International management platform for children's interstitial lung disease (chILD-EU)

BACKGROUND

Children's interstitial lung diseases (chILD) cover many rare entities, frequently not diagnosed or studied in detail. There is a great need for specialised advice and for internationally agreed subclassification of entities collected in a register.Our objective was to implement an international management platform with independent multidisciplinary review of cases at presentation for long-term follow-up and to test if this would allow for more accurate diagnosis. Also, quality and reproducibility of a diagnostic subclassification system were assessed using a collection of 25 complex chILD cases.

METHODS

A web-based chILD management platform with a registry and biobank was successfully designed and implemented.

RESULTS

Over a 3-year period, 575 patients were included for observation spanning a wide spectrum of chILD. In 346 patients, multidisciplinary reviews were completed by teams at five international sites (Munich 51%, London 12%, Hannover 31%, Ankara 1% and Paris 5%). In 13%, the diagnosis reached by the referring team was not confirmed by peer review. Among these, the diagnosis initially given was wrong (27%), imprecise (50%) or significant information was added (23%).The ability of nine expert clinicians to subcategorise the final diagnosis into the chILD-EU register classification had an overall exact inter-rater agreement of 59% on first assessment and after training, 64%. Only 10% of the 'wrong' answers resulted in allocation to an incorrect category. Subcategorisation proved useful but training is needed for optimal implementation.

CONCLUSIONS

We have shown that chILD-EU has generated a platform to help the clinical assessment of chILD.

TRIAL REGISTRATION NUMBER

Results, NCT02852928.

Automated computer-assisted evaluation of diagnosis-and-procedure-reports in Austrian hospitals

Austria's 320 hospitals with 73,000 beds have to transmit a minimum basic data set for each hospital stay with diagnosis and procedures as well as scores for use in intensive care units (last only in performance-oriented financed hospitals). Based on these data, 160 hospitals or 53,000 beds are financed through performance oriented flat rates per case (LDFs--Leistungsorientierte Diagnosen-Fallpauschalen). Those LDFs are in some principles similar to DRG's (diagnosis related groups), but have been developed by the Federal Ministry of Labor, Health and Social Affairs (BMAGS). 1.94 million data sets of hospital stays, which were reported for financing in the year 1997 had to be analyzed for their correctness and plausibility. For this aim the "Scoringprogramm" of the BMAGS is in use. We describe in detail how many diagnoses and procedures are automatically checked with diagnosis, sex, age, length of stay etc. 1.6% warnings resulted from this checking, and no errors have been reported. The checking routines have to be further developed. At present data seem to be used only with caution for epidemiology or for analyzing medical quality. For financing purposes it might be reliable, especially if data quality commissions are enlarged and if evaluation of data with medical records is improved.