TY - JOUR
T1 - Comparison of Mortality Risk Adjustment Using a Clinical Data Algorithm (American College of Surgeons National Surgical Quality Improvement Program) and an Administrative Data Algorithm (Solucient) at the Case Level Within a Single Institution
AU - Hall, Bruce Lee
AU - Hirbe, Mitzi
AU - Waterman, Brian
AU - Boslaugh, Sarah
AU - Dunagan, Wm Claiborne
N1 - Funding Information:
Dr Hall was supported by the Center for Health Policy, under the direction of Dr William Peck, Washington University in St Louis, St Louis, MO. Acknowledgments are given to Dr Shukri Khuri and his staff, Dr William Henderson and his staff, all of the principals of the Veterans Administration NSQIP and ACS-NSQIP, and the staff of QCMetrix, Inc, for their critical roles in the conduct of the Department Veterans Affairs and ACS NSQIP programs. We thank Karin Brown, Infection Control Graphic Designer, BJC HealthCare, for assistance with preparation of graphics. Descriptions of the methods used by Solucient, LLC, were graciously provided by David A Foster, PhD, MPH, Chief Scientist, Solucient, Inc; we also thank Dr Foster for review and critique of the article.
PY - 2007/12
Y1 - 2007/12
N2 - Background: There is great interest in efficiently evaluating health care quality, but there is controversy over the use of administrative versus clinical data methods. We sought to compare actual mortality with risk-adjusted expected mortality in a sample population calculated by two different methods; one based on preexisting administrative records and one based on chart reviews. Study Design: We examined a sample of patients (n = 1,234) undergoing surgical procedures at an academic teaching hospital during 1 year. The first risk-adjustment method was that used by the National Surgical Quality Improvement Program, which is based on dedicated medical record review. The second method was that used by Solucient, LLC, which is based on preexisting administrative records. Results: The ratio of observed to expected mortality for this population set was higher using the National Surgical Quality Improvement Program algorithm (1.1; 95% CI, 0.8 to 1.5) than using the Solucient algorithm (0.9; 95% CI, 0.6 to 1.2) but neither estimate was notably different from 1.0. Similarly, when observed to expected mortality ratios were calculated separately for each quartile of mortality, there were no marked differences within quartiles, although minor differences with potential importance were noted. Fit was comparable by age categories, gender, and American Society of Anesthesiologists' categories. A number of actual deaths had higher predicted mortality scores using the Solucient algorithm. Conclusions: Risk-adjusted mortality estimates were comparable using administrative or clinical data. Minor performance differences might still have implications. Because of the potential lower cost of using administrative data, this type of algorithm can be an efficient alternative and should continue to be investigated.
AB - Background: There is great interest in efficiently evaluating health care quality, but there is controversy over the use of administrative versus clinical data methods. We sought to compare actual mortality with risk-adjusted expected mortality in a sample population calculated by two different methods; one based on preexisting administrative records and one based on chart reviews. Study Design: We examined a sample of patients (n = 1,234) undergoing surgical procedures at an academic teaching hospital during 1 year. The first risk-adjustment method was that used by the National Surgical Quality Improvement Program, which is based on dedicated medical record review. The second method was that used by Solucient, LLC, which is based on preexisting administrative records. Results: The ratio of observed to expected mortality for this population set was higher using the National Surgical Quality Improvement Program algorithm (1.1; 95% CI, 0.8 to 1.5) than using the Solucient algorithm (0.9; 95% CI, 0.6 to 1.2) but neither estimate was notably different from 1.0. Similarly, when observed to expected mortality ratios were calculated separately for each quartile of mortality, there were no marked differences within quartiles, although minor differences with potential importance were noted. Fit was comparable by age categories, gender, and American Society of Anesthesiologists' categories. A number of actual deaths had higher predicted mortality scores using the Solucient algorithm. Conclusions: Risk-adjusted mortality estimates were comparable using administrative or clinical data. Minor performance differences might still have implications. Because of the potential lower cost of using administrative data, this type of algorithm can be an efficient alternative and should continue to be investigated.
UR - http://www.scopus.com/inward/record.url?scp=36248995328&partnerID=8YFLogxK
U2 - 10.1016/j.jamcollsurg.2007.08.013
DO - 10.1016/j.jamcollsurg.2007.08.013
M3 - Article
C2 - 18035260
AN - SCOPUS:36248995328
SN - 1072-7515
VL - 205
SP - 767
EP - 777
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 6
ER -