Hospital Episode Data Research Articles

Increased health service use for allergy in adults: Northumbrian hospital episodes, 2010-2015.

Little is known on the health service use for allergy. Therefore, the aim of this study was to investigate the hospital episode rates in allergy by sex and across age groups in order to understand whether and how the health service use for allergy might have changed in recent years in north-east of England. Hospital episode data in mid-2010 to mid-2015 covering five full calendar years were extracted from Northumbria Healthcare NHS Foundation Trust, which is serving nearly half of a million population and free from central government control. Hospital episode rates were calculated from all admissions divided by annual and area-specific population size for each sex and age group, presented with per 100 000 person-years using Microsoft Excel. Health service use for allergy in adults for both men and women has increased, with large increases in young adults aged 40-49 (both male and female), 50-59 (female) and 60-69 (male). In children, there were decreases in those aged 0-9, but increases in those aged 10-19. Emergency admissions due to allergy were only minimal. Higher admissions were observed in spring and autumn than in summer and winter. Allergy admissions have increased in adults. For future research, local health policy could benefit from annual clinical records on health service use due to allergy. For clinical practice, in addition to increasing and improving the role of health and nursing professionals to reduce burden and rehabilitation, public awareness, attitude and knowledge should be continuously raised and improved as well.

Assessing the impact of mass media public health campaigns. Be Clear on Cancer 'blood in pee': a case in point.

To assess the impact on suspected cancer referral burden and new cancer diagnosis of Public Health England's recent Be Clear on Cancer 'blood in pee' mass media campaign. A retrospective cohort study design was used. For two distinct time periods, August 2012 to May 2013 and August 2013 to May 2014, all referrals of patients deemed to be at risk of urological cancer by the referring primary healthcare physician to Imperial College NHS Healthcare Trust were screened. Data were collected on age and sex and whether the referral was for visible haematuria, non-visible haematuria or other suspected urological cancer. In addition to referral data, hospital episode data for all new renal cell (RCC) and upper and lower tract transitional cell carcinoma (TCC), as well as testicular and prostate cancer diagnoses for the same time periods were obtained. Over the campaign period and the subsequent 3months, the number of haematuria referrals increased by 92% (P = 0.013) when compared with the same period a year earlier. This increase in referrals was not associated with a significant corresponding rise in cancer diagnosis; instead changes of 26.8% (P = 0.56) and -3.3% (P = 0.84) were seen in RCC and TCC, respectively. This study has shown that the Be Clear on Cancer 'blood in pee' mass media campaign significantly increased the number of new suspected cancer referrals, but there was no significant change in the diagnosis of target cancers across a large catchment. Mass media campaigns are expensive, require significant planning and appropriate implementation and, while the findings of this study do not challenge their fundamental objective, more work needs to be done to understand why no significant change in target cancers was observed. Further consideration should also be given to the increased referral burden that results from these campaigns, such that pre-emptive strategies, including educational and process mapping, across primary and secondary care can be implemented.

P08 Background incidence trends of intussusception among children in england: retrospective analysis using hospital episode statistics and data linkage to compare hes with the british paediatric surveillance unit

Aims To estimate background trends in intussusception admissions prior to the introduction of rotavirus vaccine in the UK. To compare the quality of Hospital Episode Statistics (HES) with intussusception data from the British Paediatric Surveillance Unit (BPSU). Methods Retrospective analysis of the NHS inpatient HES was carried out to estimate background intussusception trends in the paediatric population in England from 1995 to 2009. Data linkage was performed between HES and previously obtained BPSU data on intussusception among infants from March 2008 to March 2009. The ICD-10 intussusception codes (K56.1, K38.8) were used to identify cases in HES (1995–2009). Incidence trends were calculated using the Office for National Statistics live births and mid-year population estimates as denominator. We performed probabilistic data linkage to match HES records with BPSU cases, followed by a manual review to confirm the status of matched (and possibly matched) pairs (2008–2009). Capture-recapture methods allowed assessing the accuracy of HES and completeness of both data sources for intussusception. Validated incidence rates in infants were obtained following data linkage. Results Of 11,259 intussusception records identified in HES and after excluding 2538 (22.5%) duplicates, 8721 (77.5%) cases were retained for trends analysis. A significant decline in background trends was observed predominantly among infants from 86.0/100,000 in 1997 to 34.0/100,000 in 2009 (60% reduction, p = 0.001). Seasonal modelling showed a significant excess of intussusception cases in winter and spring during 1995–2009 (p = 0.001, n = 4 957 infants). Data linkage between 254 intussusception cases in HES and 190 cases previously obtained via the BPSU (2008–2009) resulted in 163 matched pairs. Completeness of reporting was 85.8% for HES (163/190 BPSU cases) compared to 81.5% for BPSU (163/200 HES cases). The positive predictive value of HES was 78.7% (200/254 confirmed cases). The Lincoln-Petersen estimate yielded a total of 233 intussusception cases (95% CI: 227.4 to 238.8). The estimated annual incidence of intussusception among infants in England increased from 24.2/100,000 (unvalidated) to 28.9/100,000 (validated) (2008–2009). Conclusions Background intussusception trends have declined among infants in England. The high accuracy and completeness of HES for intussusception highlight the usefulness of routinely collected data in monitoring rotavirus vaccine safety in England.

Approaches to ascertaining comorbidity information: validation of routine hospital episode data with clinician-based case note review.

BackgroundIn clinical practice, research, and increasingly health surveillance, planning and costing, there is a need for high quality information to determine comorbidity information about patients. Electronic, routinely collected healthcare data is capturing increasing amounts of clinical information as part of routine care. The aim of this study was to assess the validity of routine hospital administrative data to determine comorbidity, as compared with clinician-based case note review, in a large cohort of patients with chronic kidney disease.MethodsA validation study using record linkage. Routine hospital administrative data were compared with clinician-based case note review comorbidity data in a cohort of 3219 patients with chronic kidney disease. To assess agreement, we calculated prevalence, kappa statistic, sensitivity, specificity, positive predictive value and negative predictive value. Subgroup analyses were also performed.ResultsMedian age at index date was 76.3 years, 44% were male, 67% had stage 3 chronic kidney disease and 31% had at least three comorbidities. For most comorbidities, we found a higher prevalence recorded from case notes compared with administrative data. The best agreement was found for cerebrovascular disease (κ = 0.80) ischaemic heart disease (κ = 0.63) and diabetes (κ = 0.65). Hypertension, peripheral vascular disease and dementia showed only fair agreement (κ = 0.28, 0.39, 0.38 respectively) and smoking status was found to be poorly recorded in administrative data. The patterns of prevalence across subgroups were as expected and for most comorbidities, agreement between case note and administrative data was similar. Agreement was less, however, in older ages and for those with three or more comorbidities for some conditions.ConclusionsThis study demonstrates that hospital administrative comorbidity data compared moderately well with case note review data for cerebrovascular disease, ischaemic heart disease and diabetes, however there was significant under-recording of some other comorbid conditions, and particularly common risk factors.

The epidemiology of hospital treated traumatic brain injury in Scotland

BackgroundTraumatic Brain Injury (TBI) is an important global public health problem made all the more important by the increased likelihood of disability following a hospital admission for TBI. Understanding those groups most at risk will help inform interventions designed to prevent causes of TBI, such as falls prevention measures. This study identifies the rate of hospitalisation episodes of TBI in Scotland, explores causes of TBI admissions, and trends in hospitalisation episodes by age and gender over a twelve year period using routinely collected hospital data.MethodsA retrospective analysis of routine hospital episode data identified records relating to TBI for the twelve years between 1998 and 2009. Descriptive and joinpoint regression analysis were used, average annual percentage changes (AAPC) and annual percentage change (APC) in rates were calculated.ResultsBetween 1998 and 2009 there were 208,195 recorded episodes of continuous hospital care in Scotland as a result of TBI. Almost half (47%) of all TBIs were the result of falls, with marked peaks observed in the very young and the oldest groups. The AAPC of hospitalization episode rates over the study period for boys and girls aged 0-14 were -4.9% (95% CI -3.5 to-6.3) and -4.7% (95% CI -2.6 to -6.8) respectively. This reduction was not observed in older age groups. In women aged 65 and over there was an APC of 3.9% (95% CI 1.2 to 6.6) between 2004 and 2009.ConclusionsHospitalisation for TBI is relatively common in Scotland. The rise in the age-adjusted rate of hospitalisation episodes observed in older people indicates that reduction of TBI should be a public health priority in countries with an ageing population. Public health interventions such as falls prevention measures are well advised and evaluations of such interventions should consider including TBI hospitalisation as an alternative or supplementary outcome measure to fractured neck of femur. Further research is needed to advance understanding of the associations of risk factors with increased incidence of TBI hospital episodes in the elderly population.

Policy for home or hospice as the preferred place of death from cancer: Scottish Health and Ethnicity Linkage Study population cohort shows challenges across all ethnic groups in Scotland

BackgroundPlace of cancer death varies ethnically and internationally. Palliative care reviews highlight limited ability to demonstrate equal access due to incomplete or unreliable ethnicity data.AimTo establish place of cancer death...

Predicting risk of emergency admission to hospital using primary care data: derivation and validation of QAdmissions score

ObjectiveTo develop and externally validate a risk algorithm (QAdmissions) to estimate the risk of emergency hospital admission for patients aged 18–100 years in primary care.DesignProspective open cohort study using routinely...

Primary angiitis of the central nervous system: experience of a Victorian tertiary‐referral hospital

Primary angiitis of the central nervous system is a rare condition, which is often difficult to diagnose and is associated with significant morbidity and mortality. There is no standardised treatment protocol or randomised clinical trial evidence to guide management. To describe the clinical features, diagnostic modalities, treatment and outcomes in an Australian hospital population-based series of primary cerebral angiitis. Data were collected via retrospective medical record review of patients with primary angiitis of the central nervous system for the period 1 July 1998 to 30 June 2009, using previously published diagnostic criteria. Eligible patient records were identified in two ways; from routinely collected hospital episode data, coded using the ICD-10-AM coding standard and by review of cerebral biopsy data. Ten of 12 included patients had a positive cerebral biopsy, with two patients diagnosed by angiography. Mean age at diagnosis was 47.2 years (range 18-73 years), with a female predominance of 5:1. Headache was the most common symptom experienced. Seventy per cent of the biopsy specimens showed a lymphocytic vasculitis. All patients received treatment with either steroids alone or a combination of steroids and cyclophosphamide, the latter treatment being initiated for those with a higher modified Rankin score of disability. Nine (75%) responded to treatment. There was one in-hospital death, and two patients had no documented response to treatment. This study presents the first Australian case series data of primary cerebral angiitis. Better understanding of management and outcomes of this rare condition would be gained through multicentre studies.

Age remains the major predictor of curative treatment non-receipt for localised prostate cancer: a population-based study

Background:Geriatric oncology guidelines state that fit older men with prostate cancer should receive curative treatment. In a population-based study, we investigated associations between age and non-receipt of curative treatment in men with localised prostate cancer, and the effect of clinical variables on this in different age groups.Methods:Clinically localised prostate cancers (T1–T2N0M0) diagnosed from 2002 to 2008 among men aged ⩾40 years, with hospital in-patient episode(s) within 1 year post-diagnosis, were included (n=5456). Clinical and socio-demographic variables were obtained from cancer registrations. Comorbidity was determined from hospital episode data. Logistic regression was used to investigate associations between age and non-receipt of treatment, adjusting for confounders; the outcome was non-receipt of curative treatment (radical prostatectomy or radiotherapy).Results:The percentage who did not receive curative treatment was 9.2%, 14.3%, 48.2% and 91.7% for men aged 40–59, 60–69, 70–79 and 80+ years, respectively. After adjusting for clinical and socio-demographic factors, age remained the main determinant of treatment non-receipt. Men aged 70–79 had a significant five-fold increased risk of not having curative treatment compared with men aged 60–69 (odds ratio (OR)=5.5; 95% confidence interval 4.7, 6.5). In age-stratified analyses, clinical factors had a higher weight for men aged 60–69 than in other age strata. Over time, non-receipt of curative treatment increased among men aged 40–59 and decreased among men aged 70–79.Conclusion:Age remains the dominant factor in determining non-receipt of curative treatment. There have been some changes in clinical practice over time, but whether these will impact on prostate cancer mortality remains to be established.

How many people need palliative care? A study developing and comparing methods for population-based estimates

Background: Understanding the need for palliative care is essential in planning services. Aim: To refine existing methods of estimating population-based need for palliative care and to compare these methods to better inform their use. Design: (1) Refinement of existing population-based methods, based on the views of an expert panel, and (2) application/comparison of existing and refined approaches in an example dataset. Existing methods vary in approach and in data sources. (a) Higginson used cause of death/symptom prevalence, and using pain prevalence, estimates that 60.28% (95% confidence interval = 60.20%–60.36%) of all deaths need palliative care, (b) Rosenwax used the International Statistical Classification of Diseases and Related Health Problems–10th Revision (ICD-10) causes of death/hospital-use data, and estimates that 37.01% (95% confidence interval = 36.94%–37.07%) to 96.61% (95% confidence interval = 96.58%–96.64%) of deaths need palliative care, and (c) Gómez-Batiste used percentage of deaths plus chronic disease data, and estimates that 75% of deaths need palliative care. Setting/participants: All deaths in England, January 2006–December 2008, using linked mortality and hospital episode data. Results: Expert panel review identified changing practice (e.g. extension of palliative care to more non-cancer conditions), changing patterns of hospital/home care and multiple, rather than single, causes of death as important. We therefore refined methods (using updated ICD-10 causes of death, underlying/contributory causes, and hospital use) to estimate a minimum of 63.03% (95% confidence interval = 62.95%–63.11%) of all deaths needing palliative care, with lower and upper mid-range estimates between 69.10% (95% confidence interval = 69.02%–69.17%) and 81.87% (95% confidence interval = 81.81%–81.93%). Conclusions: Death registration data using both underlying and contributory causes can give reliable estimates of the population-based need for palliative care, without needing symptom or hospital activity data. In high-income countries, 69%–82% of those who die need palliative care.

A Budget Impact Model for Paclitaxel-eluting Stent in Femoropopliteal Disease in France

PurposeThe Zilver PTX drug-eluting stent (Cook Ireland Ltd., Limerick, Ireland) represents an advance in endovascular treatments for atherosclerotic superficial femoral artery (SFA) disease. Clinical data demonstrate improved clinical outcomes compared to bare-metal stents (BMS). This analysis assessed the likely impact on the French public health care budget of introducing reimbursement for the Zilver PTX stent.MethodsA model was developed in Microsoft Excel to estimate the impact of a progressive transition from BMS to Zilver PTX over a 5-year horizon. The number of patients undergoing SFA stenting was estimated on the basis of hospital episode data. The analysis from the payer perspective used French reimbursement tariffs. Target lesion revascularization (TLR) after primary stent placement was the primary outcome. TLR rates were based on 2-year data from the Zilver PTX single-arm study (6 and 9 %) and BMS rates reported in the literature (average 16 and 22 %) and extrapolated to 5 years. Net budget impact was expressed as the difference in total costs (primary stenting and reinterventions) for a scenario where BMS is progressively replaced by Zilver PTX compared to a scenario of BMS only.ResultsThe model estimated a net cumulative 5-year budget reduction of €6,807,202 for a projected population of 82,316 patients (21,361 receiving Zilver PTX). Base case results were confirmed in sensitivity analyses.ConclusionAdoption of Zilver PTX could lead to important savings for the French public health care payer. Despite higher initial reimbursement for the Zilver PTX stent, fewer expected SFA reinterventions after the primary stenting procedure result in net savings.

How Dangerous is a Day in Hospital?

Despite extensive research into adverse events, there is no quantitative estimate for the risk of experiencing adverse events per day spent in hospital. This is important information for hospital managers, because they may consider discharging patients earlier to alternative care providers if this is associated with lower risk, but other costs and benefits are similar. We model adverse events as a function of patient risk factors, hospital fixed effects, and length of stay. Potential endogeneity of length of stay is addressed with instrumental variable methods, using days and months of discharge as instruments. We use administrative hospital episode data for 206,489 medical inpatients in all public hospitals in the state of Victoria, Australia, for the year 2005/2006. A hospital stay carries a 5.5% risk of an adverse drug reaction, 17.6% risk of infection, and 3.1% risk of ulcer for an average episode, and each additional night in hospital increases the risk by 0.5% for adverse drug reactions, 1.6% for infections, and 0.5% for ulcers. Length of stay is endogenous in models of adverse events, and risks would be underestimated if length of stay was treated as exogenous. The results of our research contribute to assessing the benefits and costs of hospital stays-and their alternatives-in a quantitative manner. Instead of discharging patients early to alternative care, it would be more desirable to address underlying causes of adverse events. However, this may prove costly, difficult, or impossible, at least in the short run. In such situations, our research supports hospital managers in making informed treatment and discharge decisions.

Risk of premature birth, low apgar score and low birth weight for teenage births

BackgroundPrevious research on neonatal outcomes in teenage women has focused on primiparous or multiparous teenagers separately thus failing to examine outcomes for all teenager groups. This study has addressed this...

Idiopathic thrombocytopenic purpura and the second dose of MMR

An increase in idiopathic thrombocytopenic purpura (ITP) cases in the 6 weeks following the first dose of the measles, mumps and rubella (MMR) vaccine has been established, with absolute risks...

An evaluation of the association between systemic inflammation – as measured by C-reactive protein – and hospital resource use

ABSTRACTObjective: To evaluate the association between inflammatory status, as measured by C-reactive protein (CRP), during inpatient admission and subsequent inpatient outcome and associated resource use. Methods: Probabilistic record linkage was used to match hospital episode data, laboratory reports and mortality statistics in a large urban population of 424 000 people in South Wales, UK. Inpatient mortality, length of stay, emergency readmissions and subsequent 1-year hospital bed day occupancy were assessed as a function of CRP status.Results: Between 2001 and 2005, in total there were 432 272 CRP observations from 98 505 people; 69 593 admissions had at least one CRP measurement, affecting 47 100 individual patients. Across all ICD-10 primary diagnoses, CRP was acutely high (> 10 mg/L) in three-quarters of admissions. Acutely high CRP was associated with an eight-fold increase in risk of hospital mortality ( p < 0.001) and a doubling of length of stay ( p < 0.001) compared to normal CRP levels, after standardising for age and gender. Across the range of observed maximum CRP values measured during admissions (1 mg/L to > 400 mg/L) the likelihood of emergency readmission within 28 days of discharge increased by 50% ( p < 0.001), and the predicted number of subsequent bed days occupied in the year following discharge increased by 30–58% across the range of CRP measurement ( p = 0.004).Conclusions: CRP has been found to be clearly associated with hospital resource use. Furthermore, CRP also predicted in-hospital mortality. This may imply that better management of systemic inflammation would result in resource savings in inflammatory diseases such as rheumatoid arthritis.

Evaluation of the association between the first observation and the longitudinal change in C-reactive protein, and all-cause mortality

Objective:To evaluate the association between vascular inflammation as measured by subacute C-reactive protein (CRP; 1–10 mg/l) and all-cause mortality and the association between change in CRP status (normal ⩽3 mg/l...

GEOGRAPHICAL EPIDEMIOLOGY OF HYPOSPADIAS

Hypospadias is a urogenital congenital anomaly affecting boys. It appears to have a birth prevalence of between 1 in 10,000 and 1 in 250 male births based on register data which is of limited quality. There are concerns that reported increases in birth prevalence of hypospadias in recent years may point to an important public health risk associated with environmental chemicals, so called endocrine disrupters. This study established a high quality, population based register of hypospadias cases in the North Thames, South Thames and Anglia health districts in the United Kingdom for boys born between 1.1.97 and 30.9.98. Validation was achieved through cross-referencing with Hospital Episode data. The study describes the geographical epidemiology of hypospadias in the study area, within the study period. We employed Quasi-likelihood and Poisson regression to examine the extent to which any spatial heterogeneity might be explained in terms of socio-economic deprivation, rurality, ethnicity and water supply. A register of 732 cases was ascertained from clinical sources in surgical units giving an estimated birth prevalence of hypospadias 38.2 per 10,000 male births. We found evidence (p < 0.001) of spatial heterogeneity and autocorrelation of hypospadias risk at district level (N = 120 districts). Possible ‘clusters’ to the east of the study area were also identified. Regression analysis suggested an association between hypospadias risk and districts with surface (v ground) water supply (indicating water reuse), and an inverse association with districts with >10% and >30% of population of non-white ethnic origin. Odds ratios were 1.57 (95% quasi-likelihood CI 1.17 −2.12), 0.75 (0.61–0.91), and 0.70 (0.52–0.95) respectively. No association was found with socioeconomic deprivation (Carstairs score) and after adjustment for ethnicity, there was a suggestion that hypospadias birth prevalence was lower in more rural districts, possibly reflecting a strong inverse association between rurality and ethnicity. No association with risk of hypospadias was found at postcode level, which may at least be partially explained by migratory effects and misclassification at this level. Crude relative risks at district level varied across the study area from zero to 4.2; after adjustment for water supply (ground/surface) and ethnicity, and with global smoothing using hierarchical Bayesian methods, risk estimates across the area varied from 0.67 to 1.58 and for eight districts there was >95% probability that risk estimates were >1. This study laid the groundwork for further investigation including an ongoing case-control study of hypospadias. The individual level case-control study permits further investigation of the findings of this ecological study, particularly the association found between surface water and hypospadias based on detailed environmental, diet and occupational exposure data collected by telephone interview from cases and controls. The case control study also avoids problems of ecological bias, which may be pertinent to the interpretation of this study.

Ethnic groups and our healthier nation: whither the information base?

The Government has made the health of minority ethnic groups a central part of its programme to reduce social exclusion and inequalities in health provision. It has also given a commitment in its 'contract for health' to provide the information that is needed to address inequalities, stating that it will be able to draw on a range of data sources, including mortality statistics, cancer registrations, hospital episode data, and general practitioner data. In reality, only one of these is a potential source of comprehensive information on minority ethnic groups and the information base needed to support Government policies is essentially unavailable. Priorities for further action are identified.

Compatibility relations of the aluminum silicates in the systems MgO-Al 2 O 3 -SiO 2 -H 2 O and K 2 O-MgO-Al 2 O 3 -SiO 2 -H 2 O at high pressures

<h3>Objectives</h3> Multimorbidity is the coexistence of two or more health conditions in an individual. Multimorbidity in younger adults is increasingly recognised as an important challenge. We assessed the prevalence of secondary care multimorbidity in mid-life and its association with premature mortality over 15 years of follow-up, in the Aberdeen Children of the 1950s (ACONF) cohort. <h3>Method</h3> A prospective cohort study using linked electronic health and mortality records. Scottish ACONF participants were linked to their Scottish Morbidity Record hospital episode data and mortality records. Multimorbidity was defined as two or more conditions and was assessed using healthcare records in 2001 when the participants were aged between 45 and 51 years. The association between multimorbidity and mortality over 15 years of follow-up (to ages 60–66 years) was assessed using Cox proportional hazards regression. There was also adjustment for key covariates: age, gender, social class at birth, intelligence at age 7, secondary school type, educational attainment, alcohol, smoking, body mass index and adult social class. <h3>Results</h3> Of 9625 participants (51% males), 3% had multimorbidity. The death rate per 1000 person-years was 28.4 (95% CI 23.2 to 34.8) in those with multimorbidity and 5.7 (95% CI 5.3 to 6.1) in those without. In relation to the reference group of those with no multimorbidity, those with multimorbidity had a mortality HR of 4.5 (95% CI 3.4 to 6.0) over 15 years and this association remained when fully adjusted for the covariates (HR 2.5 (95% CI 1.5 to 4.0)). <h3>Conclusion</h3> Multimorbidity prevalence was 3% in mid-life when measured using secondary care administrative data. Multimorbidity in mid-life was associated with premature mortality.