Robust estimation of infant feeding indicators by data quality assessment of longitudinal electronic health records from birth up to 18 months of life.

BACKGROUND AND OBJECTIVE: The Baby-Friendly Hospital Initiative (BFHI) is an international strategy aimed at improving breastfeeding practices in health care services. Regular monitoring of indicators is key for BFHI implementation and maintenance. Currently, routine data collected from electronic health records (EHR) is an excellent source for infant feeding monitoring, however data quality (DQ) assessment should be undertaken. The aim of this research is to enable robust estimations of infant feeding indicators through DQ assessment of routine EHR data. MATERIALS AND METHODS: We use the longitudinal series of healthcare contacts belonging to 6427 children born from 2009 to 2018 in the Health Area V of Murcia (Spain). Longitudinal data came from EHR at hospital discharge and community infant health reviews up to 18 months. The data of each healthcare contact contained a 24-h recall of infant feeding. We perform a DQ process in three phases: (1) an assessment of each-single-contact and the definition of their infant feeding status; (2) a longitudinal DQ assessment of completeness and consistency of the series of contacts to obtain meta-information that guides the duration calculus, for each case, of the different types of breastfeeding: exclusive breastfeeding (EBF), full breastfeeding (FBF) and any breastfeeding (ABF); and finally (3) a robust estimation of indicators and description of DQ of each indicator. RESULTS: We found deficiencies of DQ in 30.42% of single contacts for EBF, 19.02% for FBF and 22.50% for ABF that were used to establish the infant feeding status. However, after longitudinal DQ assessment, we obtained valid and reliable data rates for most indicators such as "median duration of breastfeeding" nearly 90%, both for FBF and ABF, not so for EBF. CONCLUSIONS: Despite the DQ deficiencies found in raw data, the DQ assurance approach by indicators proposed in this work, allowed us to obtain a robust estimation of indicators with a significant percentage of subjects with valid information for ABF and FBF monitoring. The estimations were consistent with results previously published. The methodology provided with this study allows a continuous and reliable population monitoring of infant feeding indicators of BFHI from routine EHR data.

A Standardized and Data Quality Assessed Maternal-Child Care Integrated Data Repository for Research and Monitoring of Best Practices: A Pilot Project in Spain.

We present the results of a pilot project of the Spanish Ministry of Health, Social Services and Equality, envisaged to the development of a national integrated data repository of maternal-child care information. Based on health information standards and data quality assessment procedures, the developed repository is aimed to a reliable data reuse for (1) population research and (2) the monitoring of healthcare best practices. Data standardization was provided by means of two main ISO 13606 archetypes (composed of 43 sub-archetypes), the first dedicated to the delivery and birth information and the second about the infant feeding information from delivery up to two years. Data quality was assessed by means of a dedicated procedure on seven dimensions including completeness, consistency, uniqueness, multi-source variability, temporal variability, correctness and predictive value. A set of 127 best practice indicators was defined according to international recommendations and mapped to the archetypes, allowing their calculus using XQuery programs. As a result, a standardized and data quality assessed integrated data respository was generated, including 7857 records from two Spanish hospitals: Hospital Virgen del Castillo, Yecla, and Hospital 12 de Octubre, Madrid. This pilot project establishes the basis for a reliable maternal-child care data reuse and standardized monitoring of best practices based on the developed information and data quality standards.

Construction of quality-assured infant feeding process of care data repositories: Construction of the perinatal repository (Part 2).

This is the second in a series of two papers regarding the construction of data quality (DQ) assured repositories, based on population data from Electronic Health Records (EHR), for the reuse of information on infant feeding from birth until the age of two. This second paper describes the application of the computational process of constructing the first quality-assured repository for the reuse of information on infant feeding in the perinatal period, with the aim of studying relevant questions from the Baby Friendly Hospital Initiative (BFHI) and monitoring its deployment in our hospital. The construction of the repository was carried out using 13 semi-automated procedures to assess, recover or discard clinical data. The initial information consisted of perinatal forms from EHR related to 2048 births (Facts of Study, FoS) between 2009 and 2011, with a total of 433,308 observations of 223 variables. DQ was measured before and after the procedures using metrics related to eight quality dimensions: predictive value, correctness, duplication, consistency, completeness, contextualization, temporal-stability, and spatial-stability. Once the predictive variables were selected and DQ was assured, the final repository consisted of 1925 births, 107,529 observations and 73 quality-assured variables. The amount of discarded observations mainly corresponds to observations of non-predictive variables (52.90%) and the impact of the de-duplication process (20.58%) with respect to the total input data. Seven out of thirteen procedures achieved 100% of valid births, observations and variables. Moreover, 89% of births and ~98% of observations were consistent according to the experts׳ criteria. A multidisciplinary approach along with the quantification of DQ has allowed us to construct the first repository about infant feeding in the perinatal period based on EHR population data.

Construction of quality-assured infant feeding process of care data repositories: definition and design (Part 1).

This is the first paper of a series of two regarding the construction of data quality (DQ) assured repositories for the reuse of information on infant feeding from birth until two years old. This first paper justifies the need for such repositories and describes the design of a process to construct them from Electronic Health Records (EHR). As a result, Part 1 proposes a computational process to obtain quality-assured datasets represented by a canonical structure extracted from raw data from multiple EHR. For this, 13 steps were defined to ensure the harmonization, standardization, completion, de-duplication, and consistency of the dataset content. Moreover, the quality of the input and output data for each of these steps is controlled according to eight DQ dimensions: predictive value, correctness, duplication, consistency, completeness, contextualization, temporal-stability and spatial-stability. The second paper of the series will describe the application of this computational process to construct the first quality-assured repository for the reuse of information on infant feeding in the perinatal period aimed at the monitoring of clinical activities and research.

Becoming baby-friendly in Spain: a quality-improvement process.

AIM: To describe the implementation process and effect of a quality-improvement intervention aimed at achieving compliance with the Baby-friendly Hospital Initiative (BFHI). METHODS: We conducted a prospective study of the development and evaluation of a quality-improvement intervention at the Yecla Hospital, Spain. A random sample of 1273 infants born in the hospital was followed up in primary care centres between 1997 and 2005. The study interventions were process-oriented training, audit and feedback, quality-improvement cycles and provision of breastfeeding support resources. The main outcome measures were changes in compliance with the Global Criteria for the BFHI and breastfeeding rates before, during and after the intervention. RESULTS: Compliance with the Global Criteria increased progressively, and in 2004 all criteria were met. The median duration of breastfeeding went up gradually from the start of the intervention. The likelihood of being breastfed at different ages among infants born in 2005 was between 45% [odds ratio (OR) 0.55; 95% confidence interval (CI) 0.38-0.79] and 86% (OR 0.14; 95% CI 0.09-0.20) higher than among infants born in 1997. CONCLUSION: Quality-improvement interventions based on participation, training, audit and feedback of information, and provision of resources are useful for the implementation of the BFHI, which is associated with a significant increase in breastfeeding rates.

Réplica: ciencia frente a idioma: desempolvemos el diccionario de esperanto / Reply: science vs. language: let us dust off the Esperanto dictionary

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[Analysis of literature citations in original articles published in Spanish and international nursing journals and journals in 2 closely related disciplines]. / Análisis de referencias bibliográficas de originales publicados en revistas de enfermería nacionales e internacionales y de 2 disciplinas de la salud afines.

OBJECTIVE: To compare Spanish nursing journals with 2 English-language standard journals, as well as Spanish journals in closely related disciplines, to identify possible quantitative and qualitative shortcomings in scientific documentation. METHOD: We performed a descriptive, cross-sectional study of the references contained in 796 articles from 6 Spanish journals from 3 health disciplines (2000-2002) and 2 English-language nursing journals (2000-2001). The number of references, type of publication cited, and language of the document cited were compared in individual journals, and in journals grouped by discipline and according to language. RESULTS: Spanish-language nursing journals had the lowest mean number of references per article (X- = 16.20) when compared with psychology journals (X- = 31.24), medical journals (X- = 31.39) and international nursing journals (X- = 37.11). Among Spanish journals, citation of English-language publications was most frequent in medical journals (X- = 26.28) and least frequent in nursing journals (X- = 6.04). In contrast, citation of Spanish documents was most frequent in nursing journals (X- = 9.79) and least frequent in medical journals (X- = 4.43). CONCLUSIONS: Although scientific publication of Spanish nursing has improved, it is not comparable to publication of closely related disciplines and international nursing. The low citation of English documents clearly reveals the risk of scientific insularity.

Análisis de referencias bibliográficas de originales publicados en revistas de enfermería nacionales e internacionales y de 2 disciplinas de la salud afines / Analysis of literature citations in original articles published in Spanish and international nursing journals and journals in 2 closely related disciplines

Objetivo. Comparar las publicaciones nacionales de enfermería frente a 2 referentes estándar anglosajones y respecto al constituido por sus disciplinas afines del ámbito nacional, como modo de evidenciar potenciales deficiencias cuanticualitativas en los niveles de documentación científica. Método. Estudio descriptivo y transversal, que analiza las referencias de 796 originales de 6 revistas españolas pertenecientes a 3 disciplinas de la salud (2000-2002) y de 2 revistas de enfermería anglosajonas (2000-2001), y se establecen comparaciones entre todas ellas, de forma individual y agrupándolas por disciplina y ámbito de origen, en relación con el número total de referencias, tipo de documento y su idioma. Resultados. Las revistas nacionales de enfermería presentan la media de referencias por artículo más baja (X­ = 16,20), en comparación con psicología (X­ = 31,24), medicina (X­ = 31,39) y la media agrupada para la enfermería internacional (X­ = 37,11). Con respecto al idioma, de entre las disciplinas de ámbito nacional medicina es la que más bibliografía en inglés consume (X­ = 26,28), y enfermería se encuentra en el extremo opuesto (X­ = 6,04), mientras que es la que más cita en castellano (X­ = 9,79), frente a medicina que es la que menos lo usa (X­ = 4,43). Conclusiones. Aunque la producción científica de la enfermería nacional ha mejorado, todavía no es equiparable a la de las ciencias afines ni a la de la enfermería internacional. La baja citación de documentos en inglés pone de manifiesto el riesgo de que la disciplina caiga en el aislamiento científico

Objective. To compare Spanish nursing journals with 2 English-language standard journals, as well as Spanish journals in closely related disciplines, to identify possible quantitative and qualitative shortcomings in scientific documentation. Method. We performed a descriptive, cross-sectional study of the references contained in 796 articles from 6 Spanish journals from 3 health disciplines (2000-2002) and 2 English-language nursing journals (2000-2001). The number of references, type of publication cited, and language of the document cited were compared in individual journals, and in journals grouped by discipline and according to language. Results. Spanish-language nursing journals had the lowest mean number of references per article (X­ = 16.20) when compared with psychology journals (X­ = 31.24), medical journals (X­ = 31.39) and international nursing journals (X­ = 37.11). Among Spanish journals, citation of English-language publications was most frequent in medical journals (X­ = 26.28) and least frequent in nursing journals (X­ = 6.04). In contrast, citation of Spanish documents was most frequent in nursing journals (X­ = 9.79) and least frequent in medical journals (X­ = 4.43). Conclusions. Although scientific publication of Spanish nursing has improved, it is not comparable to publication of closely related disciplines and international nursing. The low citation of English documents clearly reveals the risk of scientific insularity