Working with Existing Databases

Abstract

Objectives: On completion of the article, the reader should be able to describe the differences between large volume administrative and clinical databases and to discuss the limitations of using administrative databases for outcomes research.Surgical outcomes research has grown exponentially in the past decade with increased utilization of large-volume administrative and clinical databases. Surgeon, hospital, and regional outcomes are increasingly evaluated with comparison of both patient outcomes (morbidity and mortality) and resource utilization (cost, intensive care unit admissions). External pressures have further fueled outcomes research with the American Board of Surgery requiring surgeons to monitor their own performance, 1 the Joint Commission urging hospitals to demonstrate key surgical safety indicators, 2 and payers implementing pay-for-performance programs. 3Within the field of colon and rectal surgery, large-volume databases are increasingly utilized to study outcomes.4,5 For both outcomes analysis as well as research, these provide multiple potential advantages. Derivation of data from large, heterogeneous populations may result in decreased selection bias and increased study generalizability. 6,7 New surgical interventions 8 and assessment of quality improvement measures may be examined. 9,10 In the era of escalating health care costs, database research lends itself to the assessment of the cost and effectiveness of surgical treatments 11 while permitting investigation of the role of specialty provider and institution characteristics on resource utilization and patient outcomes. Variations at the regional, state, and national level can be assessed and risk models can be created and validated. 12On the other hand, as large-volume databases become increasingly available for research purposes, a clear understanding of the appropriate applications and limitations is necessary. The nuances and complexities of individual databases can be confusing. In this section, we aim to discuss the large-volume databases currently available for outcomes research, outlining database selection, modes of analyses, and inherent limitations. Study DesignClinical research includes the traditional prospective clinical trials, cohort studies, and case-control studies, while outcomes research has now solidified itself as a separate class of clinical research. Subtypes of surgical outcomes research include geographic variations of surgical procedures, volume outcomes analyses, treatment disparities (racial/economic/ age-related), trend analyses, cost-effectiveness studies, and surgical quality/risk adjustment.Appropriate database selection requires a thorough understanding of the individual database, including unique strengths and limitations. The utility of administrative data for assessing surgical quality depends on the measures being studied and how well they are captured in administrative and clinical records. In addition, the initial study design and hypothesis generation is a critical phase to the validity and Abstrac...

Surgical research using national databases

“…Large-volume national databases can broadly be categorized as either administrative or clinical (13). These categorizations are mostly dependent on where the data is derived from (13).…”

“…These categorizations are mostly dependent on where the data is derived from (13). Examples of each of database category are presented in Figure 1.…”

“…Examples of each of database category are presented in Figure 1. Administrative databases are generally compiled from billing information and were not originally created for clinical research (13). These databases obtain their information typically from two sources: requests to insurers for healthcare payments and claims for clinical services (13).…”

“…Administrative databases are generally compiled from billing information and were not originally created for clinical research (13). These databases obtain their information typically from two sources: requests to insurers for healthcare payments and claims for clinical services (13). Clinical databases, on the other hand, are composed of a given patient population with defined patient information (13).…”

“…These databases obtain their information typically from two sources: requests to insurers for healthcare payments and claims for clinical services (13). Clinical databases, on the other hand, are composed of a given patient population with defined patient information (13). These databases were designed to record and track information, allowing for the investigation of specific clinical questions.…”