Are hospital administrative data suitable for external quality assurance? Comparison of quality indicators based on separate statutory data collections (BQS) and hospital administrative data
Kompetenzzentrum Routinedaten im Gesundheitswesen, Fachbereich Gesundheitswesen, Hochschule Niederrhein, Krefeld. DMW - Deutsche Medizinische Wochenschrift
(Impact Factor: 0.54).
03/2011; 136(9):409-14. DOI: 10.1055/s-0031-1274523
German hospitals are obliged legally to provide clinical data for external comparative quality assurance. Data rely on administrative data and just as on additional data collections for this purpose only. They are used to identify defined quality indicators (so-called BQS data). The Agency for Healthcare Research and Quality (AHRQ) also developed quality indicators that rely on hospital administrative data to evaluate the quality of inpatient care.
Six selected quality indicators were computed by both methods. 2007 data from the nationwide external quality assurance program were analyzed and compared to quality information derived from a 2007 10 % nationwide sample of administrative hospital data.
Regarding the indicators "Obstetric trauma", "Mortality of community acquired pneumonia", "Postoperative deep vein thrombosis" and "Postoperative pulmonary embolism" rates are significantly higher in hospital administrative data than in BQS data (p < 0.01). Inversely, rates of the indicator "Decubitus ulcer" are significantly lower (p < 0.001).
Possible causes for the results might be divergent motivations for data collection or restrictions in data collection. It remains unclear which method properly reflects the true status. Selected indicators (e. g. obstetric trauma), however, are suitable to be substituted by hospital administrative data.
Available from: Christoph F Dietrich
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ABSTRACT: The German Health Care System (GHCS) faces many challenges among which an aging population and economic problems are just a few. The GHCS traditionally emphasised equity, universal coverage, ready access, free choice, high numbers of providers and technological equipment; however, real competition among health-care providers and insurance companies is lacking. Mainly in response to demographic changes and economic challenges, health-care reforms have focused on cost containment and to a lesser degree also quality issues. In contrast, generational accounting, priorisation and rationing issues have thus far been completely neglected. The paper discusses three important areas of health care in Germany, namely the funding process, hospital management and ambulatory care, with a focus on cost control mechanisms and quality improving measures as the variables of interest. Health Information Technology (HIT) has been identified as an important quality improvement tool. Health Indicators have been introduced as possible instruments for the priorisation debate.
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This study analyses the information gain achieved by additionally taking into account complications in the follow-up period instead of merely considering in-house events for a hospital-based quality measurement using the example of hip replacement.
The analysis was performed with anonymous statutory health insurance data (AOK) for the years 2007-2009 within the framework of the quality measurement method "Quality Assurance with Administrative Data (QSR)". It included cases of hip replacement surgery due to osteoarthritis. In order to analyse hospital-related outcome quality, 6 quality indicators were formed (revision surgery within 365 days, surgical complications within 90 days, thrombosis/pulmonary embolism within 90 days, femur fracture within 90 days, mortality within 90 days and complication index). For each hospital, the adjusted SMRs (standardised mortality or morbidity ratio) with 95% confidence intervals were calculated. The relation between the in-hospital and the follow-up SMR was analysed by Spearman's rank correlation coefficient. Furthermore, the percentage consistency of hospital SMRs categorised into quartiles on the basis of in-hospital and post-discharge events was determined.
A total of 154 470 AOK patients from 930 hospitals were included in the analysis. The hospitals had a median overall complication rate of 11,22%. One quarter of the hospitals had complication rates of 8,18% or below. Another quarter of the hospitals had complication rates nearly twice as high (≥15,49%). Nearly one-third of all complications occurred after the initial hospitalisation. Regarding clinic-related complications, there was little correlation between the events in the initial case and during follow-up (r<0,3) for all indicators. The order of the hospitals defined by quartiles of SMR changed significantly by adding the complications in the follow-up for the indicators considered (min 21%, max 47% changes between quartiles). In particular, for the indicators revision and death, a change in the SMR quartile occurred in almost 50% of all hospitals.
Quality assessment of hip replacement surgery based exclusively on in-house events is quite unreliable. On the one hand, nearly a third of all complications occur in the follow-up period. On the other hand, predicting the occurrence of post-discharge events from in-house complications of a clinic is not considered acceptable for the indicators analysed in this study.
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