The degree of similarity between diagnostic information furnished with claims and that simultaneously entered into the medical record was estimated for 1,215 private office visits in British Columbia, Canada. For each visit, claim card and chart diagnoses were compared by having three independent internists (blinded to source and type of the data) make judgments about each diagnostic pair. The judges were highly consistent internally and their judgments were stable over time. In 40 per cent of cases chart andBecause the largest volume of ambulatory medical care is provided in physicians' offices,1 more information and understanding of these patient contacts is needed. In the medical office visit, an often-complex diagnostic and therapeutic process is generally reduced to a few terse lines of text on the patient's chart and, in many cases, to a "reason for visit" or "diagnosis" on a third party payment claim form. The investigator in ambulatory care usually has little choice but to accept these data as representing ambulatory care problems or diagnoses. Similar limitations occur in the study of hospital care or in the derivation of vital statistics where the use of summary sheets or death certificates, while of limited validity,2 3 is nonetheless useful. In some studies, however,4-6 it has been possible to have well-trained, often medically-qualified observers observe a physician-patient visit and record or infer the data being sought. Unfortunately, the expense, unacceptability to patients and doctors, perturbation, and observer variability associated with this procedure have limited the number of these studies to small populations and often to highly specialized circumstances.The widespread introduction of health insurance plans, with associated claims systems, has in recent years provided investigators with a new source of medical-visit data, often in coded computer-compatible form. In spite of inevitable limitations of these data,7 some studies have been published8-12 in which it was assumed that the claims-associated diagnostic data were acceptable representations of the actual visit content. claims data were judged dissimilar, and in 38 per cent of cases claims data were judged more valuable as a reflection of the primary problem treated. The degree ofjudged similarity of chart and claims data correlated significantly and negatively with physician workload, income, and judges' preference for the billing card diagnosis. We conclude that in using claims data to determine the content of ambulatory visits, independent validation of such data may be important. (Am J Public Health 1981; 71:145-149.) To shed further light on the validity of claims data, we studied 1,215 office visits, and compared the chart information with that submitted to a third party payor. MethodsThe clinic studied was located in a British Columbia community of 65,000 and was comprised of 12 primary-care and five specialist physicians whose practice experience ranged from one to 35 years. Ninety-three per cent of visits were bi...
Standardized and computerized neurological data will be a requirement for clinical studies in the future. MS COSTAR is a system that has been designed for multiple sclerosis clinical research. Adoption of standards and a computer method for recording and storing these data should be a high priority for the design and future of multi-center studies on multiple sclerosis.
A set of equations was worked out to estimate the rapidity of the outward penetration of glucose from the hepatic intracellular compartment into the plasma compartment. In dynamic steady states at different blood sugar levels the average rate constant was found to be 0.46 min−1. Thus the rate at which glucose leaves the liver cell is rapid, but not instantaneous. The flux rates of glucose across the liver cell membrane were calculated and were found to be approximately eight times higher than the rate of glucose production. Two non-metabolizable glucose analogues, L-glucose and 3-O-methylglucose, were found to be distributed in 85% of the total water content of the liver.
Mall, Vancouver, B.C., Canada V6T 2B5.MS COSTAR is an integrated computer software system, written in the MUMPS computer language, and is designed to facilitate both clinical care and clinical research in the setting of an MS clinic (1). It provides functions for storing, retrieving, analyzing, and displaying the demographic, clinical, and test data that accrue as patients are seen and cared for over time in a typical MS clinic. MS COSTAR is a specialized derivative of the COSTAR (COmputer STored Ambulatory Record) (2) and was implemented for MS Clinic use in 1980 at the University of British Columbia (UBC). It has now been adopted as the standard clinical record keeping system and database for multiple sclerosis (MS) clinical research centers in both Canada and the United States (US).Cardinal features of the MS COSTAR system include a natural time base, comprehensive encoding and quantitation of clinical and test data for precise retrieval and analysis, and a broadly compatible format designed to facilitate data exchange and pooling among MS COSTAR and -other databases such as the European EDMUS system (3).There are currently twenty-three installations around the world, eight Canadian, one Japanese, one European, and thirteen in the United States. Seventeen of the sites are actively inputting data. Under a recent formal agreement, data are currently being pooled among all North American sites, creating a database of approximately 16,000 patients, which is standardized with respect to all clinical, laboratory, and imaging data.The system software is regularly updated to keep it current with advances in hardware and software, as well as to respond to user requests for enhancements and, particularly, for new codes needed to describe evolving diagnostic, therapeutic, and evaluation concepts in MS. The current release includes many new codes, reflecting new MS conr-epts, a variety of report forms, and several standard searches or queries that can be modified for local use. Also included are sample queries with output to Harvard Graphics tom and Microsoft ExcelT&dquo;' spreadsheet for data manipulation. The next release (under development) features enhanced full-screen &dquo;Windows&dquo;&dquo;' type access to many functions and full-screen data input for core clinical data.This version will be beta tested in 1994.Although it is a highly sophisticated and complex system when fully implemented, the initial use of the system for basic registration and input of clinical data is quite simple. New user centers are encouraged to first master basic use of the system on a modest (50-100) patient cohort in order to become familiar with the system. This will then provide a basis to select those features and capabilities that will best serve the needs of the individual center. Only after local information handling needs are met should there be any consideration of participating in optional multi-site data pooling. RationaleTo meet the patient care and research information needs of the MS clinic, which opened at UBC in 1980, a st...
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