Carroll Therese, Muecke Sandy, Simpson Judy, Irvine Katie, Jenkins André
Prehosp Emerg Care. 2015;19(4):504-15. doi: 10.3109/10903127.2015.1025154. Epub 2015 May 13.
This study has two aims: 1) to describe linkage rates between ambulance data and external datasets for "episodes of care" and "patient only" linkages in New South Wales (NSW), Australia; and 2) to detect and report any systematic issues with linkage that relate to patients, and operational or clinical variables that may introduce bias in subsequent studies if not adequately addressed. During 2010-11, the Centre for Health Record Linkage (CHeReL) in NSW, linked the records for patients attended by NSW Ambulance paramedics for the period July 2006 to June 2009, with four external datasets: Emergency Department Data Collection; Admitted Patient Data Collection; NSW Registry of Births, Deaths and Marriages death registration data; and the Australian Bureau of Statistics mortality data. This study reports linkage rates in terms of those "expected" to link and those who were "not expected" to link with external databases within 24 hours of paramedic attendance. Following thorough data preparation processes, 2,041,728 NSW Ambulance care episodes for 1,116,509 patients fulfilled the inclusion criteria. The overall episode-specific hospital linkage rate was 97.2%. Where a patient was not transported to hospital following paramedic care, 8.6% of these episodes resulted in an emergency department attendance within 24 hours. For all care episodes, 5.2% linked to a death record at some time within the 3-year period, with 2.4% of all death episodes occurring within 7 days of a paramedic encounter. For NSW Ambulance episodes of care that were expected to link to an external dataset but did not, nonlinkage to hospital admission records tended to decrease with age. For all other variables, issues relating to rates of linkage and nonlinkage were more indiscriminate. This quantification of the limitations of this large linked dataset will underpin the interpretation and results of ensuing studies that will inform future clinical and operational policies and practices at NSW Ambulance.
1）描述澳大利亚新南威尔士州（NSW）救护车数据与外部数据集之间关于“护理事件”和“仅患者”关联的关联率；2）检测并报告与患者相关的关联中存在的任何系统性问题，以及如果未得到充分解决可能会在后续研究中引入偏差的操作或临床变量。在2010 - 11年期间，新南威尔士州的健康记录关联中心（CHeReL）将2006年7月至2009年6月期间新南威尔士州救护车医护人员接诊患者的记录与四个外部数据集进行了关联：急诊科数据收集；住院患者数据收集；新南威尔士州出生、死亡和婚姻登记处的死亡登记数据；以及澳大利亚统计局的死亡率数据。本研究报告了在医护人员接诊后24小时内与外部数据库“预期”关联和“未预期”关联的情况的关联率。经过全面的数据准备过程，1,116,509名患者的2,041,728次新南威尔士州救护车护理事件符合纳入标准。总体特定事件的医院关联率为97.2%。在医护人员护理后患者未被送往医院的情况下，这些事件中有8.6%在24小时内导致了急诊科就诊。对于所有护理事件，5.2%在3年期间的某个时间与死亡记录相关联，所有死亡事件中有2.4%发生在医护人员接触后的7天内。对于预期与外部数据集关联但未关联的新南威尔士州救护车护理事件，与医院入院记录未关联的情况往往随着年龄增长而减少。对于所有其他变量，与关联率和未关联率相关的问题则更为杂乱。对这个大型关联数据集局限性的这种量化将为后续研究的解释和结果奠定基础，这些研究将为新南威尔士州救护车未来的临床和操作政策及实践提供参考。
