MONICA Manual, Part II, Section 2

	Medical Care Assessment Data MEDICAL CARE REPORTING FORM: FACILITIES AND SERVICES Form: UA         Version: 1      5.4.1989	FOR MDC USE ONLY Seq.no: Received: Filed:

Please print carefully or type the requested information. Please complete all blanks in accordance with the instructions provided. Complete one form for each MONICA Reporting Unit (RU) for each year, even if the responses are the same for all Reporting Units.

Instructions

The purpose of this form is to provide information about access of residents of MONICA reporting units to Specialized Services and Facilities for both emergency and elective treatment of coronary heart disease. Separate sections exist for hospital facilities (Emergency Departments; Departments of Cardiology and Cardiovascular Surgery), Ambulance Services and availability of specified cardiac procedures.

While facilities of various kinds may be available to residents of Reporting Units, access to these may in practice be restricted for a number of reasons. These include location (proximity), hours of operation of the service, limited capacity leading to waiting lists or to restrictions on use according to stated criteria. While it would be impractical to attempt to quantify the extent of restriction of services, the coding allows for some distinction to be made between various levels of access.

This form is to be completed once each year and reported to the MONICA Data Centre (MDC), so that it is received there by 31 October each year. The information should be provided for the year immediately preceding the year of reporting the data. For example, the data for 1988 should be reported by 31 October 1989. Please inform the MDC if there is any difficulty in meeting this schedule.

The first year for which the data should be provided is 1980. The forms for the years 1980 - 1988 should be reported to the MDC by 31 October 1989.

This form is to be completed by the MCC Principal Investigator or by someone officially designated to perform this task.

General instructions for completing form

This form can be completed either by typewriter or by hand. The recorded information should be examined carefully for both correctness and legibility. Further, since it may be necessary to photocopy the form, perhaps several times, as a routine part of processing and providing reserve copies it is essential that the recorded information be clear and dark. Hence, please use a dark ribbon if a typewriter is used or a dark ball-point pen if the form is completed by hand.

This form included blank spaces where you are to record the requested information. None of these spaces should be left blank.

If a mistake is made in entering information on the form, please draw a single line through the erroneous entry and provide the correct information in the immediate neighbourhood. If the number of corrections required has made the form difficult to read or perhaps confusing, please re-enter the information on a new copy and send this new copy of the form to the MDC. If this step is required, please check the final copy carefully to make sure that no new errors were made in the process of re-copying the numbers on to the new form.

A completed form with error corrections is enclosed at the end of the specific instructions.

Specific instructions for each item

These instructions should be followed carefully when completing the indicated version of the Medical Care Reporting Form - Facilities and services. Please ensure that the instructions are for the version of the form being completed. Specific instructions are listed by item below:

Item 1

Print or type the official MONICA Collaborating Centre name and code number in the spaces provided. Use the name and code number as they appear in Part I Appendix 2: MONICA Collaborating Centres and Reporting Units.

Item 2

Print or type the official MONICA Reporting Unit name and code number in the spaces provided. Use the name and code number as they appear in Part I Appendix 2. Even if your centre has only one Reporting Unit, please enter the appropriate name and code number here. Do not leave this item blank. If your centre has more than one Reporting Unit, then complete one form for each Reporting Unit and record the appropriate name and code number of the Reporting Unit in this space.

Item 3

Print or type the year for which data are being provided. The data should indicate the situation at the end of the year.

Items 4.1 - 4.3

4. HOSPITAL FACILITIES

For items 4.1 - 4.3, please indicate the availability of the facility using the following codes:

1 = Available within the RU
2 = Available to the population of the RU but facility is not in the RU
3 = Not available to the population of the RU

Item 4.1

This refers to hospital emergency departments with both a medical doctor present continuously 24 hours and equipment necessary for cardio-pulmonary resuscitation, that is, equipment for controlled ventilation, intravenous administration of drugs, and defibrillation.

Item 4.2

This refers to departments staffed by physicians with recognized specialist qualifications in cardiology and which have facilities for advanced diagnostic therapeutic procedures for example angiography, ultrasonography, percutaneous transluminal coronary angioplasty, etc.

Item 4.3

This refers to departments staffed by trained surgeons and containing surgical facilities to perform coronary artery by-pass grafting and similar and more advanced procedures.

Items 5.1 - 5.4

5. AMBULANCE SERVICES

For items 5.1 - 5.4, please indicate the availability of the service using the following codes:

1 = Available to all the population of the RU at all times
2 = Available to all the population but time of operation restricted
3 = Available at all times but only part of population served
4 = Restriction in both time available and area served
5 = Not available

There are two dimensions to the role of ambulance services in the management of acute myocardial infarction. One relates to availability and speed of response. The other is the capacity of the service to provide skilled cardio-pulmonary resuscitation (CPR). The reporting form allows for both aspects of the relevant ambulance services to be described. Information about speed of response can be obtained from the Acute Care record and is therefore not included on this reporting form. (The term "mobile coronary care unit" has been avoided because of possible problems in definition. Instead functional definitions reflecting different levels of ambulance care have been used. Level 4, "Ambulance with equipment for defibrillation and intravenous therapy and staff trained to use this equipment" would in general be equivalent to "mobile Coronary Care Unit".)

Items 6.1 - 6.7

6. SPECIALIZED DIAGNOSTIC AND THERAPEUTIC PROCEDURES

For items 6.1 - 6.12, please indicate the use of the procedure using the following codes:

1 = Routine clinical use, i.e. likely to be used if clinically indicated
2 = Restricted clinical use, i.e. usage intermediate between "routine clinical use" and "use in clinical trials only"
3 = Use in clinical trials only, i.e. used only on experimental basis
4 = Not available to the population of the Reporting Unit
8 = Not relevant (to be used for procedures Other 1-5 only)

The reporting form for this aspect of medical care recognizes that there are phases in the introduction of new technology such that while the technology is theoretically available to the population of the reporting unit, its use may be limited in various ways. Thus distinctions are made on the reporting form between procedures in routine clinical use for all cases in which there are appropriate clinical indications, occasional use, (where there are restrictions due to shortages of appropriately trained staff and/or appropriate facilities), and use for clinical trials only.

Items 6.8 - 6.12

Code 8 for these items. They are reserved for new procedures whose inclusion may be agreed upon from time to time by the Steering Committee.

Item 7

Type or print the name of the person completing this form and the date completed in the spaces provided. Note that this form is to be completed by the Principal Investigator of the MCC or his or her designate.

Item 8

8. Comments or reservations about data provided:

Type or print any reservations or comments about the data provided on this form that may be helpful to the MDC in using the data or preparing summary reports. Attach additional sheets if necessary.

Example of completed form UA version 1 5.4.89