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Comparison of Parent Report with Administrative Data to Identify Pediatric Reutilization Following Hospital Discharge.

ABSTRACT: Healthcare providers rely on historical data reported by parents to make medical decisions. The Hospital to Home Outcomes (H2O) trial assessed the effects of a onetime home nurse visit following pediatric hospitalization for common conditions. The H2O primary outcome, reutilization (hospital readmission, emergency department visit, or urgent care visit), relied on administrative data to identify reutilization events after discharge. We sought to compare parent recall of reutilization events two weeks after discharge with administrative records. Agreement was relatively high for any reutilization (kappa 0.74); however, this high agreement was driven by agreement between sources when no reutilization occurred (sources agreed 98%-99%). Agreement between sources was lower when reutilization occurred (48%-76%). Some discrepancies were related to parents misclassifying the site of care. The possibility of inaccurate parent report of reutilization has clinical implications that may be mitigated by confirmation of parent-reported data through verification with additional sources, such as electronic health record review.

SUBMITTER: Statile AM

PROVIDER: S-EPMC6613522 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Comparison of Parent Report with Administrative Data to Identify Pediatric Reutilization Following Hospital Discharge.

Statile Angela M AM White Christine M CM Sucharew Heidi J HJ Moore Margo M Tubbs-Cooley Heather L HL Simmons Jeffrey M JM Shah Samir S SS Auger Katherine A KA

Journal of hospital medicine 20190512 7

Healthcare providers rely on historical data reported by parents to make medical decisions. The Hospital to Home Outcomes (H2O) trial assessed the effects of a onetime home nurse visit following pediatric hospitalization for common conditions. The H2O primary outcome, reutilization (hospital readmission, emergency department visit, or urgent care visit), relied on administrative data to identify reutilization events after discharge. We sought to compare parent recall of reutilization events two ...[more]

PMID: 31112494

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Project description:ContextMany of the publicly available health quality report cards are based on administrative data. ICD-9-CM codes in administrative data are not date stamped to distinguish between medical conditions present at the time of hospital admission and complications, which occur after hospital admission. Treating complications as preexisting conditions gives poor-performing hospitals "credit" for their complications and may cause some hospitals that are delivering low-quality care to be misclassified as average- or high-performing hospitals.ObjectiveTo determine whether hospital quality assessment based on administrative data is impacted by the inclusion of condition present at admission (CPAA) modifiers in administrative data as a date stamp indicator.Design, setting, and patientsRetrospective cohort study based on 648,866 inpatient admissions between 1998 and 2000 for coronary artery bypass graft (CABG) surgery, coronary angioplasty (PTCA), carotid endarterectomy (CEA), abdominal aortic aneurysm (AAA) repair, total hip replacement (THR), acute MI (AMI), and stroke using the California State Inpatient Database which includes CPAA modifiers. Hierarchical logistic regression was used to create separate condition-specific risk adjustment models. For each study population, one model was constructed using only secondary diagnoses present at admission based on the CPAA modifier: "date stamp" model. The second model was constructed using all secondary diagnoses, ignoring the information present in the CPAA modifier: the "no date stamp model." Hospital quality was assessed separately using the "date stamp" and the "no date stamp" risk-adjustment models.ResultsForty percent of the CABG hospitals, 33 percent of the PTCA hospitals, 40 percent of the THR hospitals, and 33 percent of the AMI hospitals identified as low-performance hospitals by the "date stamp" models were not classified as low-performance hospitals by the "no date stamp" models. Fifty percent of the CABG hospitals, 33 percent of the PTCA hospitals, 50 percent of the CEA hospitals, and 36 percent of the AMI hospitals identified as low-performance hospitals by the "no date stamp" models were not identified as low-performance hospitals by the "date stamp" models. The inclusion of the CPAA modifier had a minor impact on hospital quality assessment for AAA repair, stroke, and CEA.ConclusionThis study supports the hypothesis that the use of routine administrative data without date stamp information to construct hospital quality report cards may result in the mis-identification of hospital quality outliers. However, the CPAA modifier will need to be further validated before date stamped administrative data can be used as the basis for health quality report cards.

Project description:ObjectivePressure ulcer development is a quality of care indicator, as pressure ulcers are potentially preventable. Yet pressure ulcer is a leading cause of morbidity, discomfort and additional healthcare costs for inpatients. Methods are lacking for accurate surveillance of pressure ulcer in hospitals to track occurrences and evaluate care improvement strategies. The main study aim was to validate hospital discharge abstract database (DAD) in recording pressure ulcers against nursing consult reports, and to calculate prevalence of pressure ulcers in Alberta, Canada in DAD. We hypothesised that a more inclusive case definition for pressure ulcers would enhance validity of cases identified in administrative data for research and quality improvement purposes.SettingA cohort of patients with pressure ulcers were identified from enterostomal (ET) nursing consult documents at a large university hospital in 2011.ParticipantsThere were 1217 patients with pressure ulcers in ET nursing documentation that were linked to a corresponding record in DAD to validate DAD for correct and accurate identification of pressure ulcer occurrence, using two case definitions for pressure ulcer.ResultsUsing pressure ulcer definition 1 (7 codes), prevalence was 1.4%, and using definition 2 (29 codes), prevalence was 4.2% after adjusting for misclassifications. The results were lower than expected. Definition 1 sensitivity was 27.7% and specificity was 98.8%, while definition 2 sensitivity was 32.8% and specificity was 95.9%. Pressure ulcer in both DAD and ET consultation increased with age, number of comorbidities and length of stay.ConclusionDAD underestimate pressure ulcer prevalence. Since various codes are used to record pressure ulcers in DAD, the case definition with more codes captures more pressure ulcer cases, and may be useful for monitoring facility trends. However, low sensitivity suggests that this data source may not be accurate for determining overall prevalence, and should be cautiously compared with other prevalence studies.

Dataset Information

Comparison of Parent Report with Administrative Data to Identify Pediatric Reutilization Following Hospital Discharge.

Publications

Comparison of Parent Report with Administrative Data to Identify Pediatric Reutilization Following Hospital Discharge.

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