The use of large administrative data sets in nursing research

Abstract

A NALYSIS OF large administrative data sets has been a method used primarily by health services researchers to examine issues such as access, regional differences in care, and health outcomes. Most administrative data sets were first developed in the 1970s for the collection of data regarding health plans, health system utilization, and claims data. Although they were not originally intended for conducting research, administrative data sets were found to be an attractive avenue for health services research studies. Technologic advances in personal computers, modern statistical analysis software, and uniform International Classification of Diseases, Ninth Revision nomenclature have widened the horizons for researchers. In the past, investigations using national or state data sets required access to mainframe computer resources, but today, analyses of this type may be conducted using one’s personal computer. The purpose of this article is to discuss the use of large administrative data sets as a tool in nursing research. As early as 1985, the limited use of secondary data analysis in nursing research was noted (McArt & McDougal, 1985). Jacobson et al.,1993 conducted a Medline search (1986-1992) for nursing citations using the key words secondary data analysis and identified 11 citations, 3 of which appeared in nursing journals. We conducted a similar literature search (1997-2003) using PUBMED with the key words secondary data analysis and nursing and identified 82 nursing studies using secondary data analysis. Of those, only 15 used existing administrative data sets. Fourteen of the 15 were published in nursing journals. Although the use of secondary analysis as a research method has increased in nursing, the use of administrative data sets has not kept equal tempo. Large administrative data sets embody information about groups of people and often describe entire populations at either state and/or national levels, thus enhancing generalizability of research findings. The data are representative of care delivered in many settings and can be useful to examine patterns of health service and resource utilization. Longitudinal administrative data sets, which collect person-level information, can be used to track subjects both over time and across settings of care. Finally, these data sets already exist, can be obtained inexpensively, and are easily adapted for use with analytical software. Various types of administrative data sets are available. Thirty-six states presently are legislatively mandated as part of public health law to collect discharge information on all hospitalized patients. Patient identifiers are removed from the data to protect patient confidentiality, and most state hospital inpatient data sets lack identifiers to track recurrent hospitalizations. Two examples of state data sets are the New York State Department