PMID- 28357824
OWN - NLM
STAT- MEDLINE
DCOM- 20170502
LR  - 20240331
IS  - 1833-3516 (Print)
IS  - 1833-3516 (Linking)
VI  - 47
IP  - 1
DP  - 2017 Mar
TI  - Identifying and acting on inappropriate metadata: a critique of the Grattan 
      Institute Report on questionable care in Australian hospitals.
PG  - 44-54
LID - 10.28920/dhm47.1.44-54 [doi]
AB  - INTRODUCTION: In an era of ever-increasing medical costs, the identification and 
      prohibition of ineffective medical therapies is of considerable economic interest 
      to healthcare funding bodies. Likewise, the avoidance of interventions with an 
      unduly elevated clinical risk/benefit ratio would be similarly advantageous for 
      patients. Regrettably, the identification of such therapies has proven 
      problematic. A recent paper from the Grattan Institute in Australia (identifying 
      five hospital procedures as having the potential for disinvestment on these 
      grounds) serves as a timely illustration of the difficulties inherent in 
      non-clinicians attempting to accurately recognize such interventions using 
      non-clinical, indirect or poorly validated datasets. AIM: To evaluate the Grattan 
      Institute report and associated publications, and determine the validity of their 
      assertions regarding hyperbaric oxygen treatment (HBOT) utilisation in Australia. 
      METHODS: Critical analysis of the HBOT metadata included in the Grattan Institute 
      study was undertaken and compared against other publicly available Australian 
      Government and independent data sources. The consistency, accuracy and 
      reproducibility of data definitions and terminology across the various 
      publications were appraised and the authors' methodology was reviewed. Reference 
      sources were examined for relevance and temporal eligibility. RESULTS: Review of 
      the Grattan publications demonstrated multiple problems, including (but not 
      limited to): confusing patient-treatments with total patient numbers; incorrect 
      identification of 'appropriate' vs. 'inappropriate' indications for HBOT; 
      reliance upon a compromised primary dataset; lack of appropriate clinical input, 
      muddled methodology and use of inapplicable references. These errors resulted in 
      a more than seventy-fold over-estimation of the number of patients potentially 
      treated inappropriately with HBOT in Australia that year. CONCLUSION: Numerous 
      methodological flaws and factual errors have been identified in this Grattan 
      Institute study. Its conclusions are not valid and a formal retraction is 
      required.
FAU - Cooper, P David
AU  - Cooper PD
AD  - Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, GPO Box 
      1061L, Hobart, Tasmania 7001, Australia, david.cooper@dhhs.tas.gov.au.
FAU - Smart, David R
AU  - Smart DR
AD  - Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital.
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PL  - Australia
TA  - Diving Hyperb Med
JT  - Diving and hyperbaric medicine
JID - 101282742
SB  - IM
MH  - Australia
MH  - Bibliometrics
MH  - Clinical Competence
MH  - *Data Accuracy
MH  - Data Interpretation, Statistical
MH  - Databases, Factual
MH  - Hyperbaric Oxygenation/classification/economics/*standards/statistics & numerical 
      data
MH  - *Medical Futility
MH  - Metadata/*standards
MH  - Patient Admission/statistics & numerical data
MH  - Reproducibility of Results
MH  - Tasmania
MH  - Terminology as Topic
PMC - PMC6147231
OTO - NOTNLM
OT  - Critical appraisal
OT  - Data
OT  - Economics
OT  - Evidence
OT  - Health
OT  - Hyperbaric oxygen therapy
OT  - Policy
COIS- Declaration of interests P David Cooper and David R Smart are employed by the 
      Tasmanian State Government as Medical Co-directors of the Department of Diving 
      and Hyperbaric Medicine, Royal Hobart Hospital, Tasmania. DRS is also the current 
      President of the South Pacific Underwater Medicine Society and has previously 
      participated in the Commonwealth's MSAC reviews 1054(2003) and 1054.1(2011).
EDAT- 2017/03/31 06:00
MHDA- 2017/05/04 06:00
PMCR- 2018/03/01
CRDT- 2017/03/31 06:00
PHST- 2017/02/05 00:00 [received]
PHST- 2017/02/09 00:00 [accepted]
PHST- 2017/03/31 06:00 [entrez]
PHST- 2017/03/31 06:00 [pubmed]
PHST- 2017/05/04 06:00 [medline]
PHST- 2018/03/01 00:00 [pmc-release]
AID - 10.28920/dhm47.1.44-54 [doi]
PST - ppublish
SO  - Diving Hyperb Med. 2017 Mar;47(1):44-54. doi: 10.28920/dhm47.1.44-54.