Data Quality in a DRG-Based Information System

Abstract

The aim of this study initiated in May 1990 was to evaluate the quality of the medical data collected from the main hospital of the "Hospices Civils de Lyon", Edouard Herriot Hospital. We studied a random sample of 593 discharge abstracts from 12 wards of the hospital. Quality control was performed by checking multi-hospitalized patients' personal data, checking that each discharge abstract was exhaustive, examining the quality of abstracting, studying diagnoses and medical procedures coding, and checking data entry. Assessment of personal data showed a 4.4% error rate. It was mainly accounted for by spelling mistakes in surnames and first names, and mistakes in dates of birth. The quality of a discharge abstract was estimated according to the two purposes of the medical information system: description of hospital morbidity per patient and Diagnosis Related Group's case mix. Error rates in discharge abstracts were expressed in two ways: an overall rate for errors of concordance between Discharge Abstracts and Medical Records, and a specific rate for errors modifying classification in Diagnosis Related Groups (DRG). For abstracting medical information, these error rates were 11.5% (SE +/- 2.2) and 7.5% (SE +/- 1.9) respectively. For coding diagnoses and procedures, they were 11.4% (SE +/- 1.5) and 1.3% (SE +/- 0.5) respectively. For data entry on the computerized data base, the error rate was 2% (SE +/- 0.5) and 0.2% (SE +/- 0.05). Quality control must be performed regularly because it demonstrates the degree of participation from health care teams and the coherence of the database.(ABSTRACT TRUNCATED AT 250 WORDS)

Continuous training as a key to increase the accuracy of administrative data

“…The higher decline in our study -from 24.3% in 1994 to 8.3% in 1999 -may be due to a higher specialization of the case-mix treated and to a private ownership. The DRG-modifying rate observed in our study in the fourth period of analysis was similar to the rate of 7% reported in a quality of abstracting study conducted in a French hospital (Colin et al 1994). The evaluation of the impact of re-abstracting on the measurement of the complexity of case-mix suggests that the so-called DRG creep -the overreporting of diagnoses and procedures aimed at 'a deliberate and systematic shift in hospital's reported case-mix in order to improve reimbursement' (Simborg 1981) -is not an issue: in the first and second period of analysis we observed a higher value of the case-mix index after re-abstracting and both in the third and fourth periods in the study there was no modification of the overall complexity of cases as measured by the case-mix index.…”

A review of hospital medical record audits: Implications for funding and training

“…This is similar to the results of two independent audits of Victorian hospital data that found that 13.5% of the medical records studied were assigned a different AN-DRG (Victorian Department of Health and Community Services & Deloitte Touche Tohmatsu 1995; MacIntyre et al 1997). These figures are higher than those reported from a French study of a single hospital, where the error in DRG assignment was only 9% (Colin et al 1994), and those of another study in Australian hospitals where the error was found to be 9.5% (Donoghue 1992). However, the error rate has been reported to increase with the rarity of the AN-DRG to as high as 56% (MacIntyre et al 1997).…”

Characterization of the Incidence and Risk Factors for the Development of Lumbar Radiculopathy

“…As the diagnoses of lumbar radiculopathy in this investigation were made entirely by practitioners not involved in this study, we were also reliant on the clinical and diagnostic acumen of others to a substantial degree. However, prior studies have found that diagnostic coding error is low in database reporting, 20,22 and the DMED contains provisions which attempt to ensure accurate data acquisition and validation. 23 Other limitations to this study include the fact that potentially important prognostic factors for lumbar radiculopathy, such as body mass index and smoking status, were not available in this system.…”