Assessing the Accuracy of Administrative Data in Health Information Systems

Peabody, John; Luck, Jeff; Jain, Sharad; Bertenthal, Daniel; Glassman, Peter

doi:10.1097/00005650-200411000-00005

Cited by 227 publications

(138 citation statements)

References 36 publications

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“…However, ICD-9 data are created for billing purposes and have a potential for selection bias, such as trend towards higher-paying diagnoses (17) and inaccuracies related to the procedure for creating the coding structure. (18).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Using Administrative Mental Health Indicators in Heart Failure Outcomes Research: Comparison of Clinical Records and International Classification of Disease Coding

Bender

Smith²

2016

Journal of Cardiac Failure

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Background: Use of mental indication in health outcomes research is of growing interest to researchers. This study, as part of a larger research program, quantified agreement between administrative ICD-9 coding for, and 'gold standard' clinician documentation of, mental health issues (MHI) in hospitalized heart failure (HF) patients to determine the validity of mental health administrative data for use in HF outcomes research. Methods:A 13% random sample (n=504) was selected from all unique patients (n=3769) hospitalized with a primary HF diagnosis at four San Diego County community hospitals between 2009-2012. MHI was defined as ICD-9 discharge diagnostic coding between 290-319. Records were audited for clinician documentation of MHI.Results: 43% (n=216) had mental health clinician documentation; 33% (n=164) had ICD-9 coding for MHI. ICD-9 code bundle 290-319 had 0.70 sensitivity, 0.97 specificity, and a Kappa of 0.69 (CI: 0.61-0.79). More specific ICD-9 MHI code bundles had Kappas ranging from 0.44 to 0.82 and sensitivities between 42-82%. Conclusion:Agreement between ICD-9 coding and clinician documentation for a broadly defined MHI is substantial, and can validly 'rule in' MHI for hospitalized heart failure patients. More specific MHI code bundles had fair to almost-perfect agreement, with a wide range of sensitivities for identifying patients with a MHI.

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Section: Accepted Manuscriptmentioning

confidence: 99%

Using Administrative Mental Health Indicators in Heart Failure Outcomes Research: Comparison of Clinical Records and International Classification of Disease Coding

Bender

Smith²

2016

Journal of Cardiac Failure

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“…Administrative data have multiple usespatient care, administrative functions, surveillance, and conducting of policy-relevant research, upon which decisions about population health and health services are made. 45 Efforts to address these gaps will increase our understanding of the strengths and limitations of these data for all their uses. …”

Section: Resultsmentioning

confidence: 99%

Quality of administrative health databases in Canada: A scoping review

Hinds

Lix

Smith

et al. 2016

Can J Public Health

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OBJECTIVE: Administrative health databases are increasingly used to conduct population-based health research and surveillance; this has resulted in a corresponding growth in studies about their quality. Our objective was to describe the characteristics of published Canadian studies about administrative health database quality.METHODS: PubMed, Scopus, and Google Advanced were searched, along with websites of relevant organizations. English-language studies that evaluated the quality of one or more Canadian administrative health databases between 2004 and 2014 were selected for inclusion. Extracted information included data quality concepts and measures, year and type of publication, type of database, and geographic origin.SYNTHESIS: More than 3,000 publications were identified from the search. Twelve reports and 144 peer-reviewed papers were included. The majority (53.5%) of peer-review publications used databases from Ontario and Alberta, while 67% of the non-peer-review publications used data from multiple provinces/ territories. Almost all peer-reviewed papers (97.2%) were validation studies. Hospital discharge abstracts and physician billing claims were the most frequently validated databases. Approximately half of the publications (53.0%) validated case definitions and 37.7% focused on a chronic physical health condition. CONCLUSION:Gaps in the Canadian administrative data quality literature include a limited number of studies evaluating data from the Maritimes and across multiple jurisdictions, newer data sources, validating methods for identifying individuals with mental illness, and assessing the completeness and serviceability of the data. Data quality studies can aid researchers to understand the strengths and limitations of the data. Administrative health databases were originally created for health care management and monitoring functions, such as remunerating physicians. Although these databases were not originally designed to be used for research and surveillance, they contain a rich source of information that is now routinely used for these purposes.5,6 Therefore a central question underlying studies that use administrative health databases is "Are the data of good quality for their intended use?" Given that administrative data are often used in epidemiological and public health research, it is important to conduct data quality studies so researchers are kept informed about the strengths and limitations of the data, and can then take steps to produce unbiased results by minimizing selection bias and measurement error. These efforts support good decision making about health and health care use. Data quality is a broad concept that is both relative and multidimensional.7 One comprehensive definition is "the totality of features and characteristics of a data set that bear on its ability to satisfy the needs that result from the intended use of the data". The latter concept refers to the ability to bring together data from different sources; for example, coherence can be achieved by using comm...

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“…While there have been no specific reviews of ICD-9 code accuracy regarding FXS, SB, or MD in the United States, broader reviews of the literature reveal that unintentional coder errors caused by the limits of the clinician's knowledge and experience with the condition, misinterpreted information from the clinical record, and data entry mistakes lead to inaccuracy in ICD coding. [29][30][31] To control for miscoding, our inclusion criteria required two or more diagnoses of FXS, SB, or MD. The specification of at least two occurrences of a diagnosis was used in a Canadian study, which linked two surveillance systems; for spina bifida, they found an agreement rate of 64.1 %.…”

Section: Discussionmentioning

confidence: 99%

Use of State Administrative Data Sources to Study Adolescents and Young Adults with Rare Conditions

Royer¹,

Hardin

McDermott

et al. 2014

J GEN INTERN MED

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BACKGROUND: Effective care of young people with rare conditions requires ongoing coordinated medical treatment as well as educational and social support services. However, information on treatment is often lacking due to limited data. South Carolina has a repository of comprehensive health and human service data with which individuals may be tracked across the data systems of multiple state agencies and organizations. OBJECTIVE: To develop a method for studying health care of young persons with rare conditions using this repository. METHODS: We identified individuals aged 15 to 24 years diagnosed during 2000-2010 with Fragile X syndrome (FXS), spina bifida (SB), or muscular dystrophy (MD) using a series of algorithms. ICD-9-CM codes were used to initially identify the cohort from medical billing data. Demographics, medical care, employment, education, and socioeconomic status data were then extracted from linked administrative sources. RESULTS: We identified 1,040 individuals with these rare conditions: 125 with FXS, 695 with SB, and 220 with MD. The vast majority of the cases (95 %) were identified in the Medicaid database. Half of the cohort was male, with a higher percentage in the FXS and MD groups. Sixty-two percent of the cohort was enrolled in the last year of high school. Over half of the cohort received support services from the state's disability and special-needs agency; 16 % received food assistance. Thirty-eight percent were employed at some point during the study period. Forty-nine individuals with SB and 56 with MD died during the study period. CONCLUSIONS: We used a linked statewide data system to study rare conditions. Strengths include the diversity of information, rigorous identification strategies, and access to longitudinal data. Despite limitations inherent to administrative data, we found that linked state data systems are valuable resources for investigating important public health questions on rare conditions.

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Assessing the Accuracy of Administrative Data in Health Information Systems

Abstract: Although more research is needed to evaluate the cause of inaccuracies and the relative contributions of patient, provider, and system level effects, it appears that significant inaccuracies in administrative data are common. Interventions aimed at correcting these errors appear feasible.

Cited by 227 publications

References 36 publications

Using Administrative Mental Health Indicators in Heart Failure Outcomes Research: Comparison of Clinical Records and International Classification of Disease Coding

Using Administrative Mental Health Indicators in Heart Failure Outcomes Research: Comparison of Clinical Records and International Classification of Disease Coding

Quality of administrative health databases in Canada: A scoping review

Use of State Administrative Data Sources to Study Adolescents and Young Adults with Rare Conditions

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