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Abstract Background Congenital anomalies and their primary prevention are a crucial public health issue. This work aimed to estimate the prevalence of congenital anomalies in Brindisi, a city in southeastern Italy at high risk of environmental crisis. Methods This research concerned newborns up to 28 days of age, born between 2001 and 2010 to mothers resident in Brindisi and discharged with a diagnosis of congenital anomaly. We classified cases according to the coding system adopted by the European Network for the Surveillance of Congenital Anomalies (EUROCAT). Prevalence rates of congenital anomalies in Brindisi were compared with those reported by EUROCAT. Logistic regression models were adapted to evaluate the association between congenital anomalies and municipality of residence of the mother during pregnancy. Results Out of 8,503 newborns we recorded 194 subjects with congenital anomalies (228.2/10,000 total births), 1.2 times higher than the one reported by the EUROCAT pool of registries. We observed 83 subjects with congenital heart diseases with an excess of 49.1%. Odds Ratios for congenital heart diseases significantly increased for newborns to mothers resident in Brindisi (OR 1.75 CI 95% 1.30-2.35). Conclusions Our findings indicated an increased prevalence of Congenital Anomalies (especially congenital heart diseases) in the city of Brindisi. More research is needed in order to analyze the role of factors potentially involved in the causation of congenital anomalies.

The article presents a case study of a male patient born at 29-week gestation, who was diagnosed with the Ichthyosis prematurity syndrome (PMS). Topics include the pregnancy-related complications for the baby along with the role played by the fatty acid transporter protein 4 (FATP4) in the condition.

Compared to the previous one, the recently updated Italian version of the International Classification of Diseases - Clinical Modification (ICD-9-CM) includes new codes for the description of medical-related vaccinations procedures. In this work the new codes are described and the Classification is proposed as a possible tool for storing electronic information systems of immunization health services.

The aim of this study was to evaluate hospital admissions assigned to DRG 124 because attributable to the diagnosis and therapy of cardiovascular diseases and the performance of an angiocardiographic exam with contrast and/or cardiac catheterism. As part of the hospital activity evaluations performed by the Lazio Region between 1 January 2002 and 30 June 2005 in four healthcare institutions in the Rome metropolitan area, 136 admissions assigned to DRG 124 were evaluated. An evaluation grid was used to verify information recorded in the hospital discharge forms and hospital medical records for these admissions. Overall 89% (121/136) of medical records were found to be incongruent with the corresponding hospital discharge form and 53% of admissions (72/136) were reassigned a different DRG after evaluation. In most of these cases (n=54; 76%) the selection of a different DRG was required because an incorrect main diagnosis had originally been chosen. The mean relative weight of admissions in which DRG reassignment was required was 1.4189 before recoding and 0.7545 after these were assigned to a new DRG.

Aim of the present study was to evaluate the different fees charged for providing paper copies of medical records and time limits for their delivery. The analysis involved all the public and private hospitals in Lazio Region (Italy). The authors administered a short telephone questionnaire to the medical affairs direction of all the hospitals in the survey. In 94.6% of cases (n=106 hospitals) the requested information have been provided. Data analysis showed that average fee charged for issuing copies of medical records was, respectively, 13.90 vs 12.66 euro for inpatient and day hospital. Average time limits for dealing with a request for paper copies of medical records was 24.2 days, less than time established by Italian Law (30 days). The survey showed, however, a huge variability that concerns both the fees and times of issue of medical charts.

In the United States, from Fiscal Year 2008 (october 1, 2007-september 30, 2008), two important innovations have been introduced in health insurance program Medicare: 1) Centers for Medicare & Medicaid Services (CMS) proposes to refine the current DRG system by implementing Medicare-Severity DRGs (MS-DRGs), increasing the number of DRGs from 538 to 745. In addition, CMS has undertaken an overhaul of today's complication and comorbidity (CC) list and created up to three tiers of payment for each DRG based on the presence of: a major complication or comorbidity (MCC), a complication or comorbidity, or no complication or comorbidity; 2) the Federal Government, in compliance with the Deficit Reduction Act of 2005, has required secondary diagnosis reporting for all Medicare patients at the time of admission by a Present On Admission (POA) indicator. The authors describe the main characteristics of the new MS-DRG system and POA indicator and their potential impact on Italian Public Health system.

Aim of the present study is to evaluate the quality of medical record and Uniform Hospital Discharge Data Set (UHDDS), regarding admissions with death of the patient assigned to a Diagnosis Related Group (DRG) with a Relative Weight (RW) less than 1; the authors suggest that these admissions involve a more expensive hospital treatment if compared to admissions with favorable outcome and, therefore, the attribution of a DRG with RW more than 1 might be ascribed to an incorrect compilation of UHDDS. The admissions with the death of the patient, carried out between July 2002 and December 2002, in 11 different Rome hospitals located within the territory of two Local Health Units, have been split into 2 groups: admissions assigned to a DRG with RW less than 1 (group 1) and more than 1 (group 2). Afterward, two doctors of the Regional System of External Controls have required and examined the medical records of the group 1 (n= 57) using an evaluating format to verify the accuracy of UHDDS information. In the 91.0% (n=51) of the cases the UHDDS coding have been considered inadequate. In the 96.2% of the cases (n=49) the principal diagnosis has not been correctly coded while, in the 69.2% of the cases (n=36), at least one of the secondary diagnosis has been incorrectly reported. Medium RW rose from 0,7893 to 1,4354 after controllers' review and assignment of the new DRG. The results have confirmed the initial hypothesis and pointed out how an incorrect compilation of the UHDDS might compromise its validity under a statistic and epidemiologic point of view and produce significant repercussions under the economic one.

Previous studies have shown that the quality of medical records is not uniform across Italian hospitals. Between March 2002 and January 2003, we assessed the quality of 6,215 medical charts regarding admissions to 11 different Rome hospitals in the year 2001. The hospitals were located within the territory of the ROMA "A" and ROMA "C" Local Health Units. The following were evaluated: 1) organization, format and lay-out of medical records; 2) medical chart and discharge abstract compilation; 3) ICD-9-CM coding accuracy. The quality of medical records and of discharge abstracts, as judged especially by their format and by the completeness, accuracy, congruency and clearness of the reported information, varied extensively among the different wards and hospitals. The main problems were identified and possible solutions are discussed. We suggest that improved quality of medical records and discharge abstracts may be promoted through: 1) use of a standardized format for medical records in all wards of the same hospital; a supplement may eventually account for the characteristic requirements of specialist wards; 2) adoption of guidelines for medical record-keeping and of a code of conduct for discharge abstract coders; 3) use of a new discharge abstract form that favours more accurate ICD-9-CM coding and that allows more effective gathering of clinical data for epidemiological purposes.