Use of Mainframe Computer for Analyzing Family Practice Information
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COMPUTERS IN FAMILY MEDICINE Continued from page 800 vitamin D deficiency rickets in a susceptible population. Pediatrics 64:871, 1979 2. De Buys LR: A clinical study of rickets in the breast is easily diagnosed and inexpensively treated. Par fed infant. Am J Dis Child 27:149, 1924 3. Little JA: Return of rickets. South Med J 75:1036, ents should be encouraged to supplement the diets 1982 of their breast-fed infants with a source of vitamin 4. O'Conner P: Vitamin D deficiency rickets in two breast-fed infants who were not receiving vitamin D sup D if they are at a high risk. The recommended plementation. Clin Pediatr 16:361, 1977 daily requirement of 400 IU of vitamin D is found in 5. Greer FR, Searcy JE, Levin RS, et al: Bone mineral content and serum 25-hydroxyvitamin D concentrations in many pediatric multivitamin preparations, as well breast-fed infants with and without supplemental vitamin as many food products (the major food source D— One year follow up. J Pediatr 100:919, 1982 6. Jackson RL, Westerfeld R, Flynn MA, et al: Growth being fortified cow’s milk), and it is now available of "well-born" American infants fed human and cow's milk. in pure form as Drisdol (Winthrop Laboratories). Pediatrics 33:642, 1964 7. Roberts CC, Chan GM, Folland DF, et al: Adequate Conversion of endogenous precursors to the ac bone mineralization in breast-fed infants. J Pediatr 99:192, tive form of vitamin D by adequate sunlight expo 1981 8. Edidin DV, Levitsky LL, Schey W, et al: Resurgence sure, especially in the first year of life, should not of nutritional rickets associated with breast feeding and be relied upon by dark-skinned persons, infants of special dietary practices. Pediatrics 65:232, 1980 9. Greer FR, Ho M, Dodson D, et al: Lack of 25- mothers who themselves may be deficient in vita hydroxyvitamin D and 1,25-dihydroxyvitamin D in human min D as a result of dietary practices or clothing, milk. J Pediatr 99:233, 1981 10. Greer FR, Reeve LE, Chesney RW, et al: Water solu and infants who are exclusively breast-fed beyond ble vitamin D in human milk: A myth. Pediatrics 69:238, 6 months of age, even though they may be other 1982 11. Greer FR, Searcy JE, Levin RS, et al: Bone mineral wise healthy. content and serum 25-hydroxyvitamin D concentrations in breast-fed infants with and without supplemental vitamin D. J Pediatr 98:696, 1981 References 12. O'Conner P: Clouds, skin color, and rickets. Pediat 1. Bachrach S, Fisher J, Parks JS: An outbreak of rics 66:332, 1980 Use of Mainframe Computer for Analyzing Family Practice Information Deborah F. Hotch, PhD Chicago, Illinois Maintaining even minimal physician-patient ducted by Lutz and Green2 indicated that of 308 encounter data for a family practice is likely to family practice residencies surveyed, 61 percent entail managing a data base of considerable size.1 were using computer systems. An additional 23 Augmenting this with the additional information percent were initiating implementation of a sys required for clinical or education research can tem. further increase the scope of the data base. Not Part of the trend toward the increased use of surprisingly, computers are being used more fre computers for processing family practice data is quently to manage and process family practice the growing popularity of small microcomputers data. Indeed, the results of a recent survey con- in family practice settings. However, while mi crocomputers may be well-suited to the needs of From the Department of Family Practice and the Rush- some physicians and training programs, others Christ Family Practice Residency Program, Rush-Presbyte- rian-St. Luke's Medical Center, Chicago, and Christ Hospital, have found the software limitations and pro Oak Lawn, Illinois. Requests for reprints should be ad gramming requirements that may be associated dressed to Dr. Deborah F. Hotch, Department of Family with such computers to be serious drawbacks to Practice, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612. their use. ® 1983 Appleton-Century-Crofts THE JOURNAL OF FAMILY PRACTICE, VOL. 16, NO. 4: 805-812, 1983 805 COMPUTERS IN FAMILY MEDICINE The data processing system developed at that use telephone-linked (acoustically coupled) Rush-Presbyterian-St. Luke’s Medical Center for modems. its family practice residency and for two affiliated Data from patient encounter records, including family practice residencies utilizes the medical patient identification and demographic data, pa center’s IBM 370 computer and a statistical tient problem(s), outpatient procedures per analysis package (SAS) to analyze patient- formed, and in two sites, faculty ratings of the encounter data. This system is one way in resident’s handling of the encounter, are analyzed which family practice information may be using SAS, version 79.5. SAS4 is a computer analyzed by computer and provides an alternative software package for data analysis that is available to using a microcomputer. on many IBM and related mainframe computers.* Data for the family practice centers in the Rush family practice network are accumulated, cleaned, Use of Mainframe Computer and analyzed in two-month blocks. The depart Using a university mainframe computer allows ment maintains two linked CMS accounts: one access to highly sophisticated analysis programs account is used exclusively for raw data entry; the and capabilities. Consequently, storing, sorting, other account is used for maintaining the SAS and analyzing large amounts of data, which would command statements needed to analyze the data. be impossible on a smaller computer, can be When all data processing for a block of records is undertaken without difficulty. In addition, a wide complete, program statements are removed, and range of user services and utilities are often avail the raw data file is copied, using IBM utility pro able to users of university mainframe computers. grams, to two magnetic tapes. One tape is a work With regard to software, when a user becomes ing copy; the other is a backup copy. familiar with the terminology and requirements for a particular statistical package, numerous proce dures and capabilities are available. In this way, Reports Produced using a software package eliminates the need to The summary reports prepared in this depart develop or purchase analysis programs. ment utilize relatively few of the many procedures With this approach, however, the results of data available to users of SAS. It is anticipated that as analyses often cannot be obtained instantane the needs of the department and its affiliates ously nor is it useful for such functions as change, the encounter record, as well as the file billing or scheduling. Clearly, this system is not a management and analysis strategies, will continue complete family practice information management to be refined. At the present time, the SAS state system. Rather, it is one means for storing, pro ments used to produce the residency’s reports cessing, and analyzing family practice patient- entail labeling variables and values, reading re encounter information. cords to obtain totals in terms of patients and visits, calculating appropriate sums, and pro viding a ranked ordering of diagnoses. These statements now serve as the core of the analysis Hardware and Software system, and the effort required to develop and The Rush Medical Center computer used by the type the program into the computer will not have Department of Family Practice is an IBM virtual to be repeated. machine facility/370 (VM/370) operated by the The bimonthly reports consist of four types of Conversational Monitor System (CMS). CMS, information: (1) a summary of demographic and with a storage capacity of 1 million bytes, enables evaluation data, (2) a summary of patient prob a user to build and manage files, execute applica lems, (3) rankings of patient problems, and (4) a tion programs, and compile, test, and execute summary of procedures performed. A simple ad- problem programs.3 Data files containing approx imately 4,000, 80-character lines may be edited in *Where SAS is not available, other analysis packages, par CMS. At the family practice centers affiliated with ticularly SPSS5 may also be used to process the informa the medical center, data are entered by data entry tion. technicians on CRT (cathode-ray tube) terminals Continued on page 811 806 THE JOURNAL OF FAMILY PRACTICE, VOL. 16, NO. 4, 1983 -ontinued from preceding page) ntihVDertensive agents that cause renin release. Aaents Affecting Sympathetic Activity — The sympathetic nervous system - b e especially important in supporting blood pressure in patients receiving COMPUTERS IN FAMILY MEDICINE ®a’t „ril a!0ne or with diuretics. Beta-adrenergic blocking drugs add some Mher antihypertensive effect to captopril, but the overall response is less additive. Therefore, use agents affecting sympathetic activity (e.g., nolionic blocking agents or adrenergic neuron blocking agents) with caution. 53Aaents Increasing Serum Potassium — Give potassium-sparing diuretics or Continued from page 806 miassium supplements only for documented hypokalemia, and then with -aution since they may lead to a significant increase of serum potassium. justment in SAS commands allows data to be ^Laboratory Test Interaction: Captopril may cause a false-positive urine summarized in parallel fashion for the center and lest for acetone. Carcinogenesis, Mutagenesis, and Impairment of Fertility: Two-year for each resident separately. Thus, in all, eight re studies with doses of 50 to 1350 mg/kg/day in mice and rats failed to show any ports are produced on a bimonthly basis. Four re evidence of carcinogenic potential. Studies in rats have revealed no impair ment of fertility. ports summarize data for the center; four sum Usage in Pregnancy: There are no adequate and well-controlled studies in marize data for residents individually.