HOW ACCURATE ARE HOSPITAL DISCHARGE DATA FOR EVALUATING EFFECTIVENESS OF CARE
HOW ACCURATE ARE HOSPITAL DISCHARGE DATA FOR EVALUATING EFFECTIVENESS OF CARE
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DOI：
10.1097/00005650-199308000-00005
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发表时间：
1993-08-01
期刊：
影响因子：
3
通讯作者：
WINTFELD, N
中科院分区：
文献类型：
--
作者：
GREEN, J;WINTFELD, N
对护理数据质量的需求导致了医院和医生调整后死亡率的公布。然而，用于这一目的的数据库的准确性是值得怀疑的，这增加了面向消费者的供应商简介可能会产生误导的可能性。分层随机抽样的出院摘要记录的医疗保险年龄住院病人在加州由国家的健康数据机构审计。对审计结果进行了分析，以确定编码错误对分配给医院的预期死亡率的影响，作为年度医疗保险医院死亡率报告中的风险调整措施。医疗保险老年患者的出院摘要包含许多用于计算预期死亡率的编码风险因素错误。合并症和从疗养院转移严重少报，“入院的紧迫性”往往被错误编码。医院在错误率方面存在差异（P <0.0001）;这些不同程度的错误编码导致的测量错误的大小范围为0.2至2.2预期30天死亡/100入院（第10百分位数与第90百分位数）。详细了解索赔数据的局限性可以帮助分析师最大限度地减少编码错误的影响。除此之外，还需要加强成果研究所用数据的质量控制。
Demand for quality of care data has led to publication of adjusted mortality rates of hospitals and physicians. Yet the accuracy of databases used for this purpose is questionable, raising the possibility that consumer-oriented profiles of providers could be misleading. A stratified random sample of discharge abstract records of Medicare-aged patients hospitalized in California were audited by the state's health data agency. The results of the audit were analyzed to determine the effect that coding errors have on expected death rates assigned to hospitals as risk-adjustment measures in the annual Medicare hospital mortality report. Discharge abstracts of Medicare-aged patients contained many errors among coded risk factors used to calculate expected death rates. Comorbidities and transfers from nursing homes were seriously underreported and 'urgency of admission' was often miscoded. Hospitals differed with respect to error rates (P < .0001); these varying levels of miscoding caused measurement errors that ranged in size from 0.2 to 2.2 expected 30-day deaths per 100 admissions (10th vs. 90th percentile). Detailed knowledge of the limitations of claims data can help analysts minimize the impact of coding error. Beyond this, quality control of data used for outcomes research needs strengthening.