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      Factors Associated With First Medication Time for Children Treated in the Emergency Department for Asthma

      , , ,
      Pediatric Emergency Care
      Ovid Technologies (Wolters Kluwer Health)

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          A Harmonized Data Quality Assessment Terminology and Framework for the Secondary Use of Electronic Health Record Data

          Objective: Harmonized data quality (DQ) assessment terms, methods, and reporting practices can establish a common understanding of the strengths and limitations of electronic health record (EHR) data for operational analytics, quality improvement, and research. Existing published DQ terms were harmonized to a comprehensive unified terminology with definitions and examples and organized into a conceptual framework to support a common approach to defining whether EHR data is ‘fit’ for specific uses. Materials and Methods: DQ publications, informatics and analytics experts, managers of established DQ programs, and operational manuals from several mature EHR-based research networks were reviewed to identify potential DQ terms and categories. Two face-to-face stakeholder meetings were used to vet an initial set of DQ terms and definitions that were grouped into an overall conceptual framework. Feedback received from data producers and users was used to construct a draft set of harmonized DQ terms and categories. Multiple rounds of iterative refinement resulted in a set of terms and organizing framework consisting of DQ categories, subcategories, terms, definitions, and examples. The harmonized terminology and logical framework’s inclusiveness was evaluated against ten published DQ terminologies. Results: Existing DQ terms were harmonized and organized into a framework by defining three DQ categories: (1) Conformance (2) Completeness and (3) Plausibility and two DQ assessment contexts: (1) Verification and (2) Validation. Conformance and Plausibility categories were further divided into subcategories. Each category and subcategory was defined with respect to whether the data may be verified with organizational data, or validated against an accepted gold standard, depending on proposed context and uses. The coverage of the harmonized DQ terminology was validated by successfully aligning to multiple published DQ terminologies. Discussion: Existing DQ concepts, community input, and expert review informed the development of a distinct set of terms, organized into categories and subcategories. The resulting DQ terms successfully encompassed a wide range of disparate DQ terminologies. Operational definitions were developed to provide guidance for implementing DQ assessment procedures. The resulting structure is an inclusive DQ framework for standardizing DQ assessment and reporting. While our analysis focused on the DQ issues often found in EHR data, the new terminology may be applicable to a wide range of electronic health data such as administrative, research, and patient-reported data. Conclusion: A consistent, common DQ terminology, organized into a logical framework, is an initial step in enabling data owners and users, patients, and policy makers to evaluate and communicate data quality findings in a well-defined manner with a shared vocabulary. Future work will leverage the framework and terminology to develop reusable data quality assessment and reporting methods.
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            Status of childhood asthma in the United States, 1980-2007.

            Centers for Disease Control and Prevention data were used to describe 1980-2007 trends among children 0 to 17 years of age and recent patterns according to gender, race, and age. Asthma period prevalence increased by 4.6% per year from 1980 to 1996. New measures introduced in 1997 show a plateau at historically high levels; 9.1% of US children (6.7 million) currently had asthma in 2007. Ambulatory care visit rates fluctuated during the 1990 s, whereas emergency department visits and hospitalization rates decreased slightly. Asthma-related death rates increased through the middle 1990 s but decreased after 1999. Recent data showed higher prevalence among older children (11-17 years), but the highest rates of asthma-related health care use were among the youngest children (0-4 years). After controlling for racial differences in prevalence, disparities in adverse outcomes remained; among children with asthma, non-Hispanic black children had greater risks for emergency department visits and death, compared with non-Hispanic white children. For hospitalizations, for which Hispanic ethnicity data were not available, black children had greater risk than white children. However, nonemergency ambulatory care use was lower for non-Hispanic black children. Although the large increases in childhood asthma prevalence have abated, the burden remains large. Potentially avoidable adverse outcomes and racial disparities continue to present challenges. These findings suggest the need for sustained asthma prevention and control efforts for children.
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              Asthma prevalence, health care use, and mortality: United States, 2005-2009.

              This report presents recent data on asthma prevalence and health care use. Additional data on school and work absences and asthma management practices are also presented. Where possible, differences are examined by age, sex, race or ethnicity, geographic region, poverty status, and urbanicity. Data from the National Health Interview Survey, the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, the National Hospital Discharge Survey, and the National Vital Statistics System were used to calculate national estimates. The most recent data available from each system are presented, and 3-year annual averages are used to increase the reliability of estimates for subgroups where necessary. In 2009, current asthma prevalence was 8.2% of the U.S. population (24.6 million people); within population subgroups it was higher among females, children, persons of non-Hispanic black and Puerto Rican race or ethnicity, persons with family income below the poverty level, and those residing in the Northeast and Midwest regions. In 2008, persons with asthma missed 10.5 million school days and 14.2 million work days due to their asthma. In 2007, there were 1.75 million asthma-related emergency department visits and 456,000 asthma hospitalizations. Asthma emergency visit and hospitalization rates were higher among females than males, among children than adults, and among black than white persons. Despite the high burden from adverse impacts, use of some asthma management strategies based on clinical guidelines for the treatment of asthma remained below the targets set by the Healthy People 2010 initiative.
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                Author and article information

                Journal
                Pediatric Emergency Care
                Ovid Technologies (Wolters Kluwer Health)
                0749-5161
                2018
                October 2 2018
                : Publish Ahead of Print
                Article
                10.1097/PEC.0000000000001609
                30281550
                2bb57e97-4da5-48e4-8f67-6e4703124482
                © 2018
                History

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