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      Assessment of an incentivised scheme to provide annual health checks in primary care for adults with intellectual disability: a longitudinal cohort study

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          Abstract

          People with intellectual disabilities (ID) have many comorbidities but experience inequities in access to health care. National Health Service England uses an opt-in incentive scheme to encourage annual health checks of patients with ID in primary care. We investigated whether the first 3 years of the programme had improved health care of people with ID.

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          Generalisability of The Health Improvement Network (THIN) database: demographics, chronic disease prevalence and mortality rates

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            The importance of defining periods of complete mortality reporting for research using automated data from primary care.

            To define periods of acceptable mortality reporting in primary care and to demonstrate through examples the implication for research using automated medical data. Annual death counts were obtained for each primary care practice participating in The Health Improvement Network "THIN" (UK). Expected counts were calculated from national death rates, accounting for the practice's age/sex structure. The standardized mortality ratio (SMR) was calculated with 95% confidence intervals (CI). A visual review process was undertaken to assign the year from which the practice had acceptable mortality reporting (AMR). The process involved reviewer pairs who were blinded to each other's decisions. Patterns of death reporting were checked. The AMR year was applied as a filter to THIN data to assess its impact on the SMR. For most practices the SMR was relatively stable and the AMR year was easily identified with 86% agreement between the blinded reviewer pairs. Applying the AMR to THIN removed under-reporting of death. However, the total computerized follow-up reduced from 37 to 32 million patient-years. Problematic death recording patterns included some practices keeping only live patient records when converting their software systems thereby creating 'immortal periods' prior to this moment, and peaks occurring when practices updated the vital status of their patients' records. This is the first time that an external standard has been used to assess completeness of mortality in automated primary care data. The resulting AMR year provides a natural filter for research and avoids biases associated with 'immortal periods', record updating and under-reporting.
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              The Read clinical classification.

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                Author and article information

                Journal
                The Lancet Psychiatry
                The Lancet Psychiatry
                Elsevier BV
                22150366
                December 2014
                December 2014
                : 1
                : 7
                : 522-530
                Article
                10.1016/S2215-0366(14)00079-0
                26361311
                ef2737da-3801-47ce-9f7d-d4f6e7cfb75a
                © 2014

                https://www.elsevier.com/tdm/userlicense/1.0/

                http://creativecommons.org/licenses/by/4.0/

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