Are administrative data valid when measuring patient safety in hospitals? A comparison of data collection methods using a chart review and administrative data

Maass, Christina; Kuske, Silke; Lessing, Constanze; Schrappe, Matthias

doi:10.1093/intqhc/mzv045

Cited by 31 publications

(30 citation statements)

References 23 publications

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“…Thus, assuming a prevalence of 2%, an optimal sample of 3164 medical records should be randomly selected from participating hospitals and abstracted: 126 GPSI+ and 3038 GPSI– medical records. These results are consistent with the literature [73]. …”

Section: Resultssupporting

confidence: 94%

“…We estimated optimal sample sizes, as well as sampling fractions of GPSI+ and GPSI– medical records to be abstracted, for prevalence (ie, proportion of medical records in which at least 1 adverse event was recorded) ranging from 0.4% to 5%, a desired algorithm sensitivity of 75%, a 20% width for sensitivity 95% confidence interval, and unknown numbers of at-risk stays (ie, unknown GPSI denominators). We extracted prevalence values and PPVs from the literature [16,24,32-34,44,50,73-75] and calculated sample size using Stata/IC software version 13 (see Multimedia Appendix 2). Thus, assuming a prevalence of 2%, an optimal sample of 3164 medical records should be randomly selected from participating hospitals and abstracted: 126 GPSI+ and 3038 GPSI– medical records.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Geriatric Patient Safety Indicators Based on Linked Administrative Health Data to Assess Anticoagulant-Related Thromboembolic and Hemorrhagic Adverse Events in Older Inpatients: A Study Proposal

et al. 2017

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BackgroundFrail older people with multiple interacting conditions, polypharmacy, and complex care needs are particularly exposed to health care-related adverse events. Among these, anticoagulant-related thromboembolic and hemorrhagic events are particularly frequent and serious in older inpatients. The growing use of anticoagulants in this population and their substantial risk of toxicity and inefficacy have therefore become an important patient safety and public health concern worldwide. Anticoagulant-related adverse events and the quality of anticoagulation management should thus be routinely assessed to improve patient safety in vulnerable older inpatients.ObjectiveThis project aims to develop and validate a set of outcome and process indicators based on linked administrative health data (ie, insurance claims data linked to hospital discharge data) assessing older inpatient safety related to anticoagulation in both Switzerland and France, and enabling comparisons across time and among hospitals, health territories, and countries. Geriatric patient safety indicators (GPSIs) will assess anticoagulant-related adverse events. Geriatric quality indicators (GQIs) will evaluate the management of anticoagulants for the prevention and treatment of arterial or venous thromboembolism in older inpatients.MethodsGPSIs will measure cumulative incidences of thromboembolic and bleeding adverse events based on hospital discharge data linked to insurance claims data. Using linked administrative health data will improve GPSI risk adjustment on patients’ conditions that are present at admission and will capture in-hospital and postdischarge adverse events. GQIs will estimate the proportion of index hospital stays resulting in recommended anticoagulation at discharge and up to various time frames based on the same electronic health data. The GPSI and GQI development and validation process will comprise 6 stages: (1) selection and specification of candidate indicators, (2) definition of administrative data-based algorithms, (3) empirical measurement of indicators using linked administrative health data, (4) validation of indicators, (5) analyses of geographic and temporal variations for reliable and valid indicators, and (6) data visualization.ResultsStudy populations will consist of 166,670 Swiss and 5,902,037 French residents aged 65 years and older admitted to an acute care hospital at least once during the 2012-2014 period and insured for at least 1 year before admission and 1 year after discharge. We will extract Swiss data from the Helsana Group data warehouse and French data from the national health insurance information system (SNIIR-AM). The study has been approved by Swiss and French ethics committees and regulatory organizations for data protection.ConclusionsValidated GPSIs and GQIs should help support and drive quality and safety improvement in older inpatients, inform health care stakeholders, and enable international comparisons. We discuss several limitations relating to the representativeness of study populations, ...

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Section: Resultssupporting

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Geriatric Patient Safety Indicators Based on Linked Administrative Health Data to Assess Anticoagulant-Related Thromboembolic and Hemorrhagic Adverse Events in Older Inpatients: A Study Proposal

et al. 2017

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“…For the last 20 years, administrative data, such as billing data, have been a frequently used data source to efficiently capture information on the safety of care. [8][9][10][11][12] Examples of safety measures captured through administrative data include AHRQ's Patient Safety Indicators and 3M's Potentially Preventable Complications. 13,14 A key coding system used for capturing procedures and patient diagnoses in the hospital setting is the World Health Organization's (WHO) International Classification of Diseases (ICD).…”

Section: R E S E a R C H A R T I C L Ementioning

confidence: 99%

“…While AHRQ continues to invest in the development of QSRS, other options might exist to complement QSRS in order to more efficiently and completely identify adverse events in EHRs and other databases. For the last 20 years, administrative data, such as billing data, have been a frequently used data source to efficiently capture information on the safety of care . Examples of safety measures captured through administrative data include AHRQ's Patient Safety Indicators and 3M's Potentially Preventable Complications …”

Section: Introductionmentioning

confidence: 99%

A comparison of two structured taxonomic strategies in capturing adverse events in U.S. hospitals

Austin

Kirley

Rosen

et al. 2018

Health Services Research

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Objective To compare the Agency for Healthcare Research and Quality's Quality and Safety Review System (QSRS) and the proposed triadic structure for the 11th version of the International Classification of Disease (ICD‐11) in their ability to capture adverse events in U.S. hospitals. Data Sources/Study Setting One thousand patient admissions between 2014 and 2016 from three general, acute care hospitals located in Maryland and Washington D.C. Study Design The admissions chosen for the study were a random sample from all three hospitals. Data Collection/Extraction Methods All 1000 admissions were abstracted through QSRS by one set of Certified Coding Specialists and a different set of coders assigned the draft ICD‐11 codes. Previously assigned ICD‐10‐CM codes for 230 of the admissions were also used. Principal Findings We found less than 20 percent agreement between QSRS and ICD‐11 in identifying the same adverse event. The likelihood of a mismatch between QSRS and ICD‐11 was almost twice that of a match. The findings were similar to the agreement found between QSRS and ICD‐10‐CM in identifying the same adverse event. When coders were provided with a list of potential adverse events, the sensitivity and negative predictive value of ICD‐11 improved. Conclusions While ICD‐11 may offer an efficient way of identifying adverse events, our analysis found that in its draft form, it has a limited ability to capture the same types of events as QSRS. Coders may require additional training on identifying adverse events in the chart if ICD‐11 is going to prove its maximum benefit.

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“…The use of administrative data, based on the International Classification of Diseases (ICD), as a support to monitoring adverse events occurring during hospitalization (in-hospital events) has gained increasing relevance in the past decade, because it requires less resources -economic and human, among others -and is readily available 14 .…”

Section: Introductionmentioning

confidence: 99%

In-hospital adverse drug events: analysis of trend in Portuguese public hospitals

2020

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The objectives of this study were to analyze in-hospital adverse drug events (ADEs) in Portuguese public hospitals, and their association with mortality and the duration of hospitalization. We analyzed an administrative database containing the registration of all hospitalizations occurring in Portuguese public hospitals in 2013-2015. ADEs were identified using the codes E850-858.9 and E930-949.9 from ICD-9-CM. We identified all episodes with registration of in-hospital ADE and we compared them with a random sample of an equal number of episodes with no events recorded. A total of 3,041,443 cases were analyzed, 60,521 presented at least one ADE from which 17,213 occurred in hospital context. The most frequent drug classes associated with ADE were the antineoplastics/immunosuppressant drugs, antibiotics and steroids. Patient characteristics associated with a greater occurrence of in-hospital ADEs (all with p < 0.001) were medical admissions (OR = 1.29), the diagnosis - myeloid leukaemia (OR = 18.63), nephrotic syndrome (OR = 15.75), pneumonia (OR = 1.33) -, a higher number of secondary diagnoses (OR = 1.27), and increased duration of hospital stay (OR = 1.06). Hospitalizations with records of in-hospital ADEs presented a significantly higher mortality (9.6% vs. 4.5) and duration of hospitalization (22.6 vs. 6.4 days). ADEs were shown to be directly associated with an increase in the duration of hospital stay of 8.18 days. This study adds some interesting insights related to the most frequent drug classes and patient characteristics that can influence the frequency of ADEs in Portuguese public hospitals and also the burden of injury resulting from them.

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Are administrative data valid when measuring patient safety in hospitals? A comparison of data collection methods using a chart review and administrative data

Cited by 31 publications

References 23 publications

Geriatric Patient Safety Indicators Based on Linked Administrative Health Data to Assess Anticoagulant-Related Thromboembolic and Hemorrhagic Adverse Events in Older Inpatients: A Study Proposal

Geriatric Patient Safety Indicators Based on Linked Administrative Health Data to Assess Anticoagulant-Related Thromboembolic and Hemorrhagic Adverse Events in Older Inpatients: A Study Proposal

A comparison of two structured taxonomic strategies in capturing adverse events in U.S. hospitals

In-hospital adverse drug events: analysis of trend in Portuguese public hospitals

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