Indexing and active fund management: International evidence

Author's pre-print

How many diagnosis fields are needed to capture safety events in administrative data? Findings and recommendations from the WHO ICD-11 Topic Advisory Group on Quality and Safety

OBJECTIVE: As part of the WHO ICD-11 development initiative, the Topic Advisory Group on Quality and Safety explores meta-features of morbidity data sets, such as the optimal number of secondary diagnosis fields. DESIGN: The Health Care Quality Indicators Project of the Organization for Economic Co-Operation and Development collected Patient Safety Indicator (PSI) information from administrative hospital data of 19-20 countries in 2009 and 2011. We investigated whether three countries that expanded their data systems to include more secondary diagnosis fields showed increased PSI rates compared with six countries that did not. Furthermore, administrative hospital data from six of these countries and two American states, California (2011) and Florida (2010), were analysed for distributions of coded patient safety events across diagnosis fields. RESULTS: Among the participating countries, increasing the number of diagnosis fields was not associated with any overall increase in PSI rates. However, high proportions of PSI-related diagnoses appeared beyond the sixth secondary diagnosis field. The distribution of three PSI-related ICD codes was similar in California and Florida: 89-90% of central venous catheter infections and 97-99% of retained foreign bodies and accidental punctures or lacerations were captured within 15 secondary diagnosis fields. CONCLUSIONS: Six to nine secondary diagnosis fields are inadequate for comparing complication rates using hospital administrative data; at least 15 (and perhaps more with ICD-11) are recommended to fully characterize clinical outcomes. Increasing the number of fields should improve the international and intra-national comparability of data for epidemiologic and health services research, utilization analyses and quality of care assessment.

Physical activity level and health-related quality of life in the general adult population: a systematic review.

OBJECTIVE: Little is known regarding health-related quality of life and its relation with physical activity level in the general population. Our primary objective was to systematically review data examining this relationship. METHODS: We systematically searched MEDLINE, EMBASE, CINAHL, and PsycINFO for health-related quality of life and physical activity related keywords in titles, abstracts, or indexing fields. RESULTS: From 1426 retrieved references, 55 citations were judged to require further evaluation. Fourteen studies were retained for data extraction and analysis; seven were cross-sectional studies, two were cohort studies, four were randomized controlled trials and one used a combined cross sectional and longitudinal design. Thirteen different methods of physical activity assessment were used. Most health-related quality of life instruments related to the Medical Outcome Study SF-36 questionnaire. Cross-sectional studies showed a consistently positive association between self-reported physical activity and health-related quality of life. The largest cross-sectional study reported an adjusted odds ratio of "having 14 or more unhealthy days" during the previous month to be 0.40 (95% Confidence Interval 0.36-0.45) for those meeting recommended levels of physical activity compared to inactive subjects. Cohort studies and randomized controlled trials tended to show a positive effect of physical activity on health-related quality of life, but similar to the cross-sectional studies, had methodological limitations. CONCLUSION: Cross-sectional data showed a consistently positive association between physical activity level and health-related quality of life. Limited evidence from randomized controlled trials and cohort studies precludes a definitive statement about the nature of this association.

ICD-11 for quality and safety: overview of the who quality and safety topic advisory group.

This paper outlines the approach that the WHO's Family of International Classifications (WHO-FIC) network is undertaking to create ICD-11. We also outline the more focused work of the Quality and Safety Topic Advisory Group, whose activities include the following: (i) cataloguing existing ICD-9 and ICD-10 quality and safety indicators; (ii) reviewing ICD morbidity coding rules for main condition, diagnosis timing, numbers of diagnosis fields and diagnosis clustering; (iii) substantial restructuring of the health-care related injury concepts coded in the ICD-10 chapters 19/20, (iv) mapping of ICD-11 quality and safety concepts to the information model of the WHO's International Classification for Patient Safety and the AHRQ Common Formats; (v) the review of vertical chapter content in all chapters of the ICD-11 beta version and (vi) downstream field testing of ICD-11 prior to its official 2015 release. The transition from ICD-10 to ICD-11 promises to produce an enhanced classification that will have better potential to capture important concepts relevant to measuring health system safety and quality-an important use case for the classification.

Capturing diagnosis-timing in ICD-coded hospital data: recommendations from the WHO ICD-11 topic advisory group on quality and safety.

PURPOSE: To develop a consensus opinion regarding capturing diagnosis-timing in coded hospital data. METHODS: As part of the World Health Organization International Classification of Diseases-11th Revision initiative, the Quality and Safety Topic Advisory Group is charged with enhancing the capture of quality and patient safety information in morbidity data sets. One such feature is a diagnosis-timing flag. The Group has undertaken a narrative literature review, scanned national experiences focusing on countries currently using timing flags, and held a series of meetings to derive formal recommendations regarding diagnosis-timing reporting. RESULTS: The completeness of diagnosis-timing reporting continues to improve with experience and use; studies indicate that it enhances risk-adjustment and may have a substantial impact on hospital performance estimates, especially for conditions/procedures that involve acutely ill patients. However, studies suggest that its reliability varies, is better for surgical than medical patients (kappa in hip fracture patients of 0.7-1.0 versus kappa in pneumonia of 0.2-0.6) and is dependent on coder training and setting. It may allow simpler and more precise specification of quality indicators. CONCLUSIONS: As the evidence indicates that a diagnosis-timing flag improves the ability of routinely collected, coded hospital data to support outcomes research and the development of quality and safety indicators, the Group recommends that a classification of 'arising after admission' (yes/no), with permitted designations of 'unknown or clinically undetermined', will facilitate coding while providing flexibility when there is uncertainty. Clear coding standards and guidelines with ongoing coder education will be necessary to ensure reliability of the diagnosis-timing flag.

Equivalence and translation strategies in multilingual thesaurus construction

In the present dissertation, multilingual thesauri were approached as cultural products and the focus was twofold: On the empirical level the focus was placed on the translatability of certain British-English social science indexing terms into the Finnish language and culture at a concept, a term and an indexing term level. On the theoretical level the focus was placed on the aim of translation and on the concept of equivalence. In accordance with modern communicative and dynamic translation theories the interest was on the human dimension. The study is qualitative. In this study, equivalence was understood in a similar way to how dynamic, functional equivalence is commonly understood in translation studies. Translating was seen as a decision-making process, where a translator often has different kinds of possibilities to choose in order to fulfil the function of the translation. Accordingly, and as a starting point for the construction of the empirical part, the function of the source text was considered to be the same or similar to the function of the target text, that is, a functional thesaurus both in source and target context. Further, the study approached the challenges of multilingual thesaurus construction from the perspectives of semantics and pragmatics. In semantic analysis the focus was on what the words conventionally mean and in pragmatics on the ‘invisible’ meaning - or how we recognise what is meant even when it is not actually said (or written). Languages and ideas expressed by languages are created mainly in accordance with expressional needs of the surrounding culture and thesauri were considered to reflect several subcultures and consequently the discourses which represent them. The research material consisted of different kinds of potential discourses: dictionaries, database records, and thesauri, Finnish versus British social science researches, Finnish versus British indexers, simulated indexing tasks with five articles and Finnish versus British thesaurus constructors. In practice, the professional background of the two last mentioned groups was rather similar. It became even more clear that all the material types had their own characteristics, although naturally not entirely separate from each other. It is further noteworthy that the different types and origins of research material were not used to represent true comparison pairs, and that the aim of triangulation of methods and material was to gain a holistic view. The general research questions were: 1. Can differences be found between Finnish and British discourses regarding family roles as thesaurus terms, and if so, what kinds of differences and which are the implications for multilingual thesaurus construction? 2. What is the pragmatic indexing term equivalence? The first question studied how the same topic (family roles) was represented in different contexts and by different users, and further focused on how the possible differences were handled in multilingual thesaurus construction. The second question was based on findings of the previous one, and answered to the final question as to what kinds of factors should be considered when defining translation equivalence in multilingual thesaurus construction. The study used multiple cases and several data collection and analysis methods aiming at theoretical replication and complementarity. The empirical material and analysis consisted of focused interviews (with Finnish and British social scientists, thesaurus constructors and indexers), simulated indexing tasks with Finnish and British indexers, semantic component analysis of dictionary definitions and translations, coword analysis and datasets retrieved in databases, and discourse analysis of thesauri. As a terminological starting point a topic and case family roles was selected. The results were clear: 1) It was possible to identify different discourses. There also existed subdiscourses. For example within the group of social scientists the orientation to qualitative versus quantitative research had an impact on the way they reacted to the studied words and discourses, and indexers placed more emphasis on the information seekers whereas thesaurus constructors approached the construction problems from a more material based solution. The differences between the different specialist groups i.e. the social scientists, the indexers and the thesaurus constructors were often greater than between the different geo-cultural groups i.e. Finnish versus British. The differences occurred as a result of different translation aims, diverging expectations for multilingual thesauri and variety of practices. For multilingual thesaurus construction this means severe challenges. The clearly ambiguous concept of multilingual thesaurus as well as different construction and translation strategies should be considered more precisely in order to shed light on focus and equivalence types, which are clearly not self-evident. The research also revealed the close connection between the aims of multilingual thesauri and the pragmatic indexing term equivalence. 2) The pragmatic indexing term equivalence is very much context-depended. Although thesaurus term equivalence is defined and standardised in the field of library and information science (LIS), it is not understood in one established way and the current LIS tools are inadequate to provide enough analytical tools for both constructing and studying different kinds of multilingual thesauri as well as their indexing term equivalence. The tools provided in translation science were more practical and theoretical, and especially the division of different meanings of a word provided a useful tool in analysing the pragmatic equivalence, which often differs from the ideal model represented in thesaurus construction literature. The study thus showed that the variety of different discourses should be acknowledged, there is a need for operationalisation of new types of multilingual thesauri, and the factors influencing pragmatic indexing term equivalence should be discussed more precisely than is traditionally done.

A DHT-Based Grid Resource Indexing and Discovery Scheme

This paper presents a DHT-based grid resource indexing and discovery (DGRID) approach. With DGRID, resource-information data is stored on its own administrative domain and each domain, represented by an index server, is virtualized to several nodes (virtual servers) subjected to the number of resource types it has. Then, all nodes are arranged as a structured overlay network or distributed hash table (DHT). Comparing to existing grid resource indexing and discovery schemes, the benefits of DGRID include improving the security of domains, increasing the availability of data, and eliminating stale data.

Professional, Legal and ethical issues - indicative topic list

indicative list of topic areas for professional, legal and ethical issues modules clustered into broad themes. Document is to be consulted in conjunction with other slides and notes for the module.

Lifestyle and health promoting habits as topic for school education

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The DREAM Framework: using a network of scalable ontologies for intelligent indexing and retrieval of visual content

There are still major challenges in the area of automatic indexing and retrieval of digital data. The main problem arises from the ever increasing mass of digital media and the lack of efficient methods for indexing and retrieval of such data based on the semantic content rather than keywords. To enable intelligent web interactions or even web filtering, we need to be capable of interpreting the information base in an intelligent manner. Research has been ongoing for a few years in the field of ontological engineering with the aim of using ontologies to add knowledge to information. In this paper we describe the architecture of a system designed to automatically and intelligently index huge repositories of special effects video clips, based on their semantic content, using a network of scalable ontologies to enable intelligent retrieval.