Systematic review of discharge coding accuracy

Burns, Elaine; Rigby, Elizabeth; Mamidanna, Ravikrishna; Bottle, Alex; Aylin, Paul; Ziprin, Paul; Faiz, Omar

doi:10.1093/pubmed/fdr054

Cited by 554 publications

(506 citation statements)

References 29 publications

(19 reference statements)

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“…Second, our study population was unrestricted and thus was representative of patients with type 2 diabetes of varying age, disease stage, and severity. Third, the CPRD and HES databases used in this study have been validated extensively to ensure data accuracy (11,29). Moreover, the CPRD collects information on potentially important confounders, such as HbA 1c and BMI.…”

Section: Resultsmentioning

confidence: 99%

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Incretin-Based Drugs and the Risk of Congestive Heart Failure

Filion

Azoulay

et al. 2014

Diabetes Care

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OBJECTIVETo determine whether the use of incretin-based drugs, including GLP-1 analogs and dipeptidyl peptidase-4 inhibitors, is associated with an increased risk of congestive heart failure (CHF) among patients with type 2 diabetes. RESEARCH DESIGN AND METHODSThe U.K. Clinical Practice Research Datalink, linked to the Hospital Episode Statistics database, was used to conduct a cohort study with a nested case-control analysis among patients newly prescribed antidiabetic drugs between 1 January 2007 and 31 March 2012 and no prior history of CHF. Case subjects were defined as patients hospitalized for a first CHF and matched with up to 20 control subjects on age, duration of treated diabetes, calendar year, and time since cohort entry. Conditional logistic regression was used to estimate odds ratios (ORs) with corresponding 95% CIs of incident CHF comparing current use of incretin-based drugs with current use of two or more oral antidiabetic drugs. RESULTSThe cohort consisted of 57,737 patients followed for a mean 2.4 years, during which time 1,118 incident cases of hospitalized CHF were identified (incidence rate 8.1/1,000 person-years). Current use of incretin-based drugs was not associated with an increased risk of CHF (adjusted OR 0.85 [95% CI 0.62-1.16]). Secondary analyses revealed no duration-response relationship (P trend = 0.39). CONCLUSIONSIn our population-based study, incretin-based drug use was not associated with an increased risk of CHF among patients with type 2 diabetes. These findings provide some reassurance, but will need to be replicated in other large-scale studies.Incretin-based drugs, which consist of dipeptidyl peptidase-4 (DPP-4) inhibitors and GLP-1 analogs, were first approved by the U.S. Food and Drug Administration in 2006 for the treatment of type 2 diabetes. Both DPP-4 inhibitors and GLP-1 analogs improve glycemic control by increasing plasma levels of endogenous and exogenous GLP-1, respectively. This increase in GLP-1 stimulates insulin secretion and inhibits glucagon secretion (1).The cardiovascular safety of incretin-based drugs is currently under debate. This debate stems from a secondary analysis of the randomized controlled trial SAVOR-TIMI 53, in which saxagliptin was associated with an increased risk of congestive heart failure (CHF) (hazard ratio [HR] 1.27 [95% CI 1.07-1.51]) (2). In contrast, the EXAMINE trial found no association between alogliptin and CHF (HR 1.07 [95% CI 0.79-1.46]) (3). A subsequent meta-analysis of randomized controlled trials found an increased risk of CHF with DPP-4 inhibitors (relative risk 1.16 [95% CI 1.01-1.33]) (4), but these results were driven by those of SAVOR-TIMI 53. Although the safety

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Section: Resultsmentioning

confidence: 99%

“…Prescriptions and diagnoses collected in the CPRD are regularly audited and have been shown to be valid and of high quality (7)(8)(9)(10). The HES database records hospital admission dates, primary and secondary diagnoses (coded using the ICD-10 classification), and related procedures and has been shown to have good accuracy (11).…”

Section: Data Sourcesmentioning

confidence: 99%

Incretin-Based Drugs and the Risk of Congestive Heart Failure

Filion

Azoulay

et al. 2014

Diabetes Care

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“…[36][37][38][39] Nonetheless, a recent systematic review of discharge coding accuracy in routine UK data found that primary diagnosis accuracy has improved from 73.8% to 96.0% in the 10 years since the introduction of Payment by Results. 40 Not all delivery records contain supplementary information, although the percentage of records with a complete maternity tail has improved over time. 41 HES data have more general limitations in the recording other potential confounders.…”

Section: Discussionmentioning

confidence: 99%

The Risk of Adverse Pregnancy Outcomes Following Nonobstetric Surgery During Pregnancy

et al. 2017

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Objective: The aim of this study was to estimate the risk of adverse birth outcomes for women who underwent nonobstetric surgery during pregnancy compared with those who did not. Background: Previous research suggests that nonobstetric surgery occurs during 1% to 2% of pregnancies. However, there is limited evidence quantifying risks to the mother or pregnancy of such surgery. Methods: We examined maternity admissions using hospital administrative data collected between April 1, 2002, and March 31, 2012, and identified pregnancies wherein nonobstetric surgery occurred. We used logistic regression models to determine the adjusted relative risk, attributable risk, and number needed to harm of nonobstetric surgical procedures for adverse birth outcomes. Results: We identified 6,486,280 pregnancies. In 47,628 of these pregnancies, nonobstetric surgery had occurred. We found that nonobstetric surgery during pregnancy was associated with a higher risk of adverse birth outcomes, although the attributable risk was generally low. We estimated that every 287 surgical operations were associated with 1 additional stillbirth, every 31 operations associated with 1 additional preterm delivery, every 39 operations associated with 1 additional low birth weight baby, every 25 operations associated with 1 additional caesarean section, and every 50 operations associated with 1 additional long inpatient stay. Conclusions: Although we have no means of disentangling the effect of the surgery from the effect of the underlying condition, we found that the risk associated with nonobstetric surgery was relatively low, confirming that surgical procedures during pregnancy are generally safe. We believe that our findings improve upon previous research, and are useful reference points for any discussion of risk with prospective patients.Keywords: complications, obstetric, pregnancy, safety, surgery (Ann Surg 2017;266:260-266) T raditional teaching states that there is an increased risk of miscarriage, stillbirth, and preterm labor when a pregnant woman undergoes surgery under general anesthesia during pregnancy.1 This risk has however never been quantified and such risks may have decreased with the use of modern anesthetic agents and techniques. At present, when counseling a pregnant woman on this risk, the information provided is not robustly evidence-based.Previous research suggests that 1% to 2 % of women undergo nonobstetric surgery during pregnancy, 2 common operations being appendicectomy, cancer surgery, and orthopedic procedures. Research has also suggested that nonobstetric surgery during pregnancy is associated with adverse birth outcomes: a Canadian study of 2565 pregnant women reported an increased risk of spontaneous abortion after a general anesthetic [relative risk (RR) ¼ 1.58, 95% confidence interval (95% CI) 1.19-2.09];3 and a Swedish registry study showed associations between nonobstetric operations during pregnancy and low birth weight. 4 A systematic review brought these and many smaller studies together.5 In this analy...

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“…Second, some England non-HF admissions might actually have been for HF and so should have been included in our cohort. However, this is not likely to have a big effect, as the primary diagnosis in English data is well recorded [22]. This difference could also happen if those who survive their first HF admission in Lombardy are sicker than those who survive it in England.…”

Section: Lombardy Patients Had More Hf Admissions Each On Average Thamentioning

confidence: 99%

“…Some quality of care measures and some predictors of readmission are associated only with HF readmissions but not with other readmissions [26]. Administrative databases typically have some underrecording of comorbidities, though this has been found not to bias estimated relations between comorbidity and mortality [27] and the primary diagnosis is well recorded [22]. We were unable to capture symptom severity or other physiological parameters for either country, as these are not included in the databases.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Regional variation in hospitalisation and mortality in heart failure: comparison of England and Lombardy using multistate modelling

Bottle

Ventura

Dharmarajan

et al. 2017

Health Care Manag Sci

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Heart failure (HF) is a common, serious chronic condition with high morbidity, hospitalisation and mortality. The healthcare systems of England and the northern Italian region of Lombardy share important similarities and have comprehensive hospital administrative databases linked to the death register. We used them to compare admission for HF and mortality for patients between 2006 and 2012 (n = 37,185 for Lombardy, 234,719 for England) with multistate models. Despite close similarities in age, sex and common comorbidities of the two sets of patients, in Lombardy, HF admissions were longer and more frequent per patient than in England, but short-and medium-term mortality was much lower. English patients had more very short stays, but their very elderly also had longer stays than their Lombardy counterparts. Using a three-state model, the predicted total time spent in hospital showed large differences between the countries: women in England spent an average of 24 days if aged 65 at first admission and 19 days if aged 85; in Lombardy these figures were 68 and 27 days respectively. Eight-state models suggested disease progression that appeared similar in each country. Differences by region within England were modest, with London patients spending more time in hospital and having lower mortality than the rest of England. Whilst clinical practice differences plausibly explain these patterns, we cannot confidently disentangle the impact of alternatives such as coding, casemix, and the availability and use of nonhospital settings. We need to better understand the links between rehospitalisation frequency and mortality.

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Systematic review of discharge coding accuracy

Abstract: Accuracy rates are improving. Current levels of reported accuracy suggest that routinely collected data are sufficiently robust to support their use for research and managerial decision-making.

Cited by 554 publications

References 29 publications

Incretin-Based Drugs and the Risk of Congestive Heart Failure

Incretin-Based Drugs and the Risk of Congestive Heart Failure

The Risk of Adverse Pregnancy Outcomes Following Nonobstetric Surgery During Pregnancy

Regional variation in hospitalisation and mortality in heart failure: comparison of England and Lombardy using multistate modelling

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