TITLE

The Hazards of Using Administrative Data to Measure Surgical Quality

AUTHOR(S)
Fry, Donald E.; Pine, Michael B.; Jordan, Harmon S.; Hoaglin, David C.; Jones, Barbara; Meimban, Roger
PUB. DATE
November 2006
SOURCE
American Surgeon;Nov2006, Vol. 72 Issue 11, p1031
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Administrative claims data have been used to measure risk-adjusted clinical outcomes of hospitalized patients. These data have been criticized because they cannot differentiate risk factors present at the time of admission from complications that occur during hospitalization. This paper illustrates how valid riskadjustment can be achieved by enhancing administrative data with a present-on-admission code, admission laboratory data, and admission vital signs. Examples are presented for inpatient mortality rates following craniotomy and rates of postoperative sepsis after elective surgical procedures. Administrative claims data alone yielded a risk-adjustment model with 10 variables and a C-statistic of 0.891 for mortality after craniotomy, and a model with 18 variables and a C-statistic of 0.827 for postoperative sepsis. In contrast, the combination of administrative data and clinical data abstracted from medical records increased the number of variables in the craniotomy model to 21 with a C-statistic of 0.923, and the number of variables in the postoperative sepsis model to 29 with a C-statistic of 0.858. Use of only administrative data resulted in unacceptable amounts of systematic bias in 24 per cent of hospitals for craniotomy and 19 per cent of hospitals for postoperative sepsis. Addition of a present-on-admission code, laboratory data, and vital signs reduced the percentage of hospitals with unacceptable bias to two percent both for craniotomy and for postoperative sepsis. These illustrations demonstrate suboptimal risk stratification with administrative claims data only, but show that present-on-admission coding combined with readily available laboratory data and vital signs can support accurate risk-adjustment for the assessment of surgical outcomes.
ACCESSION #
23041967

 

Related Articles

  • Is there an association between deprivation and pre-operative disease severity? A cross-sectional study of patient-reported health status. SOLJAK, MICHAEL; BROWNE, JOHN; LEWSEY, JAMES; BLACK, NICK // International Journal for Quality in Health Care;Oct2009, Vol. 21 Issue 5, p311 

    Objective: Differences in access to elective surgery may contribute to socioeconomic differences in health. We studied the associations between pre-operative health status (as an indicator of clinical need) and deprivation.

  • Care in U.S. Hospitals – The Hospital Quality Alliance Program. Jha, Ashish K.; Li, Zhonghe; Orav, E. John; Epstein, Arnold M. // New England Journal of Medicine;7/21/2005, Vol. 353 Issue 3, p265 

    Background: The Hospital Quality Alliance (HQA) is the first initiative that routinely reports data on hospitals' performance nationally. Heretofore, such data have been unavailable. Methods: We used data collected by the Centers for Medicare and Medicaid Services on 10 indicators of the quality...

  • Science of health care delivery: Re: Venous thromboembolism in hospitalized patients: An updated analysis of missed opportunities for thromboprophylaxis at a university affiliated tertiary care center. McBane, Robert // Vascular Medicine;Oct2014, Vol. 19 Issue 5, p392 

    The author reflects on the incidence of venous thromboembolism (VTE) among hospitalized patients compared with community residents. Topics discussed include the science of health care delivery for the improvement of quality, outcomes, and societal health care, the implementation of proper VTE...

  • Use of Interpreters by Physicians. López, Lenny; López, Lenny // JGIM: Journal of General Internal Medicine;Nov2015, Vol. 30 Issue 11, p1590 

    A response from one of the authors of the article "Use of interpreters by physicians for hospitalized limited English proficient patients and its impact on patient outcomes" that was published in the previous issue is presented.

  • We Value Your Opinion, Please Tell Us About Your Experience. Ellsworth, Marvin // Executive Housekeeping Today;Nov2012, Vol. 34 Issue 11, p10 

    The article discusses the prevalence of customer satisfaction surveys in the U.S. It informs that these surveys by the companies encourage their customers to complete a short customer satisfaction survey, as they want to retain their customers in today's competitive business world. It informs...

  • HOSPITALS PERFORM BETTER, BUT STILL NEED IMPROVEMENT.  // RN;Oct2007, Vol. 70 Issue 10, p14 

    The article reports on the quality of hospital care in the U.S. Based on performance data from hospitals accredited by the Joint Commission, the quality of care provided for patient suffering from heart diseases and pneumonia has improved. A separate study revealed that patient safety incidents...

  • Patient experiences of inpatient hospital care: a department matter and a hospital matter. Krol, Maarten W.; De Boer, Dolf; Sixma, Herman; Van Der Hoek, Lucas; Rademakers, Jany J.D.J.M.; Delnoij, Diana M. // International Journal for Quality in Health Care;Feb2015, Vol. 27 Issue 1, p17 

    Objective To examine the added value of measuring and possibly presenting patient experiences at the department level, in addition to the hospital level, and to explore the possibility that patient experiences differ according to the ‘type’ of hospital department. Design Secondary...

  • The Challenge of Small Numbers to the Contemporary Excellence of Elective Specialty Surgery. Polk, Hiram C. // American Surgeon;Nov2006, Vol. 72 Issue 11, p1043 

    The article emphasizes the value of elective surgery as a marker for the quality of medical practice. It defines elective operation as a surgery that is often associated with an outcome that can be determined in a few weeks or months at most, with the patient returning to his or her desired...

  • Influence of hospital surgical volume of radical prostatectomy on quality of perioperative care. Nojiri, Yoshikatsu; Okamura, Kikuo; Tanaka, Yoshinori; Yanaihara, Hitoshi; Sassa, Naoto; Hattori, Ryohei; Machida, Jiroh; Hashine, Katsuyoshi; Matsuda, Tadashi; Arai, Yoichi; Naito, Seiji; Hasegawa, Tomonori // International Journal of Clinical Oncology;Oct2013, Vol. 18 Issue 5, p898 

    Purpose: We investigated the relationships between hospital surgical volume, surgical outcome, care plans indicated in critical pathways and actual perioperative care using data from a nationwide survey for radical prostatectomy. Materials and methods: In this study, urologists from 155...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics