Dear Colleagues,
Accurate monitoring of admission and outcome data is useful in tracking progress in paediatrics and maternal health. However, it is difficult to do manually and report on a large scale, electronic medical record systems are unaffordable in all but the highest income countries, and very few countries can manage the complexity of ICD-11 or have the training and resources to be ICD compliant.
In 2008 we designed a program that would monitor the most basic paediatric data: admissions, deaths, and calculate case fatality rates for the commonest illnesses in children, neonates, and mothers. This program has been used for over a decade in Papua New Guinea, and it has evolved and improved with use and various updated versions. The program is the basis of Annual Reports of Child Morbidity and Mortality, which can be used for monitoring disease outcomes over time, quality improvement, vaccine-preventable disease surveillance, and identifying epidemiological trends.
There is an admission record form that goes with the patient medical record, which is filled out by clinicians when they are admitting and discharging a patient. The program uses standardised WHO diagnoses for common illnesses in children, consistent with ICD-11 diagnoses. The data from the admission record form are entered into the program; this takes about 1-2 minutes for each patient. A summary for the ward or hospital is automatically generated by searching on a date range.
The PHR program allows for more than one diagnosis to be recorded on each patient. This is rare in NHIS systems, which is why underlying problems like malnutrition and anaemia are commonly under-recognised in hospital statistics. It is common for children to present with one problem, but there may be more than one condition or co-morbidity. In fact, the children most likely to die often have more than one diagnosis. Increasingly social problems are identified as causes of child morbidity, and some are included in the program also. The program has recently revised to include admission and outcome data for adolescents (12 years and over), to disaggregate data according to sex, so that we can track overall outcomes for girls and boys, and to include more chronic non-communicable diseases and neonatal diagnoses in the summary forms.
The PHR program (version 12.3) can be downloaded at: https://pngpaediatricsociety.org/hospital-reporting-program/
Some examples of Annual Reports that are produced by a committee, and based on the data derived from the program are at: https://pngpaediatricsociety.org/reports/annual-child-morbidity-and-mort...
We share this in case it is of use to paediatricians or countries that may not have a system for accurate paediatric data collection. It is freely available, so please feel free to use it if it helps.
Kind regards,
Trevor Duke
Adrian Hutchinson
Edilson Yano
CHIFA Profile:Trevor Duke is Director of the Centre for International Child Health at the University of Melbourne, Australia which is a WHO Collaborating Centre for Research and Training in Child and Neonatal Health. The Centre is extensively involved with WHO's Child Survival Strategy and Hospital Care Quality Improvement approach. Trevor works closely with countries throughout the Asia-Pacific region, particularly Papua New Guinea and the Solomon Islands on child health policy, research and health worker training. trevor.duke AT rch.org.au
