Administrative Hospitalization Database Validation of Cardiac Procedure Codes

Lee, Douglas S.; Stitt, Audra; Wang, Xuesong; Yu, Jeffery S.; Gurevich, Yana; Kingsbury, Kori; Austin, Peter C.; Tu, Jack V.

doi:10.1097/mlr.0b013e3182329778

Cited by 101 publications

(52 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite this shortcoming, our capture of covariate information was based on validated algorithms within high‐quality administrative databases, which were complemented by detailed patient‐level data from the robust CorHealth Ontario provincial registry. Our CABG cohort was well defined using valid procedural codes that were cross validated with the CorHealth Ontario registry records,48 and our ascertainment of mortality was based on province‐wide vital statistics data, ensuring complete follow‐up for all patients. Third, the binary Johns Hopkins ACG frailty‐defining diagnoses indicator did not allow for outcome assessment at different levels of frailty.…”

Section: Discussionmentioning

confidence: 99%

Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Tran

Dupuis

et al. 2018

JAHA

Self Cite

104

View full text Add to dashboard Cite

BackgroundFrailty is increasing in prevalence and poses a formidable challenge for clinicians. The cardiac surgery literature consists primarily of small single‐center studies with limited follow‐up, and the epidemiological features of frailty remain to be elucidated in long‐term follow‐up.Methods and ResultsWe conducted a population‐based, retrospective, cohort study in Ontario, Canada, between 2008 and 2015. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty indicator (a multidimensional instrument validated for research using administrative data). The primary outcome was mortality. Mortality rates were calculated using the Kaplan‐Meier method. The hazard of death was assessed using a multivariable Cox proportional hazard model. Of 40 083 patients, 8803 (22%) were frail. At 4±2 years of follow‐up, age‐ and sex‐standardized mortality rate per 1000 person‐years was higher in frail (33; 95% confidence interval, 29–36) compared with nonfrail (22; 95% confidence interval, 19–24) patients. Frailty was associated with an increased risk of long‐term mortality (adjusted hazard ratio, 1.20; 95% confidence interval, 1.12–1.28) and greater differences in the survival of patients between 40 and 74 years of age than in those who were ≥85 years old.ConclusionsFrailty was present in a large proportion of patients undergoing coronary artery bypass grafting and was independently associated with long‐term mortality. The adjusted risk of frailty‐related death was inversely proportional to age. Our findings highlight the need for more comprehensive preoperative risk stratification models to assist with optimal selection of operative candidates. In addition, we identified the <75 years age group as a potential target for comprehensive preoperative optimization programs, such as cardiac prehabilitation, nutritional augmentation, and psychosocial support.

show abstract

Section: Discussionmentioning

confidence: 99%

Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Tran

Dupuis

et al. 2018

JAHA

Self Cite

104

View full text Add to dashboard Cite

show abstract

“…We used a look‐back window of 20 years (back to January 1, 1992) to exclude patients with prior cardiovascular disease. Previous cardiovascular disease was defined by prior hospitalization for acute myocardial infarction, stroke, congestive heart failure, percutaneous coronary intervention, and coronary artery bypass grafting, using previously validated algorithms 13, 14, 15, 16, 17, 18, 19. We also used a 1‐year washout period such that patients who had 1 of the 4 noninvasive diagnostic tests during the 2011 calendar year were excluded.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Anatomic and Clinical Outcomes in Patients Undergoing Alternative Initial Noninvasive Testing Strategies for the Diagnosis of Stable Coronary Artery Disease

Roifman

Wijeysundera

Austin

et al. 2017

JAHA

Self Cite

View full text Add to dashboard Cite

BackgroundThe optimal initial noninvasive diagnostic testing strategy for stable coronary artery disease (CAD) is unknown. Although American guidelines recommend an exercise stress test as the first‐line test, European guidelines suggest that stress imaging (myocardial perfusion imaging or stress echocardiography) or coronary computed tomography angiography may be preferable. Understanding the relationship between the initial strategy and downstream yield of obstructive CAD and major adverse cardiac events may provide insight as to the optimal strategy.Methods and ResultsWe conducted a population‐based retrospective cohort study of adults in Ontario, Canada, using health administrative and clinical data. The relationship between the initial testing strategy and obstructive CAD on invasive angiography was examined. Patients were then followed from their angiogram onward to determine whether they developed a composite end point of major adverse cardiac events. After adjusting for covariates, patients with initial myocardial perfusion imaging (odds ratio: 0.92; 95% confidence interval, 0.85, 1.00), coronary computed tomography angiography (odds ratio: 1.51; 95% confidence interval, 0.91, 2.49), or stress echo (odds ratio: 0.95; 95% confidence interval, 0.84, 1.08) did not a have significantly different yield of obstructive CAD compared with those with an initial exercise stress test. Furthermore, there was no significant difference in downstream major adverse cardiac events after invasive angiography among the 4 initial testing strategies after adjusting for clinically relevant covariates.ConclusionsOur study found no evidence to suggest significant differences in either yield of obstructive CAD or downstream major adverse cardiac events in patients undergoing an initial noninvasive testing strategy with stress or anatomical imaging compared with those undergoing an initial exercise stress test.

show abstract

“…CIHI diagnostic code sensitivity ranges from 46%-76%, specificity is 99%, positive predictive value 94%-98% and negative predictive value 55%. 20,28 …”

Section: Data Sourcesmentioning

confidence: 99%

“…19 The Ontario Health Insurance Plan (OHIP) database contains information as of 1991 on claims billed for physician and laboratory services, including endoscopic procedures. OHIP database diagnostic codes have been shown to have a high positive predictive rate (> 90%) [20][21][22][23] and high specificity (> 85%) [24][25][26][27] but somewhat limited sensitivity (35%-85%). [24][25][26][27] The Registered Persons Database is a roster of OHIP beneficiaries and maintains information on age, sex, postal code and vital statistics for all Ontarians with a valid OHIP number.…”

Section: Data Sourcesmentioning

confidence: 99%

“…However, OHIP billing data have been shown to be highly accurate for other procedures. [20][21][22][23][24][25][26][27] We attempted to maximize the specificity of the endoscopic ultrasonography codes by excluding procedures not performed by physicians in related health care specialties; however, future validation studies are needed. Second, it is possible that endoscopic ultrasound procedures performed in the earlier years of this cohort were not captured by OHIP billing codes; however, as the study period was designed to begin 2 years after codes for endoscopic ultrasonography were introduced in Ontario, we feel that this is unlikely.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

See 1 more Smart Citation

Regional differences in use of endoscopic ultrasonography in Ontario: a population-based retrospective cohort study

et al. 2017

View full text Add to dashboard Cite

Background: Endoscopic ultrasonography is a safe and accurate modality for evaluating and managing hepatobiliary and gastrointestinal conditions (malignant and nonmalignant); its use is increasing. The aim of this study was to describe regional trends in the use of endoscopic ultrasonography in Ontario. Methods:We conducted a population-based retrospective cohort study using health administrative databases. We identified all patients who underwent an endoscopic ultrasound procedure in Ontario from 2003 to 2011 using physician billing data. Patient, physician and institution characteristics were examined. The primary outcome was use of endoscopic ultrasonography. Results:We identified 9076 endoscopic ultrasound procedures performed in 8001 patients (3858 women [48.2%]; median patient age at first procedure 59 years). A total of 3066 procedures (33.8%) involved fine-needle aspiration. Use of endoscopic ultrasonography increased 17-fold over the study period. In 2011, people living in the health region with the highest rate of use of endoscopic ultrasonography were more than 4 times more likely to undergo the procedure than people living in the health region with the lowest rate of use (standardized rate 61.6 v. 12.9 per 100 000). About 7 in 10 endoscopic ultrasound procedures were performed in an academic institution or regional cancer centre. All 17 endoscopists performing endoscopic ultrasonography during the study period practised in urban areas.Interpretation: Although the use of endoscopic ultrasonography increased over time in Ontario, there were marked regional differences in use. Provincial needs-and evidence-based initiatives may be needed to narrow the regional gaps in provision of endoscopic ultrasound services in the province. AbstractResearch Research CMAJ OPEN E438CMAJ OPEN, 5(2)

show abstract

Administrative Hospitalization Database Validation of Cardiac Procedure Codes

Abstract: Using a clinical registry as the gold standard, the coding accuracy of common cardiac procedures in the CIHI administrative database was high.

Cited by 101 publications

References 9 publications

Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Comparison of Anatomic and Clinical Outcomes in Patients Undergoing Alternative Initial Noninvasive Testing Strategies for the Diagnosis of Stable Coronary Artery Disease

Regional differences in use of endoscopic ultrasonography in Ontario: a population-based retrospective cohort study

Contact Info

Product

Resources

About