ors included patient visits found in the MHH EHR between August 2005 and August 2006. Additional visits absent from the HFD dataset were also included. For example, if the HFD dataset shows two visits between August 2004 and August 2006 for a patient and the MHH EHR listed even visits for that same patient during that time interval, then all seven patientvisits were recorded in the study dataset. Missing, conflicting, or ambiguous data were marked as unknown by the abstractors and later reviewed by senior members of the research team for quality control/assurance purposes. Measures: Data was collected on the following variables: name, Medical Record Number (MRN), Date of Birth (DOB), race, arrival date, discharge date, visit type, chief complaint, and top three diagnoses, along with ICD 9 codes, medical insurance, and listed address were recorded for each patient visit. Patient visit data was collected from each patient’s face sheet in the EHR. Highest hospital location and EMS usage data were obtained by a review of discharge summaries or ED physician and nurse documentation. Primary data analysis An inter-rater reliability assessment was done on 20 patient visits from each of the 74 datasets. Patient visits were randomly selected and abstracted again by a single abstractor. Data from the abstractors were compared and the inter-rater reliability was assessed using Cohen’s Kappa co-efficient with Microsoft Excel® spreadsheet Version 14.0.7116.5000 (Microsoft Corporation, 2010, Redmond, Washington, USA) (See Table 1). Abstractor agreement for each variable (number of agreements divided by the agreements plus disagreements) was illustrated. Only patient visits that concluded in the Emergency Department were utilized for data analysis, all inpatient, observation and outpatient visits to MHH were excluded. RESULTS The abstraction process flow is mapped in Figure 1. HFD cohort data contained 11,305 entries and dates of transport ranged from August 2005 to January 2007. ‘Entries’ are line items by HFD personnel and confirm an ambulatory phone call was made. Missing patient identification data, such as date of birth or social security number [4(.04%)] and duplicate entries [1,023(9%)] were removed. ‘Patient visits’ reflect patient-encounters to the ED. In some cases, a single patient had multiple patient visits. ‘Patients’ are the individual person present at a patient visit. ‘MHH destination’ refers to MHH. Frequency data reported in Figure 1 reflect the variable described as the numerator and the preceding cell as the denominator. Abstractor agreements in Table 1 were highest in categories with well-defined, objective criteria such as gender and race (99% to 100% agreement; 0.99-1.00). However, fair abstractor agreements were noted in subjective categories such as visit type, highest hospital acuity (85% to 91% agreement; 0.780.91).or agreements in Table 1 were highest in categories with well-defined, objective criteria such as gender and race (99% to 100% agreement; 0.99-1.00). However, fair abstractor agreements were noted in subjective categories such as visit type, highest hospital acuity (85% to 91% agreement; 0.780.91).
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Sep 24, 2016
Keith Gordon 
Open Access