title: Validation of the Provincial Transfer Authorization Centre database: a comprehensive database containing records of all inter-facility patient transfers in the province of Ontario.
abstract: BACKGROUND
  The Provincial Transfer Authorization Centre (PTAC) was established as a part of the emergency response in Ontario, Canada to the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003. Prior to 2003, data relating to inter-facility patient transfers were not collected in a systematic manner. Then, in an emergency setting, a comprehensive database with a complex data collection process was established. For the first time in Ontario, population-based data for patient movement between healthcare facilities for a population of twelve million are available. The PTAC database stores all patient transfer data in a large database. There are few population-based patient transfer databases and the PTAC database is believed to be the largest example to house this novel dataset. A patient transfer database has also never been validated. This paper presents the validation of the PTAC database.
  
  
  METHODS
  A random sample of 100 patient inter-facility transfer records was compared to the corresponding institutional patient records from the sending healthcare facilities. Measures of agreement, including sensitivity, were calculated for the 12 common data variables.
  
  
  RESULTS
  Of the 100 randomly selected patient transfer records, 95 (95%) of the corresponding institutional patient records were located. Data variables in the categories patient demographics, facility identification and timing of transfer and reason and urgency of transfer had strong agreement levels. The 10 most commonly used data variables had accuracy rates that ranged from 85.3% to 100% and error rates ranging from 0 to 12.6%. These same variables had sensitivity values ranging from 0.87 to 1.0.
  
  
  CONCLUSIONS
  The very high level of agreement between institutional patient records and the PTAC data for fields compared in this study supports the validity of the PTAC database. For the first time, a population-based patient transfer database has been established. Although it was created during an emergency situation and data collection is dependent on front-line medical workers, the PTAC data has achieved a high level of validity, perhaps even higher than many purpose built databases created during non-emergency settings.
authors.affiliation: Institute of Medical Science, University of Toronto, Toronto, Canada. victoriar@gmail.com
authors.forename: Victoria A
authors.initials: VA
authors.lastname: Robinson
authors.forename: Russell D
authors.initials: RD
authors.lastname: MacDonald
authors.forename: Doug
authors.initials: D
authors.lastname: Manuel
authors.forename: Vivek
authors.initials: V
authors.lastname: Goel
mesh_terms: D003628:Database Management Systems; D016208:Databases, Factual / Q000592:standards* / Q000706:statistics & numerical data; D003659:Decision Making, Organizational; D004196:Disease Outbreaks; D004630:Emergencies; D005568:Forms and Records Control; D006268:Health Facilities / Q000706:statistics & numerical data*; D006801:Humans; D009864:Ontario / Q000453:epidemiology; D016134:Organizational Policy; D010360:Patient Transfer / Q000706:statistics & numerical data*; D040442:Public Health Informatics / Q000592:standards* / Q000706:statistics & numerical data; D012308:Risk Management; D018571:Sentinel Surveillance; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology*; D014164:Transfer Agreement