Abstract
BackgroundThe purpose of this study was to assess the validity of patient administrative data (PAS) for calculating 30-day mortality after hip fracture as a quality indicator, by a retrospective study of medical records.MethodsWe used PAS data from all Norwegian hospitals (2005–2009), merged with vital status from the National Registry, to calculate 30-day case-mix adjusted mortality for each hospital (n = 51). We used stratified sampling to establish a representative sample of both hospitals and cases. The hospitals were stratified according to high, low and medium mortality of which 4, 3, and 5 hospitals were sampled, respectively. Within hospitals, cases were sampled stratified according to year of admission, age, length of stay, and vital 30-day status (alive/dead). The final study sample included 1043 cases from 11 hospitals. Clinical information was abstracted from the medical records. Diagnostic and clinical information from the medical records and PAS were used to define definite and probable hip fracture. We used logistic regression analysis in order to estimate systematic between-hospital variation in unmeasured confounding. Finally, to study the consequences of unmeasured confounding for identifying mortality outlier hospitals, a sensitivity analysis was performed.ResultsThe estimated overall positive predictive value was 95.9% for definite and 99.7% for definite or probable hip fracture, with no statistically significant differences between hospitals. The standard deviation of the additional, systematic hospital bias in mortality estimates was 0.044 on the logistic scale. The effect of unmeasured confounding on outlier detection was small to moderate, noticeable only for large hospital volumes.ConclusionsThis study showed that PAS data are adequate for identifying cases of hip fracture, and the effect of unmeasured case mix variation was small. In conclusion, PAS data are adequate for calculating 30-day mortality after hip-fracture as a quality indicator in Norway.
Highlights
In recent years, public reporting of hospital quality indicators in general, and outcome indicators in particular, have been established in several health care systems and in international comparative studies [1,2,3,4]
This study showed that patient administrative data (PAS) data are adequate for identifying cases of hip fracture, and the effect of unmeasured case mix variation was small
PAS data are adequate for calculating 30-day mortality after hip-fracture as a quality indicator in Norway
Summary
Public reporting of hospital quality indicators in general, and outcome indicators in particular, have been established in several health care systems and in international comparative studies [1,2,3,4]. Mortality within a fixed time period after admission, for certain conditions, is in widespread use as a quality indicator. The Norwegian Institute for Public Health reports one overall indicator (based on diagnosis groups leading to 80% of all deaths within 30 days) and three condition-specific indicators; i.e. first time acute myocardial infarction (AMI), stroke and hip fracture [5,6,7,8] [9]. The purpose of this study was to assess the validity of patient administrative data (PAS) for calculating 30-day mortality after hip fracture as a quality indicator, by a retrospective study of medical records
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