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Problems with criteria and quality control in the registration of coronary events in the MONICA study
1MONICA Quality Control Centre for Event Registration, Cardiovascular Epidemiology Unit, Ninewells Hospital and Medical School, Dundee, Scotland.
Insights
Registering coronary events for the World Health Organization MONICA study presents challenges due to large populations. Practical difficulties in coding events require adapting methods to local healthcare systems and monitoring for biases.
Area of Science:
- Cardiology
- Epidemiology
- Public Health Surveillance
Background:
- The World Health Organization MONICA study monitors fatal and non-fatal coronary events.
- Large study populations necessitate reliance on routine medical and medico-legal data sources for event identification.
Purpose of the Study:
- To discuss practical difficulties in registering and coding coronary events within the MONICA study.
- To highlight how local healthcare systems and constraints impact data collection methods.
Main Methods:
- Utilizing routine medical and medico-legal sources for identifying potential coronary events.
- Employing "hot pursuit" (admission) and "cold pursuit" (discharge) methods for registering non-fatal hospital cases.
- Adapting registration methods to local medical care systems, legal, and ethical constraints.
Main Results:
- Registration methods vary significantly between MONICA Collaborating Centres due to local adaptations.
- The adequacy of event investigation and completeness of medical records critically influence registration quality.
- Potential biases in event rates can arise from changes in medical care practices.
Conclusions:
- Effective coronary event registration requires overcoming practical challenges in data collection and coding.
- Standardization is difficult due to the need for local adaptation in methods and the influence of healthcare system variations.
- Continuous monitoring for biases introduced by healthcare system changes is essential for accurate epidemiological surveillance.
Abstract:
This paper discusses the practical difficulties experienced in registering and coding coronary events. The populations being monitored for fatal and non-fatal coronary events in the World Health Organization MONICA study are too large for surveillance of individuals. Routine medical and medico-legal sources have to be used to indentify potential events, which are then coded and categorized according to standard criteria. Methods are dependent on, and have to be adapted to the local system of medical care. Non-fatal cases in hospital are identified and registered either through their admission, "hot pursuit", or through their discharge, "cold pursuit". Each method has its own advantages and disadvantages. Local legal and ethical constraints are also responsible for differences between MONICA Collaborating Centres. Adequacy of investigation of events, and the availability and completeness of medical records are major determinants of the ease and quality of registration. Changes in medical care could cause spurious changes in event rates, and so potential biases need to be monitored and allowed for.