Validating Indigenous status in a regional Queensland hospital emergency department dataset with patient‐linked data

O'Loughlin, Mary Ann; Harriss, Linton; Mills, Jane; Thompson, Fintan; McDermott, Robyn

doi:10.5694/mja2.50401

Cited by 3 publications

(4 citation statements)

References 2 publications

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“…Importantly, we found that 16% of people who were reported as Aboriginal on the PSP were not reported as Aboriginal on any of their linked records. This is similar to the results of a recent Queensland study that examined ED presentations in a single facility [ 17 ].…”

Section: Discussionsupporting

confidence: 89%

Accuracy of reporting of Aboriginality on administrative health data collections using linked data in NSW, Australia

Nelson

Lim

Boyd³

et al. 2020

BMC Med Res Methodol

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Background Aboriginal people are under-reported on administrative health data in Australia. Various approaches have been used or proposed to improve reporting of Aboriginal people using linked records. This cross-sectional study used self-reported Aboriginality from the NSW Patient Survey Program (PSP) as a reference standard to assess the accuracy of reporting of Aboriginal people on NSW Admitted Patient (APDC) and Emergency Department Data Collections (EDDC), and compare the accuracy of selected approaches to enhance reporting Aboriginality using linked data. Methods Ten PSP surveys were linked to five administrative health data collections, including APDC, EDDC, perinatal, and birth and death registration records. Accuracy of reporting of Aboriginality was assessed using sensitivity, specificity, and positive and negative predictive values (PPVs and NPVs) and F score for the EDDC and APDC as baseline and four enhancement approaches using linked records: “Most recent linked record”, “Ever reported as Aboriginal”, and two approaches using a weight of evidence, “Enhanced Reporting of Aboriginality (ERA) algorithm” and “Multi-stage median (MSM)”. Results There was substantial under-reporting of Aboriginality on APDC and EDDC records (sensitivities 84 and 77% respectively) with PPVs of 95% on both data collections. Overall, specificities and NPVs were above 98%. Of people who were reported as Aboriginal on the PSP, 16% were not reported as Aboriginal on any of their linked records. Record linkage approaches generally increased sensitivity, accompanied by decrease in PPV with little change in overall F score for the APDC and an increase in F score for the EDDC. The “ERA algorithm” and “MSM” approaches provided the best overall accuracy. Conclusions Weight of evidence approaches are preferred when record linkage is used to improve reporting of Aboriginality on administrative health data collections. However, as a substantial number of Aboriginal people are not reported as Aboriginal on any of their linked records, improvements in reporting are incomplete and should be taken into account when interpreting results of any analyses. Enhancement of reporting of Aboriginality using record linkage should not replace efforts to improve recording of Aboriginal people at the point of data collection and addressing barriers to self-identification for Aboriginal people.

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Section: Discussionsupporting

confidence: 89%

Accuracy of reporting of Aboriginality on administrative health data collections using linked data in NSW, Australia

Nelson

Lim

Boyd³

et al. 2020

BMC Med Res Methodol

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“…We acknowledge this as a limitation of this paper. It is also possible that the numbers of suicidal presentations by Indigenous people and first-generation migrants are under-estimated in our analysis, as has been noted in some earlier studies [55,56], particularly in the early years before GCHHS invested concentrated efforts towards improving the recording of sociodemographic characteristics of its consumers [57]. In analyzing re-presentations to ED, different periods of follow-up were applied to consumers depending on the year of their index presentation.…”

Section: Limitationsmentioning

confidence: 99%

Suicidal Presentations to Emergency Departments in a Large Australian Public Health Service over 10 Years

Stapelberg

Sveticic

Hughes

et al. 2020

IJERPH

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This paper presents trends and characteristics for 32,094 suicidal presentations to two Emergency Departments (EDs) in a large health service in Australia across a 10-year period (2009–2018). Prevalence of annual suicidal presentations and for selected groups of consumers (by sex, age groups, and ethnicity) was determined from a machine learning diagnostic algorithm developed for this purpose and a Bayesian estimation approach. A linear increase in the number of suicidal presentations over 10 years was observed, which was 2.8-times higher than the increase noted in all ED presentations and 6.1-times higher than the increase in the population size. Females had higher presentation rates than males, particularly among younger age groups. The highest rates of presentations were by persons aged 15–24. Overseas-born persons had around half the rates of suicidal presentations than Australian-born persons, and Indigenous persons had 2.9-times higher rates than non-Indigenous persons. Of all presenters, 70.6% presented once, but 5.7% had five or more presentations. Seasonal distribution of presentations showed a peak at the end of spring and a decline in winter months. These findings can inform the allocation of health resources and guide the development of suicide prevention strategies for people presenting to hospitals in suicidal crisis.

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“…found that it was more common for Indigenous peoples to be under-identified than over-identified. 30 An Australian study of Indigenous identity collection in primary care settings found that nearly 20% of Indigenous patients did not have their status recorded in their clinical record suggesting that there was a systemic problem of failing to collect Indigenous identity data. 31 Health care systems are encouraged to provide staff training on the multilayered benefits of systematically tracking Indigenous identification among clients.…”

Section: Resultsmentioning

confidence: 99%

“…32,33 Despite Australia having legislation requiring the collection of Aboriginal and Torres Strait Islander identification, Indigenous status remains frequently underreported. 22,30 Research has found that many health care practitioners in Australia do not systematically collect Indigenous identity information. 28,33 A study of Indigenous identity collection in primary care settings in Australia found that higher rates of identifier recording were often associated with older patient age, practices outside of a major city, and patients who were long-time clients of a practice.…”

Section: General Characteristicsmentioning

confidence: 99%

Indigenous identity identification in administrative health care data globally: A scoping review

Gray,

Williams,

Oster

et al. 2023

J Health Serv Res Policy

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Objective Both Indigenous and non-Indigenous governments and organizations have increasingly called for improved Indigenous health data in order to improve health equity among Indigenous peoples. This scoping review identifies best practices, potential consequences and barriers for advancing Indigenous health data and Indigenous data sovereignty globally. Methods A scoping review was conducted to capture the breadth and nature of the academic and grey literature. We searched academic databases for academic records published between 2000 and 2021. We used Google to conduct a review of the grey literature. We applied Harfield’s Aboriginal and Torres Strait Islander Quality Appraisal Tool (QAT) to all original research articles included in the review to assess the quality of health information from an Indigenous perspective. Results In total, 77 academic articles and 49 grey literature records were included. Much of the academic literature was published in the last 12 years, demonstrating a more recent interest in Indigenous health data. Overall, we identified two ways for Indigenous health data to be retrieved. The first approach is health care organizations asking clients to voluntarily self-identify as Indigenous. The other approach is through data linkage. Both approaches to improving Indigenous health data require awareness of the intergenerational consequences of settler colonialism along with a general mistrust in health care systems among Indigenous peoples. This context also presents special considerations for health care systems that wish to engage with Indigenous communities around the intention, purpose, and uses of the identification of Indigenous status in administrative databases and in health care settings. Partnerships with local Indigenous nations should be developed prior to the systematic collection of Indigenous identifiers in health administrative data. The QAT revealed that many research articles do not include adequate information to describe how Indigenous communities and stakeholders have been involved in this research. Conclusion There is consensus within the academic literature that improving Indigenous health should be of high priority for health care systems globally. To address data disparities, governments and health organizations are encouraged to work in collaboration with local Indigenous nations and stakeholders at every step from conceptualization, data collection, analysis, to ownership. This finding highlights the need for future research to provide transparent explanation of how meaningful Indigenous collaboration is achieved in their research.

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Validating Indigenous status in a regional Queensland hospital emergency department dataset with patient‐linked data

Cited by 3 publications

References 2 publications

Accuracy of reporting of Aboriginality on administrative health data collections using linked data in NSW, Australia

Accuracy of reporting of Aboriginality on administrative health data collections using linked data in NSW, Australia

Suicidal Presentations to Emergency Departments in a Large Australian Public Health Service over 10 Years

Indigenous identity identification in administrative health care data globally: A scoping review

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