Goodyear-Smith Felicity, Grant Cameron, York Deon, Kenealy Tim, Copp Jackie, Petousis-Harris Helen, Turner Nikki, Kerse Ngaire
Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand.
Int J Med Inform. 2008 Jul;77(7):477-85. doi: 10.1016/j.ijmedinf.2007.08.008. Epub 2007 Sep 29.
To explore the quality of data recording by practices and identify issues to be considered and addressed before such data can be used as a continuous measure of immunisation delivery.
One hundred and twenty-four randomly selected general practices visited to measure immunisation coverage using the various practice management systems (PMS) in use. To capture all target children it was necessary to build two queries: one generated a list of all children aged between 6 weeks and 2 years who had been to the practice, regardless of enrollment status; the other asked dates and nature of all immunisations given. Each different PMS required a unique query to extract the necessary information.
Variability encountered included different types and versions of PMS and operating systems; variable degree of staff technical competence with their PMS; proportion of enrolled children ranging from nearly 0 to 100%; lack of consistency of the nature and location of data entry and coding; and unreliability of dates relating to some vaccination events.
To improve recording of immunisation coverage we recommend a standard early age of registration and enrollment; standard definitions of the denominator and of immunisation delay; greater uniformity of PMS; improved staff training; intrinsic data quality checks; integration of PMS with changes in the immunisation schedule; incentives and interval electronic checks to improve data quality.
探讨各医疗机构数据记录的质量,并确定在将此类数据用作免疫接种服务持续衡量指标之前需要考虑和解决的问题。
随机选取124家普通医疗机构,利用其使用的各种实践管理系统(PMS)来测量免疫接种覆盖率。为了涵盖所有目标儿童,有必要构建两个查询:一个查询生成所有6周龄至2岁之间曾到该医疗机构就诊的儿童名单,无论其登记状态如何;另一个查询询问所有已接种疫苗的日期和类型。每个不同的PMS都需要一个独特的查询来提取必要信息。
发现的差异包括PMS和操作系统的不同类型和版本;工作人员对其PMS的技术能力程度各异;登记儿童的比例从近0到100%不等;数据录入和编码的性质及位置缺乏一致性;以及与某些疫苗接种事件相关日期的不可靠性。
为了改善免疫接种覆盖率的记录,我们建议采用标准的早期登记和注册年龄;分母及免疫接种延迟的标准定义;PMS的更大一致性;改进工作人员培训;内在数据质量检查;PMS与免疫接种计划变更的整合;激励措施和定期电子检查以提高数据质量。