Administrative Versus Clinical Data for Coronary Artery Bypass Graft Surgery Report Cards

Parker, Joseph P.; Li, Zhongmin; Damberg, Cheryl L.; Danielsen, Beate; Carlisle, D

doi:10.1097/01.mlr.0000215815.70506.b6

Cited by 57 publications

(41 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nevertheless, for analysis of hospital volume influence in specific conditions, we choose DRG, for which coding was expected to be robust, as a way to limit this bias. In addition, earlier work showed that administrative databases performed relatively well compared to clinical databases, being capable of identifying outlying hospitals with slight [30] or major [31] differences. Finally, our findings may not apply to other countries.…”

Section: Discussionmentioning

confidence: 99%

Procedure volume is one determinant of centre effect in mechanically ventilated patients

Darmon¹,

Azoulay²,

Fulgencio³

et al. 2010

Eur Respir J

View full text Add to dashboard Cite

Survival rates vary significantly between intensive care units, most notably in patients requiring mechanical ventilation (MV). The present study sought to estimate the effect of hospital MV volume on hospital mortality.We included 179,197 consecutive patients who received mechanical ventilation in 294 hospitals. Multivariate logistic regression models with random intercepts were used to estimate the effect of annual MV volume in each hospital, adjusting for differences in severity of illness and case mix.Median annual MV volume was 162 patients (interquartile range 99-282). Hospital mortality in MV patients was 31.4% overall, 40.8% in the lowest annual volume quartile and 28.2% in the highest quartile. After adjustment for severity of illness, age, diagnosis and organ failure, higher MV volume was associated with significantly lower hospital mortality among MV patients (OR 0.9985 per 10 additional patients, 95% CI 0.9978-0.9992; p50.0001). A significant centre effect on hospital mortality persisted after adjustment for volume effect (p,0.0001).Our study demonstrated higher hospital MV volume to be independently associated with increased survival among MV patients. Significant differences in outcomes persisted between centres after adjustment for hospital MV volume, supporting a role for other significant determinants of the centre effect.

show abstract

Section: Discussionmentioning

confidence: 99%

Procedure volume is one determinant of centre effect in mechanically ventilated patients

Darmon¹,

Azoulay²,

Fulgencio³

et al. 2010

Eur Respir J

View full text Add to dashboard Cite

show abstract

“…The coding comorbidity algorithm for the index event allowed analysis only of patient factors on admission or close to admission as case mix predictors, excluding events potentially on the causal pathway between hospital and outcome. Even if detailed clinical data on patient risk factors collected from chart reviews is considered the ''gold standard'', several comparative studies demonstrated a good correlation between risk-adjusted outcomes obtained from clinical data versus administrative datasets [25,26]. The empirical approach we used to define severity and adjust for it allowed the identification and control of confounding factors according to their specific relationship with the outcome in the population.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, administrative data did not allow insight into clinical or physiological factors. However, important clinical determinants of outcomes after COPD were found to explain only 15% of the variability in mortality across institutions [12], and we trust the known good performance of administrative data for studies on outcomes [26,27]. Residual confounding bias for unmeasured factors should be considered as a potential limitation of the study [30].…”

Section: Discussionmentioning

confidence: 99%

Profiling hospital performance to monitor the quality of care: the case of COPD

Agabiti¹,

Belleudi²,

Davoli³

et al. 2009

Eur Respir J

View full text Add to dashboard Cite

Comparative outcomes data are widely used to monitor quality of care in the cardiovascular area; little is available in the respiratory field. We applied validated methods to compare hospital outcomes for chronic obstructive pulmonary disease (COPD) exacerbation.From the hospital information system, we selected all hospital admissions for COPD exacerbation in Rome (for 2001Rome (for -2005. Vital status within 30 days was obtained from the municipality mortality register. Each hospital was compared to a pool of hospitals with the lowest adjusted mortality rate (the benchmark). Age, sex and several potential clinical predictors were covariates in logistic regression analysis.12,756 exacerbated COPD patients were analysed (mean age 74 yrs, 71% males). Diabetes, hypertension, ischaemic heart disease, heart failure and arrhythmia were the most common coexisting conditions. The average crude mortality in the benchmark group was 3.8%; in the remaining population it was 7.5% (range 5.2-17.2%). In comparison with the benchmark, the relative risk of 30-day mortality varied widely across the hospitals (range 1.5-5.9%).A large variability in 30-day mortality after COPD exacerbation exists even considering patients' characteristics. Although these results do not detect mechanisms related to worse outcomes, they may be useful to stimulate providers to revision and improvement of COPD care management.

show abstract

“…This is currently the practice in at least 2 states, New York and California. 4,52 • Outlier determination. Several studies have shown differences in the outliers determined using administrative versus clinical data, even when the administrative databases were relatively sophisticated.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Clinical and Administrative Data Sources for Hospital Coronary Artery Bypass Graft Surgery Report Cards

et al. 2007

View full text Add to dashboard Cite

Background-Regardless of statistical methodology, public performance report cards must use the highest-quality validated data, preferably from a prospectively maintained clinical database. Using logistic regression and hierarchical models, we compared hospital cardiac surgery profiling results based on clinical data with those derived from contemporaneous administrative data. Methods and Results-Fiscal year 2003 isolated coronary artery bypass grafting surgery results based on an audited and validated Massachusetts clinical registry were compared with those derived from a contemporaneous state administrative database, the latter using the inclusion/exclusion criteria and risk model of the Agency for Healthcare Research and Quality. There was a 27.4% disparity in isolated coronary artery bypass grafting surgery volume (4440 clinical, 5657 administrative), a 0.83% difference in observed in-hospital mortality (2.05% versus 2.88%), corresponding differences in risk-adjusted mortality calculated by various statistical methodologies, and 1 hospital classified as an outlier only with the administrative data-based approach. The discrepancies in volumes and risk-adjusted mortality were most notable for higher-volume programs that presumably perform a higher proportion of combined procedures that were misclassified as isolated coronary artery bypass grafting surgery in the administrative cohort. Subsequent analyses of a patient cohort common to both databases revealed the smoothing effect of hierarchical models, a 9% relative difference in mortality (2.21% versus 2.03%) resulting from nonstandardized mortality end points, and 1 hospital classified as an outlier using logistic regression but not using hierarchical regression. Conclusions-Cardiac surgery report cards using administrative data are problematic compared with those derived from audited and validated clinical data, primarily because of case misclassification and nonstandardized end points.

show abstract

Administrative Versus Clinical Data for Coronary Artery Bypass Graft Surgery Report Cards

Cited by 57 publications

References 19 publications

Procedure volume is one determinant of centre effect in mechanically ventilated patients

Procedure volume is one determinant of centre effect in mechanically ventilated patients

Profiling hospital performance to monitor the quality of care: the case of COPD

Comparison of Clinical and Administrative Data Sources for Hospital Coronary Artery Bypass Graft Surgery Report Cards

Contact Info

Product

Resources

About