Use of hospital admissions data to quantify the burden of emergency admissions in people with diabetes mellitus.

AIMS: Accurate measurement of emergency diabetes admissions is essential for healthcare delivery and research. This study examines whether current approaches to identifying diabetes-related admissions may underestimate the true burden on hospital care. METHODS: Data spanning the period 1 January 2006 to 31 December 2010 inclusive were extracted from Hospital Episode Statistics data for England. Emergency admissions citing diabetes (E10, E11, E13 or E14) in any diagnosis position in adults (≥ 17 years) were included. E10 and E11 were considered analogous to type 1 and type 2 diabetes mellitus respectively; E13 and E14 were grouped as 'other or unspecified' diabetes mellitus. For admissions citing diabetes multiple times, those with concordant citations were classified as appropriate; discordant citations were assigned to the 'other or unspecified' group. Frequencies of diabetes classifications and complications for each diagnosis position and frequencies of all International Classification of Diseases 10th revision codes for the primary diagnosis field were calculated. RESULTS: In total, 2 443 046 admissions were identified. Diabetes was cited as the primary diagnosis in 6.2% and most commonly cited as the third diagnosis (23.1%). Type 2 diabetes mellitus was the most common (85.0%). The majority of diabetes citations were 'without complication' (2 188 965, 89.6%). The most common primary diagnosis was 'chest pain, unspecified' (R07.4, 99 678, 4.1%). CONCLUSIONS: Reliance on the primary diagnosis field to identify emergency admissions in people with diabetes grossly underestimates the true burden placed on hospital care and leads to underestimates of effect sizes in studies utilizing admission rates as outcome measures. An alternative strategy to identify such admissions is required.

Impact of a promotion program for hepatitis B immunisation.

This study compared levels of hepatitis B immunisation in a group of 524 infants in Northland, New Zealand, with levels in the remainder of the country. The Northland sample had specific encouragement from an immunisation coordinator and had been followed from birth. Levels throughout the rest of the country were estimated from four samples totalling 317 infants whose parents were interviewed when the child was at least two years old. The cross-sectional nationwide sample had fewer children 'fully immunised' by two years of age (minimum estimate 61.8 per cent, maximum estimate 69.7 per cent) than the cohort of children (not lost to follow-up) who were encouraged to have the immunisations in Northland (77.5 per cent) (Z = 4.73, P < 0.001 for comparison with the minimum nationwide estimate; Z = 2.45, P = 0.014 for comparison with the maximum estimate). Of the Northland cohort, 13.5 per cent were lost to follow-up before the scheduled completion of the hepatitis B vaccinations. Assuming that every child lost to follow-up was not fully immunised, the efforts of the immunisation promotion program operated by a nurse coordinator increased the percentage of children fully immunised by between about 7.8 per cent and 15.7 per cent. A promotion program for hepatitis B immunisation, operated by an immunisation coordinator, is an effective tool for increasing immunisation coverage.

Early results from the Northland immunisation register.

A controlled trial to determine the effects of introducing a centralised, computerised immunisation register commenced in Northland in May 1985. All infants born since 1 January 1985 have been registered on the Health Department's mainframe computer and assigned to either control or test groups. This birth information has been used to study two interventions aimed at increasing immunisation levels in the experimental group. The first involves sending to general practitioners lists of infants due for immunisation, and the second sending immunisation reminder cards to parents. Results show significant differences in immunisation levels between test group infants and comparable controls: an 18.2% increase for the six week immunisation, a 16.7% increase for the three month immunisation, and a 4.7% increase for the five month immunisation. A user survey has shown a high degree of acceptance by GPs and practice nurses. The pilot scheme will continue through 1986, and will be used over this period to improve acceptability to users and assist in planning a possible national computerised immunisation information system.

How many children are fully immunised?

An attempt was made to find the number of confirmed immunisations received by a group of Whangarei four-year-olds. The claims made for the immunisation benefit by each child's general practitioner were compared with questionnaire responses given by the parents of the children. Of 135 parents, 91.1% claimed that their child had received all four early childhood immunisations. Corresponding claims for the immunisation benefit by the child's general practitioner for all four immunisations were found in only 34.9% of cases. There was 79.7% agreement between parental reports and general practitioners' claims for the three-month immunisation. Corresponding figures were 72.3%, 67.2% and 66.4% for the five-, twelve- and eighteen-month immunisations respectively. These findings suggest that many children miss one or two immunisations rather than a few missing most. Present methods of monitoring may therefore tend to over-estimate the level of full immunisation. Computerisation of immunisation data is proposed as an alternative.

A new syndrome of short stature, joint limitation and muscle hypertrophy.

A further case is presented of a new growth deficiency syndrome first reported by Myre et al. in 1981. The major clinical features are mental retardation, growth deficiency, muscular hypertrophy, joint limitation and abnormal skeletal radiography.