Post on 24-Dec-2015
transcript
MEDICAL CONDITIONS IN ADOLESCENTS
– FROM EPIDEMIOLOGICAL TRENDS TO A
NATIONWIDE HEALTH PROJECT FOR
DISEASE RISK REDUCTION
Y. Chaiter1, Y. Machluf 1, A. Pirogovsky2, A. Yona1, A. Navon1, O. Tal2, E. Ringler1, G. Abbebe-Campino1, Y.
Erlich1, and N. Ash2
1 Israel Defence Forces, Israel2 Ministry of Health, Israel
The medical process at recruitment centers
DocumentsPreliminary medical information (from family physician)
Basic measurementsAntropometric Visual analysisVital signs Urinalysis
Medical committeeSystematic anamnesis (history, habits,
psychology…)Complete physical examination
Further investigationPsychological
evaluationSpecialist
consultationLaboratory testsImaging + measuresDocumentation
Medical statusMedical profile ± Functional classification codes (FCCs)
Quality assurance and control system
GoalsTo assess components of the medical process and committees’ performances and to ensure a uniform and professional medical process at recruitment centres
Assessment1.Medical committee staff
2.Administrative medical personnel
3.Recruits
4.Physical conditions & medical equipment
5.Computer-based assessment
ToolsObservations, Sampling, Re-examination, Questionnaires, Medical files, Report & data analysis
Analysis1.Inadequacies in
anamnesis quality
2. Insufficient physical examination
3.Errors in decision-making
4.Local administrative procedures
5.Inappropriate equipment and use
6. inconsistencies in medical process
7.Variability in prevalence of medical conditions
Intervention program1.Lectures &
Instructions
2.Simulation centre
3.Manual
4.Renewal of medical equipment
5.Reports
Improvements1.Professional
performance
2.Working environment
3.Patients’ satisfaction
4.Uniform working platform
Opportunity for epidemiological research
New horizons
The medical processes for the adolescent population of
Israel present a unique opportunity to assess the health
status of the young Israeli population on a nationwide level
and to identify risk factors that can affect present and
future morbidity.
A pilot study
General characteristics
~105,000 adolescents
61427 males and 43473 females
Age of 16-19 years old, at time of medical examination
Were born between 1971-1992 (>1000 people / gender/
years)
All have basic measurements data (height, weight…)
All from 1 recruitment centreGoals
Medical conditions- trends over the years
Assess risk factors
BMI
A significant increase in average BMI was observed
(more pronounced in male recruits)
BMI
A significant decrease in the prevalence of normal BMI was observed, in both male and
female recruits
BMI
A significant increase in the prevalence of overweight BMI was observed (more pronounced
in male recruits)
BMI
A significant increase in the prevalence of obesity BMI was observed, in both female and male
recruits
BMI
A significant increase in the prevalence of underweight BMI was observed, in female but not
in male recruits
A pilot study
Data stratification – identification of risk factors
Except gender, data was stratified by religion, country of
origin, education, family-related parameters, medical
measurements (blood pressure, pulse etc.) and inter-
relations were assessed.
This approach led to the identification of novel risk factors
as well as supported known ones.
Periodic data mining
“Old data – new insights”
One way by which the control system operates is data
mining and processing from the computerized medical
database.
It is aimed at identifying discrepancies in medical profiling,
along with follow-ups and analyses of medical profiles and
FCCs assigned to recruits. Comparison of findings over the
years may uncover interesting trends…
Solid tumors
An increase in the prevalence of solid tumors in both male and female recruits
Congenital heart disease
An increase in the prevalence of both valvular and non-valvular congenital heart disease, among male
recruits
A nationwide health project
Need
A need for a nationwide intervention program to reduce
morbidity and future illness and even mortality.
Benefits
Identification of important trends in risk factors by the
quality assurance and control system.
An automated process of information sharing between
the military and civilian medical systems.
Complete communication between various medical
systems.
Future view: one medical file for the life time of a person.
A nationwide health project
IDF 1. Medical committee2. Quality assurance &
control system
Ministry of healthPsychiatric hospitalizations
Ministry of Social affairsMentally retarded
populations in special institutions
Past
Present & Future
HMOSFamily physicians in primary
clinics
Ministry of Social affairsExpansion: severely
disabled, pervasive developmental disorders, etc.
Israeli National Cancer Registry
National insuranceHandicaps
A nationwide health project
Pilot I:
A project of information sharing was started at northern Israel with family physicians at primary clinics (Clalit Health Services).Pilot phase (launched in 03/2010): 4 selected primary clinics, ~500 recruits (growing…).
Pilot II:
A project of information sharing and was started on a nationwide level, with the Israeli National Cancer Registry, The Ministry of Social Affairs and National Insurance.Pilot phase, launched in 04/2010: 24449 male (0.233%) + 21892 (0.169%) female recruits (prevalence).
IDF – CHS Pilot
Higher rate of information gathering from clinics as compared to questionnaires
Total (n=105)
Clinic – B (n=70)
Clinic – A (n=35)
62.9% 58.6% 71.4% Information - Questionnaire
74.3% 71.4% 80.0% Information – Clinics (computer)
IDF – CHS Pilot
A significant contribution to both recruits that did not return questionnaire or did return
questionnaire, indicating the importance of a complementary source of information
Total (n=105)
Clinic – B (n=70)
Clinic – A (n=35)
62.9% 58.6% 71.4% Information - Questionnaire
74.3% 71.4% 80.0% Information – Clinics (computer)
39.7% 38.0% 42.9% Novel medical findings*
46.7% 30.0% 80.0% Rate among recruits that did not return questionnaire
35.1% 43.3% 22.5% Rate among recruits that did return questionnaire
IDF – ICR Pilot
Bi-directional information sharing
Distribution of Malignancies Among Male and Female Recruits(which were born Sep-92 to Apr-93)
Summary
Quality assurance and control
system
Epidemiological pilot study
A nationwide health project
Medical process at medical
committees
Thank You!
Height
A slight but significant decrease in average height was observed in female but not in male
recruits
Weight
A significant increase in average weight was observed
(more pronounced in male recruits(