Invited Commentary

Abstract

In the current health care environment, there is a seemingly endless amount of data with which one can assess performance, identify patterns, compare processes, and hopefully improve outcomes. We have powerful software and tools to help us use data in ways not imagined when the data were first collected. Yet, to use data wisely, one must remember the words of 19th century mathematician Charles Babbage [1Babbage C. Passages from the life of a philosopher. Longman and Company, London1864Google Scholar]:On two occasions I have been asked, “Pray, Mr. Babbage, if you put into the machine wrong figures, will the right answers come out?” I am not able rightly to apprehend the kind of confusion of ideas that could provoke such a question. In other words, as the old adage of computing goes garbage in, garbage out. In this article, Pasquali and colleagues [2Pasquali S.K. Peterson E.D. Jacobs J.P. et al.Differential case ascertainment in clinical registry versus administrative data and impact on outcomes assessment in pediatric cardiac operations.Ann Thorac Surg. 2013; 95: 197-203Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar] assess the quality of the figures we put into our machines, using an example in pediatric heart surgery. In a comparison of administrative data from the Pediatric Health Information Systems (PHIS) database with clinical data from the Society for Thoracic Surgeons Congenital Heart Surgery (STS-CHS) database, agreement between the two databases was poor. Furthermore, the administrative database had a rather low positive predictive value for identifying true cases of pediatric heart surgery. As the authors indicate, the finding that administrative data fare poorly as compared to clinical data with regards to accuracy of diagnosis and procedure is not novel. However, what is noteworthy about these findings is the effect that these inaccuracies may have on assessing and comparing outcomes. The administrative data substantially overestimated the mortality for some operations and underestimated the mortality for others. For a system in which hospitals are often compared based on outcomes determined by administrative data, these results should be eye-opening. Where should we go from here? Rather than focus on the inadequacies of administrative data demonstrated in this article, I believe that we should recognize the paradigm shift that these findings present. No database is perfect; each has its own set of strengths and weaknesses. By merging databases, however, we can maximize the strengths while minimizing the weaknesses. In the absence of global unique identifiers, this is not an easy task. Yet the opportunity (and challenge) before us lies in the ability to successfully link databases such as PHIS and STS-CHS with a myriad of other databases in critical care, anesthesia, catheterization, electrophysiology, federal agencies, and more. Only by taking advantage of the strengths that the various databases offer will we be able to put the right figures into the machine so that the right answers may come out. Differential Case Ascertainment in Clinical Registry Versus Administrative Data and Impact on Outcomes Assessment for Pediatric Cardiac OperationsThe Annals of Thoracic SurgeryVol. 95Issue 1PreviewAdministrative datasets are often used to assess outcomes and quality of pediatric cardiac programs; however their accuracy regarding case ascertainment is unclear. We linked patient data (2004–2010) from the Society of Thoracic Surgeons Congenital Heart Surgery (STS-CHS) Database (clinical registry) and the Pediatric Health Information Systems (PHIS) database (administrative database) from hospitals participating in both to evaluate differential coding/classification of operations between datasets and subsequent impact on outcomes assessment. Full-Text PDF