Abstract
BackgroundIn clinical practice, research, and increasingly health surveillance, planning and costing, there is a need for high quality information to determine comorbidity information about patients. Electronic, routinely collected healthcare data is capturing increasing amounts of clinical information as part of routine care. The aim of this study was to assess the validity of routine hospital administrative data to determine comorbidity, as compared with clinician-based case note review, in a large cohort of patients with chronic kidney disease.MethodsA validation study using record linkage. Routine hospital administrative data were compared with clinician-based case note review comorbidity data in a cohort of 3219 patients with chronic kidney disease. To assess agreement, we calculated prevalence, kappa statistic, sensitivity, specificity, positive predictive value and negative predictive value. Subgroup analyses were also performed.ResultsMedian age at index date was 76.3 years, 44% were male, 67% had stage 3 chronic kidney disease and 31% had at least three comorbidities. For most comorbidities, we found a higher prevalence recorded from case notes compared with administrative data. The best agreement was found for cerebrovascular disease (κ = 0.80) ischaemic heart disease (κ = 0.63) and diabetes (κ = 0.65). Hypertension, peripheral vascular disease and dementia showed only fair agreement (κ = 0.28, 0.39, 0.38 respectively) and smoking status was found to be poorly recorded in administrative data. The patterns of prevalence across subgroups were as expected and for most comorbidities, agreement between case note and administrative data was similar. Agreement was less, however, in older ages and for those with three or more comorbidities for some conditions.ConclusionsThis study demonstrates that hospital administrative comorbidity data compared moderately well with case note review data for cerebrovascular disease, ischaemic heart disease and diabetes, however there was significant under-recording of some other comorbid conditions, and particularly common risk factors.
Highlights
In clinical practice, research, and increasingly health surveillance, planning and costing, there is a need for high quality information to determine comorbidity information about patients
Patients with chronic kidney disease (CKD) are often elderly and the presence of comorbidity is common; the cohort used in this study provides a useful model for understanding the recording of comorbidity in routine administrative data as compared to clinician-based case note review (CNR), in those with a chronic disease
Individuals were included in GLOMMS-I if they met the Kidney Disease Outcomes Quality Initiative (KDOQI) definition of stage 3 to 5 CKD [13] (glomerular filtration rate (GFR) < 60 mL/min/1.73 m2 for at least three months)
Summary
Research, and increasingly health surveillance, planning and costing, there is a need for high quality information to determine comorbidity information about patients. Morbidity Record (SMR01), which is collated nationally by the Information Services Division (ISD), part of NHS National Services Scotland, and data have been routinely available since 1980. The accuracy of such data is important to a wide range of users. Administration systems and the increasing complexity of patients’ health care records, driven by increasing life expectancy, and the growing burden of chronic disease, may all impact on the quality of recorded data. Quality assurance assessment of the recording of clinical codes for diagnoses associated with individual episodes of hospitalisation for Scottish hospital episode data in 2010–11, has shown high accuracy (88% for the Main Condition and 82% for Other Conditions) [5]
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