Quality Of Linkage Research Articles

What’s in a name field?

The National Center for Health Statistics (NCHS) has a data linkage program that combines national survey data with key sources of health outcomes and health care utilization. The overall accuracy and quality of a data linkage depends on the quality of the data fields. This applies in a variety of data linkage methods, including clear text and privacy preserving record linkage. Data pre-processing and cleaning are essential to address data quality issues in most linkage tasks. Automating data cleaning prevents time-consuming manual reviews particularly when linkages involve a large number of records. For some data fields, these activities are relatively straightforward. For example, dates typically have a limited number of plausible values that make checking and cleaning relatively easy and straightforward. Unique identifiers (e.g., social security number) often conform to some set format or have restrictions on the values that would be expected. Other data fields such as first name and last name present greater challenges with respect to automating the cleaning process. For some data sources, first name and last name fields may contain non-name text that needs to be identified and removed. In this project, we examined the use of an artificial intelligence (AI) based large language model (LLM) and a simple rule-based algorithm to identify non-name text in name fields that should be removed prior to linkage. We also investigated the impact of automated name clean-up algorithms on the quality of an example linkage.

Improving transparency and quality assurance: Operationalising semi-automated data provenance tracking in a Trusted Research Environment

We present a prototype solution for improving transparency and quality assurance of the data linkage process through a data provenance dashboard designed to assist data analysts, researchers and information governance teams in authenticating and auditing data workflows within a trusted research environment (TRE). Building on prior research (Scheliga, et al., 2022), this work describes our first operationalised prototype tested in a real-world setting. The prototype development involved four stages: (1) Co-design of interfaces with end users for provenance data collection and visualisation, producing a low-fidelity design; (2) Extension and refinement of the Safe Haven Provenance (SHP) ontology (https://tre-provenance.github.io/SHP-ontology/releases/v0.2/index-en.html); (3) Design and implementation of mechanisms for semi-automated collection of data linkage provenance using the SHP ontology; (4) Implementation and user evaluation of the dashboard. A participatory design process with data analysts, researchers and information governance teams resulted in a low-fidelity prototype and was validated via public consultations to ensure it met public trust. The resulting prototype dashboard (https://tre-provenance.github.io/) was built as an offline desktop app to match the deployment TRE requirements. The interactive dashboard displays the data linkage information extracted from a knowledge graph described using the SHP ontology (e.g., modifications of datasets, data release) and results of rule-based validation checks (e.g., checking extracted data against researchers' specification). User evaluations confirmed the dashboard would contribute to better quality of data linkage. This project demonstrates the next stage in advancing transparency and quality assurance within TREs by semi-automating and systematising data tracking from ingress to egress in a single tool.

Investigating the quality of NHS number linkage of COVID 19 vaccines data to Census 2021.

Objectives Due to the availability of data and the speed of delivery required, NHS number (Health ID) was used during the COVID-19 pandemic to join different health datasets to census 2021. This research sought to assess the quality of linkage done by NHS number, between COVID-19 vaccinations data and census 2021, by comparing to the quality that could be achieved with deterministic linkage using Personal Identifiable Information (PII). Specifically, we wanted to assure against concern that unlinked records may have been misclassified as unvaccinated due to inaccurate recording of NHS number at time of vaccination. Approach We used deterministic (rules-based) linkage to identify extra links that were not made on NHS number. We also investigated how many links were incongruent between NHS number linkage and PII deterministic linkage. Results We were able to link 98.5% of census records to vaccines data, with a precision of 98.94% and a recall of 99.71% This identified 1,833,626 additional links made using PII linkage. Furthermore, analysis of the linked data was re-run with the additional links. Conclusion We were able to assure that the NHS number linkage used to produce COVID-19 vaccinations statistics, was valid. Whilst 1,833,626 more links were made, the findings resulting from the linked data were unchanged. Implications Whilst this research demonstrates the utility of NHS number-based linkage, acquisition and use of PII on health datasets can increase the link rate and plays a vital role in estimating linkage error.

HIV Prevention and Treatment Interventions for Black Men Who Have Sex With Men in Canada: Scoping Systematic Review.

Black men who have sex with men (MSM) experience disproportionately high HIV incidence globally. A comprehensive, intersectional approach (race, gender, and sexuality or sexual behavior) in understanding the experiences of Black MSM in Canada along the HIV prevention and care continuums has yet to be explored. This scoping review aims to examine the available evidence on the access, quality, gaps, facilitators, and barriers of engagement and identify interventions relevant to the HIV prevention and care continuum for Black MSM in Canada. We conducted a systematic database search, in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, of the available studies on HIV health experience and epidemiology concerning Black MSM living with or without HIV in Canada and were published after 1983 in either English or French. Searched databases include MEDLINE, Excerpta, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, the NHUS Economic Development Database, Global Health, PsycInfo, PubMed, Scopus, and Web of Science. From the 3095 articles identified, 19 met the inclusion criteria and were analyzed. Black MSM in Canada consistently report multiple forms of stigma and lack of community support contributing to an increased HIV burden. They experience discrimination based on their intersectional identities while accessing HIV preventative and treatment interventions. Available data demonstrate that Black MSM have higher HIV incidences than Black men who have sex with women (MSW) and White MSM, and low preexposure prophylaxis knowledge and HIV literacy. Black MSM experience significant disparities in HIV prevention and care knowledge, access, and use. Structural barriers, including anti-Black racism, homophobia, and xenophobia, are responsible for gaps in HIV prevention and care continuums, poor quality of care and linkage to HIV services, as well as a higher incidence of HIV. Considering the lack of targeted interventions, there is a clear need for interventions that reduce HIV diagnoses among Black MSM, increase access and reduce structural barriers that significantly affect the ability of Black MSM to engage with HIV prevention and care, and address provider's capacity for care and the structural barriers. These findings can inform future interventions, programming, and tools that may alleviate this HIV inequity. RR2-10.1136/bmjopen-2020-043055.

Research on the High-Quality Development of Cultural and Tourism Integration in the Ganzi Section of the Long March National Cultural Park

The construction of the Ganzi section of the Long March National Cultural Park is of great significance for the development of the entire Ganzi Prefecture and can drive the integration of culture and tourism in the region. Currently, the feasibility of achieving high-quality development of the integration of culture and tourism in the Ganzi section of the Long March National Cultural Park is strong, but there are also some constraints, such as the lack of in-depth exploration and research, and the lack of a virtuous cycle between development and conservation. The integration of Long March culture and tourism resources is also challenged by regional factors and economic development, and the lack of systematic, forward-looking, and innovative planning. Therefore, it is necessary to develop a scientific plan for the development of the integration of culture and tourism in the Ganzi section of the Long March National Cultural Park, strengthen the protection and excavation of cultural heritage, improve the quality and competitiveness of cultural tourism products, strengthen cooperation and linkage with surrounding areas, stimulate the vitality and innovation of the integration of Long March culture and tourism development, and achieve the goal of high-quality development of the integration of culture and tourism in the Ganzi section of the Long March National Cultural Park. This can be achieved by adhering to a virtuous cycle of protecting and utilizing Long March cultural resources, exploring and utilizing the inherent value of Long March cultural resources, strengthening cultural brand building, and cultivating sustainable development momentum for the industry through market-oriented, diversified, and sustainable Long March cultural tourism operation and management.

Challenges and lessons learned from Scotland and England using linked administrative data to evaluate the Family Nurse Partnership: two administrative data cohort studies

BackgroundThe Family Nurse Partnership (FNP) is an early intervention aiming to support adolescent mothers and their children. The FNP has been evaluated in England and Scotland in two separate studies using linked administrative data from health, education, and social care. We aimed to make recommendations for studies using linked administrative data to evaluate public health interventions. MethodsWe constructed two cohorts of all mothers aged 13–19 years giving birth in NHS hospitals between 2010 and 2016–17 using data from Hospital Episode Statistics (England) and Maternity Inpatient and Day Case (Scotland). FNP participation was identified through linkage to FNP programme data. We also linked to health, educational, and social care data for mothers and their babies (data from the National Pupil Database and electronic Data Research and Innovation Service). Ethical approval was obtained but no consent was required because we used secondary data. We used these data to evaluate the effect of the FNP on maternal and child outcomes. FindingsKey challenges included characterising the intervention and usual care, understanding quality of multi-sector data linkage, data access delays, constructing appropriate comparator groups, and interpreting outcomes captured in administrative data. Lessons learned included that evaluations required detailed data on intervention activity (dates and geography) and assessment of usual care, which are rarely readily available and are time-consuming to gather; data linkage quality information was variable or not available, making defining denominators challenging; data access delays impeded on data analysis time; and unmeasured confounders not captured in administrative data possibly prevented the generation of an appropriate comparator group. We recommend that characteristics informing targeting should be explicitly documented, and could be enhanced by using linked primary care data and information on household members (eg, fathers). Process evaluation and qualitative research could help to provide a better understanding of mechanisms of effect. InterpretationLinkage of administrative data presents opportunities for efficient evaluation of large-scale, complex public health interventions. However, sufficient information is needed on programme metadata, targeting, and important confounders to generate meaningful results. Our findings should help to stimulate exploration by practitioners about how such programmes can be improved. FundingNational Institute for Health and Care Research.

Revisiting the Quality of the Scottish Record Linkage System.

ObjectivesTo evaluate the quality of linkage carried out by operators in the Trusted Third Parties (TTPs) in Public Health Scotland (PHS) and National Records of Scotland (NRS). To compare results with a PHS automated production system. To produce individual reports to feedback results to operators, informing areas for improvement. ApproachA test dataset (n=274,479) containing names, dates of birth, sex and postcode, was derived from hospital episodes and additional synthetic records added. For a proportion of records, some variables were perturbed. The true reference index number was retained to compare against the indexes returned by operators from matching to the population spine. A run of the Medical Record Linkage (MRL) system (used to routinely link the centrally held hospitalisations, cancer and death registrations over the last 25 years) was executed without clerical review, to provide a benchmark for the TTPs. Recall, precision and F-measures were calculated to compare results. ResultsThere were 5 reports produced, including the MRL run. NRS contributed a single run, and PHS-TTP offered 3. Quality overall was excellent, with some variation dependent on operator, methods, and spine used. The MRL run was ranked 3rd overall for F-measure, with overall precision of 99.69% and 97.36% recall. Where data had been unperturbed precision was 99.92% with 99.90% recall. The best ranked run was carried out by a member of PHS TTP, with 99.72% precision (99.93% unperturbed) and 98.77% recall (99.94% unperturbed). NRS results showed precision of 99.56% (99.91% unperturbed) and 96.71% recall (99.80% unperturbed). Individual reports were produced and tailored to highlight the types of perturbations where each operator performed strongly or otherwise, encouraging operators to learn and adapt processes in future. ConclusionData Linkage in Scotland has evolved over 5 decades, more recently with the introduction of TTPs as key support services for research projects. However, little evaluation of the quality of linkage has been conducted. The results demonstrated by this exercise provide re-assurance to researchers that linkage quality remains high

Challenges and lessons learned from two countries using linked administrative data to evaluate the Family Nurse Partnership.

ObjectivesWe describe the challenges and lessons learned from two studies using linked administrative data from health, education and social care sectors to evaluate the Family Nurse Partnership (FNP), an intervention supporting adolescent mothers in England(E) and Scotland(S). We present recommendations for studies using linked administrative data to evaluate complex interventions. ApproachWe constructed two cohorts of all mothers aged 13-19 giving birth in NHS hospitals in England and Scotland between 2010-2016/17 using linkage of mothers and babies in hospital admissions data (E:Hospital Episode Statistics/S:Maternity Inpatient and Day Case), and identified FNP participation through linkage to FNP programme data. We additionally linked to health, educational and social care data for mothers and their babies (E:National Pupil Database/S:eDRIS). We used these data to identify key risk factors for enrolment in the FNP, assess the effect of the FNP on maternal and child outcomes, and determine programme characteristics modifying the effect of the FNP. ResultsKey challenges: characterising the intervention and usual care, understanding quality of multi-sector data linkage, data access delays, constructing appropriate comparator groups and interpreting outcomes captured in administrative data. Lessons learned: evaluations require detailed data on intervention activity (dates/geography), and assessment of usual care, which are rarely readily available and are time-consuming to gather; data linkage quality is variable/not available, making defining denominators challenging; data access delays impeded on data analysis time; unmeasured confounders not captured in administrative data may prevent generation of an appropriate comparator group. Recommendations: Characteristics informing targeting should be explicitly documented, and could be enhanced using linked primary care data and information on household members (e.g. fathers). Process evaluation and qualitative research could help to provide better understanding of mechanisms of effect. ConclusionLinkage of administrative data presents exciting opportunities for efficient evaluation of large-scale, complex public health interventions. However, sufficient information is needed on programme meta-data, targeting and important confounders in order to generate meaningful results. Study findings should help stimulate exploration with practitioners about how programmes can be improved.

Opportunities and obstacles in linking large health care registries: the primary secondary cancer care registry - breast cancer

BackgroundThe growing volume of health data provides new opportunities for medical research. By using existing registries, large populations can be studied over a long period of time. Patient-level linkage of registries leads to even more detailed and extended information per patient, but brings challenges regarding responsibilities, privacy and security, and quality of data linkage. In this paper we describe how we dealt with these challenges when creating the Primary Secondary Cancer Care Registry (PSCCR)- Breast Cancer.MethodsThe PSCCR – Breast Cancer was created by linking two existing registries containing data on 1) diagnosis, tumour and treatment characteristics of all Dutch breast cancer patients (NCR), and 2) consultations and diagnoses from primary care electronic health records of about 10% of Dutch GP practices (Nivel-PCD). The existing registry governance structures and privacy regulations were incorporated in those of the new registry. Privacy and security risks were reassessed. Data were restricted to females and linked using postal code and date of birth. The breast cancer diagnosis was verified in both registries and for a subsample of 44 patients with the GP as well.ResultsA collaboration agreement was signed in which the organisations retained data responsibility and accountability for ‘their’ registry. A Trusted Third Party performed the record linkage. Ten percent of the patients with breast cancer could be linked to the primary care registry, as was expected based on the coverage of Nivel-PCD, and finally 7 % could be included. The breast cancer diagnosis was verified by the GP in 42 of the 44 patients.ConclusionsWe developed and validated a procedure for patient-level linkage of health data registries without a unique identifier, while preserving the integrity and privacy of the original registries. The method described may help researchers wishing to link existing health data registries.

The role of all-payer claims databases to expand central cancer registries: Experience from Colorado.

To evaluate the quality of a multiyear linkage between the Colorado all-payer claims database (APCD) and the Colorado Central Cancer Registry. Secondary 2012-2017 data from the APCD and the Colorado Cancer Registry. Descriptive analysis of the proportion of cases captured by the linkage in relation to the cases reported by the registry. We used probabilistic linkage to combine records from both data sources for all patients diagnosed with cancer. We successfully linked 93% of the 146,884 patients in the registry. Approximately 63% of linked patients were perfect matches on five identifiers. Of partial matches, 81.6% were matched on four identifiers with missing or partial Social Security Numbers. The linkage rate was lower for uninsured patients at diagnosis (74.7%) or patients with private plans (89.4%) but close to 100% for Medicare and Medicaid enrollees. Most of the 29% of patients who did not have claims at the time of diagnosis were covered by private plans that may not submit claims. APCD-registry linkages are a promising source of data to conduct population-based research from multiple payers. However, not all payers submit claims, and the quality of the data may vary by state.

Linking education and hospital data in England: linkage process and quality.

IntroductionLinkage of administrative data for universal state education and National Health Service (NHS) hospital care would enable research into the inter-relationships between education and health for all children in England.ObjectivesWe aim to describe the linkage process and evaluate the quality of linkage of four one-year birth cohorts within the National Pupil Database (NPD) and Hospital Episode Statistics (HES).MethodsWe used multi-step deterministic linkage algorithms to link longitudinal records from state schools to the chronology of records in the NHS Personal Demographics Service (PDS; linkage stage 1), and HES (linkage stage 2). We calculated linkage rates and compared pupil characteristics in linked and unlinked samples for each stage of linkage and each cohort (1990/91, 1996/97, 1999/00, and 2004/05).ResultsOf the 2,287,671 pupil records, 2,174,601 (95%) linked to HES. Linkage rates improved over time (92% in 1990/91 to 99% in 2004/05). Ethnic minority pupils and those living in more deprived areas were less likely to be matched to hospital records, but differences in pupil characteristics between linked and unlinked samples were moderate to small.ConclusionWe linked nearly all pupils to at least one hospital record. The high coverage of the linkage represents a unique opportunity for wide-scale analyses across the domains of health and education. However, missed links disproportionately affected ethnic minorities or those living in the poorest neighbourhoods: selection bias could be mitigated by increasing the quality and completeness of identifiers recorded in administrative data or the application of statistical methods that account for missed links.HighlightsLongitudinal administrative records for all children attending state school and acute hospital services in England have been used for research for more than two decades, but lack of a shared unique identifier has limited scope for linkage between these databases.We applied multi-step deterministic linkage algorithms to 4 one-year cohorts of children born 1 September-31 August in 1990/91, 1996/97, 1999/00 and 2004/05. In stage 1, full names, date of birth, and postcode histories from education data in the National Pupil Database were linked to the NHS Personal Demographic Service. In stage 2, NHS number, postcode, date of birth and sex were linked to hospital records in Hospital Episode Statistics.Between 92% and 99% of school pupils linked to at least one hospital record. Ethnic minority pupils and pupils who were living in the most deprived areas were least likely to link. Ethnic minority pupils were less likely than white children to link at the first step in both algorithms.Bias due to linkage errors could lead to an underestimate of the health needs in disadvantaged groups. Improved data quality, more sensitive linkage algorithms, and/or statistical methods that account for missed links in analyses, should be considered to reduce linkage bias.

Record Linkage of Chinese Patent Inventors and Authors of Scientific Articles

We present an algorithm to find corresponding authors of patents and scientific articles. The authors are given as records in Scopus and the Chinese Patents Database. This issue is known as the record linkage problem, defined as finding and linking individual records from separate databases that refer to the same real-world entity. The presented solution is based on a record linkage framework combined with text feature extraction and machine learning techniques. The main challenges were low data quality, lack of common record identifiers, and a limited number of other attributes shared by both data sources. Matching based solely on an exact comparison of authors’ names does not solve the records linking problem because many Chinese authors share the same full name. Moreover, the English spelling of Chinese names is not standardized in the analyzed data. Three ideas on how to extend attribute sets and improve record linkage quality were proposed: (1) fuzzy matching of names, (2) comparison of abstracts of patents and articles, (3) comparison of scientists’ main research areas calculated using all metadata available. The presented solution was evaluated in terms of matching quality and complexity on ≈250,000 record pairs linked by human experts. The results of numerical experiments show that the proposed strategies increase the quality of record linkage compared to typical solutions.

Overcoming the Impasse 2: Assessing the Quality of Recent Australian Applications of a Privacy-Preserving Record Linkage Method (PPRL-BLOOM)

IntroductionWhile the quantity and type of datasets used by data linkage projects is growing, there remain some datasets that are ‘not available’ or ‘hard to access’ by researchers and linkers, either due to legal/regulatory constraints restricting the release of personally identifying information or because of privacy or reputational concerns. Advances in privacy-preserving record linkage methods (e.g. PPRL-Bloom) have made it possible to overcome this impasse. These techniques aim to provide strong privacy protection while still maintaining high linkage quality.
 PPRL-Bloom methods are being used in practice. The Centre for Data Linkage (CDL) at Curtin University has been involved in several PPRL linkage and evaluation projects using real-world data. As the methods are relatively new, published information on achievable linkage quality in real-world scenarios is limited.
 Objectives and ApproachWe present and describe several real-world applications of privacy preserving record linkage (PPRL-Bloom) where the quality of the linkage could be ascertained. In each case, data was linked ‘blind’; that is, without linkers having access to the original personal identifiers at any stage, or having any additional information about the records. Evaluations include a linkage of state-based morbidity and mortality records, a linkage of a number of general practice datasets to morbidity and emergency records, and a linkage of a range of state-based non-health administrative data, including education, police, housing, birth and child protection records.
 ResultsThe privacy preserving record linkage performed admirably, with very high-quality results across all evaluations.
 Conclusion / ImplicationsPrivacy preserving linkage is a useful and innovative methodology that is currently being used in real world projects. The results of these evaluation suggest it can be an appropriate linkage tool when legal or other constraints block release of personally identifying information to third party linkage units.

Linkage of maternity hospital episode statistics birth records to birth registration and notification records for births in England 2005–2006: quality assurance of linkage

ObjectivesThe objectives of this study were to describe the methods used to assess the quality of linkage between records of babies’ birth registration and hospital birth records, and to evaluate...

Patient satisfaction & use of health care: a cross-sectional study of asylum seekers in the Freiburg initial reception centre

BackgroundIn response to a high number of incoming asylum seekers and refugees (AS&R) in Germany, initial reception centres were established to provide immediate shelter, food and health support. This study evaluates the satisfaction with and use of the health care available at the Freiburg initial reception centre (FIRC) where an integrated health care facility (ICF) was set up in 2015.MethodsWe assessed use and satisfaction with health services available to resident AS&R within and outside the FIRC in a cross-sectional design. Data were collected in 2017 using a questionnaire with both open and closed ended items.ResultsThe majority of 102 included participants were young (mean age 24.2; 95%CI 22.9–25.5, range 18–43) males (93%), from Sub-Saharan Africa (92%). High use frequencies were reported from returning patients of the ICF; with 56% fortnightly use and 19% daily use reported. The summary of satisfaction scores indicated that 84% (CI95 76–89%) of respondents were satisfied with the ICF. Multivariate analysis showed female gender and non-English speaking as risk factors for low satisfaction. Outside the FIRC, the satisfaction scores indicated that 60% of participants (95%CI 50–69%) were satisfied with the health care received.ConclusionOur study shows that AS&R residing in the FIRC are generally satisfied with the services at the ICF, though strategies to enhance care for females and non-English speakers should be implemented. Satisfaction with health care outside of the FIRC was not as high, indicating the need to improve quality of care and linkage to regular health care services.

Conflict Management Strategies Utilized by Nurse Managers and its Relationship to Vertical Dyad Linkage with Nurses

Background: Conflict management skill is an essential skill for an effective nurse leader. As inappropriate use of conflict resolution skills leads to degeneration of communication and poor working relationships particularly between nurse leader and their staff nurses. Aim:the current study aimed todetermine the relationship between conflict management strategies used by head nurses, and the quality of vertical dyad linkage at Port Said hospitals. Subjects and Methods: A descriptive correlational design was applied in this study on 31 head nurses and 203 staff nurses working in Port Said General Hospital and Port Said Health Insurance Hospitals, using two tools; the first was Thomas-Kilmann conflict mode instrument to assess head nurses' preferred conflict resolution strategies, and the second was vertical dyad linkage scale from staff nurses point of view. Results: The results of the present study showed more than two-thirds of head nurses (67.7%) used accommodating strategy as a primary method to resolve conflict, followed by compromising strategy used by 51.6% by them to resolve conflict and less than two third (64%) of staff nurses had a neutral relation with their head nurses. Conclusion: Based on the results of the present study, it can be concluded that, there was no statistically significance relation between conflict management strategies used by head nurses, and the quality of vertical dyad linkage in Port-Said hospitals. It was recommended that head nurses should use conflict management styles depending on the situation. In addition to, develop an in-group relationship with as many staff nurses as possible.

A supervised machine learning approach to trace doctorate recipients’ employment trajectories

Only scarce information is available on doctorate recipients’ career outcomes ( BuWiN, 2013 ). With the current information base, graduate students cannot make an informed decision on whether to start a doctorate or not ( Benderly, 2018 ; Blank et al., 2017 ). However, administrative labor market data, which could provide the necessary information, are incomplete in this respect. In this paper, we describe the record linkage of two data sets to close this information gap: data on doctorate recipients collected in the catalog of the German National Library (DNB), and the German labor market biographies (IEB) from the German Institute of Employment Research. We use a machine learning-based methodology, which (a) improves the record linkage of data sets without unique identifiers, and (b) evaluates the quality of the record linkage. The machine learning algorithms are trained on a synthetic training and evaluation data set. In an exemplary analysis, we compare the evolution of the employment status of female and male doctorate recipients in Germany.

Evaluating record linkage of birth registration and notification records to Hospital Episode Statistics: Singleton births in 2005 and 2006 across England

Background with rationaleLinked administrative datasets are particularly useful within the field of perinatal epidemiology. By linking multiple datasets, researchers can create longitudinal datasets, which allow them to explore research questions relating to early exposures and outcomes later in life.
 Main AimThe aims of this study were to describe the methods used to deal with duplicate hospital admission records, assess the quality of linkage between babies birth registration records and subsequent hospital admissions, and to evaluate the potential bias that may be introduced as a result of these methods.
 MethodsThree routinely collected datasets were linked for use within this study and included data from birth registration, NHS Numbers for Babies (NN4B) and Hospital Episode Statistics (HES) for babies born in England between 1st January 2005 and 31st December 2006. A number of stages to cleaning were undertaken, including dealing with duplicate HES records and assessing the quality of the linkage using a deterministic algorithm. Internal and external validity was also assessed.
 ResultsThere were a total of 1,170,970 live, singleton births, occurring in NHS hospitals, to mothers who normally reside in England in 2005 and 2006 combined. Of these, approximately 92% were successfully linked with a HES birth record. Data quality was somewhat poorer in HES birth records compared to birth registration and NN4B. The quality assurance algorithms identified 1,456 incorrect linkages (<1%) and examination of external validity identified children that were not linked were slightly more likely to be born to mothers who were older and of higher socio-economic status.
 ConclusionIt is possible to create valuable longitudinal datasets allowing researchers to explore important questions about exposures and childhood outcomes using administrative datasets, however, missing data and coding errors and inconsistencies mean it is important that the quality of linkage is assessed prior to analysis.

780. Inpatient Addiction Medicine Consultations at the Urban/Rural Frontier: Improving Quality of Care and Linkage to Outpatient Services for Patients with Substance Use Disorder in Central Kentucky

BackgroundWhen persons with opioid use disorder (OUD) are hospitalized with medical complications (e,g. endocarditis, viral hepatitis) they frequently do not receive medications for the underlying OUD. In recent years, a number of hospitals have implemented addiction medicine consultation (AMC) services to help address this treatment gap, though these are all in large urban centers. AMCs provide comprehensive substance use disorder (SUD) assessments, manage SUDs, initiate pharmacotherapy for OUD, and arrange linkage to ongoing treatment. The aim of this study was to describe the initial implementation and outcomes of a new AMC at the University of Kentucky Hospital, a 945-bed tertiary referral center with a large rural catchment.MethodsThe Addiction Consultation and Education Service(ACES) began October, 2018 and was comprised of several physicians and an APRN. A patient navigator assisted with prior authorizations and outpatient linkage. ACES referred to a new bridge clinic at the University for ongoing office-based opioid treatment as well as to community programs and licensed opioid treatment programs. Patient demographics, SUD diagnoses, and comorbidities (including details of the injection-related infections) are collected from the electronic health record, as well as key process metrics including: time-to-consultation and medication initiation, length of stay(LOS), discharge against medical advice(AMA), and details of linkage to outpatient services.ResultsFrom October-December, 91 patients were seen, 73 met DSM-5 criteria for OUD, 82 had a medical complication of SUD, and 53 lived in rural counties (Rural-Urban Continuum Codes 4–9). Average LOS was 19.5 days. Among OUD patients, 71% underwent buprenorphine/naloxone induction, 9% were started on methadone. Less than 6% of patients started on buprenorphine or methadone left against medical advice.ConclusionAMCs are a key part of providing comprehensive care for persons hospitalized with infectious complications of substance use. Initiating medication for OUD likely decreases rates of discharge against medical advice. Compared with other AMCs, a greater percentage of patients seen by ACES resided in rural counties. Establishing a bridge clinic prior to starting an AMC is critical to ensure ongoing care.Disclosures All authors: No reported disclosures.

Zur Autonomie indirekter Redewiedergabe – Eine diachrone Perspektive

AbstractRegarding verbal mood and complementation patterns of reporting verbs, the distinction between direct and indirect reported speech is well established in present-day German. This paper looks into the history of German: Common knowledge has it that both the use of verbal mood as well as the quality of clause linkage undergo considerable changes giving rise to the question how these changes affect the manifestations of indirect reported speech in earlier stages of German. The historical record of the 16th century (with an outlook on the 17th century) shows that the distinction between direct and indirect reported speech is not yet grammaticalized in historical sources at the time. In particular with respect to dependent (in)direct reported speech, both types prefer V2-complements with only verbal mood differentiating between the types. Although present and past subjunctive have a much wider distribution in earlier stages of German, the occurrence of free indirect speech likewise testifies to its increasing use as a marker of indirect reported speech. The growing conventionalization of patterns of indirect reported speech in the course of Early Modern German may be considered as an example for an increase of subjectification in its development.