News | December 10, 2007

Administrative Data from Healthcare Claims Can be Used to Evaluate Surgical Care

December 11, 2007 - When it comes to evaluating the quality of surgical care, a Thomson Healthcare analytical method that uses data from healthcare claims is as effective as a methodology that uses data taken directly from medical records, according to a study published in the Journal of the American College of Surgeons.

There is great interest in fairly and accurately assessing the quality of healthcare that has led to questions about whether analyses based on data extracted from medical claims, called administrative data, are as effective as analyses using clinical data culled from medical records. Hospitals and the organizations that pay for healthcare - including employers, insurers, and state and federal agencies - commonly study administrative data to evaluate, compare, and improve clinical performance. Medical records typically are not used in large-scale evaluations, because they generally are not available electronically.

The study was led by Dr. Bruce L. Hall of the Department of Surgery at the Washington University School of Medicine in St. Louis. It examined patient mortality in the 30 days following surgery using both an administrative data method developed at Thomson Healthcare’s Solucient unit and a clinical data methodology used by the American College of Surgeon’s National Surgical Quality Improvement Program (NSQIP).

The study concluded results were comparable using administrative or clinical data. The study authors said, “Minor performance differences might... 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.”

The researchers examined a sample of 1,234 patients undergoing surgery at an academic teaching hospital during a one-year period. They compared actual mortality rates with risk-adjusted expected mortality rates calculated by the two methods - the Thomson Healthcare method based on pre-existing administrative records and the NSQIP method based on reviews of medical records.

The research team reported that neither estimate was notably different from the actual mortality rate. Researchers said a potential limitation of the administrative data model used in the study was its ability to control for patients’ pre-existing medical conditions, because that information was not available in the data.

While the study validated Thomson Healthcare methodology, it was conducted independently. Thomson Healthcare was not involved in designing or conducting the study and provided no financial support.

The paper is titled “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.” It is published in the December 2007 issue of the Journal of the American College of Surgeons (Vol. 205, Issue 6, Pages, 767-77.) The study was funded in part by a grant from the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services.

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