Secondary Health Data Linkage for Health Services Research: Prevalence and determinants of avoidable emergency department utilization
Public Health, Healthcare Research, Social and Occupational Medicine
Final Report Abstract
Linked health care data are useful for monitoring of health care measures and health care reporting in general and suitable to investigate also whole populations. This includes cost-effectiveness studies, identification of adverse health care trends, monitoring of infectious diseases or immunization programs and detection of health services problems. Thus tailored health policy interventions, funding and campaigns are possible and likely to be more effective and improve clinical practice. Researchers need to be trained and multidisciplinary teams (data managers, programmers, statisticians, health services researchers) should be established. The introduction of common and unique identifiers in all data collections contributes to accurate data linkage. Interoperability across different care providers and data custodians should be assured and text information in clinical documentation needs to be reduced in order to facilitate the analysis and comparison of different care providers. Once a harmonized data collection and successful data linkage has been established the analysis of high amounts of health care data is possible with less costs of data acquisition and could reduce redundant duplicate primary data collections. Another strength is a usually high amount of data which also enables the analyses of small populations. Longitudinal and intergenerational analyses are possible as well. Still selection bias should be considered (systematic selection/non-differentially missing data). Regular local census data are useful to identify and assess potential selection bias. Furthermore specific information could be missing or not be available in great detail as it would have been in prospective data collections, thus also linkage project with primary data collections are useful to complete available routine information. In Australia, the inadequate use of emergency rooms is already regularly reported and understood as a performance indicator (PI) for care and services in the outpatient health care sector. It is defined as “Attendances at public hospital emergency departments that could have potentially been avoided through the provision of appropriate non-hospital services in the community”. (PI 19—Selected potentially avoidable GP-type presentations to emergency departments). The present evaluation shows that the definition used in the Australian health care system, in comparison with other established definitions of inadequate use, does lead to different results with regard to the estimation of prevalence. In the Australian context, an overestimation of the prevalence of inadequate emergency use on the basis of the current definition of PI-19 is discussed. This may lead to an inappropriate increase in resources in the outpatient health sector while at the same time neglecting the appropriate equipment of overcrowded emergency rooms. With regard to the analysis of preventable emergency admissions (ambulatory care sensitive conditions) it was shown that the definitions currently used also lead to considerably different estimates. Furthermore, in Germany, the frequency of ACSC is interpreted as analogous to inappropriate ED-visits. The current analyses show that this is only the case for about one fifth of preventable hospitalizations and that this interpretation is therefore inadmissible. Current research aims at developing specific ACSC subsets for the identification of preventable ED cases and should be further pursued in future research projects. The experience gained in this project will be incorporated into the further development and harmonization of German emergency department documentation standards. Based on these documentation standards, which could also become mandatory for emergency departments in Germany in the future, quality indicators for emergency care can be developed, calculated, regularly reported and potentially linked with other data sources.
Publications
- (2019) Folic acid deficiency declined substantially after introduction of the mandatory fortification programme in Queensland, Australia: a secondary health data analysis. Public health nutrition 22 (18) 3426–3434
Slagman, Anna; Harriss, Linton; Campbell, Sandra; Muller, Reinhold; McDermott, Robyn
(See online at https://doi.org/10.1017/S1368980019002258) - Suitability of the German version of the Manchester Triage System to redirect emergency department patients to general practitioner care: a prospective cohort study. BMJ Open. 2019 May 6;9(5):e024896
Anna Slagman, Felix Greiner, Julia Searle, Linton Harriss, Fintan Thompson, Johann Frick, Myrto Bolanaki, Tobias Lindner, Martin Möckel
(See online at https://doi.org/10.1136/bmjopen-2018-024896)
