Approaches to ascertaining comorbidity information

validation of routine hospital episode data with clinician-based case note review

Martin Soo, Lynn M Robertson, Tariq Ali, Laura E Clark, Nicholas Fluck, Marjorie Johnston, Angharad Marks, Gordon J Prescott, William Cairns S Smith, Corri Black, GLOMMS Group

Research output: Contribution to journalArticle

14 Citations (Scopus)
9 Downloads (Pure)

Abstract

Background
In clinical practice, research, and increasingly health surveillance, planning and costing, there is a need for high quality information to determine comorbidity information about patients. Electronic, routinely collected healthcare data is capturing increasing amounts of clinical information as part of routine care. The aim of this study was to assess the validity of routine hospital administrative data to determine comorbidity, as compared with clinician-based case note review, in a large cohort of patients with chronic kidney disease.

Methods
A validation study using record linkage. Routine hospital administrative data were compared with clinician-based case note review comorbidity data in a cohort of 3219 patients with chronic kidney disease. To assess agreement, we calculated prevalence, kappa statistic, sensitivity, specificity, positive predictive value and negative predictive value. Subgroup analyses were also performed.

Results
Median age at index date was 76.3 years, 44% were male, 67% had stage 3 chronic kidney disease and 31% had at least three comorbidities. For most comorbidities, we found a higher prevalence recorded from case notes compared with administrative data. The best agreement was found for cerebrovascular disease (κ = 0.80) ischaemic heart disease (κ = 0.63) and diabetes (κ = 0.65). Hypertension, peripheral vascular disease and dementia showed only fair agreement (κ = 0.28, 0.39, 0.38 respectively) and smoking status was found to be poorly recorded in administrative data. The patterns of prevalence across subgroups were as expected and for most comorbidities, agreement between case note and administrative data was similar. Agreement was less, however, in older ages and for those with three or more comorbidities for some conditions.

Conclusions
This study demonstrates that hospital administrative comorbidity data compared moderately well with case note review data for cerebrovascular disease, ischaemic heart disease and diabetes, however there was significant under-recording of some other comorbid conditions, and particularly common risk factors.
Original languageEnglish
Article number253
Number of pages8
JournalBMC Research Notes
Volume7
DOIs
Publication statusPublished - 21 Apr 2014

Fingerprint

Comorbidity
Chronic Renal Insufficiency
Cerebrovascular Disorders
Medical problems
Myocardial Ischemia
Health Planning
Vascular Dementia
Peripheral Vascular Diseases
Validation Studies
Smoking
Health
Statistics
Hypertension
Delivery of Health Care
Planning
Sensitivity and Specificity
Research

Keywords

  • chronic kidney disease
  • validation study
  • medical record linkage
  • patient outcomes
  • public health

Cite this

@article{ed4cda5cbe1c4ca4a51e4163d6f8ded5,
title = "Approaches to ascertaining comorbidity information: validation of routine hospital episode data with clinician-based case note review",
abstract = "BackgroundIn clinical practice, research, and increasingly health surveillance, planning and costing, there is a need for high quality information to determine comorbidity information about patients. Electronic, routinely collected healthcare data is capturing increasing amounts of clinical information as part of routine care. The aim of this study was to assess the validity of routine hospital administrative data to determine comorbidity, as compared with clinician-based case note review, in a large cohort of patients with chronic kidney disease.MethodsA validation study using record linkage. Routine hospital administrative data were compared with clinician-based case note review comorbidity data in a cohort of 3219 patients with chronic kidney disease. To assess agreement, we calculated prevalence, kappa statistic, sensitivity, specificity, positive predictive value and negative predictive value. Subgroup analyses were also performed.ResultsMedian age at index date was 76.3 years, 44{\%} were male, 67{\%} had stage 3 chronic kidney disease and 31{\%} had at least three comorbidities. For most comorbidities, we found a higher prevalence recorded from case notes compared with administrative data. The best agreement was found for cerebrovascular disease (κ = 0.80) ischaemic heart disease (κ = 0.63) and diabetes (κ = 0.65). Hypertension, peripheral vascular disease and dementia showed only fair agreement (κ = 0.28, 0.39, 0.38 respectively) and smoking status was found to be poorly recorded in administrative data. The patterns of prevalence across subgroups were as expected and for most comorbidities, agreement between case note and administrative data was similar. Agreement was less, however, in older ages and for those with three or more comorbidities for some conditions.ConclusionsThis study demonstrates that hospital administrative comorbidity data compared moderately well with case note review data for cerebrovascular disease, ischaemic heart disease and diabetes, however there was significant under-recording of some other comorbid conditions, and particularly common risk factors.",
keywords = "chronic kidney disease, validation study, medical record linkage, patient outcomes, public health",
author = "Martin Soo and Robertson, {Lynn M} and Tariq Ali and Clark, {Laura E} and Nicholas Fluck and Marjorie Johnston and Angharad Marks and Prescott, {Gordon J} and Smith, {William Cairns S} and Corri Black and {GLOMMS Group}",
year = "2014",
month = "4",
day = "21",
doi = "10.1186/1756-0500-7-253",
language = "English",
volume = "7",
journal = "BMC Research Notes",
issn = "1756-0500",
publisher = "BioMed Central",

}

TY - JOUR

T1 - Approaches to ascertaining comorbidity information

T2 - validation of routine hospital episode data with clinician-based case note review

AU - Soo, Martin

AU - Robertson, Lynn M

AU - Ali, Tariq

AU - Clark, Laura E

AU - Fluck, Nicholas

AU - Johnston, Marjorie

AU - Marks, Angharad

AU - Prescott, Gordon J

AU - Smith, William Cairns S

AU - Black, Corri

AU - GLOMMS Group

PY - 2014/4/21

Y1 - 2014/4/21

N2 - BackgroundIn clinical practice, research, and increasingly health surveillance, planning and costing, there is a need for high quality information to determine comorbidity information about patients. Electronic, routinely collected healthcare data is capturing increasing amounts of clinical information as part of routine care. The aim of this study was to assess the validity of routine hospital administrative data to determine comorbidity, as compared with clinician-based case note review, in a large cohort of patients with chronic kidney disease.MethodsA validation study using record linkage. Routine hospital administrative data were compared with clinician-based case note review comorbidity data in a cohort of 3219 patients with chronic kidney disease. To assess agreement, we calculated prevalence, kappa statistic, sensitivity, specificity, positive predictive value and negative predictive value. Subgroup analyses were also performed.ResultsMedian age at index date was 76.3 years, 44% were male, 67% had stage 3 chronic kidney disease and 31% had at least three comorbidities. For most comorbidities, we found a higher prevalence recorded from case notes compared with administrative data. The best agreement was found for cerebrovascular disease (κ = 0.80) ischaemic heart disease (κ = 0.63) and diabetes (κ = 0.65). Hypertension, peripheral vascular disease and dementia showed only fair agreement (κ = 0.28, 0.39, 0.38 respectively) and smoking status was found to be poorly recorded in administrative data. The patterns of prevalence across subgroups were as expected and for most comorbidities, agreement between case note and administrative data was similar. Agreement was less, however, in older ages and for those with three or more comorbidities for some conditions.ConclusionsThis study demonstrates that hospital administrative comorbidity data compared moderately well with case note review data for cerebrovascular disease, ischaemic heart disease and diabetes, however there was significant under-recording of some other comorbid conditions, and particularly common risk factors.

AB - BackgroundIn clinical practice, research, and increasingly health surveillance, planning and costing, there is a need for high quality information to determine comorbidity information about patients. Electronic, routinely collected healthcare data is capturing increasing amounts of clinical information as part of routine care. The aim of this study was to assess the validity of routine hospital administrative data to determine comorbidity, as compared with clinician-based case note review, in a large cohort of patients with chronic kidney disease.MethodsA validation study using record linkage. Routine hospital administrative data were compared with clinician-based case note review comorbidity data in a cohort of 3219 patients with chronic kidney disease. To assess agreement, we calculated prevalence, kappa statistic, sensitivity, specificity, positive predictive value and negative predictive value. Subgroup analyses were also performed.ResultsMedian age at index date was 76.3 years, 44% were male, 67% had stage 3 chronic kidney disease and 31% had at least three comorbidities. For most comorbidities, we found a higher prevalence recorded from case notes compared with administrative data. The best agreement was found for cerebrovascular disease (κ = 0.80) ischaemic heart disease (κ = 0.63) and diabetes (κ = 0.65). Hypertension, peripheral vascular disease and dementia showed only fair agreement (κ = 0.28, 0.39, 0.38 respectively) and smoking status was found to be poorly recorded in administrative data. The patterns of prevalence across subgroups were as expected and for most comorbidities, agreement between case note and administrative data was similar. Agreement was less, however, in older ages and for those with three or more comorbidities for some conditions.ConclusionsThis study demonstrates that hospital administrative comorbidity data compared moderately well with case note review data for cerebrovascular disease, ischaemic heart disease and diabetes, however there was significant under-recording of some other comorbid conditions, and particularly common risk factors.

KW - chronic kidney disease

KW - validation study

KW - medical record linkage

KW - patient outcomes

KW - public health

U2 - 10.1186/1756-0500-7-253

DO - 10.1186/1756-0500-7-253

M3 - Article

VL - 7

JO - BMC Research Notes

JF - BMC Research Notes

SN - 1756-0500

M1 - 253

ER -