What to write
Details about missing data.
Explanation
Whenever possible, the results section of a healthcare improvement paper should account for missing data. Doing so enables the reader to understand potential biases in the analysis, and may add important context to the study findings. It is important for authors to clearly state why data are missing, such as technical problems or errors in data entry, attrition of participants from an improvement initiative over time, or patients lost to follow-up. Efforts made by the team to recover the data should be described, and any available details about the missing data provided.
In the first example,1 the improvement team was unable to contact 56 patients for phone or email follow-up (ie, why the data are missing). To account for this missing data, the team performed serial reviews of medical records. In doing so, they were able to report patient information relevant to the study outcomes. In the second example,2 the authors also clearly state the reasons for missing data (failure to recover outside records, transfers of care, unreachable by phone or email). In addition, they give details about the number of outreach attempts made for specific patient groups. Providing a detailed description of missing data allows for a more accurate interpretation of study findings.
Examples
Example 1
We successfully contacted 69% (122/178) of patients/families in the post implementation group…Among the remaining 56 patients (31%) for whom no phone or E-mail follow-up was obtained, 34 had another encounter in our hospital on serial reviews of their medical record. Nine patients were evaluated in a cardiology clinic and 7 in a neurology clinic. As a result of these encounters, there were no patients ultimately diagnosed with a cardiac or neurologic condition.1
Example 2
We identified 328 patients as under-immunized between September 2009 and September 2010. We fully immunized 194 (59%) of these patients by September 2010…We failed to recover missing outside immunization records on 15 patients (5%). The remaining 99 patients (30%) refused vaccines, transferred care, or were unreachable by phone or mail. For the 194 patients we fully immunized, we made 504 (mean 2.6) total outreach attempts for care coordination. We immunized 176 (91%) of these patients by age 24 months. For the 20 patients who remained under-immunized, we made 113 (mean 5.7) total outreach attempts for care coordination. We continued attempting outreach to immunize these patients even after their second birthday.2
Training
The UK EQUATOR Centre runs training on how to write using reporting guidelines.
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