Dataset Information

Accuracy of death certification and hospital record linkage for identification of incident stroke.

ABSTRACT:

Background

There is little information on the validity of using record linkage with routinely collected data for case ascertainment of stroke in large population-based studies in the UK. We examined the accuracy of these routine record linkage approaches for identifying incident stroke cases in a large UK population-based study, the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort.

Methods

We examined a sample of hospital records of incident stroke cases identified by linkage with two routine data sources, death certificates and a national hospital record linkage system (ENCORE), using predefined study criteria. Two senior Specialist Registrars with clinical experience in stroke medicine examined the hospital records and searched for the evidence of stroke recorded in these records between 1993/97-2003.

Results

Of 520 incident strokes identified between 1993/1997-2003 using record linkage systems in the EPIC-Norfolk, a sample of 250 medical case notes were examined between March and July 2004. Using the predefined study criteria, there were 191 definite strokes (76%), 20 probable strokes (8%), 11 possible strokes and 11 cases of transient ischaemic attacks (4% each) i.e. 233/250 (93%) with possible or definite stroke or transient ischaemic attacks. Stroke could not be verified using hospital records in 13 cases (5%) and 4 cases (2%) had other diagnoses: 3 cases of vascular dementia and 1 case of benign intracranial hypertension. The diagnosis of stroke in 185 out of 250 cases identified in the EPIC-Norfolk (74.0%) was supported by radiological evidence using WHO criteria.

Conclusion

Death certificates and hospital record linkage in this British prospective study have a high accuracy or positive predictive value in correctly identifying incident stroke cases.

SUBMITTER: Sinha S

PROVIDER: S-EPMC2605452 | biostudies-literature | 2008 Nov

REPOSITORIES: biostudies-literature

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Publications

Accuracy of death certification and hospital record linkage for identification of incident stroke.

Sinha Shubhada S Myint Phyo K PK Luben Robert N RN Khaw Kay-Tee KT

BMC medical research methodology 20081110

<h4>Background</h4>There is little information on the validity of using record linkage with routinely collected data for case ascertainment of stroke in large population-based studies in the UK. We examined the accuracy of these routine record linkage approaches for identifying incident stroke cases in a large UK population-based study, the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort.<h4>Methods</h4>We examined a sample of hospital records of incident stroke cases identi ...[more]

PMID: 19000303

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Project description:BackgroundCorrect certification of cause of death by physicians (i.e. completing the medical certificate of cause of death or MCCOD) and correct coding according to International Classification of Diseases (ICD) rules are essential to produce quality mortality statistics to inform health policy. Despite clear guidelines, errors in medical certification are common. This study objectively measures the impact of different medical certification errors upon the selection of the underlying cause of death.MethodsA sample of 1592 error-free MCCODs were selected from the 2017 United States multiple cause of death data. The ten most common types of errors in completing the MCCOD (according to published studies) were individually simulated on the error-free MCCODs. After each simulation, the MCCODs were coded using Iris automated mortality coding software. Chance-corrected concordance (CCC) was used to measure the impact of certification errors on the underlying cause of death. Weights for each error type and Socio-demographic Index (SDI) group (representing different mortality conditions) were calculated from the CCC and categorised (very high, high, medium and low) to describe their effect on cause of death accuracy.FindingsThe only very high impact error type was reporting an ill-defined condition as the underlying cause of death. High impact errors were found to be reporting competing causes in Part 1 [of the death certificate] and illegibility, with medium impact errors being reporting underlying cause in Part 2 [of the death certificate], incorrect or absent time intervals and reporting contributory causes in Part 1, and low impact errors comprising multiple causes per line and incorrect sequence. There was only small difference in error importance between SDI groups.ConclusionsReporting an ill-defined condition as the underlying cause of death can seriously affect the coding outcome, while other certification errors were mitigated through the correct application of mortality coding rules. Training of physicians in not reporting ill-defined conditions on the MCCOD and mortality coders in correct coding practices and using Iris should be important components of national strategies to improve cause of death data quality.

Project description:BackgroundMedical certificates of cause of death (MCCOD) issued by hospital physicians are a key input to vital registration systems. Deaths certified by hospital physicians have been implicitly considered to be of high quality, but recent evidence suggests otherwise. We conducted a medical record review (MRR) of hospital MCCOD in the Philippines and compared the cause of death concordance with certificates coded by the Philippines Statistics Authority (PSA).MethodsMCCOD for adult deaths in Bohol Regional Hospital (BRH) in 2007-2008 and 2011 were collected and reviewed by a team of study physicians. Corresponding MCCOD coded by the PSA were linked by a hospital identifier. The study physicians wrote a new MCCOD using the patient medical record, noted the quality of the medical record to produce a cause of death, and indicated whether it was necessary to change the underlying cause of death (UCOD). Chance-corrected concordance, cause-specific mortality fraction (CSMF) accuracy, and chance-corrected CSMF were used to examine the concordance between the MRR and PSA.ResultsA total of 1052 adult deaths were linked between the MRR and PSA. Median chance-corrected concordance was 0.73, CSMF accuracy was 0.85, and chance-corrected CSMF accuracy was 0.58. 74.8% of medical records were deemed to be of high enough quality to assign a cause of death, yet study physicians indicated that it was necessary to change the UCOD in 41% of deaths, 82% of which required addition of a new UCOD.ConclusionsMedical records were generally of sufficient quality to assign a cause of death and concordance between the PSA and MRR was reasonably high, suggesting that routine mortality statistics data are reasonably accurate for describing population level causes of death in Bohol. While overall agreement between the PSA and MRR in major cause groups was sufficient for public health purposes, improvements in death certification practices are recommended to help physicians differentiate between treatable (immediate) COD and COD that are important for public health surveillance.

Project description:ImportanceThe increased number of stroke centers in the United States may not be equitably distributed across all populations. Anecdotal reports suggest there may be differential proliferation in wealthier and urban communities.ObjectiveTo examine hospital characteristics and economic conditions of communities surrounding hospitals with and without stroke centers.Design, setting, and participantsThis cohort study included all general, short-term, acute hospitals in the continental United States and used merged data from the Joint Commission, Det Norske Veritas, Healthcare Facilities Accreditation Program, state health departments, the Centers for Medicare & Medicaid Services, the American Hospital Association, the Dartmouth Atlas of Health Care, and the US Census Bureau from January 1, 2009, to September 30, 2017, to compare hospital and community characteristics of stroke-certified and non-stroke-certified hospitals and assessed characteristics of early and late adopters of stroke certification.Main outcomes and measuresStroke center certification was the primary outcome. Risk factors were grouped into 3 categories: economic and financial, hospital, and community characteristics. Survival analyses were performed using a Cox proportional hazards regression model.ResultsThe study included 4546 US hospitals. During the study period, 1689 hospitals (37.2%) were stroke certified (961 adopted certification on or before January 1, 2009, 728 afterward). After controlling for other area and hospital characteristics, hospitals in low-income hospital service areas and the lower tertile of profit-margin distribution were less likely to adopt stroke certification (hazard ratio [HR], 0.62; 95% CI, 0.52-0.74 and HR, 0.87; 95% CI, 0.78-0.98, respectively). Urban hospitals had a higher likelihood of stroke certification than rural hospitals (HR, 12.79; 95% CI, 10.64-15.37).Conclusions and relevanceThis study found that stroke centers have proliferated unevenly across geographic localities, where hospitals in high-income hospital service areas and with higher profit margins have a greater likelihood of being stroke certified. These findings suggest that market-driven factors may be associated with stroke center certification.

Dataset Information

Accuracy of death certification and hospital record linkage for identification of incident stroke.

Background

Methods

Results

Conclusion

Publications

Accuracy of death certification and hospital record linkage for identification of incident stroke.

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