Dear Colleagues,
Monitoring of admission and outcome data is useful for tracking progress in newborn, child and maternal health. However, it is difficult to do accurately manually, and to 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 and resources needed to be ICD-10 compliant.
In 2008 we designed a program to 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 to monitor disease outcomes over time, for initiatives in quality improvement, for vaccine-preventable disease surveillance, and for identifying epidemiological trends.
The program is simple to use. There is an admission record form that goes with the patient's 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 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 national health information systems, which is why underlying problems like malnutrition and anaemia are 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. And the children most likely to die often have more than one diagnosis, so HIS need to be able to record comorbidities. Social problems are also causes of child morbidity and mortality, and some are included in the PHR program also. The program has recently revised so that the automated summary includes admission and outcome data for adolescents, 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 more neonatal diagnoses in the summary forms.
The PHR program (version 12.3) can be downloaded at: https://pngpaediatricsociety.org/hospital-reporting-program/
Examples of annual reports that are based on the data derived from the program are at: https://pngpaediatricsociety.org/reports/annual-child-morbidity-and-mort...
We share this program in case it is of use to paediatricians in other countries that may not have a system for accurate paediatric data collection. The PHR is freely available, so please feel free to use it.
Kind regards,
Trevor Duke
Edilson Yano
Adrian Hutchinson
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
