Bias in the Coding of Hospital Discharge Data and Its Implications for Quality Assessment

Romano, Patrick S.; Mark, David H.

doi:10.1097/00005650-199401000-00006

Cited by 321 publications

(195 citation statements)

References 12 publications

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“…However, previous validation studies of this data source demonstrated high accuracy (23)(24)(25). Data abstracting and coding errors could be present, but improvements in coding accuracy over time would be expected to identify more patients with RA in more recent years, rather than fewer.…”

Section: Discussionmentioning

confidence: 94%

“…Reabstraction studies that have compared OSHPD data files with original medical records have found specificities for diagnoses ranging from 0.98 to 1.00, and sensitivities for diagnoses ranging from 0.88 to 1.00 (23)(24)(25). Because these data are based in part on those used for billing purposes, there is near-complete recording of major surgical procedures, although recording of minor procedures such as blood transfusions is less complete (23)(24)(25). To protect patient confidentiality, the data are anonymous, so validation of specific diagnoses and procedures in this study could not be performed.…”

Section: Methodsmentioning

confidence: 99%

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Decreases in rates of hospitalizations for manifestations of severe rheumatoid arthritis, 1983–2001

Ward

2004

Arthritis & Rheumatism

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Conclusion. Rates of hospitalization for rheumatoid vasculitis and splenectomy in Felty's syndrome have decreased over the past 19 years, and there has been a recent decrease in the rates of primary total knee arthroplasty in patients with RA. Although several factors may account for these decreases, these findings suggest that since the early 1980s, the long-term health outcomes of patients with RA have improved.

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Section: Discussionmentioning

confidence: 94%

Section: Methodsmentioning

confidence: 99%

Decreases in rates of hospitalizations for manifestations of severe rheumatoid arthritis, 1983–2001

Ward

2004

Arthritis & Rheumatism

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“…However, because the dataset is based on ICD-9 CM coding, there is the potential for diagnostic misclassification. While ICD-9 CM coding is generally considered to be highly specific and have a low false-positive rate, coding can also have low sensitivity, resulting in omission of cases [27] . This would imply that our calculated event rates are lower than actual rates, although this misclassification should not differ among the patient groups examined; therefore, our rate comparisons would still be valid.…”

Section: Discussionmentioning

confidence: 99%

Hospitalized ulcerative colitis patients have an elevated risk of thromboembolic events

Wang¹,

Terdiman²,

Vittinghoff³

et al. 2009

WJG

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AIM:To compare thromboembolism rates between hospitalized patients with a diagnosis of ulcerative colitis and other hospitalized patients at high risk for thromboembolism. To compare thromboembolism rates between patients with ulcerative colitis undergoing a colorectal operation and other patients undergoing colorectal operations. METHODS:Data from the National Hospital Discharge Survey was used to compare thromboembolism rates between (1) hospitalized patients with a discharge diagnosis of ulcerative colitis and those with diverticulitis or acute respiratory failure, and (2) hospitalized patients with a discharge diagnosis of ulcerative colitis who underwent colectomy and those with diverticulitis or colorectal cancer who underwent colorectal operations. RESULTS:Patients diagnosed with ulcerative colitis had similar or higher rates of combined venous thromboembolism (2.03%) than their counterparts with diverticulitis (0.76%) or respiratory failure (1.99%), despite the overall greater prevalence of thromboembolic risk factors in the latter groups. Discharged patients with colitis that were treated surgically did not have significantly different rates of venous or arterial thromboembolism than those with surgery for diverticulitis or colorectal cancer. CONCLUSION:Patients with ulcerative colitis who do not undergo an operation during their hospitalization have similar or higher rates of thromboembolism than other medical patients who are considered to be high risk for thromboembolism.

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“…24 These concerns, however, are mainly in the context of using administrative databases for assessment of the quality of care. In Victoria, it is standard practice for hospital coders to use the Australian Coding Standards (vol.…”

Section: Study Limitationsmentioning

confidence: 99%

Incidence of non-traumatic spinal cord injury in Victoria, Australia: a population-based study and literature review

2007

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Study design: Data extraction from a state-wide, population-based, health-administration database of hospital admissions. Objective: To determine the incidence of non-traumatic spinal cord injury (NTSCI). Setting: Victoria, Australia. Methods: All patients admitted to hospital with a new onset of NTSCI, or who developed NTSCI after hospitalization, between 1 July 2000 and 30 June 2006, were identified using a population-based database. Age and gender of NTSCI patients were recorded. Results: The number of adults aged 15 years and older with NTSCI in each of the 12-month periods was 82, 111, 96, 108, 133 and 101. The average age-adjusted incidence rate of NTSCI in adults was 26.3 cases per million per year. There was no statistically significant increase in the age-adjusted incidence of NTSCI over the study period (Spearman's r ¼ 0.35, P ¼ 0.5). The incidence of NTSCI was significantly greater than the reported incidence for traumatic spinal cord injury (w 2 1 ¼ 19.5, Po0.0000). There was a very strong correlation between age and the incidence of NTSCI, for both men (Spearman's r ¼ 1, Po0.0000) and women (Spearman's r ¼ 0.98, P ¼ 0.0000). Men had a statistically significantly (w 2 1 ¼ 13.1, P ¼ 0.000) higher incidence of NTSCI (30.5 million adults per year) compared to women (22.9 million adults per year). The average incidence of NTSCI in children o15 years was 0.7 cases per million per year. Conclusion: NTSCI is strongly correlated with age and is more common than traumatic spinal cord injury. The method used in this study to calculate the incidence of NTSCI can be used to monitor the anticipated increase in the incidence of NTSCI in the years ahead, and can be used to in comparative studies.

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Bias in the Coding of Hospital Discharge Data and Its Implications for Quality Assessment

Cited by 321 publications

References 12 publications

Decreases in rates of hospitalizations for manifestations of severe rheumatoid arthritis, 1983–2001

Decreases in rates of hospitalizations for manifestations of severe rheumatoid arthritis, 1983–2001

Hospitalized ulcerative colitis patients have an elevated risk of thromboembolic events

Incidence of non-traumatic spinal cord injury in Victoria, Australia: a population-based study and literature review

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