BackgroundThe technical challenges associated with national data linkage, and the extent of cross-border population movements, are explored as part of a pioneering research project. The project involved linking state-based hospital admission records and death registrations across Australia for a national study of hospital related deaths.MethodsThe project linked over 44 million morbidity and mortality records from four Australian states between 1st July 1999 and 31st December 2009 using probabilistic methods. The accuracy of the linkage was measured through a comparison with jurisdictional keys sourced from individual states. The extent of cross-border population movement between these states was also assessed.ResultsData matching identified almost twelve million individuals across the four Australian states. The percentage of individuals from one state with records found in another ranged from 3-5 %. Using jurisdictional keys to measure linkage quality, results indicate a high matching efficiency (F measure 97 to 99 %), with linkage processing taking only a matter of days.ConclusionsThe results demonstrate the feasibility and accuracy of undertaking cross jurisdictional linkage for national research. The benefits are substantial, particularly in relation to capturing the full complement of records in patient pathways as a result of cross-border population movements.The project identified a sizeable ‘mobile’ population with hospital records in more than one state. Research studies that focus on a single jurisdiction will under-enumerate the extent of hospital usage by individuals in the population. It is important that researchers understand and are aware of the impact of this missing hospital activity on their studies.The project highlights the need for an efficient and accurate data linkage system to support national research across Australia.
Every neurology service should have access to specialist liaison psychiatryEditor-Crimlisk et al's report on the outcome of motor symptoms that were medically unexplained in a cohort first identified at the National Hospital for Nervous Diseases is welcomed by those interested in the psychiatry of physical illness.1 Slater's work, based on cohorts recruited in the 1950s, overestimated the likelihood of misdiagnosis in modern neurology, 2 and his conclusions have dissuaded psychiatrists from becoming involved in the management of hysteria.O'Brien's editorial on Crimlisk et al's study could have sounded two cautionary notes.3 Firstly, the study was not based on a true inception cohort, and it was recruited from a highly specialised centre. Usually, these factors lead to the finding of a worse prognosis than if only incident cases were included and the sample was less prone to recruitment bias. In this case, however, the bias may have been in the other direction. Patients seen at the National Hospital are likely to have been more exhaustively investigated and observed for longer (either in this episode or before referral) than they would be in most hospitals, so that the chances of misdiagnosis are reduced. We should not generalise the study findings to hospitals where initial assessment may be undertaken with little or no access to specialist neurological opinion or investigations.Secondly, the negative message-that high rates of undetected neurological disease are not seen at follow up-has been allowed to obscure the important positive findings of the study. Even years later, the patients had disabling physical symptoms and substantial psychiatric problems. As in Slater's original study, preventable deaths occurred from suicide and the complications of immobility. Many people were apparently not referred for psychiatric help either at the time of the initial presentation or subsequently.The important conclusion of Crimlisk et al's study must be that every neurology service should have easy access to referral to specialist liaison psychiatry. 4 This group of patients, who are difficult to treat, are often resistant to treatment, and have a poor prognosis, may then have a reasonable chance of obtaining appropriate treatment for their primary disorder. but he takes no account of the findings of the only previous follow up study from the National Hospital for Neurology and Neurosurgery comparable in size to Slater's study. 4 That follow up study looked at the clinical history of patients presenting between 1978 and 1980 with unexplained seizures and sensory deficits as well as motor symptoms, in similar proportions to those in Slater's study. All of the patients had been referred for a psychiatric opinion, unlike either Slater's or Crimlisk et al's patients. Forty one per cent of our patients (10 year follow up) failed to improve compared with 52% of patients in Crimlisk et al's study (six year follow up), with two of our patients going into remission after between six and 10 years. This percentage was maintained a...
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