Dataset Information

Changes in safety on England's roads: analysis of hospital statistics.

ABSTRACT:

Objective

To compare trends in the numbers of people with serious traffic injuries according to police statistics and hospital episode statistics (HES).

Design

Descriptive study based on two independent population based data sources.

Setting

Police statistics and hospital episode statistics in England.

Main outcome measures

Rates of injury and death and their change over time reported in each data source, for 1996 to 2004.

Results

According to police statistics, rates of people killed or seriously injured on the roads fell consistently from 85.9 per 100,000 in 1996 to 59.4 per 100,000 in 2004. Over the same time, however, hospital admission rates for traffic injuries were almost unchanged at 90.0 in 1996 and 91.1 in 2004. Both datasets showed a significant reduction in rates of injury in children aged < or = 15, but the reduction in hospital admission rates was substantially less than the reduction shown in the police statistics. The definition of serious injury in police statistics includes every hospital admission; in each year, none the less, the number of admissions exceeded the number of injuries reported in the police system.

Conclusions

The overall fall seen in police statistics for non-fatal road traffic injuries probably represents a fall in completeness of reporting of these injuries.

SUBMITTER: Gill M

PROVIDER: S-EPMC1489232 | biostudies-literature | 2006 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Changes in safety on England's roads: analysis of hospital statistics.

Gill Mike M Goldacre Michael J MJ Yeates David G R DG

BMJ (Clinical research ed.) 20060623 7558

<h4>Objective</h4>To compare trends in the numbers of people with serious traffic injuries according to police statistics and hospital episode statistics (HES).<h4>Design</h4>Descriptive study based on two independent population based data sources.<h4>Setting</h4>Police statistics and hospital episode statistics in England.<h4>Main outcome measures</h4>Rates of injury and death and their change over time reported in each data source, for 1996 to 2004.<h4>Results</h4>According to police statistic ...[more]

PMID: 16798753

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Project description:BackgroundUse of routine data sources within clinical research is increasing and is endorsed by the National Institute for Health Research to increase trial efficiencies; however there is limited evidence for its use in clinical trials, especially in relation to self-harm. One source of routine data, Hospital Episode Statistics, is collated and distributed by NHS Digital and contains details of admissions, outpatient, and Accident and Emergency attendances provided periodically by English National Health Service hospitals. We explored the reliability and accuracy of Hospital Episode Statistics, compared to data collected directly from hospital records, to assess whether it would provide complete, accurate, and reliable means of acquiring hospital attendances for self-harm - the primary outcome for the SHIFT (Self-Harm Intervention: Family Therapy) trial evaluating Family Therapy for adolescents following self-harm.MethodsParticipant identifiers were linked to Hospital Episode Statistics Accident and Emergency, and Admissions data, and episodes combined to describe participants' complete hospital attendance. Attendance data were initially compared to data previously gathered by trial researchers from pre-identified hospitals. Final comparison was conducted of subsequent attendances collected through Hospital Episode Statistics and researcher follow-up. Consideration was given to linkage rates; number and proportion of attendances retrieved; reliability of Accident and Emergency, and Admissions data; percentage of self-harm episodes recorded and coded appropriately; and percentage of required data items retrieved.ResultsParticipants were first linked to Hospital Episode Statistics with an acceptable match rate of 95%, identifying a total of 341 complete hospital attendances, compared to 139 reported by the researchers at the time. More than double the proportion of Hospital Episode Statistics Accident and Emergency episodes could not be classified in relation to self-harm (75%) compared to 34.9% of admitted episodes, and of overall attendances, 18% were classified as self-harm related and 20% not related, while ambiguity or insufficient information meant 62% were unclassified. Of 39 self-harm-related attendances reported by the researchers, Hospital Episode Statistics identified 24 (62%) as self-harm related while 15 (38%) were unclassified. Based on final data received, 1490 complete hospital attendances were identified and comparison to researcher follow-up found Hospital Episode Statistics underestimated the number of self-harm attendances by 37.2% (95% confidence interval 32.6%-41.9%).ConclusionAdvantages of routine data collection via NHS Digital included the acquisition of more comprehensive and timely trial outcome data, identifying more than double the number of hospital attendances than researchers. Disadvantages included ambiguity in the classification of self-harm relatedness. Our resulting primary outcome data collection strategy used routine data to identify hospital attendances supplemented by targeted researcher data collection for attendances requiring further self-harm classification.

Project description:OBJECTIVE:To evaluate the association between hospital penalization in the US Hospital Acquired Condition Reduction Program (HACRP) and subsequent changes in clinical outcomes. DESIGN:Regression discontinuity design applied to a retrospective cohort from inpatient Medicare claims. SETTING:3238 acute care hospitals in the United States. PARTICIPANTS:Medicare fee-for-service beneficiaries discharged from acute care hospitals between 23 July 2014 and 30 November 2016 and eligible for at least one targeted hospital acquired condition (n=15 470 334). INTERVENTION:Hospital receipt of a penalty in the first year of the HACRP. MAIN OUTCOME MEASURES:Episode level count of targeted hospital acquired conditions per 1000 episodes, 30 day readmissions, and 30 day mortality. RESULTS:Of 724 hospitals penalized under the HACRP in fiscal year 2015, 708 were represented in the study. Mean counts of hospital acquired conditions were 2.72 per 1000 episodes for penalized hospitals and 2.06 per 1000 episodes for non-penalized hospitals; 30 day readmissions were 14.4% and 14.0%, respectively, and 30 day mortality was 9.0% for both hospital groups. Penalized hospitals were more likely to be large, teaching institutions, and have a greater share of patients with low socioeconomic status than non-penalized hospitals. HACRP penalties were associated with a non-significant change of -0.16 hospital acquired conditions per 1000 episodes (95% confidence interval -0.53 to 0.20), -0.36 percentage points in 30 day readmission (-1.06 to 0.33), and -0.04 percentage points in 30 day mortality (-0.59 to 0.52). No clear patterns of clinical improvement were observed across hospital characteristics. CONCLUSIONS:Penalization was not associated with significant changes in rates of hospital acquired conditions, 30 day readmission, or 30 day mortality, and does not appear to drive meaningful clinical improvements. By disproportionately penalizing hospitals caring for more disadvantaged patients, the HACRP could exacerbate inequities in care.

Dataset Information

Changes in safety on England's roads: analysis of hospital statistics.

Objective

Design

Setting

Main outcome measures

Results

Conclusions

Publications

Changes in safety on England's roads: analysis of hospital statistics.

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