Håheim Lise Lund, Helgeland Jon
BMC Health Serv Res. 2014 Oct 29;14:493. doi: 10.1186/s12913-014-0493-5.
Norway introduced 32 priority guidelines for elective health treatment in the specialist health service in the period 2008-9. The guidelines were intended to reduce large differences in waiting times among hospitals, streamline referrals and ensure that patients accessed the necessary healthcare to which they were entitled for certain conditions. Referral information guided the priorities. As the referral information was key to future evaluation of the guidelines, this study validates the referral information in hospital patient records against discharge diagnoses, because only the discharge diagnosis is recorded in the Norwegian Patient Register (NPR) database, which is used in the main evaluation.
Of the specific conditions from 10 priority guidelines, 20 were selected for review for the period 2008-9 at 4 hospitals in Norway. The ICD-10 diagnoses per disease or condition were given in retrospect by clinicians who participated in the expert groups developing the priority guidelines. Reasons for deviations between referral information and discharge diagnoses were coded into four categories, according to the degree of precision of the former compared with the latter.
In all, 1854 medical records were available for review. The diagnostic precision of the referrals differed significantly between hospitals, and across the 2 years 2008 and 2009. The overall sensitivity was 0.93 (95% confidence interval 0.92-0.94). For the separate conditions, sensitivity was in the range 0.60-1.00. Experience showed that it was necessary to pay careful attention to the selection of ICD-10 diagnoses for identifying patients. The medical records of psychiatry patients were unavailable in some cases and for certain conditions some were unavailable after use of our record extraction algorithm.
The sensitivity of the referral information on diagnosis or condition was high compared with the discharge diagnosis for the 20 selected conditions from the 10 priority guidelines. Although the review assessed a limited number of the total, we consider the results sufficiently representative and, hence, they will allow use of the NPR data for analyses of the introduction and follow-up of the 32 priority guidelines.
挪威在2008 - 2009年期间为专科医疗服务引入了32项选择性健康治疗优先指南。这些指南旨在减少医院之间等待时间的巨大差异，简化转诊流程，并确保患者能够获得针对某些病症的必要医疗保健服务，而他们有权享受这些服务。转诊信息指导了优先次序。由于转诊信息对于指南的未来评估至关重要，本研究对照出院诊断验证了医院患者记录中的转诊信息，因为挪威患者登记册（NPR）数据库中仅记录了出院诊断，而该数据库用于主要评估。
从10项优先指南中的特定病症中，选取了20项在2008 - 2009年期间于挪威的4家医院进行审查。参与制定优先指南的专家小组的临床医生回顾性地给出了每种疾病或病症的ICD - 10诊断。根据转诊信息与出院诊断相比的精确程度，将转诊信息与出院诊断之间偏差的原因分为四类。
总共1854份病历可供审查。转诊的诊断精确度在不同医院之间以及2008年和2009年这两年间存在显著差异。总体敏感性为0.93（95%置信区间0.92 - 0.94）。对于各个病症，敏感性范围为0.60 - 1.00。经验表明，在识别患者时必须仔细注意ICD - 10诊断的选择。在某些情况下，精神病患者的病历不可用，并且对于某些病症，在使用我们的病历提取算法后，部分病历也不可用。
与10项优先指南中选取的20种选定病症的出院诊断相比，转诊信息在诊断或病症方面的敏感性较高。尽管此次审查评估的总数有限，但我们认为结果具有足够的代表性，因此，它们将允许使用NPR数据对32项优先指南的引入和后续情况进行分析。
