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Databases for assessing the outcomes of the treatment of patients with congenital and paediatric cardiac disease – a comparison of administrative and clinical data

Part of: The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD)

Published online by Cambridge University Press:  01 December 2008

Karl F. Welke ,
Tara Karamlou  and
Brian S. Diggs
Karl F. Welke*
Affiliation:
Division of Cardiothoracic Surgery, Oregon Health and Science University, Portland, Oregon, United States of America
Tara Karamlou
Affiliation:
Department of Surgery, Oregon Health and Science University, Portland, Oregon, United States of America
Brian S. Diggs
Affiliation:
Department of Surgery, Oregon Health and Science University, Portland, Oregon, United States of America
*
Correspondence to: Karl F. Welke, MD, Division of Cardiothoracic Surgery L353, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, Portland, Oregon 97239-3098, United States of America. Tel: (503) 418-5443; Fax: (503) 418-1385; E-mail: [email protected]
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Abstract

The introduction of the reporting of medical and surgical outcomes to the public and the potential implementation of initiatives involving pay-for-performance have invigorated debates about the relative benefits of administrative and clinical databases for comparing rates of mortality at the level of the hospital and surgeon. While general agreement exists that public performance report cards must use the highest quality data available, debate continues regarding whether administrative or clinical data should be utilized for this purpose. Clinical databases may contain information more relevant to risk-adjustment, but the currently available clinical databases are voluntary and suffer from validity concerns. Administrative data, however, suffer from inaccuracies of coding and a lack of potentially informative covariates. Particularly problematic to congenital heart surgery is the non-uniform application of coding algorithms to define complex reconstructive procedures for which there is no unique code assignment. The purposes of this manuscript are; therefore, to discuss the relative advantages and limitations of both clinical and administrative data, and to provide a brief introduction to currently available databases germane to the study of congenital cardiac disease.

Keywords

Congenital heart diseaseoutcomespaediatricsurgery
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue S2: Databases and the assessment of complications associated with the treatment of patients with congenital cardiac disease , December 2008 , pp. 137 - 144
Copyright
Copyright © Cambridge University Press 2008

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References

1.HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). 1988–2006. Agency for Healthcare Research and Quality, Rockville, MD.http://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed June 16, 2008.Google Scholar
2.HCUP Kids’ Inpatient Database (KID). Healthcare Cost and Utilization Project (HCUP). 1997, 2000, 2003, and 2006. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/kidoverview.jsp. Accessed June 16, 2008.Google Scholar
3.Hannan, EL, Racz, MJ, Jollis, JG, Peterson, ED. Using medicare claims data to assess provider quality for CABG surgery. Does it work well enough? Health Serv Res 1997; 31: 659–678.Google ScholarPubMed
4.Parker, JP, Li, Z, Darnberg, CL, Danielsen, B, Carlisle, D. Administrative versus clinical data for coronary artery bypass graft surgery report cards: the view from California. Med Care 2006; 44: 687–695.CrossRefGoogle ScholarPubMed
5.Glance, LG, Dick, AW, Osler, TM, Mukamel, DB. Does date stamping ICD-CM codes increase the value of clinical information in administrative data? Heath Serv Res 2006; 41: 1413–1437.CrossRefGoogle Scholar
6.DeLong, ER, Peterson, ED, DeLong, DM, Muhlbaier, LH, Hackett, S, Mark, DB. Comparing risk-adjustment methods for provider profiling. Stat Med 1997; 16: 2645–2664.3.0.CO;2-D>CrossRefGoogle ScholarPubMed
7.Shahian, DM, Silverstein, T, Lovett, AF, Wolf, RE, Normand, SLT. Comparison of clinical and administrative data sources for hospital coronary artery bypass graft surgery report cards. Circulation 2007; 115: 1518–1527.CrossRefGoogle ScholarPubMed
8.Iezzoni, LI. Assessing quality using administrative data. Ann Intern Med 1997; 127: 666–674.CrossRefGoogle ScholarPubMed
9.Mack, MJ, Herbert, M, Prince, S, Dewey, TM, Magee, MJ, Edgerton, JR. Does reporting of coronary artery bypass grafting from administrative databases accurately reflect actual clinical outcomes? J Thorac Cardiovasc Surg 2005; 129: 1309–1317.CrossRefGoogle ScholarPubMed
10.Cronk, CE, Malloy, ME, Pelech, AN, et al. Completeness of state administrative databases for surveillance of congenital heart disease. Birth Defects Res A Clin Mol Tetratol 2003; 67: 597–603.CrossRefGoogle ScholarPubMed
11.Frohnert, BK, Lussky, RC, Alms, MA. Validity of hospital discharge data for identifying infants with cardiac defects. J Perinatol 2005; 25: 727–742.CrossRefGoogle ScholarPubMed
12.Finlayson, EVA, Birkmeyer, JD, Stukel, TA, Siewers, AE, Lucas, FL, Wennberg, DE. Adjusting surgical mortality rates for patient comorbidities: more harm than good? Surgery 2002; 132: 787–794.CrossRefGoogle ScholarPubMed
13.Romano, PS. Asking too much of administrative data? J Am Coll Surg 2003; 196: 337–338.CrossRefGoogle ScholarPubMed
14.Williams, WG. Surgical outcomes in congenital heart disease: expectations and realities. Eur J Cardiothorac Surg 2005; 27: 937–944.CrossRefGoogle ScholarPubMed
15.Williams, WG, McCrindle, BW. Practical experience with databases for congenital heart disease: a registry versus an academic database. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2002; 5: 132–142.CrossRefGoogle ScholarPubMed
16.Gallivan, S, Stark, J, Pagel, C, Williams, G, Williams, WG. Dead reckoning: can we trust estimates of mortality rates in clinical databases? Eur J Cardiothorac Surg 2008; 33: 334–340.CrossRefGoogle ScholarPubMed
17.Jacobs, JP, Mavroudis, C, Jacobs, ML, et al. What is operative mortality? Defining death in a surgical registry database: A report from the STS Congenital Database Task Force and the Joint EACTS-STS Congenital Database Committee. Ann Thorac Surg 2006; 81: 1937–1941.CrossRefGoogle Scholar
18.Ashburn, DA, McCrindle, BW, Tchervenkov, CI, et al. Outcomes after the Norwood operation in neonates with critical aortic stenosis or aortic valve atresia. J Thorac Cardiovasc Surg 2003; 125: 1070–1082.CrossRefGoogle ScholarPubMed
19.Welke, KF, Peterson, ED, Vaughn-Sarrazin, MS, et al. Comparison of cardiac surgery volumes and mortality rates between the Society of Thoracic Surgeons and Medicare databases from 1993 through 2001. Ann Thorac Surg 2007; 84: 1538–1546.CrossRefGoogle Scholar
20.Ugolini, C, Nobilio, L. Risk adjustment for coronary artery bypass graft surgery: an administrative approach versus EuroSCORE. Int J for Qual in Health Care 2004; 16: 157–164.CrossRefGoogle ScholarPubMed
21.Moller, JH, Powell, CB, Joransen, JA, Borbas, C. The pediatric cardiac care consortium – revisited. Jt Comm J Qual Improv 1994; 20: 661–668.Google ScholarPubMed
22.Welke, KF, Shen, I, Ungerleider, RM. Current assessment of mortality rates in congenital cardiac surgery. Ann Thorac Surg 2006; 82: 164–171.CrossRefGoogle ScholarPubMed
23.Jenkins, KJ, Gauvreau, K, Newburger, JW, Spray, TL, Moller, JH, Iezzoni, LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123: 110–118.CrossRefGoogle ScholarPubMed
24. The Society of Thoracic Surgeons Congenital Heart Surgery Database 2008 Spring Harvest Congenital Report Executive Summary – All Patients. Available at http://www.sts.org/documents/pdf/ndb/Spring_2008_STSCONG-ALLPatientsSUMMARY.pdf. Accessed June 16, 2008.Google Scholar