Reliability of the HMRI (CIHI) database : a re-abstracting study

• Main Author: Brown, Linda Anne
• Format: Others
• Language: English
• Published: 2009
• Online Access: http://hdl.handle.net/2429/4137

Accuracy of the information in health care database systems is essential throughout the health care system for functions such as planning and research. This study examines the reliabihty of the HMRI database, recently amalgamated under the CIHI. It compares selected data items from the in-patient hospital discharge database against a re-abstracted set of data items from the original health record in a sample of six Vancouver acute care hospitals for the fiscal year 31 March 1986 - 1 April 1987. Cases were restricted to acute care medical and surgical cases. A total of 606 cases using the ICD-9 classification system were re-abstracted using the original health record. Results demonstrated nondiagnostic variables demonstrated an overall agreement of 92.4%. The agreement for the Most Responsible Diagnosis (MRD) to four-digits is 61.4%, while individual hospital scores ranged from 52.0 to 69.6%. For the MRD to three-digits agreement increased to 72.1%, with individual hospitals ranging between 62.4 and 79.4%. The Principal Procedure (PP) agreement to three-digits was 64.8% with individual hospital scores ranging from 56.3 to 75.6%. For the PP at two-digits, agreement was 72.9%, with individual hospitals ranging from 61.4 to 85.4%. Denominators for secondary diagnoses and secondary procedures reflect the total number of diagnoses and/or procedures recorded. Secondary diagnoses to four-digits had agreement scores of 67.4% by number of diagnoses recorded and secondary procedures to three-digits of 80.7% by number of secondary procedures recorded. Total diagnoses and procedures combined demonstrated an overall agrement score of 68.3% with individual hospitals ranging from 61.8 to 73.1%. Agreement by case, where all relevant diagnostic and procedural codes in the entire record matched, dropped significantly to 34.5% for secondary diagnoses and to 59.7% for secondary procedures. The greatest frequency overall for the type of discrepancy was for clerical errors, especially for code books not used properly to determine specificity of the diagnosis. Specificity of the code is required, the information is available in the record, but specificity is not determined by the coder. The greatest frequency of discrepancy for the MRD was 73.1 % for clerical errors. For the PP, 46.9% of discrepancies were in the selection of principal procedure and 42.9% for clerical errors. This study did not demonstrate a significant difference between individual coders by years of experience, by credentials or by years of experience and credentials. It was deterrnined that the data are unsuitable for a quality of care study where the data are utilized beyond the individual hospital site. Care must be taken when utilizing those data for research purposes. === Medicine, Faculty of === Population and Public Health (SPPH), School of === Graduate