burns 41 (2015) 1092–1099
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Development a minimum data set of the information management system for burns Maryam Ahmadi a,b, Jahanpour Alipour c,*, Ali Mohammadi d, Farid Khorami e a
Professor of Health Information Management Department, School of Management and Medical Information Sciences, Iran University of Medical Sciences, Tehran, Iran b Health management and economics research center, Iran University of medical sciences, Tehran, Iran c PhD student of Health Information Management, Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran d PhD student of Health Information Management, Health management and economics research center, Iran University of medical sciences, Tehran, Iran e MSc of Health Information Technology, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
article info
abstract
Article history:
Background: Burns are the most common and destructive injuries in across of the world and
Received 5 August 2014
especially in developing countries. Nevertheless, a standard tool for collecting the data of
Received in revised form
burn injury has not been developed yet. The purpose of this study was to develop a
5 October 2014
minimum data set (MDS) of the information management system for burns in Iran.
Accepted 10 December 2014
Materials and methods: This descriptive and cross-sectional study was performed in 2014. Data were collected from hospitals affiliated with Hormozgan and Iran University of Medical Sciences and medical documents centers, emergency centers and legal medicine centers
Keywords:
located in Bandar Abbas city, in addition to internet access and library. Investigated
Minimum data set
documents were burn injury records in 2013, and documents that retrieved from the
Burn
internet, and printed materials. Records were selected randomly based on T20-T29 catego-
Injuries
ries from ICD-10. Data were collected using a checklist. In order to make a consensus about
Information management system
the data elements the decision Delphi technique was applied using a questionnaire. The content validity and reliability of questionnaire were assessed by expert’s opinions and test– retest method, respectively. Results: An MDS of burns was developed. This MDS divided into two categories: administrative and clinical with six and 17 section and 161 and 311 data elements respectively. Conclusions: This study showed that comprehensive and uniform data elements about burns do not exist in Iran. Therefore a MDS was developed for burns in Iran. Development of an MDS will result in standardization and effective management of the data through providing uniform and comprehensive data elements for burns. Thus, comparability of the extracted information from different analyses and researches will be possible in various levels. In addition, establishment of policies and prevention and control of burns will be possible, which results in the improvement of the quality of care and containment of costs. # 2014 Elsevier Ltd and ISBI. All rights reserved.
* Corresponding author at: School of Health Management and Information Sciences, Iran University of Medical Sciences, No. 6, Rashid Yasemi St., Vali-e-asr Ave., 1995614111 Tehran, Iran. Tel.: +98 9171876641; fax: +98 21 88883334. E-mail address:
[email protected] (J. Alipour). http://dx.doi.org/10.1016/j.burns.2014.12.009 0305-4179/# 2014 Elsevier Ltd and ISBI. All rights reserved.
burns 41 (2015) 1092–1099
1.
Introduction
Burns are the most common and destructive injuries worldwide [1]. The majority of burns are unintentional and cause various problems in the societies throughout the world [2,3]. These injuries not only may lead to death, but also result in major economic impacts and occasionally somatic sequelae that people suffer from lifelong [4]. Patients with burns experience physical pain and emotional issues that start from the moment of injury. Also, these injuries have direct and indirect costs such as dressing change, operations, rehabilitation, and time lost from work, education, etc. that these patients have to endure [5]. Furthermore, burns are the main problems in low to middle income countries. In 2004, WHO estimated that 310,000 people died throughout the world due to fire with a total mortality rate of 4.8 per 100,000 per year [6]. According to the data of Tehran Forensic Medicine Council, burns account for 18% of all injury related mortalities in Iran. There is inconsistency in the description of burning agents in different studies conducted in Iran. Some contradictions could result from dissimilarly used terminology and definitions in reporting the etiology of burn injury. For example, in some studies, fuel related burns are separately classified and not included in flame-related burns. studies conducted on burns in Iran have reported show different mortality rates from1.4/ 100,000 to 9.7/100,000 in different study populations [4]. Torabian and Saba reported that the patients’ medical records did not describe the details of burns clearly while having comprehensive information about burns such as the place of occurrence, etiology, etc. is essential [7]. Nearly 95% of burns occur in low to middle income countries. There is data about burns in developing countries, but the data may not be comparable because of problem in its quality and completeness. Standardization of the data to make burn injury studies comparable and to eliminate ambiguity of the trends in burns seems necessary [8]. A minimum data set (MDS) is an essential and appropriate set of potentially available data elements on specific entities that ensures certain examination of determined sets of research, policy, and planning at preferred levels and could be used for planning, development, monitoring, and evaluation [9]. Designing and performing minimum data sets (MDS) in health care institutions is considered as a preliminary step of disease information management which results in the improvement of the quality of care and disease control [10]. The purpose of all MDSs, as main health data elements, are to ensure comparability and conformity of the data using standard data items with uniform definitions [11]. An MDS provides a structured method for information organization to make effective care plans. The purpose of this tool is to determine data elements that must be collected for each patient and also to provide consistent definitions for common terminology and data elements [12]. Despite the growing number of published studies on the etiology and epidemiology of burns in Iran, the findings of studies do not provide sufficient and comparable information about burns [4,7,13–24]. Since burns have physical, mental, and economic burdens for injured patients, information management of these injuries in order to improve health care quality and
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control of injuries is necessary. Nevertheless, a standard tool for collecting the data of burn injury has not been developed yet. The aim of the study was to develop a minimum data set of the information management system for burns in Iran.
2.
Materials and methods
This applied descriptive, cross-sectional study was conducted in 2014. Data was collected from patient medical records of Shahid Mohammadi Public Hospital affiliated with Hormozgan University of Medical Sciences, medical document centers (Social Security, Medical Services, Armed Forces, and Assistance Committee Insurance Institutions), four medical emergency centers, and legal medicine centers located in Bandar Abbas. In order to validate the study, medical records of the patients of Shahid Motahari Burn Hospital affiliated with Iran University of Medical Sciences in the city of Tehran, which is a specialized hospital in burns, was studied, as well. In hospitals, medical document centers, and legal medicine centers, 10 medical records in each T20–T29 category related to burns based on International Classification of Diseases 10th Revision (ICD-10) were randomly selected. In addition, data elements of emergency forms in medical emergency centers were studied. In order to extract the data elements from the sources listed above, a checklist was used. In the next step, a review of the literature was conducted to retrieve related data resources. The resources included articles, reports, and forms available on the internet, texts, and theses. In this step, a checklist was also used for extraction of data element. To find relevant resources, studies were identified via keywords including minimum data set form, burn injury data, MDS, minimum data set, trauma registry form, burn injury form, and injury registry in Persian and Cochran, PubMed, Scopus, MagIran, SID, and Iran Doc. The research was mainly confined to materials published from 1998 to April 2014. In this stage, sampling was not performed and all of the literature based on inclusion criteria was evaluated and their desired data elements were entered into the checklist. Literature review was limited to Persian and English languages between 1998 to April 2014 in the full text from valid sources, with a clearly related purpose, as well as hard copies of available texts and theses. The articles whose full texts were impossible to access in addition to letter to editor, forms, and reports retrieved from websites were excluded. Literature review was continued until data saturation. Collected data were divided into clinical and administrative categories using a checklist. Then, extracted data elements form the literature review, patient medical records, and emergency department forms in Iran were combined and the final content of the checklist was constructed. The questionnaire was constructed using the data elements of the mentioned checklist. The questionnaire was composed of three columns with ‘‘yes’’ (including required and optional) and ‘‘no’’ in front of each data element. At the end of each section, a blank row was considered for adding necessary data elements by experts. Content validity of the questionnaire was evaluated by 12 experts including three health information management
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experts, a plastic and reconstructive surgeon, two general practitioners, two insurance experts, two legal medicine specialists, and two emergency medicine specialists. Test– retest reliability (with a 10-day interval) was performed to determine the reliability of the questionnaire. The collected data was analyzed using SPSS 16, and a Spearman’s rank correlation coefficient of 82% was achieved. To determine the final data elements of the MDS of the information management system related to burn injury, data elements were chosen by 25 samples of attending experts through the Decision Delphi technique in two rounds. Table 1 shows the attending experts demographic characteristics. The criteria for the acceptance of data elements in the final MDS were the agreement level of experts. Thus, data elements with agreement levels less than 50% were excluded at the first round, 50 to 75% agreement levels entered the second round, and agreement levels more than 75% were accepted in the first round of the Delphi technique. In the second round, an agreement level of 75% was considered on each data element. In the end, final data elements of the MDS were achieved in two rounds.
3.
Results
The MDS of burn injury was divided into two categories: administrative with six sections and clinical with 17 sections.
The total number of final data elements for administrative and clinical categories was 202 and 447, respectively. After applying two rounds of the decision Delphi technique, the final data elements for administrative and clinical categories were 161 and 311, respectively (Tables 2 and 3). The administrative data category included patient demographic data (first and last name, age, gender, etc.), health care provider data (such as health care institutions and practitioners), insurance data including the necessary information for reimbursement of hospitalization and treatment costs paid by the insurance company, and legal data such as essential data for insurance claims, compensation, indemnity, disability, and legal claims. This category of data also included the cause data (intent, name of the burn agent, and type of activity of the victim), location data such as data elements concerning the location of the occurrence of injury. Table 4 shows some administrative data. The first section of the clinical data category was related to diagnostic data which was classified into two subsections of general data for diagnosis and data elements for burns based on T20-T29 entities of ICD-10. The overall data elements were presented in the first subsection. In the second subsection, diagnostic data elements concerning burns based on T20–T29 categories of ICD-10 were presented in detail. These data elements include data elements of burns of the head and neck, trunk, shoulder and upper limb except for the wrist and hand,
Table 1 – Demographic characteristics of participants in decision Delphi technique. Participants
Numbers
Gender
Age group
Education
Health information management or medical records
6
Female:3
20–29: 1
PhD: 2
Male: 3
30–39: 3 40–49: 2 50–59: 0
MSc: 4
Specialist of Plastic and Reconstructive Surgery
3
Female:0 Male: 3
20–29: 0
Specialist:3
30–39: 0 40–49: 2 50–59: 1 Legal medicine
3
Female:0 Male:3
20–29: 0
Specialist: 3
Academic field Health information management: 2 Medical records: 4
Plastic and Reconstructive Surgery
Legal medicine
30–39: 0 40–49: 2 50–59: 1 General Practitioner (GP)
5
Female:2 male: 3
20–29: 30–39: 40–49: 50–59:
0 2 2 1
General Practitioner: 5
General Practitioner
Insurance expert
5
Female:1 nursing Male: 4
20–29: 30–39: 40–49: 50–59:
0 0 4 1
GP: 2 BSc nursing: 3
General Practitioner + BSc nursing
Emergency medicine specialist
3
Female:0 male:3
20–29: 30–39: 40–49: 50–59:
0 0 2 1
Specialist: 3
Emergency medicine
Experience < 5: 3–6: 11–15: 16–20: > 20: < 5:0 3–6:1 11–15:1 16–20:1 > 20:0 < 5:0 3–6:1 11–15:1 16–20:1 > 20:0 < 5:0 3–6:3 11–15:1 16–20:0 > 20:1 < 5:0 3–6:0 11–15:2 16–20:2 > 20:1 < 5: 3 3–6: 0 11–15: 0 16–20: 0 > 20: 0
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Table 2 – Administrative data category for Minimum Data Set for burns. Data sections
Demographic Provider ID Insurance Legal Cause Place Total
Number of data elements
First round of Delphi
Second round of Delphi
Final number of data elements
