A process for obtaining patient clinical information in the ambulatory setting.

The Wisconsin Ambulatory Review Project is the most extensive study to date with the goal of describing in detail the nature of care in the ambulatory setting. To assist in the description, a detailed, electronic clinical data base was created from a random sample of nonstandard, often hand-written, ambulatory patient medical records. This paper describes the set of processes that enabled significant clinical data to be collected, organized, and made available to researchers, including the collection of a representative sample of patient medical records, the creation of a detailed clinical vocabulary, the implementation of the vocabulary as a data abstraction tool, the collection and aggregation of distributed electronic data files, and the assessment of the efficiency of the abstraction process.

Hospitalization with vertebral fracture among the aged: a national population-based study, 1986-1989.

Whereas fractures related to osteoporosis have become a pressing public health concern, relatively few epidemiologic studies have focused on vertebral fractures. To shed further light on the occurrence of this injury, we collected data from the Health Care Financing Administration on 151,986 discharges listing a diagnosis of vertebral fracture over a 4-year period. After adjusting for age, white women experienced the highest rates of discharge, at 17.

Geographic variation in the use of breast-conserving treatment for breast cancer.

Background: In the past decade there has been an increase in the use of treatment designed to conserve the breast for women with breast cancer. The extent to which such treatment has been adopted in various regions of the country and whether characteristics of hospitals and patients predict its use is not known, however.

Methods: We used national data on Medicare claims for inpatient care provided in 1986 to study 36,982 women 65 to 79 years of age, who had local or regional breast cancer and underwent either mastectomy or breast-conserving treatment (local excision, quadrantectomy, or subtotal mastectomy).