Hospital episode statistics: time for clinicians to get involved?

Abstract

The validity of hospital episode statistics was questioned by Körner in 1982. Recent publications have shown that problems persist in England and Wales, and that the quality of the data is inadequate for the task. The lack of involvement of clinicians in the process of data collection and validation is no longer acceptable. To rectify the situation there should be a change of process and culture, supported by education and investment. NHS data definitions of terms such as 'spells' , 'episodes' and 'diagnoses' need to be reviewed. The development of separate data processes to monitor national service frameworks is regrettable.

Hospital Episode Statistics and changing trends in glaucoma surgery

“…This vast set of data can only be made more accurate by the involvement of clinicians in the coding process. 7 …”

“…There have been a number of attempts to validate the HES data, which has resulted in questioning of the data. These studies have shown a variation in coding of the data at an individual department/hospital level 7,12 and it is important to bear in mind when analysing any study that utilises HES statistics that this variation can account for some (or all) of the results. The large amount of data and its geographical coverage are potentially very useful but there needs to be continuing assessment of accuracy to ensure questions regarding the validity of conclusions drawn from the data can be answered.…”

“…The data do however remain the largest data set of their kind in the UK (coverage and completeness of over 96% of England) and have been validated by a number of studies. 6,7 …”

Gallstones — an increasing problem: a study of hospital admissions in England between 1989/1990 and 1999/2000

“…However, as gallstones are positively associated with body weight, 3,22 it is possible that, as our society becomes more affluent and individual's diets change, more people are becoming obese, 23 leading to an increase in the incidence of gallstone disease. Although there are a number of problems associated with the use of HES, such as errors in coding and incomplete coding of admissions, 24 there has not been any significant change in either the recording process or disease classification over our study period. For example, the change to the use of ICD10 to code hospital admissions from April 1995 onwards did not appear to have an impact on the admission and operation rates.…”

Diagnosis of Liver Cirrhosis in England, a Cohort Study, 1998–2009: A Comparison With Cancer

“…Despite the possibility that the rise in diagnoses could refl ect better ascertainment rather than a true rise in the number of people acquiring the disease, (mediated by, e.g., an increase in diagnostic endoscopy or exploratory ultrasound), our fi gures refl ect the increase in the number of people subsequently treated with cirrhosis and a more accurate representation of the health-care burden this disease places on the health system than has previously been available. Th ere are oft en questions raised about the validity of coding seen in both primary-and secondary-care data ( 18,19,20 ) but in most studies that have validated recording of chronic disease accuracy has been high ( 21,22 ). A limitation of the HES data is that they cannot be directly validated against medical records because of the anonymization process used.…”