Volume 185 - Issue 10
Public reporting of hospital outcomes based on administrative data
Authors: Ian A Scott and Michael Ward
Med J Aust 2006; 185 (10): 574. || doi: 10.5694/j.1326-5377.2006.tb00697.x
Published online: 20 November 2006
Published online: 20 November 2006
In reply: Innes and colleagues accuse us of overstating the potential inaccuracy of coded administrative data. They refer to state and national initiatives underway to ensure such accuracy, but offer no hard statistics that would reassure us that such data, in their current form, are as accurate as they need to be for purposes of quality monitoring and public disclosure. Until they do, we feel we have good reason to recommend caution in light of the few published Australian reports that are available (which we cited1,2), together with other research3 and feedback from clinical directors, about significant error rates when coded diagnoses are audited by clinicians or compared with independent datasets maintained by clinicians (Professor David Johnson, Director of Nephrology, and Dr Paul Garrahy, Director of Cardiology, Princess Alexandra Hospital, personal communication).
In Queensland, formal regular audits on coding accuracy were initiated only in October 2005. They involve small numbers of randomly selected charts from each hospital and focus on specific coding issues identified for each hospital (Professor Stephen Duckett, Executive Director of Reform and Development, Queensland Health, personal communication). While we welcome (and were aware of) the introduction of “alpha flags” to distinguish in-hospital complications from pre-existing conditions, these remain a recent development (especially in Queensland), and others with considerable experience in their use express caution in interpreting results in the absence of rigorous validation.4,5
References
- Vu HD, Heller RF, Lim LL, et al. Mortality after acute myocardial infarction is lower in metropolitan regions than in non-metropolitan regions. J Epidemiol Community Health 2000; 54: 590-595.<eMJA full text>
- Powell H, Lim LL, Heller RF. Accuracy of administrative data to assess comorbidity in patients with heart disease: an Australian perspective. J Clin Epidemiol 2001; 54: 687-693. 0_i1091785
- Iezzoni LI. Assessing quality using administrative data. Ann Intern Med 1997; 127: 666-674. 0_i1091787
- Weingart SN, Iezzoni LI, Davis RB, et al. Use of administrative data to find substandard care: validation of the complications screening program. Med Care 2000; 38: 796-806. 0_i1091789
- Naessens JM, Huschka TR. Distinguishing hospital complications of care from pre-existing conditions. Int J Qual Health Care 2004; 16 Suppl 1: i27-i35. 0_CBBCCCBJ
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