BMJ  2007;334:1044 (19 May), doi:10.1136/bmj.39168.496366.55 (published 23 April 2007)

Research

Use of administrative data or clinical databases as predictors of risk of death in hospital: comparison of models

¹ Dr Foster Unit, Imperial College London, London EC1A 9LA, ² Department of Primary Care and Social Medicine, Imperial College London

Objective To compare risk prediction models for death in hospital based on an administrative database with published results based on data derived from three national clinical databases: the national cardiac surgical database, the national vascular database and the colorectal cancer study.

Design Analysis of inpatient hospital episode statistics. Predictive model developed using multiple logistic regression.

Setting NHS hospital trusts in England.

Patients All patients admitted to an NHS hospital within England for isolated coronary artery bypass graft (CABG), repair of abdominal aortic aneurysm, and colorectal excision for cancer from 1996-7 to 2003-4.

Main outcome measures Deaths in hospital. Performance of models assessed with receiver operating characteristic (ROC) curve scores measuring discrimination (<0.7=poor, 0.7-0.8=reasonable, >0.8=good) and both Hosmer-Lemeshow statistics and standardised residuals measuring goodness of fit.

Results During the study period 152 523 cases of isolated CABG with 3247 deaths in hospital (2.1%), 12 781 repairs of ruptured abdominal aortic aneurysm (5987 deaths, 46.8%), 31 705 repairs of unruptured abdominal aortic aneurysm (3246 deaths, 10.2%), and 144 370 colorectal resections for cancer (10 424 deaths, 7.2%) were recorded. The power of the complex predictive model was comparable with that of models based on clinical datasets with ROC curve scores of 0.77 (v 0.78 from clinical database) for isolated CABG, 0.66 (v 0.65) and 0.74 (v 0.70) for repairs of ruptured and unruptured abdominal aortic aneurysm, respectively, and 0.80 (v 0.78) for colorectal excision for cancer. Calibration plots generally showed good agreement between observed and predicted mortality.

Conclusions Routinely collected administrative data can be used to predict risk with similar discrimination to clinical databases. The creative use of such data to adjust for case mix would be useful for monitoring healthcare performance and could usefully complement clinical databases. Further work on other procedures and diagnoses could result in a suite of models for performance adjusted for case mix for a range of specialties and procedures.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

Screening for abdominal aortic aneurysm

Roger Greenhalgh and Janet Powell
BMJ 2007 335: 732-733. [Extract] [Full Text] [PDF]

The value of administrative databases

Mohammed A Mohammed and Andrew Stevens
BMJ 2007 334: 1014-1015. [Extract] [Full Text] [PDF]

Surgery for congenital heart conditions in Oxford

Bruce Keogh
BMJ 2005 330: 319-320. [Extract] [Full Text] [PDF]

Cross sectional survey of multicentre clinical databases in the United Kingdom

Nick Black, Marian Barker, and Mary Payne
BMJ 2004 328: 1478. [Abstract] [Full Text] [PDF]

Payment by results—new financial flows in the NHS

Jennifer Dixon
BMJ 2004 328: 969-970. [Extract] [Full Text] [PDF]

Operative mortality in colorectal cancer: prospective national study

Paris P Tekkis, Jan D Poloniecki, Michael R Thompson, and Jeffrey D Stamatakis
BMJ 2003 327: 1196-1201. [Abstract] [Full Text] [PDF]

Making routine data adequate to support clinical audit

M McKee, J Dixon, and L Chenet
BMJ 1994 309: 1246-47. [Extract] [Full Text]

This article has been cited by other articles:

• Walsh, B., Roberts, H. C., Nicholls, P. G., Lattimer, V. A (2008). Trends in hospital inpatient episodes for signs, symptoms and ill-defined conditions: observational study of older people's hospital episodes in England, 1995-2003. Age Ageing 37: 455-458 [Full text]  
• Greenhalgh, R., Powell, J. (2007). Screening for abdominal aortic aneurysm. BMJ 335: 732-733 [Full text]  
• Mohammed, M. A, Stevens, A. (2007). The value of administrative databases. BMJ 334: 1014-1015 [Full text]  

Rapid Responses:

Read all Rapid Responses

In-patient death is only one of many possible performance measures

Chris P. Gale
bmj.com, 23 May 2007 [Full text]

SHFA- value for money

Damien G Reid, et al.
bmj.com, 30 May 2007 [Full text]

Benchmarking with administrative or clinical databases: Serious pitfalls.

Alain Braillon
bmj.com, 1 Jun 2007 [Full text]