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Medical Record Review: Methodological Considerations
AEP Vol. 17, No. 9 September 2007 : 723–751
ABSTRACTS (ACE)
CONCLUSION: These results demonstrate a complex interaction between several demographic, sociodemographic and housing characteristics in predicting BLLs of U.S. children. doi: 10.1016/j.annepidem.2007.07.038
P35 AREA-BASED SOCIAL CHARACTERISTICS OF WORKPLACE HOMICIDE RISK ML Ta, SW Marshall, DP Loomis, Department of Epidemiology, University of North Carolina, Chapel Hill, NC and Department of Environmental and Occupational Health, University of Nevada, Reno, NV PURPOSE: Community-level factors associated with workplace homicide have not been explored in detail. The aim of our study is to describe socioeconomic (SES) and crime characteristics associated with areas at high-risk for worker homicide. METHODS: Using GIS methods, North Carolina workplaces were spatially linked to SES data from the census and crime data from law enforcement agencies. Census block groups (nZ4076) comprised the unit of analysis and were categorized as being at high (> 75th percentile) or low risk for workplace homicide according to the proportion of workplaces in each block group classified as highrisk for worker homicide (based on pervious research). Separate models were constructed to examine social factors (social organization disruptions and SES advantage) and agency-level crime (index, property and violent) rates, respectively. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: From multivariate models where crime was the primary exposure, violent crime rates O 75th percentile was associated with block groups at high-risk for workplace homicide (ORZ1.48; 95%CIZ1.05–2.09). In models examining social organization disruption measures: residential mobility (ORZ 1.86, 95%CIZ1.27–2.72), population density (ORZ1.28, 95%CIZ1.04–1.58), and low percentages (< 25th percentile) of Black, non-Hispanic (ORZ1.36, 95%CIZ1.13–1.64) and foreign born (ORZ1.40, 95%CIZ1.18–1.68) residents were positively associated with high-risk block groups. Level of SES advantage was inversely associated with block groups containing a high proportion of high-risk workplaces (ORZ0.57, 95%CIZ0.42–0.78). CONCLUSION: Areas with a high violent crime rate, social organization disruption and low SES advantage contain a higher proportion of high-risk workplaces. Elucidating social influences on violence complements current understanding of workplace homicide. doi: 10.1016/j.annepidem.2007.07.039
P36 MEDICAL RECORD REVIEW: METHODOLOGICAL CONSIDERATIONS LL Engel, CA Henderson, A Colantonio, Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada PURPOSE: Medical chart or record review (MRR) is commonly used in epidemiological studies. However, there is a dearth of
735
literature summarizing the most methodologically rigorous way to conduct this type of retrospective research. The purpose of this paper is to present a) guidelines concerning the development and implementation of a MRR based on a thorough literature review and b) methodological issues related to MRR within the context of a work-related traumatic brain injury (wrTBI) surveillance and prevention study involving MRR. METHODS: A comprehensive literature review regarding MRR methodological considerations was conducted. Key words including medical, chart, record, retrospective, review, method(s) and methodology were used within various databases such as Ovid, CINAHL, scholars-portal, PubMed, and Medline. The principles obtained from the literature were applied to a MRR reliability study concerning workers who sustained work related injuries, primarily wrTBI, and who were assessed at a multi-disciplinary neurology service in Ontario, Canada within the years 1998 & 1999. This MRR was designed to abstract variables related to pre-injury and incident related person, occupation and environment factors, and postinjury sequelae related to wrTBI to inform injury prevention strategies. RESULTS: The authors developed and utilized a model of MRR methodology, the MRR-Conduction Model, which outlines the relationships between different entities involved in a MRR. These entities include the investigator, the data abstractor(s), the data source, the abstraction tool, and the abstraction manual. Within each entity, guidelines were found that aided in creating a more feasible, effective and reliable MRR. These guidelines and their application to improved MRR reliability will be presented. CONCLUSION: MRR is often perceived as an easy and potentially expedient data collection method however, creating an effective MRR takes planning and time. The MRR-Conduction Model facilitates understanding of the entities and relationships involved in using MRR methodologies. doi: 10.1016/j.annepidem.2007.07.040
HEALTH SERVICES P37 THE COST OF INTRACEREBRAL HAEMORRHAGE: A CANADIAN EXAMPLE AV Specogna, MD Hill, SB Patten, Department of Community Health Sciences, University of Calgary, Alberta, Canada PURPOSE: Primary Intracerebral Haemorrhage (ICH) is one of the most devastating forms of stroke with substantial morbidity and mortality. Although the human cost of ICH has been reported frequently, the economic cost of ICH is still unclear. This study reports on the economic cost of ICH over two consecutive years at three centers in Calgary, Alberta Canada. METHODS: Cost data was derived from hospital and physician claims for patients who were treated for primary ICH at three hospitals in Calgary Alberta for the 1999–2000 and 2000–2001 fiscal years. ICH was defined as one event and cost was calculated from the time the patients were admitted to the time they were discharged from hospital or died. All cost data is reported in Canadian dollars and is calculated for the year the event occurred. Mean comparison tests were used to assess the difference in days spent in hospital, inpatient cost and non-physician health care cost between those that survived and those that died.
ABSTRACTS (ACE)
CONCLUSION: These results demonstrate a complex interaction between several demographic, sociodemographic and housing characteristics in predicting BLLs of U.S. children. doi: 10.1016/j.annepidem.2007.07.038
P35 AREA-BASED SOCIAL CHARACTERISTICS OF WORKPLACE HOMICIDE RISK ML Ta, SW Marshall, DP Loomis, Department of Epidemiology, University of North Carolina, Chapel Hill, NC and Department of Environmental and Occupational Health, University of Nevada, Reno, NV PURPOSE: Community-level factors associated with workplace homicide have not been explored in detail. The aim of our study is to describe socioeconomic (SES) and crime characteristics associated with areas at high-risk for worker homicide. METHODS: Using GIS methods, North Carolina workplaces were spatially linked to SES data from the census and crime data from law enforcement agencies. Census block groups (nZ4076) comprised the unit of analysis and were categorized as being at high (> 75th percentile) or low risk for workplace homicide according to the proportion of workplaces in each block group classified as highrisk for worker homicide (based on pervious research). Separate models were constructed to examine social factors (social organization disruptions and SES advantage) and agency-level crime (index, property and violent) rates, respectively. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: From multivariate models where crime was the primary exposure, violent crime rates O 75th percentile was associated with block groups at high-risk for workplace homicide (ORZ1.48; 95%CIZ1.05–2.09). In models examining social organization disruption measures: residential mobility (ORZ 1.86, 95%CIZ1.27–2.72), population density (ORZ1.28, 95%CIZ1.04–1.58), and low percentages (< 25th percentile) of Black, non-Hispanic (ORZ1.36, 95%CIZ1.13–1.64) and foreign born (ORZ1.40, 95%CIZ1.18–1.68) residents were positively associated with high-risk block groups. Level of SES advantage was inversely associated with block groups containing a high proportion of high-risk workplaces (ORZ0.57, 95%CIZ0.42–0.78). CONCLUSION: Areas with a high violent crime rate, social organization disruption and low SES advantage contain a higher proportion of high-risk workplaces. Elucidating social influences on violence complements current understanding of workplace homicide. doi: 10.1016/j.annepidem.2007.07.039
P36 MEDICAL RECORD REVIEW: METHODOLOGICAL CONSIDERATIONS LL Engel, CA Henderson, A Colantonio, Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada PURPOSE: Medical chart or record review (MRR) is commonly used in epidemiological studies. However, there is a dearth of
735
literature summarizing the most methodologically rigorous way to conduct this type of retrospective research. The purpose of this paper is to present a) guidelines concerning the development and implementation of a MRR based on a thorough literature review and b) methodological issues related to MRR within the context of a work-related traumatic brain injury (wrTBI) surveillance and prevention study involving MRR. METHODS: A comprehensive literature review regarding MRR methodological considerations was conducted. Key words including medical, chart, record, retrospective, review, method(s) and methodology were used within various databases such as Ovid, CINAHL, scholars-portal, PubMed, and Medline. The principles obtained from the literature were applied to a MRR reliability study concerning workers who sustained work related injuries, primarily wrTBI, and who were assessed at a multi-disciplinary neurology service in Ontario, Canada within the years 1998 & 1999. This MRR was designed to abstract variables related to pre-injury and incident related person, occupation and environment factors, and postinjury sequelae related to wrTBI to inform injury prevention strategies. RESULTS: The authors developed and utilized a model of MRR methodology, the MRR-Conduction Model, which outlines the relationships between different entities involved in a MRR. These entities include the investigator, the data abstractor(s), the data source, the abstraction tool, and the abstraction manual. Within each entity, guidelines were found that aided in creating a more feasible, effective and reliable MRR. These guidelines and their application to improved MRR reliability will be presented. CONCLUSION: MRR is often perceived as an easy and potentially expedient data collection method however, creating an effective MRR takes planning and time. The MRR-Conduction Model facilitates understanding of the entities and relationships involved in using MRR methodologies. doi: 10.1016/j.annepidem.2007.07.040
HEALTH SERVICES P37 THE COST OF INTRACEREBRAL HAEMORRHAGE: A CANADIAN EXAMPLE AV Specogna, MD Hill, SB Patten, Department of Community Health Sciences, University of Calgary, Alberta, Canada PURPOSE: Primary Intracerebral Haemorrhage (ICH) is one of the most devastating forms of stroke with substantial morbidity and mortality. Although the human cost of ICH has been reported frequently, the economic cost of ICH is still unclear. This study reports on the economic cost of ICH over two consecutive years at three centers in Calgary, Alberta Canada. METHODS: Cost data was derived from hospital and physician claims for patients who were treated for primary ICH at three hospitals in Calgary Alberta for the 1999–2000 and 2000–2001 fiscal years. ICH was defined as one event and cost was calculated from the time the patients were admitted to the time they were discharged from hospital or died. All cost data is reported in Canadian dollars and is calculated for the year the event occurred. Mean comparison tests were used to assess the difference in days spent in hospital, inpatient cost and non-physician health care cost between those that survived and those that died.