Assessment of the Completeness and Accuracy of Case Ascertainment in the Michigan Stroke Registry

Abstract

The MSR collects information on the quality of acute stroke care as part of the Centers for Disease Control and Prevention Paul Coverdell National Acute Stroke Registry.3 Hospitals were selected through a stratified complex sampling scheme (based on geography, urban versus rural setting, and minority status [black versus white]) to obtain a representative statewide sample of hospitals providing acute stroke care. Human subjects' approval was obtained from the Michigan Department of Community Health institutional review board. Each hospital was responsible for complying with its own institutional review board process before starting data collection. Because of the quality improvement focus of the project, the requirement for individual patient consent was waived. Databases were linked using hospital, age, sex, and admission date. The MIDB was regarded as the gold standard. To assess completeness, we calculated the percent difference between the number of cases entered in the registry relative to the MIDB. To quantify accuracy, we defined sensitivity as the proportion of cases identified in the MIDB that were matched to the registry and positive predictive value as the proportion of cases identified in the registry that were matched to the MIDB. Before data linkage, 4 hospitals were known to be using a case sampling approach. The remaining 26 registry hospitals submitted 21% fewer cases (n=3403) than were found in the MIDB (n=4340). The overall sensitivity was 68.8% (95% confidence interval, 76.4%-79.3%), and positive predictive value was 87.7% (95% confidence interval, 87.4%-89.8%). The sensitivity of case ascertainment was significantly lower in teaching hospitals and primary stroke centers but was higher in the sites that used prospective case ascertainment methods. Conclusions-Among registry hospitals, these results revealed relatively high levels of completeness and accuracy.Matching registry data to hospital discharge data identified hospitals that changed their case ascertainment method to a case sampling approach. This study illustrates the value of monitoring case ascertainment in stroke registries using external data sources. (Circ Cardiovasc Qual Outcomes. 2014;7:757-763.)

Comparison of the validity of stroke diagnoses in a medical quality register and an administrative health register

“…In a 1992 study, a sensitivity of 96% and a PPV of 100% were reported for the Northern Sweden MONICA Registry [14], whereas a recent study found that the Danish Stroke Registry had a sensitivity of 97% and a PPV of 90% [15]. The sensitivity and PPV of the Michigan Stroke Registry were reported to be 68.8 and 87.7%, respectively, in a 2014 study [16]. The results from the present study indicate a lower sensitivity for the Stroke Register than in these two European studies and a higher sensitivity than that found in the US study.…”

Characteristics and Outcomes of Stroke Patients Transferred to Hospitals Participating in the Michigan Coverdell Acute Stroke Registry

“…11,12 Over a 3 year period from 2009 to 2011, a total of 22 382 cases from 36 hospitals were included in the registry. Human subjects' approval was obtained from the Michigan Department of Community Health IRB.…”

Balancing the Optimal and the Feasible: A Practical Guide for Setting Up Patient Registries for the Collection of Real-World Data for Health Care Decision Making Based on Dutch Experiences

“…The number of patient registries will continue to rise in the near future [21]. Their importance was shown in many areas including general practice [22], neurology [23,24], orthopedics [25,26], and oncology [27,28].…”