Accuracy of hospital report cards based on administrative data
Accuracy of hospital report cards based on administrative data
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DOI：
10.1111/j.1475-6773.2006.00554.x
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发表时间：
2006-08-01
影响因子：
3.4
通讯作者：
Mukamel, Dana B.
中科院分区：
文献类型：
--
作者：
Glance, Laurent G.;Dick, Andrew W.;Mukamel, Dana B.
上下文。许多公开的健康质量成绩单都是基于行政数据。行政数据中的ICD-9-CM代码没有日期戳，以区分入院时存在的医疗状况和入院后发生的并发症。将并发症视为预先存在的疾病会给表现不佳的医院带来并发症，并可能导致一些提供低质量医疗服务的医院被错误地归类为中等或高绩效医院。确定基于管理数据的医院质量评估是否受管理数据中包含的入院时病情(CPAA)修饰符作为日期戳指示器的影响。根据1998至2000年间收治的648,866名住院患者进行的回顾性队列研究，这些患者包括冠状动脉旁路移植术(CABG)、冠状动脉成形术(PTCA)、颈动脉内膜切除术(CEA)、腹主动脉瘤(AAA)修复术、全髋关节置换(THR)、急性心肌梗死(AMI)和中风。分层Logistic回归被用来创建单独的特定条件的风险调整模型。对于每个研究人群，只使用入院时存在的二次诊断建立一个模型，基于CPAA修饰符：“日期戳”模型。第二个模型是使用所有二次诊断构建的，忽略了CPAA修改器中存在的信息：“无日期戳模型”。分别使用“日期戳”和“无日期戳”风险调整模型对医院质量进行评估。有40%的CABG医院、33%的PTCA医院、40%的THR医院和33%的急性心肌梗死医院通过“日期戳”模型被确定为低绩效医院，而不是按“无日期戳”模型被归类为低绩效医院。有50%的CABG医院、33%的PTCA医院、50%的CEA医院和36%的急性心肌梗死医院通过“无日期戳”模型识别为低性能医院，而不是通过“日期戳”模型识别为低性能医院。纳入CPAA修饰物对AAA修复、卒中和CEA的医院质量评估影响较小。这项研究支持这样的假设，即使用没有日期戳信息的常规管理数据来构建医院质量报告卡-可能会导致对医院质量离群值的错误识别。然而，需要进一步验证CPAA修改器，然后才能将带有日期戳的管理数据用作健康质量报告卡的基础。
Context. Many of the publicly available health quality report cards are based on administrative data. ICD-9-CM codes in administrative data are not date stamped to distinguish between medical conditions present at the time of hospital admission and complications, which occur after hospital admission. Treating complications as preexisting conditions gives poor-performing hospitals "credit'' for their complications and may cause some hospitals that are delivering low-quality care to be misclassified as average- or high-performing hospitals.Objective. To determine whether hospital quality assessment based on administrative data is impacted by the inclusion of condition present at admission ( CPAA) modifiers in administrative data as a date stamp indicator.Design, Setting, and Patients. Retrospective cohort study based on 648,866 inpatient admissions between 1998 and 2000 for coronary artery bypass graft (CABG) surgery, coronary angioplasty ( PTCA), carotid endarterectomy (CEA), abdominal aortic aneurysm ( AAA) repair, total hip replacement (THR), acute MI ( AMI), and stroke using the California State Inpatient Database which includes CPAA modifiers. Hierarchical logistic regression was used to create separate condition-specific risk adjustment models. For each study population, one model was constructed using only secondary diagnoses present at admission based on the CPAA modifier: "date stamp'' model. The second model was constructed using all secondary diagnoses, ignoring the information present in the CPAA modifier: the "no date stamp model.'' Hospital quality was assessed separately using the "date stamp'' and the "no date stamp'' risk-adjustment models.Results. Forty percent of the CABG hospitals, 33 percent of the PTCA hospitals, 40 percent of the THR hospitals, and 33 percent of the AMI hospitals identified as low-performance hospitals by the "date stamp'' models were not classified as low-performance hospitals by the "no date stamp'' models. Fifty percent of the CABG hospitals, 33 percent of the PTCA hospitals, 50 percent of the CEA hospitals, and 36 percent of the AMI hospitals identified as low-performance hospitals by the "no date stamp'' models were not identified as low-performance hospitals by the " date stamp'' models. The inclusion of the CPAA modifier had a minor impact on hospital quality assessment for AAA repair, stroke, and CEA.Conclusion. This study supports the hypothesis that the use of routine administrative data without date stamp information to construct hospital quality report cards-may result in the mis-identification of hospital quality outliers. However, the CPAA modifier will need to be further validated before date stamped administrative data can be used as the basis for health quality report cards.