Quan Hude, Parsons Gerry A, Ghali William A
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Med Care. 2004 Aug;42(8):801-9. doi: 10.1097/01.mlr.0000132391.59713.0d.
Administrative hospital discharge data are widely used to assess quality of care in patients undergoing certain procedures. However, little is known about the validity of administrative coding of procedure data. We conducted a detailed chart review to evaluate the accuracy and completeness of information on procedures in administrative data.
We randomly selected 1200 hospital separations in the period April 1, 1996, to March 31, 1997, from administrative discharge data of 3 acute adult hospitals in Calgary, Alberta, Canada. Each separation record in administrative data contains up to 10 procedure coding fields. The corresponding medical charts were reviewed for recording presence or absence of procedures. We then determined sensitivity to quantify the accuracy of coding presence of procedures in administrative data when these are present in the chart data (criterion standard).
The agreement between the 2 databases varied greatly across 35 procedures studied. The sensitivity ranged from 0% to 94%. Of 6 major procedures studied, validity of coding was generally good, with 5 procedures having coding sensitivity of 69% and over and only 1 (lysis of peritoneal adhesion) with a low sensitivity of 41%. In contrast, many minor procedures had low sensitivities. Of 29 minor procedures studied, sensitivity was lower than 50% for 15 procedures, between 50% and 79% for 10, and 80% and over for 4.
Validity of information on procedures in administrative discharge data appears to be related to type of procedures. Major procedures that are usually performed in operating rooms are reasonably well-coded. Meanwhile, minor procedures that are routinely performed on wards or in radiology departments are generally undercoded.
医院行政出院数据被广泛用于评估接受特定手术患者的护理质量。然而，对于手术数据行政编码的有效性知之甚少。我们进行了详细的病历审查，以评估行政数据中手术信息的准确性和完整性。
我们从加拿大阿尔伯塔省卡尔加里市3家急性成人医院的行政出院数据中，随机选取了1996年4月1日至1997年3月31日期间的1200例出院病例。行政数据中的每份出院记录包含多达10个手术编码字段。对相应的病历进行审查，以记录是否进行了手术。然后，我们确定敏感度，以量化行政数据中手术编码存在情况的准确性，前提是这些手术在病历数据中存在（标准对照）。
在研究的35项手术中，两个数据库之间的一致性差异很大。敏感度范围为0%至94%。在所研究的6项主要手术中，编码的有效性总体良好，5项手术的编码敏感度达到69%及以上，只有1项（腹膜粘连松解术）敏感度较低，为41%。相比之下，许多小手术的敏感度较低。在研究的29项小手术中，15项手术的敏感度低于50%，10项在50%至79%之间，4项在80%及以上。
行政出院数据中手术信息的有效性似乎与手术类型有关。通常在手术室进行的主要手术编码较为合理。同时，在病房或放射科常规进行的小手术一般编码不足。
