Validity and Reliability of Administrative Coded Data for the Identification of Hospital‐Acquired Infections: An Updated Systematic Review with Meta‐Analysis and Meta‐Regression Analysis

González, Olga Redondo; Tenías, José María; Arias, Ángel; Lucendo, Alfredo J.

doi:10.1111/1475-6773.12691

Cited by 29 publications

(30 citation statements)

References 71 publications

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“…Whether surgeons and hospitals can rely on hospital administrative discharge coding for accurate and thorough AE reporting is currently equivocal. 5,6 Overall, our findings are comparable with those from previous studies, wherein reviewers using SAVES and OrthoSAVES recorded more AEs than coders. [7][8][9] In our assessment, we found a significant discrepancy in AE reporting among coders, surgeons and reviewers.…”

Section: What Does It All Mean?supporting

confidence: 89%

Capturing adverse events in elective orthopedic surgery: comparison of administrative, surgeon and reviewer reporting

Garland

Chen

Poitras

et al. 2020

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Capturing adverse events in elective orthopedic surgery: comparison of administrative, surgeon and reviewer reporting E nsuring adverse event (AE) recording is standardized and accurate can bring about improvements in patient care, and may help hospitals track quality-improvement indexes, leading to improved postoperative outcomes and reduced expenditures. However, there is still no one method, tool or protocol that is effective at capturing all AEs. The Spine Adverse Events Severity System (SAVES) has been successfully implemented to record AEs in spine surgery. 1 The Orthopedic Surgical Adverse Events Severity System (OrthoSAVES) is a modification of SAVES that has been used to record AEs in general orthopedic surgery procedures. 2 By using SAVES and OrthoSAVES, we previously showed that independent clinical reviewers reported more AEs than orthopedic surgeons in elective orthopedic surgical patients. 3 Currently, AEs are often captured by hospital administrative discharge abstract coders via a retrospective review of physician directives in medical charts after discharge. This can be inefficient and incomplete owing to the nature of the coding, and can often not be linked back directly to the chart itself. 4 In this discussion we outline our comparison of AE data recorded by orthopedic surgeons and independent clinical reviewers using SAVES and OrthoSAVES against AE data recorded by hospital administrative discharge abstract coders as well as our assessment of the appropriateness of using OrthoSAVES across the general orthopedic surgery population, including spine patients. What We did All elective orthopedic surgical patients operated on by 1 of 6 surgeons (3 spine, 1 hip, 1 knee, and 1 shoulder) over a 10-week period at a tertiary-care teaching hospital were included. Emergency and oncology

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Section: What Does It All Mean?supporting

confidence: 89%

Capturing adverse events in elective orthopedic surgery: comparison of administrative, surgeon and reviewer reporting

Garland

Chen

Poitras

et al. 2020

CJS

View full text Add to dashboard Cite

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“…We manually checked to ensure that each person in our numerator is included in the denominator. Differences in output between routine hospital data and academic studies have been the subject of an extensive literature 16–19…”

Section: Discussionmentioning

confidence: 99%

Randomised controlled trial of a theory-based intervention to prompt front-line staff to take up the seasonal influenza vaccine

et al. 2019

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ObjectiveTo evaluate the effectiveness of reminder letters informed by social normative theory (a type of ‘nudge theory’) on uptake of seasonal influenza vaccination by front-line hospital staff.DesignIndividually randomised controlled trial.SettingA large acute care hospital in England.ParticipantsFront-line staff employed by the hospital (n=7540) were randomly allocated to one of four reminder types in a factorial design.InterventionsThe standard letter included only general information directing the staff to take up the vaccine. A second letter highlighted a type of social norm based on peer comparisons. A third letter highlighted a type of social norm based on an appeal to authority. A fourth letter included a combination of the social norms.Main outcome measureThe proportion of hospital staff vaccinated on-site.ResultsVaccine coverage was 43% (812/1885) in the standard letter group, 43% (818/1885) in the descriptive norms group, 43% (814/1885) in the injunctive norms group and 43% (812/1885) in the combination group. There were no statistically significant effects of either norm or the interaction. The OR for the descriptive norms factor is 1.01 (0.89–1.15) in the absence of the injunctive norms factor and 1.00 (0.88–1.13) in its presence. The OR for the injunctive norms factor is 1.00 (0.88–1.14) in the absence of the descriptive norms factor and 0.99 (0.87–1.12) in its presence.ConclusionsWe find no evidence that the uptake of the seasonal influenza vaccination is affected by reminders using social norms to motivate uptake.

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“…Keeping in mind that it was assessed by central recoders with their own potential biases, the overall quality of coding in our study was moderate, with significant variations between comorbidities (online supplementary table). Other studies for various specific indications such as venous thromboembolism,24 25 arrhythmia,26 stroke,27 hypersensitivity reactions,28 bone metastases,29 glaucoma,30 hip fractures,31 hidradenitis suppurativa,32 acute kidney injury,33 overdoses34 and sepsis19 35 have also found average validity, with significant variations between studies for the same condition 19 27 36. Under the French hospital payment system, patients with comorbidities are associated with higher payments to compensate for the higher burden of care, which may have favoured NPV over PPV and sensitivity over specificity.…”

Section: Discussionmentioning

confidence: 99%

Effect of data validation audit on hospital mortality ranking and pay for performance

et al. 2018

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BackgroundQuality improvement and epidemiology studies often rely on database codes to measure performance or impact of adjusted risk factors, but how validity issues can bias those estimates is seldom quantified.ObjectivesTo evaluate whether and how much interhospital administrative coding variations influence a typical performance measure (adjusted mortality) and potential incentives based on it.DesignNational cross-sectional study comparing hospital mortality ranking and simulated pay-for-performance incentives before/after recoding discharge abstracts using medical records.SettingTwenty-four public and private hospitals located in FranceParticipantsAll inpatient stays from the 78 deadliest diagnosis-related groups over 1 year.InterventionsElixhauser and Charlson comorbidities were derived, and mortality ratios were computed for each hospital. Thirty random stays per hospital were then recoded by two central reviewers and used in a Bayesian hierarchical model to estimate hospital-specific and comorbidity-specific predictive values. Simulations then estimated shifts in adjusted mortality and proportion of incentives that would be unfairly distributed by a typical pay-for-performance programme in this situation.Main outcome measuresPositive and negative predictive values of routine coding of comorbidities in hospital databases, variations in hospitals’ mortality league table and proportion of unfair incentives.ResultsA total of 70 402 hospital discharge abstracts were analysed, of which 715 were recoded from full medical records. Hospital comorbidity-level positive predictive values ranged from 64.4% to 96.4% and negative ones from 88.0% to 99.9%. Using Elixhauser comorbidities for adjustment, 70.3% of hospitals changed position in the mortality league table after correction, which added up to a mean 6.5% (SD 3.6) of a total pay-for-performance budget being allocated to the wrong hospitals. Using Charlson, 61.5% of hospitals changed position, with 7.3% (SD 4.0) budget misallocation.ConclusionsVariations in administrative data coding can bias mortality comparisons and budget allocation across hospitals. Such heterogeneity in data validity may be corrected using a centralised coding strategy from a random sample of observations.

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Validity and Reliability of Administrative Coded Data for the Identification of Hospital‐Acquired Infections: An Updated Systematic Review with Meta‐Analysis and Meta‐Regression Analysis

Cited by 29 publications

References 71 publications

Capturing adverse events in elective orthopedic surgery: comparison of administrative, surgeon and reviewer reporting

Capturing adverse events in elective orthopedic surgery: comparison of administrative, surgeon and reviewer reporting

Randomised controlled trial of a theory-based intervention to prompt front-line staff to take up the seasonal influenza vaccine

Effect of data validation audit on hospital mortality ranking and pay for performance

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