or having pathology causing lead points, such that enema reduction should not be attempted. The Pediatric Health Information System database was reviewed from January 1, 2009-June 30, 2014. Patients were followed for 6months from initial presentation or until bowel resection occurred. Successful enema reduction was defined as having radiologic reduction without additional procedures. A total of 7,412 patients were identified: 6,681 were <3years old, 731 patients were >3years old. In those >3years old, 450 (62%) were treated successfully with enema reduction; the rate of patients with a tumor diagnosis was similar in patients <3years old and patients >3years old (5% vs 6%, P=.07). The rate of a Meckel's diagnosis was greater in patients >3years old (2% vs 14%, P<.0001). In patients >3years old, duration of stay between patients who underwent primary operative therapy versus those who underwent operative therapy after enema reduction was similar (4days vs 4days, P=.06). Older age was not associated with increased risk of recurrent admission for intussusception (P=.45). Pediatric Health Information System data suggest that enema reduction may be safe and effective for a majority of children even if older than 3years.

Effects of Results Based Financing Models on Data Quality Improvement in Benin on 2014

The performances generated by results based financing (RBF) raise questions about the quality of data used to measure them. This study was carried out to evaluate the RBF contribution to the quality improvement of maternal and child health data. Sixty seven health facilities are sampled randomly in three strata (RBF_PRPSS, RBF_PASS, No_ RBF) gathering health zones in Benin. The strata comparison with maternal and child health data for the first halves 2014 and 2011 revealed that timeliness and completeness have improved in the strata exposed to results based financing compared to unexposed (p <0.05). Compared to No_RBF stratum, accuracy deteriorated in RBF_PRPSS stratum, with a 52% decrease in the proportion of concordance reports between 2011 and 2014. In 2014, recorded discrepancies are largely under-reported in the RBF_PRPSS stratum, and over-reported in RBF_PASS stratum. The accuracy of National Health Information and Management System (SNIGS) data compared to RBF's validated data was low, verification factors varying between 30% and 97%. In total, the data quality was globally poor in most areas in Benin and it is not improved by the results based financing models implemented between 2011 and 2014. There is a need to target data quality in RBF models and to use SNIGS as a unique system of reporting.