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J Thorac Cardiovasc Surg 2005;129:1223-1225
© 2005 The American Association for Thoracic Surgery

Editorial

Use of administrative data for clinical quality measurement

Department of Surgery, Massachusetts General Hospital, Boston, Mass

Received for publication January 11, 2005; accepted for publication February 10, 2005.

^_* Address for reprints: David F. Torchiana, MD, Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (Email: dtorchiana@partners.org).

The first 20% of the full text of this article appears below.

Dr Torchiana

In this edition of the Journal, an article comparing outcomes in California and New York State demonstrates that the low-volume programs in California are the main reason for the disparity in cardiac surgical outcomes between the two states.¹ The report presents results in a way that we are all used to seeing, risk adjusted with confidence limits, statistical significance, and the like, with primary and secondary conclusions that make sense. Although everything the authors assert may be right on the money, we need to use caution in interpreting this kind of report, because for the California outcomes it relies exclusively on administrative data, and there lies a slippery slope.

The first problem with using claims data in clinical studies is that it is starting with an inexact tool. Administrative data are generated by professional coders who work in hospital medical records departments. Coders are trained to review charts and identify the diseases and procedures that define the most resource-intensive diagnosis-related group (DRG) assignment for each hospitalization. By definition, DRGs encompass similar but not identical patient categories, so coding does not create exact lists of clinical conditions. Going back to International Classification of Diseases, Ninth Revision (ICD-9) codes helps, but it does not . . . [Full Text of this Article]

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