BackgroundBecause the collection of mental health information through interviews is expensive and time consuming, interest in using population-based administrative health data to conduct research on depression has increased. However, there is concern that misclassification of disease diagnosis in the underlying data might bias the results. Our objective was to determine the validity of International Classification of Disease (ICD)-9 and ICD-10 administrative health data case definitions for depression using review of family physician (FP) charts as the reference standard.MethodsTrained chart reviewers reviewed 3362 randomly selected charts from years 2001 and 2004 at 64 FP clinics in Alberta (AB) and British Columbia (BC), Canada. Depression was defined as presence of either: 1) documentation of major depressive episode, or 2) documentation of specific antidepressant medication prescription plus recorded depressed mood. The charts were linked to administrative data (hospital discharge abstracts and physician claims data) using personal health numbers. Validity indices were estimated for six administrative data definitions of depression using three years of administrative data.ResultsDepression prevalence by chart review was 15.9–19.2% depending on year, region, and province. An ICD administrative data definition of ‘2 depression claims with depression ICD codes within a one-year window OR 1 discharge abstract data (DAD) depression diagnosis’ had the highest overall validity, with estimates being 61.4% for sensitivity, 94.3% for specificity, 69.7% for positive predictive value, and 92.0% for negative predictive value. Stratification of the validity parameters for this case definition showed that sensitivity was fairly consistent across groups, however the positive predictive value was significantly higher in 2004 data compared to 2001 data (78.8 and 59.6%, respectively), and in AB data compared to BC data (79.8 and 61.7%, respectively).ConclusionsSensitivity of the case definition is often moderate, and specificity is often high, possibly due to undercoding of depression. Limitations to this study include the use of FP charts data as the reference standard, given the potential for missed or incorrect depression diagnoses. These results suggest that that administrative data can be used as a source of information for both research and surveillance purposes, while remaining aware of these limitations.

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ObjectiveTo assess if the Agency for Healthcare Research and Quality  patient safety indictors (PSIs) could be used for case findings in the International Classification of Disease 10th revision (ICD-10) hospital discharge abstract data.DesignWe identified and randomly selected 490 patients with a foreign body left during a procedure (PSI 5—foreign body), selected infections (IV site) due to medical care (PSI 7—infection), postoperative pulmonary embolism (PE) or deep vein thrombosis (DVT; PSI 12—PE/DVT), postoperative sepsis (PSI 13—sepsis)and accidental puncture or laceration (PSI 15—laceration) among patients discharged from three adult acute care hospitals in Calgary, Canada in 2007 and 2008. Their charts were reviewed for determining the presence of PSIs and used as the reference standard, positive predictive value (PPV) statistics were calculated to determine the proportion of positives in the administrative data representing ‘true positives’.ResultsThe PPV for PSI 5—foreign body was 62.5% (95% CI 35.4% to 84.8%), PSI 7—infection was 79.1% (67.4% to 88.1%), PSI 12—PE/DVT was 89.5% (66.9% to 98.7%), PSI 13—sepsis was 12.5% (1.6% to 38.4%) and PSI 15—laceration was 86.4% (75.0% to 94.0%) after excluding those who presented to the hospital with the condition.ConclusionsSeveral PSIs had high PPV in the ICD administrative data and are thus powerful tools for true positive case finding. The tools could be used to identify potential cases from the large volume of admissions for verification through chart reviews. In contrast, their sensitivity has not been well characterised and users of PSIs should be cautious if using them for ‘quality of care reporting’ presenting the rate of PSIs because under-coded data would generate falsely low PSI rates.

Background: It is essential that clinical documentation and clinical coding be of high quality for the production of healthcare data. Objective: This study assessed qualitatively the strengths and barriers regarding clinical coding quality from the perspective of health information managers. Method: Ten health information managers and clinical coding quality coordinators who oversee clinical coders (CCs) were identified and recruited from nine provinces across Canada. Semi-structured interviews were conducted, which included questions on data quality, costs of clinical coding, education for health information management, suggestions for quality improvement and barriers to quality improvement. Interviews were recorded, transcribed and analysed using directed content analysis and informed by institutional ethnography. Results: Common barriers to clinical coding quality included incomplete and unorganised chart documentation, and lack of communication with physicians for clarification. Further, clinical coding quality suffered as a result of limited resources (e.g. staffing and budget) being available to health information management departments. Managers unanimously reported that clinical coding quality improvements can be made by (i) offering interactive training programmes to CCs and (ii) streamlining sources of information from charts. Conclusion: Although clinical coding quality is generally regarded as high across Canada, clinical coding managers perceived quality to be limited by incomplete and inconsistent chart documentation, and increasing expectations for data collection without equal resources allocated to clinical coding professionals. Implications: This study presents novel evidence for clinical coding quality improvement across Canada.

Diary users showed evidence of improved clinical and hospital outcomes. Further investigation is needed to clarify the characteristics of a diary user and the effect of diary use on self-management and outcomes.