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临床登记与行政数据中不同病例确定方式对小儿心脏手术资源利用评估的影响

The Impact of Differential Case Ascertainment in Clinical Registry Versus Administrative Data on Assessment of Resource Utilization in Pediatric Heart Surgery.

作者信息

Jantzen David W, He Xia, Jacobs Jeffrey P, Jacobs Marshall L, Gaies Michael G, Hall Matt, Mayer John E, Shah Samir S, Hirsch-Romano Jennifer, Gaynor J William, Peterson Eric D, Pasquali Sara K

机构信息

Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, MI, USA.

Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.

出版信息

World J Pediatr Congenit Heart Surg. 2014 Jul;5(3):398-405. doi: 10.1177/2150135114534274.

Abstract

BACKGROUND

Resource utilization in congenital heart surgery is typically assessed using administrative data sets. Recent analyses have called into question the accuracy of coding of cases in administrative data; however, it is unclear whether miscoding impacts assessment of associated resource use.

METHODS

We merged data coded within both an administrative data set and clinical registry on children undergoing heart surgery (2004-2010) at 33 hospitals. The impact of differences in coding of operations between data sets on reporting of postoperative length of stay (PLOS) and total hospital costs associated with these operations was assessed.

RESULTS

For each of the eight operations of varying complexity evaluated (total n = 57,797), there were differences in coding between data sets, which translated into differences in the reporting of associated resource utilization for the cases coded in either data set. There were statistically significant differences in PLOS and cost for seven of the eight operations, although most PLOS differences were relatively small with the exception of the Norwood operation and truncus repair (differences of two days, P < .001). For cost, there was a >5% difference for three of the eight operations and >10% difference for truncus repair (US$10,570; P < .01). Grouping of operations into categories of similar risk appeared to mitigate many of these differences.

CONCLUSION

Differences in coding of cases in administrative versus clinical registry data can translate into differences in assessment of associated PLOS and cost for certain operations. This may be minimized through evaluating larger groups of operations when using administrative data or using clinical registry data to accurately identify operations of interest.

摘要

背景

先天性心脏病手术中的资源利用情况通常使用行政数据集进行评估。最近的分析对行政数据中病例编码的准确性提出了质疑;然而,尚不清楚编码错误是否会影响对相关资源使用情况的评估。

方法

我们将33家医院接受心脏手术的儿童(2004 - 2010年)的行政数据集和临床登记处编码的数据进行了合并。评估了数据集之间手术编码差异对术后住院时间(PLOS)报告以及与这些手术相关的总住院费用的影响。

结果

对于评估的八种不同复杂程度的手术中的每一种(总计n = 57,797),数据集之间的编码存在差异,这转化为在任一数据集中编码的病例相关资源利用报告的差异。八种手术中有七种在PLOS和费用方面存在统计学显著差异,尽管除了诺伍德手术和动脉干修复手术外,大多数PLOS差异相对较小(相差两天,P <.001)。对于费用,八种手术中有三种差异超过5%,动脉干修复手术差异超过10%(10,570美元;P <.01)。将手术分组为风险相似的类别似乎减轻了许多这些差异。

结论

行政数据与临床登记数据中病例编码的差异可转化为某些手术相关PLOS和费用评估的差异。在使用行政数据时通过评估更大组的手术或使用临床登记数据准确识别感兴趣的手术,这种情况可能会最小化。

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