Methods Inf Med - Appropriateness of ICD-coded diagnostic inpatient hospital discharge data for medical practice assessment. A systematic review.

Tópicos

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Resumo

JECTIVES: We performed a systematic review to investigate the quality of diagnostic hospital discharge data (DHDD) in order to gain insight in the usefulness of these data for medical practice assessment. We investigated the methods used to evaluate data quality, factors that determine data quality and its consequences for medical practice assessment.METHODS: We selected studies in which both completeness (or sensitivity: SENS) and correctness (or positive predictive value: PPV) were measured. We used the random-effects model to calculate mean SENS and PPV and to explore the effect of a number of covariates.RESULTS: The 101 included studies were very heterogeneous. We distinguished six typical study designs. We found a mean SENS of 0.67 (95%CI: 0.62-0.73) and PPV of 0.76 (95%CI: 0.73-0.79); SENS was significantly lower for comorbidity and complication studies than for some single disease studies. PPV was significantly higher for Scandinavian countries than for other countries. Recoding compared to re-abstracting of the medical record as a gold standard gave a significantly lower PPV. Diagnostic data were considered appropriate by the authors of the studies for quality of care purposes when both SENS and PPV were at least 0.85. Only 13% of the studies fulfilled this criterion.CONCLUSIONS: Variability in quality of care between settings can easily be overshadowed by variability in data quality. However, the use of DHDD by physicians to evaluate their own medical practice may be useful. But only if physicians are willing to critically interpret the meaning of the information for their medical practice assessment.

Resumo Limpo

jectiv perform systemat review investig qualiti diagnost hospit discharg data dhdd order gain insight use data medic practic assess investig method use evalu data qualiti factor determin data qualiti consequ medic practic assessmentmethod select studi complet sensit sen correct posit predict valu ppv measur use randomeffect model calcul mean sen ppv explor effect number covariatesresult includ studi heterogen distinguish six typic studi design found mean sen ci ppv ci sen signific lower comorbid complic studi singl diseas studi ppv signific higher scandinavian countri countri recod compar reabstract medic record gold standard gave signific lower ppv diagnost data consid appropri author studi qualiti care purpos sen ppv least studi fulfil criterionconclus variabl qualiti care set can easili overshadow variabl data qualiti howev use dhdd physician evalu medic practic may use physician will critic interpret mean inform medic practic assess

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