Original article
Accuracy of administrative data for assessing outcomes after knee replacement surgery

https://doi.org/10.1016/S0895-4356(96)00368-XGet rights and content

Abstract

Objective: To assess the accuracy of information in an administrative database (Canadian Institute for Health Information; CIHI) compared with the hospital record for patients undergoing knee replacement (KR). Methods: A stratified random sample of 185 KR recipients from 5 Ontario hospitals were chosen. Their hospital records and corresponding CIHI files were compared to assess percent complete agreement, false negative (FN) and false positive (FP) rates for demographic data, procedures, and diagnoses. Results: Of 185 records, 175 (95%) were reviewed. Percent complete agreement was greater than 94% for each of patient demographics and procedures (mean FN rates: 0%; mean FP rates: 0–5%). For comorbidities and complications, although mean percent complete agreement was high, and FP rates were low, mean FN rates were 63% for specific comorbid conditions and 70% for organ systems. Conclusions: High FN rates have been found in documentation of comorbidities and in-hospital complications for CIHI data compared with the hospital record. Under-coding of comorbidities and in-hospital complications has potential implications for researchers using administrative databases.

References (46)

  • JE Wennberg et al.

    Use of claims data systems to evaluate health care outcomes. Mortality and reoperation following prostatectomy

    JAMA

    (1987)
  • NP Roos et al.

    Using administrative data to predict important health outcomes entry to hospital, nursing home, and death

    Med Care

    (1988)
  • LI Iezzoni et al.

    Comorbidities, complications, and coding bias. Does the number of diagnosis codes matter in predicting in-hospital mortality?

    JAMA

    (1992)
  • JE Wennberg

    Commentary: Using claims to measure health status

    J Chron Dis

    (1987)
  • J Whittle et al.

    Accuracy of medicare claims data for estimation of cancer incidence and resection rates among elderly Americans

    Med Care

    (1991)
  • JE Wennberg et al.

    An assessment of prostatectomy for benign urinary tract obstruction. Geographic variations and the evaluation of medical care outcomes

    JAMA

    (1988)
  • LL Roos et al.

    Monitoring adverse outcomes of surgery using administration data

    Health Care Fin Rev

    (1987)
  • G Anderson et al.

    Development of clinical and economic prognoses from Medicare claims data

    JAMA

    (1990)
  • DS Hsia et al.

    Accuracy of diagnostic coding for Medicare patients under the prospective payment system

    N Engl J Med

    (1988)
  • SS Lloyd et al.

    Physician and coding errors in patient records

    JAMA

    (1985)
  • LI Iezzoni et al.

    Coding of acute myocardial infarction: Clinical and policy implications

    Ann Intern Med

    (1988)
  • ES Fisher et al.

    Overcoming potential pitfalls in the use of medicare data for epidemiologic research

    Am J Pub Health

    (1990)
  • LL Ross et al.

    How good are the data? Reliability of one health care data bank

    Med Care

    (1982)
  • Cited by (97)

    • Agreement between medical record and administrative coding of common comorbidities in orthopaedic trauma patients

      2019, Injury
      Citation Excerpt :

      Traditionally, the gold standard for capturing information about pre-existing comorbidities is through clinical interviews. However, in large epidemiological studies, this is not feasible nor time efficient [4]. An alternative is to review medical records, which provide extensive detailed clinical information, but this can be tedious, time-consuming and labour-intensive [5].

    • Development and validation of a prediction model for patients discharged to post–acute care after colorectal cancer surgery

      2017, Surgery (United States)
      Citation Excerpt :

      Patients were excluded from the study if they had a postoperative complication during the index admission, because complications are associated with prolonged LOS. For the same reason, we also excluded patients with an LOS greater than the 75th percentile for a given procedure9-12 (Table I). This approach to using procedure-specific, prolonged LOS as a surrogate for postoperative complications has been described in detail and validated by Silber et al.13 Patients who were not discharged to home or post–acute care were excluded from the study.

    View all citing articles on Scopus

    This study was conducted for the Total Knee Replacement Patient Outcome Research Team (PORT), funded by the U.S. Agency for Health Care Policy and Research Grant No. 06432 to Indiana University and sub-grantees, to study total knee replacement surgery.

    1

    Drs. Wright and Hawker are recipients of Medical Research Council of Canada Research Scholarships.

    View full text