Accuracy of the discharge destination field in administrative data for identifying transfer to a long-term acute care hospital

被引：25

作者：

Kahn J.M. ^{[1
]}

Iwashyna T.J. ^{[2
]}

机构：

[1] Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Blockley Hall 723, Philadelphia, PA 19104

[2] Division of Pulmonary and Critical Care, University of Michigan, 3A23 300 NIB, SPC 5419, Ann Arbor, MI 48109

来源：

BMC Research Notes | / 3卷 / 1期

基金：

美国国家卫生研究院;

关键词：

Administrative Data; Acute Care Hospital; Skilled Nursing Facility; Rehabilitation Hospital; High False Negative Rate;

D O I：

10.1186/1756-0500-3-205

中图分类号：

学科分类号：

摘要：

Background. Long-term acute care hospitals (LTACs) provide specialized care for patients recovering from severe acute illness. In order to facilitate research into LTAC utilization and outcomes, we studied whether or not the discharge destination field in administrative data accurately identifies patients transferred to an LTAC following acute care hospitalization. Findings. We used the 2006 hospitalization claims for United States Medicare beneficiaries to examine the performance characteristics of the discharge destination field in the administrative record, compared to the reference standard of directly observing LTAC transfers in the claims. We found that the discharge destination field was highly specific (99.7%, 95 percent CI: 99.7% - 99.8%) but modestly sensitive (77.3%, 95 percent CI: 77.0% - 77.6%), with corresponding low positive predictive value (72.6%, 95 percent CI: 72.3% - 72.9%) and high negative predictive value (99.8%, 95 percent CI: 99.8% - 99.8%). Sensitivity and specificity were similar when limiting the analysis to only intensive care unit patients and mechanically ventilated patients, two groups with higher rates of LTAC utilization. Performance characteristics were slightly better when limiting the analysis to Pennsylvania, a state with relatively high LTAC penetration. Conclusions. The discharge destination field in administrative data can result in misclassification when used to identify patients transferred to long-term acute care hospitals. Directly observing transfers in the claims is the preferable method, although this approach is only feasible in identified data. © 2010 Kahn et al; licensee BioMed Central Ltd.

引用

共 10 条

[1]

Carson S.S., Know your long-term care hospital, Chest, 131, pp. 2-5, (2007)

[2]

Scheinhorn D.J., Hassenpflug M.S., Votto J.J., Chao D.C., Epstein S.K., Doig G.S., Knight E.B., Petrak R.A., Ventilator-dependent survivors of catastrophic illness transferred to 23 long-term care hospitals for weaning from prolonged mechanical ventilation, Chest, 131, pp. 76-84, (2007)

[3]

Kahn J.M., Benson N.M., Appleby D., Carson S.S., Iwashyna T.J., Long-term acute care hospital utilization after critical illness, JAMA, 303, pp. 2253-2259, (2010)

[4]

Kahn J.M., The evolving role of dedicated weaning facilities in critical care, Intensive Care Med, 36, pp. 8-10, (2010)

[5]

Wunsch H., Harrison D.A., Rowan K., Health services research in critical care using administrative data, J Crit Care, 20, pp. 264-269, (2005)

[6]

Peabody J.W., Luck J., Jain S., Bertenthal D., Glassman P., Assessing the accuracy of administrative data in health information systems, Med Care, 42, pp. 1066-1072, (2004)

[7]

Iwashyna T.J., Christie J.D., Moody J., Kahn J.M., Asch D.A., The structure of critical care transfer networks, Med Care, 47, pp. 787-793, (2009)

[8]

Scales D.C., Guan J., Martin C.M., Redelmeier D.A., Administrative data accurately identified intensive care unit admissions in Ontario, J Clin Epidemiol, 59, pp. 802-807, (2006)

[9]

Quan H., Parsons G.A., Ghali W.A., Validity of procedure codes in International Classification of Diseases, 9th revision, clinical modification administrative data, Med Care, 42, pp. 801-809, (2004)

[10]

Liu K., Baseggio C., Wissoker D., Maxwell S., Haley J., Long S., Long-term care hospitals under Medicare: Facility-level characteristics, Health Care Financ Rev, 23, pp. 1-18, (2001)

← 1 →