BACKGROUND: Adolescent idiopathic scoliosis (AIS) surgery is the most common reason for elective pediatric orthopaedic surgery. Minimization of adverse events is an important goal. Institute of Medicine (IOM) outlined 6 facets of healthcare quality improvement within the acronym STEEEP. Two of these facets, Safety and Timeliness for AIS surgery in Canada, are examined in this thesis. METHODS: A three - part study, using clinical records at the largest Canadian pediatric hospital and CIHI national administrative data, determined i) the relationship between surgical wait times and rates of adverse events, along with determination of an empirically derived access target, ii) accuracy of ICD-10 coding of surgical AIS cases along with an optimal search strategy to identify surgical AIS cases, and iii) the volume – outcome relationships for scoliosis surgery using hierarchical and conventional single level multi-variate regression analysis. RESULTS: Access target of 3 months minimized the adverse events related to waiting. Optimal search strategy for AIS surgical cases using ICD-10 coding required combination of codes as each code in isolation was inaccurate due to limitations in coding definitions. There was no significant volume – outcome relationship using appropriate modeling strategies. CONCLUSIONS: Ensuring timeliness of surgical treatment of less than 3 months is important in surgical cases of AIS given the potential for curve progression in higher risk individuals who are skeletally immature with large magnitude curves at time of surgical consent. At the administrative database level, knowledge of coding accuracy and optimal search strategies are needed to capture a complete cohort for analysis. In AIS, several ICD-10 codes need to be combined. AIS surgery cases captured through this optimal search strategy, revealed no significant volume-outcome relationships with appropriate modeling. Based on these results, minimum volume thresholds and regionalization of care for AIS surgery does not appear to be justified. However, a larger sample size was needed to determine whether there was a clinically significant difference in wound infection and blood transfusion rates. Furthermore, clinical variables, not part of an administrative database such as curve pattern were not included.

ADHD has for a long time been perceived as something that affects children and grows away with time. American psychiatric association state that ADHD may appear differently with adolescences and adults than with children. That could lead to misunderstandings and exclusion by adults and adolescences with ADHD at work life amongst other situations. This report investigates that exclusion and tries to find what information that needs to reach certain target groups to prevent it from happen. The works focus is text design, a part of information design, and looks firstly at the factors that make good information material. Then I investigate if there is a need for more information about ADHD within working life and if so what it would contain. The next part brings up what criteria it takes to be diagnosed with ADHD and different kinds of support; such as administrative, economical or cognitive. The goal of the report is to form information, mostly with text. Therefore the theoretical part ends with factors connected to information design followed by the design development. / ADHD har länge uppfattats som något som drabbar barn och växer bort med tiden. American psychiatric association uppger att ADHD kan uppträda annorlunda hos ungdomar och vuxna än hos barn. Något som kan leda till missförstånd och exkludering av vuxna och ungdomar med ADHD på bland annat arbetsmarknaden. Denna rapport undersöker den exkluderingen och söker vilken information som behöver nå vilka målgrupper för att förebygga den. Arbetets inriktning är textdesign, en del av informationsdesign, och fokuserar inledningsvis på de faktorer som bygger effektiv informationsmaterial. Sedan undersöks om det finns behov av mer information om ADHD inom yrkeslivet och vad den i så fall ska innehålla. Nästa del tar upp vilka kriterier som ska uppfyllas för att diagnostiseras med ADHD och vilken typ av stöd som då går att få; det kan handla om administrativ, ekonomisk eller kognitiv. Rapportens mål är att gestalta information och det är i första hand med hjälp av text. Därför avslutas den teoretiska delen med faktorer kopplade till informationsdesign och följs av designarbetets utveckling.

Background: Pre-eclampsia (PET) is one of the major causes of maternal and neonatal morbidity and mortality1. Misclassification of PET can lead to biased or erroneous results in epidemiologic studies resulting in false conclusions. Objectives: The objectives of this thesis are to determine the validity of PET diagnosis in pregnant women in administrative database using the ICD-10-CA codes, to explore the nature of misclassification, and to estimate whether misclassification of PET diagnosis in administrative database may result in biased conclusions. Methods: Pregnant women who participated in the Ottawa and Kingston (OaK) Birth Cohort study and delivered in the Ottawa Hospital were included in the study. All cases with hypertensive disorder of pregnancy in the study population were adjudicated to confirm diagnosis of PET. This adjudicated dataset was used as a reference standard. The PET incidence in hospital discharge database was compared with PET incidence calculated from the reference standard database. Results: 2887 of the requested charts were available for review. The PET incidence was much lower in administrative database (1.47%) than in the OaK Birth Cohort Study (3.6%). The results of the study demonstrated that hospital discharge database via ICD-10-CA was not very sensitive to determine incidence of PET since sensitivity of ICD-10-CA diagnostic codes for PET was low (35.92% with 95% Confidence Intervals (CI): 26.7; 45.9) but specificity, PPV, and NPV were high. The majority of misclassified cases belonged to the category (according to the proposed classification) “PET pregnancies coded with incorrect ICD-10-CA code” (78.88%) followed by the category “Pregnancies affected by PET coded as normal” (14.08%). Conclusion: Using hospital discharge database and ICD-10-CA coding to determine incidence of PET in certain settings may yield low sensitivity. Researchers should validate the results when using the hospital discharge database for PET research to ensure that the findings based on analyses of such data demonstrate what they claimed to demonstrate.

In dieser Arbeit soll auf das gesellschaftliche Problem der Altersgebrechlichkeit (Frailty) aufmerksam gemacht werden. Die Bedeutung für jedes Individuum, gebrechlich, frail zu altern und damit den Verlust an Lebensqualität und eine vorzeitige Mortalität zu riskieren wird deutlich gemacht. Das Alterssyndrom wäre einfach zu diagnostizieren, fällt aber dennoch zurzeit durch ein Raster. Deshalb wird ein Kodierungsvorschlag für Frailty entworfen, aus dem sich gezielte individuelle Therapie- und Rehabilitationsmaßnahmen ableiten lassen. Der Zusammenhang von altersphysiologischen immuno-neuro-endokrinen Veränderungen und der Frailty bilden die Grundlage für eine Präventionskaskade: F1, F2; F3 in Anlehnung der „U“-Untersuchungen für Kinder.

Background. In-hospital mortality is a measure recognized by US Agency for Healthcare Quality to represent quality of care within hospitals, that accounts for mortality based on three indicators: 1. select medical conditions and procedures; 2. procedures linked with questions of use (misuse, over/under use); 3. high volume procedures traditionally associated with lower mortality rates. Understanding how different comorbidity models measure in-hospital mortality is essential not only for determining patient health status in the hospital setting, but also help to regulating mortality risk and mortality risk predictions. One of the most widely used discriminatory models is the Charlson model, which predicts the risk of mortality within one year of hospitalization of patients with various comorbidities using CCSR codes for ICD-10 diagnoses which is quantified by the c-statistics, represented by the area under the curve (AUC). Objectives. To adapt a comorbidity index model to the National Inpatient Sample (NIS) database of 2020 to predict 1-year mortality for patients admitted with select ICD-10 codes of diagnoses. Methods Our study analysis examined mortality with comorbidity using the Charlson model in a sample population of estimated 5,533,477 adult inpatients (individuals ≥18 years of age). A multivariate logistic regression model was constructed with in-hospital mortality as the outcome variable and identifying predictor variables as defined by the Clinical Classifications Software Refined Variables (CCSR) codes for selected ICD-10 diagnoses (Table 3). Descriptive statistics and the base logistic regression analyses were conducted using SAS statistical software version 9.4. To avoid overpowering and avoid variables attaining statistical significance while only marginally changing the outcome, a subsample (n=100,000) was randomly selected from the original data set. Ultimately, 20 CCSR variables with p-values <0.20 from the base simple logistic regression models were included in the subsequent backward stepwise logistic regression analysis. Results Table 1 shows the prevalence of the selected diagnoses for our analysis. Anemia (28.32%), pulmonary disease (asthma, COPD, pneumoconiosis;21.88%), and diabetes without complications (19.47%) were the three most prevalent conditions among hospitalized patients. Table 2 shows the results of the base logistic regression analysis conducted, which excluded connective tissue/rheumatologic disorders, peptic ulcer disease, anemia, diabetes with complications, and human immunodeficiency as predictors of inpatient mortality. Results of the backward stepwise regression analysis revealed that severe liver disease/hepatic failure ([adjusted odds ratio (aOR): 10.50, (CI: 10.40-10.59)], acute myocardial infarction ([2.85, (2.83-2.87)] and malnutrition ([2.15, (2.14-2.16)] were three most important risk factors and had the highest impact on inpatient mortality (p-value <0.0001). However, smoking history, obesity, and liver disease were negatively associated with inpatient mortality. The c-statistic or the area under the curve (AUC) for the final model was 0.752. Conclusion Our findings, based on Charlson modeling procedures, indicate that independent variables representative of comorbidity with the strongest 1-year risk of mortality were among patients with ICD-10 codes relating to: severe liver disease/hepatic failure, acute myocardial infarction, and malnutrition. Hence, relevant stakeholders (patients, family members, and healthcare providers) can utilize this knowledge to advance models of care and prevention strategies that limit disease progression and improve patient outcomes.

Psykisk hälsa/ohälsa är ett svårdefinierat begrepp som sätter fingret på ett av de största folkhälsoproblemen i vårt land, där depression är en av de vanligaste diagnoserna. Manualerna DSM-IV TR och ICD-10 används inom stora delar av sjukvården, världen över, i syfte att ge kunskap om lämpligast behandling till patienter med psykiska besvär. Denna studie syftar till att, genom en kvalitativ analys, undersöka vilka grunder som finns bakom de vanligast använda diagnosmanualerna och vilka kriterier som krävs för att uppfylla två vanligt förekommande diagnoser, PTSD och svår depression. Vidare syftar studier till att belysa eventuella likheter och olikheter mellan dessa diagnoser och vad det kan föra med sig. Såväl psykologisk forskning som klinisk praktik utgår idag mestadels från psykiatriska diagnoser, vilket kan ha såväl fördelar som nackdelar, men samtidigt diskuteras huruvida man istället ska lägga fokus på en annan mer underliggande nivå, nämligen processerna som sträcker sig över diagnosernas gränser. Fördelarna med ett transdiagnostiskt perspektiv är att det delvis kan ge en förklaring till den höga komorbiditet som finns i kliniska grupper och som skulle kunna iakttas även i de sjukdomsbilder som denna studie fokuserar på. Unified Protocol är en annan behandlingsmodell som tas upp i studien, vilken baseras på en betydande fenotypisk över-lappning mellan olika ångeststörningar hos patienter, där personer med subkliniska nivåer av symtom ändå kan ha en nedsatt funktionsnivå och ett subjektivt lidande, fastän de inte uppfyller alla de diagnostiska kriterierna för en specifik störning. Resultatet visar på möjligheten att se över diagnosgränser, för att öka chanserna för ett tillfrisknande hos patienten. Människans upplevelser av olika situationer den befinner sig i formas av personens egen uppfattning om sin förmåga, eller oförmåga, att påverka resultatet. Att uppleva sig ha mist kontroll över sitt eget liv kan i sig leda till såväl depression som suicidala tankar/-handlingar. Om symtomen för depression jämförs med kriterierna som står att finna under diagnosbilden “Posttraumatiskt stressyndrom” under kapitlet “ångestsyndrom”, kan många likheter konstateras. Slutsatsen blir att likheterna i symtombild skulle ge patienter med PTSD en behandlingsrekommendation som inte alls överensstämmer med de rekommenderade riktlinjer som är utformade för PTSD. Trots diagnosernas likheter rekommenderas olikartad behandling, och även olika förutsättningar för att fungera i kombination med förvärvsarbete påvisas. Vid så lika symtombilder, men ändå så skilda rekommenderade behandlingsplaner utifrån de olika diagnoserna, torde risken för en felaktig rehabiliteringsplan vara över-hängande. / Mental health/illness is complex to define and this highlight of the biggest public health problems in our country, in which depression is one of the most common diagnoses. The manuals DSM-IV TR and ICD-10 is used in much of health care, worldwide, in order to provide knowledge of appropriate treatment for patients with mental disorders. This study aims to, through a qualitative analysis, examine the grounds behind the most commonly used diagnostic manuals and the criteria required to meet two common diagnoses, PTSD and severe depression. Further studies aimed to highlight any similarities and differences between these diagnoses and what it can bring. Both psychological research and clinical practice today is based mostly from psychiatric diagnoses, which can have both advantages and disadvantages, but also discussed whether they should instead focus on another more underlying level, namely the processes that extend across the diagnostic boundaries. The advantages of a trans-diagnostic perspective are that it may partly explain the high co-morbidity found in clinical groups and that could be observed even in those syndromes which this study focuses on. Unified Protocol is a different treatment model that is entered in the study, which is based on a significant phenotypic overlap between anxiety disorders in patients, where individuals with subclinical levels of symptoms still can have a reduced level of functionality and a subjective suffering, although they do not meet all the diagnostic criteria for a specific disorder. The result shows at the opportunity to review the diagnostic boundaries, to increase the chances for a recovery of the patient. The human experiences of different situations it is in the form of personal self-perception of their ability, or inability, to influence the outcome. To experience they have lost control over his own life in itself can lead to both depression that suicidal thoughts / actions. If the symptoms of depression compared with criteria that are to be found during diagnostic image "Post-traumatic stress disorder" in the chapter "disorder" can be found many similarities. The discourse comes to that the similarities in symptoms would provide patients with PTSD, a treatment recommendation, which did not conform to the recommended guidelines that are designed for PTSD. Despite the diagnosis, the similarities are recommended disparate treatment, and also different conditions to work in conjunction with work shown. At this same symptom pictures, yet so different recommended treatment plans based on the different diagnoses, would risk a false rehabilitation plan to be imminent

No description available.

The Emergency department at Södersjukhuset currently suffers from very long waiting times. This is partly due to problems within visualisation and mapping of patient data and other information that is fundamental in the handling of patients at the Emergency department. This led to a need in the creation of improvement suggestions to the visualisation of the patient flow between the Emergency department and the Gastroenterology department at Södersjukhuset. During the project, a simulated graphical user interface was created with the purpose of mimicking Södersjukhusets current patient flow. This simulated user interface would visualise the patient flow between the Emergency department and the Gastroenterology department. Additionally, a patient symptoms estimation algorithm was implemented to guess the likelihood of a patient being admitted to a department. The result shows that there are many possible improvements to Södersjukhusets current hospital information system, TakeCare, that would facilitate the care coordinators work and in turn lower the waiting times at the Emergency department. / Akutmottagningen på Södersjukhuset har i dagsläget väldigt långa väntetider. Detta beror till viss del utav problem inom visualiseringen och kartläggning av patient data och annan fundamental information för att hantera patienter på akutmottagningen. Detta ledde till att det finns ett behov att skapa förbättringsförslag på visualiseringen av patientflödet mellan akutmottagningen och gastroenterologiavdelningen på Södersjukhuset. Under projektets gång skapades ett simulerat användargränssnitt med syfte att efterlikna Södersjukhusets nuvarande patientflöde. Denna lösning visualiserar patientflödet mellan akutmottagningen och gastroenterologiavdelningen. Dessutom implementerades en enkel sorteringsalgoritm som kan bedöma sannolikheten om en patient skall bli inlagd på en avdelning. Resultatet visar att det finns flera möjliga förbättringar i Södersjukhusets nuvarande elektroniska journalsystemet, TakeCare, som skulle underlätta vårdkoordinatorernas arbete och därmed sänka väntetiderna på akutmottagningen.

Magister Public Health - MPH / Background: The Provincial Government Western Cape (PGWC) Department of Health identified a lack of data on inpatient diagnoses and procedures in a form suitable to use for operational, strategic as well as financial health care planning. The only format in which diagnostic and procedure data was available was a paper based one encompassing individual patient notes in folders and discharge summaries. Making the data available in a coded format within an electronic database would facilitate storage, analysis and utilisation of that data for health service planning. Recognising the lack of availability of such coded data, this study was undertaken to evaluate different coding systems for their ability to code data in order to assist in deciding which coding systems best fit the need to facilitate easy and accurate recording of data on diagnoses and procedures from patient records. The identification of the most appropriate coding system for the context in which the PGWC Department of health functions should facilitate the easy recording, storage and retrieval of data that is accurate, reliable and useful for management decision making and would support optimal patient care. Aim: The aim of the study was to evaluate a selection of potentially suitable coding systems in order to determine which would be best able to code public sector district and regional hospital diagnostic and procedure data in the Western Cape Province. Method: A cross sectional analytical study design was used. Discharge diagnosis and procedure data were extracted from 342 patient folders from 3 district and 3 regional public hospitals in the Western Cape. This yielded 221 different diagnostic concepts and 126 different procedure concepts. The diagnostic concepts were further grouped into “all” diagnostic concepts recorded, diagnostic concepts recorded as “symptoms only” and diagnostic concepts recorded as “proper diagnoses”. The diagnostic coding systems evaluated were ICD-10 (International Classification of Diseases), ICPC-2 (International Classification of Primary Care 2nd edition) and ICD-10 Condensed Morbidity List. The procedure coding systems evaluated were CCSA-2001 (Current Procedure Terminology for South Africa) ICD-9-CM (International Classification of Diseases Clinical Modification 9th revision) and ICPC-2. The diagnoses and procedures were then coded in all of the coding systems being evaluated. Each diagnosis and procedure concept was matched with its representing concept in the coding system and scored according to the ability of the coding system to provide an “exact” match which was scored as (3) or a “partial” match scored as (2) or a “poor” match scored as (1) or “no” match scored as (0). Results: ICD-10 was better able to code diagnoses obtained from district and regional hospitals in the Western Cape compared to ICPC-2 and ICD-10 Condensed Morbidity list. For all recorded diagnostic concepts, ICD-10 was able to score 82% of the concepts as either an “exact” or a “partial” match compared to 79% in ICPC-2 and 30% in ICD-10-CL. ICD-10 consistently performed best across different stratification of diagnostic concepts namely concepts recorded as “proper diagnoses”, concepts recorded from regional hospitals only, concepts recorded from district hospitals only, concepts designated as “common diagnoses” and for concepts designated as “very common diagnoses”. In addition ICD-10 had zero diagnostic concepts for which “no match” could be found. CCSA -2001 proved to be the best coding system for coding procedures across all hospitals with an overall percentage of “exact” and “partial” matches of 83% compared to 65% for ICD-9-CM and 39% for ICPC-2 and also proved to be best across all strata. Conclusion: There were striking differences between the evaluated coding systems with regard to their ability to code diagnoses and procedures in the evaluated district and regional hospitals in the Western Cape Province. ICD-10 covers the scope of clinical diagnoses in more accurate and specific detail than ICPC-2 and ICD-10 CL. Though ICPC-2 is simpler and easier to use than ICD-10, it is not as detailed and specific as the latter but it proved ideal for symptoms rather than for specific diagnoses. ICD-10 Condensed Morbidity List was shown to be inadequate for coding diagnoses. However the difference between the two, although statistically significant were not very large and given the ease of use of ICPC-2, it could be recommended for use. As for procedures CCSA-2001 was assessed as being the most appropriate for coding procedures recorded in this setting compared to the other coding systems. ICPC-2 performed poorest for coding procedures across all evaluated settings and thus would be inappropriate to use. ICD-10 in most comparisons performed second best to ICPC-2 in terms of coding ability for diagnoses and could be considered for recommendation as a diagnostic coding tool.

Clinical documentation is at the center of a patient's medical record; this record contains all the information applicable to the care a patient receives in the hospital. The practice problem addressed in this project was the lack of clear, consistent, accurate, and complete patient medical records in a pediatric hospital. Although the occurrence of incomplete medical records has been a known issue for the project hospital, the issue was further intensified following the implementation of the 10th revision of International Classification of Diseases (ICD-10) standard for documentation, which resulted in gaps in provider documentation that needed to be filled. Based on this, the researcher recommended a quality improvement project and worked with a multidisciplinary team from the hospital to develop an evidence-based documentation guideline that incorporated ICD-10 standard for documenting pediatric diagnoses. Using data generated from the guideline, an artificial intelligence (AI) was developed in the form of best practice advisory alerts to engage providers at the point of documentation as well as augment provider efforts. Rosswurm and Larrabee's conceptual framework and Kotter's 8-step change model was used to develop the guideline and design the project. A descriptive data analysis using sample T-test significance indicated that financial reimbursement decreased by 25%, while case denials increased by 28% after ICD-10 implementation. This project promotes positive social change by improving safety, quality, and accountability at the project hospital.