Using administrative data to identify and stage breast cancer cases: Implications for assessing quality of care

Yuen, Elaine J.; Louis, Daniel Z.; Cisbani, Luca; Rabinowitz, Carol; Palma, Rossana De; Maio, Vittorio; Leoni, Maurizio; Grilli, Roberto

doi:10.1177/030089161109700403

Cited by 25 publications

(44 citation statements)

References 17 publications

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“…The Regione Emilia-Romagna (RER) Italian Longitudinal Health Care Utilization Database is a population-based database that includes demographic and utilization data for individuals who were residents of the Emilia-Romagna region at any time from 2002 onward (29,30). The database was built from encounter-based records of an individual's interaction with the health care system using administrative data.…”

Section: Data Sourcementioning

confidence: 99%

“…Currently, the database contains more than 5 million individuals who were residents of the RER at any time during 2002 to 2013, including health care data of residents of the region who have gone outside the region to receive health care services. Prior publications offer additional details of the RER database and its use for health services research (29)(30)(31)(32).…”

Section: Data Sourcementioning

confidence: 99%

See 1 more Smart Citation

Assessing Adverse Events of Postprostatectomy Radiation Therapy for Prostate Cancer: Evaluation of Outcomes in the Regione Emilia-Romagna, Italy

Showalter

Hegarty

Rabinowitz

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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Section: Data Sourcementioning

confidence: 99%

Section: Data Sourcementioning

confidence: 99%

Assessing Adverse Events of Postprostatectomy Radiation Therapy for Prostate Cancer: Evaluation of Outcomes in the Regione Emilia-Romagna, Italy

Showalter

Hegarty

Rabinowitz

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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“…4 Prior studies have also highlighted the limitations of using administrative claims data, especially for determining detailed information. Yuen et al 10 showed that claims data could accurately identify index cases of breast cancer but could not differentiate patients based on cancer stage, which may be an important distinction in evaluating a hospital's quality of care. Additionally, Ko et al 7 evaluated the accuracy of administrative claims data for identifying procedures and findings during colonoscopy.…”

Section: Discussionmentioning

confidence: 99%

Pitfalls of calculating hospital readmission rates based on nonvalidated administrative data sets

Amin¹,

Schairer

et al. 2013

SPI

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Object Administrative databases are increasingly being used to establish benchmarks for quality of care and to compare performance across peer hospitals. As proposals for accountable care organizations are being developed, readmission rates will be increasingly scrutinized. The purpose of the present study was to assess whether the all-cause readmissions rate appropriately reflects the University of California, San Francisco (UCSF) Medical Center hospital's clinically relevant readmission rate for spine surgery patients and to identify predictors of readmission. Methods Data for 5780 consecutive patient encounters managed by 10 spine surgeons at UCSF Medical Center from October 2007 to June 2011 were abstracted from the University HealthSystem Consortium (UHC) using the Clinical Data Base/Resource Manager. Of these 5780 patient encounters, 281 patients (4.9%) were rehospitalized within 30 days of the previous discharge date. The authors performed an independent chart review to determine clinically relevant reasons for readmission and extracted hospital administrative data to calculate direct costs. Univariate logistic regression analysis was used to evaluate possible predictors of readmission. The two-sample t-test was used to examine the difference in direct cost between readmission and nonreadmission cases. Results The main reasons for readmission were infection (39.8%), nonoperative management (13.4%), and planned staged surgery (12.4%). The current all-cause readmission algorithm resulted in an artificially high readmission rate from the clinician's point of view. Based on the authors' manual chart review, 69 cases (25% of the 281 total readmissions) should be excluded because 39 cases (13.9%) were planned staged procedures; 16 cases (5.7%) were unrelated to spine surgery; and 14 surgical cases (5.0%) were cancelled or rescheduled at index admission due to unpredictable reasons. When these 69 cases are excluded, the direct cost of readmission is reduced by 29%. The cost variance is in excess of $3 million. Predictors of readmission were admission status (p < 0.0001), length of stay (p = 0.0001), risk of death (p < 0.0001), and age (p = 0.021). Conclusions The authors' findings identify the potential pitfalls in the calculation of readmission rates from administrative data sets. Benchmarking algorithms for defining hospitals' readmission rates must take into account planned staged surgery and eliminate unrelated reasons for readmission. When this is implemented in the calculation method, the readmission rate will be more accurate. Current tools overestimate the clinically relevant readmission rate and cost.

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“…Results were analyzed according to (a) age groups (≤49, 50–69 and ≥70 years old); (b) stage of disease at diagnosis (using ICD-9-CM coding as a proxy) [16, 17] (Additional file 1: Table S2a); (c) hospital complexity; and (d) comorbidity. Three levels of comorbidity were defined according to Quan’s update of the CCI, as applied to ICD-9-CM [18]: no comorbidity = 0, low comorbidity = from 1 to median truncated to 1, and high comorbidity = more than the median truncated to 1.…”

Section: Methodsmentioning

confidence: 99%

“…Hospital discharge ICD-9 codes were mapped using the American Joint Committee on Cancer (AJCC) stages [17] (Additional file 1: Tables S2a and S2b).…”

Section: Methodsmentioning

confidence: 99%

Trends in the surgical procedures of women with incident breast cancer in Catalonia, Spain, over a 7-year period (2005–2011)

Escribà¹,

Pareja²,

Esteban³

et al. 2014

BMC Res Notes

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BackgroundBreast cancer (BC) is the most frequent cancer in women, accounting for 28% of all tumors among women in Catalonia (Spain). Mastectomy has been replaced over time by breast-conserving surgery (BCS) although not as rapidly as might be expected. The aim of this study was to assess the evolution of surgical procedures in incident BC cases in Catalonia between 2005 and 2011, and to analyze variations based on patient and hospital characteristics.MethodsWe processed data from the Catalonian Health Service’s Acute Hospital Discharge database (HDD) using ASEDAT software (Analysis, Selection and Extraction of Tumor Data) to identify all invasive BC incident cases according to the codes 174.0-174.9 of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) that were attended for the one-year periods in 2005, 2008 and 2011. Patients were classified according to surgical procedures (BCS vs mastectomy, and immediate vs delayed reconstruction), and results were compared among periods according to age, stage, comorbidity and hospital level.ResultsBC surgical procedures were performed in more than 80% of patients. Surgical cases showed a significant increasing trend in the proportion of women aged 50–69 years, more advanced disease stages, higher comorbidity and they were attended in hospitals of less complexity level throughout the study period. Similar pattern was found for patients treated with BCS, which increased significantly from 67.9% in 2005 to 74.0% in 2011.Simple lymph node removal increased significantly (from 48.8% to 71.4% and from 63.6% to 67.8% for 2005 and 2011 in conservative and radical surgery, respectively). A slightly increase in the proportion of mastectomized young women (from 28% in 2005 to 34% in 2011) was detected, due to multiple factors. About 22% of women underwent post-mastectomy breast reconstruction, this being mostly immediate.ConclusionsThe use of HDD linked to the ASEDAT allowed us to evaluate BC surgical treatment in Catalonia. A consolidating increasing trend of BCS was observed in women aged 50–69 years, which corresponds with the pattern in most European countries. Among the mastectomized patients, immediate breast reconstructions have risen significantly over the period 2005–2011.Electronic supplementary materialThe online version of this article (doi:10.1186/1756-0500-7-587) contains supplementary material, which is available to authorized users.

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Using administrative data to identify and stage breast cancer cases: Implications for assessing quality of care

Cited by 25 publications

References 17 publications

Assessing Adverse Events of Postprostatectomy Radiation Therapy for Prostate Cancer: Evaluation of Outcomes in the Regione Emilia-Romagna, Italy

Assessing Adverse Events of Postprostatectomy Radiation Therapy for Prostate Cancer: Evaluation of Outcomes in the Regione Emilia-Romagna, Italy

Pitfalls of calculating hospital readmission rates based on nonvalidated administrative data sets

Trends in the surgical procedures of women with incident breast cancer in Catalonia, Spain, over a 7-year period (2005–2011)

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