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1.
BMC Health Serv Res ; 6: 129, 2006 Oct 06.
Article in English | MEDLINE | ID: mdl-17026763

ABSTRACT

BACKGROUND: The Provincial Transfer Authorization Centre (PTAC) was established as a part of the emergency response in Ontario, Canada to the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003. Prior to 2003, data relating to inter-facility patient transfers were not collected in a systematic manner. Then, in an emergency setting, a comprehensive database with a complex data collection process was established. For the first time in Ontario, population-based data for patient movement between healthcare facilities for a population of twelve million are available. The PTAC database stores all patient transfer data in a large database. There are few population-based patient transfer databases and the PTAC database is believed to be the largest example to house this novel dataset. A patient transfer database has also never been validated. This paper presents the validation of the PTAC database. METHODS: A random sample of 100 patient inter-facility transfer records was compared to the corresponding institutional patient records from the sending healthcare facilities. Measures of agreement, including sensitivity, were calculated for the 12 common data variables. RESULTS: Of the 100 randomly selected patient transfer records, 95 (95%) of the corresponding institutional patient records were located. Data variables in the categories patient demographics, facility identification and timing of transfer and reason and urgency of transfer had strong agreement levels. The 10 most commonly used data variables had accuracy rates that ranged from 85.3% to 100% and error rates ranging from 0 to 12.6%. These same variables had sensitivity values ranging from 0.87 to 1.0. CONCLUSION: The very high level of agreement between institutional patient records and the PTAC data for fields compared in this study supports the validity of the PTAC database. For the first time, a population-based patient transfer database has been established. Although it was created during an emergency situation and data collection is dependent on front-line medical workers, the PTAC data has achieved a high level of validity, perhaps even higher than many purpose built databases created during non-emergency settings.


Subject(s)
Database Management Systems , Databases, Factual/standards , Health Facilities/statistics & numerical data , Patient Transfer/statistics & numerical data , Public Health Informatics/standards , Severe Acute Respiratory Syndrome/epidemiology , Transfer Agreement , Databases, Factual/statistics & numerical data , Decision Making, Organizational , Disease Outbreaks , Emergencies , Forms and Records Control , Humans , Ontario/epidemiology , Organizational Policy , Public Health Informatics/statistics & numerical data , Risk Management , Sentinel Surveillance
2.
BMC Health Serv Res ; 6: 10, 2006 Feb 15.
Article in English | MEDLINE | ID: mdl-16480500

ABSTRACT

BACKGROUND: The science of syndromic surveillance is still very much in its infancy. While a number of syndromic surveillance systems are being evaluated in the US, very few have had success thus far in predicting an infectious disease event. Furthermore, to date, the majority of syndromic surveillance systems have been based primarily in emergency department settings, with varying levels of enhancement from other data sources. While research has been done on the value of telephone helplines on health care use and patient satisfaction, very few projects have looked at using a telephone helpline as a source of data for syndromic surveillance, and none have been attempted in Canada. The notable exception to this statement has been in the UK where research using the national NHS Direct system as a syndromic surveillance tool has been conducted. METHODS/DESIGN: The purpose of our proposed study is to evaluate the effectiveness of Ontario's telephone nursing helpline system as a real-time syndromic surveillance system, and how its implementation, if successful, would have an impact on outbreak event detection in Ontario. Using data collected retrospectively, all "reasons for call" and assigned algorithms will be linked to a syndrome category. Using different analytic methods, normal thresholds for the different syndromes will be ascertained. This will allow for the evaluation of the system's sensitivity, specificity and positive predictive value. The next step will include the prospective monitoring of syndromic activity, both temporally and spatially. DISCUSSION: As this is a study protocol, there are currently no results to report. However, this study has been granted ethical approval, and is now being implemented. It is our hope that this syndromic surveillance system will display high sensitivity and specificity in detecting true outbreaks within Ontario, before they are detected by conventional surveillance systems. Future results will be published in peer-reviewed journals so as to contribute to the growing body of evidence on syndromic surveillance, while also providing an non US-centric perspective.


Subject(s)
Communicable Diseases, Emerging/epidemiology , Disease Outbreaks/prevention & control , Hotlines/statistics & numerical data , Information Centers/statistics & numerical data , Population Surveillance/methods , Algorithms , Bioterrorism/prevention & control , Bioterrorism/statistics & numerical data , Communicable Diseases, Emerging/prevention & control , Computer Systems , Emergency Service, Hospital/statistics & numerical data , Health Services Research , Humans , Nursing Services/statistics & numerical data , Ontario/epidemiology , Research Design , Syndrome
3.
Can J Public Health ; 94(5): 391-6, 2003.
Article in English | MEDLINE | ID: mdl-14577752

ABSTRACT

BACKGROUND: Little attention has been paid to the need for accountability instruments applicable across all health units in the public health system. One tool, the balanced scorecard was created for industry and has been successfully adapted for use in Ontario hospitals. It consists of 4 quadrants: financial performance, outcomes, customer satisfaction and organizational development. The aim of the present study was to determine if a modified nominal group technique could be used to reach consensus among public health unit staff and public health specialists in Ontario about the components of a balanced scorecard for public health units. METHODS: A modified nominal group technique consensus method was used with the public health unit staff in 6 Eastern Ontario health units (n=65) and public health specialists (n=18). RESULTS: 73.8% of the public health unit personnel from all six health units in the eastern Ontario region participated in the survey of potential indicators. A total of 74 indicators were identified in each of the 4 quadrants: program performance (n=44); financial performance (n=11); public perceptions (n=11); and organizational performance (n=8). INTERPRETATION: The modified nominal group technique was a successful method of incorporating the views of public health personnel and specialists in the development of a balanced scorecard for public health.


Subject(s)
Benchmarking/methods , Consensus , Process Assessment, Health Care , Public Health Administration/standards , Quality Indicators, Health Care , Social Responsibility , Benchmarking/standards , Decision Making , Health Care Surveys , Humans , Ontario , Organizational Objectives , Planning Techniques
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