Original article
Congenital heart surgery
Measuring Hospital Performance in Congenital Heart Surgery: Administrative Versus Clinical Registry Data

https://doi.org/10.1016/j.athoracsur.2014.10.069Get rights and content

Background

In congenital heart surgery, hospital performance has historically been assessed using widely available administrative data sets. Recent studies have demonstrated inaccuracies in case ascertainment (coding and inclusion of eligible cases) in administrative versus clinical registry data; however, it is unclear whether this impacts assessment of performance on a hospital level.

Methods

Merged data from The Society of Thoracic Surgeons (STS) database (clinical registry) and the Pediatric Health Information Systems (PHIS) database (administrative data set) for 46,056 children undergoing cardiac operations (2006–2010) were used to evaluate in-hospital mortality for 33 hospitals based on their administrative versus registry data. Standard methods to identify/classify cases were used: Risk Adjustment in Congenital Heart Surgery, version 1 (RACHS-1) in the administrative data and STS–European Association for Cardiothoracic Surgery (STAT) methodology in the registry.

Results

Median hospital surgical volume based on the registry data was 269 cases per year; mortality was 2.9%. Hospital volumes and mortality rates based on the administrative data were on average 10.7% and 4.7% lower, respectively, although this varied widely across hospitals. Hospital rankings for mortality based on the administrative versus registry data differed by 5 or more rank positions for 24% of hospitals, with a change in mortality tertile classification (high, middle, or low mortality) for 18% and a change in statistical outlier classification for 12%. Higher volume/complexity hospitals were most impacted. Agency for Healthcare Quality and Research (AHRQ) methods in the administrative data yielded similar results.

Conclusions

Inaccuracies in case ascertainment in administrative versus clinical registry data can lead to important differences in assessment of hospital mortality rates for congenital heart surgery.

Section snippets

Data Source

A merged data set containing information coded both in The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD—a clinical registry) and the Pediatric Health Information Systems (PHIS) database (an administrative data set) for children undergoing cardiac operations at 33 US children’s hospitals was used for this study.

Study Population

The cohort included 46,056 patients from 33 hospitals. Patient and hospital characteristics are displayed in Table 1. Compared with the overall cohort of hospitals participating in the national STS-CHSD during the study period (n = 114), the 33 hospitals included in the present analysis had a higher average annual volume of pediatric cardiac cases (391 versus 204 cases per year).

Case Ascertainment

The proportion of operations in the overall cohort included within the various case ascertainment systems used in

Comment

The relative merits of different data sources in the assessment of cardiac surgical outcomes have been debated since the 1980s, when concern among cardiac surgeons regarding outcomes reports from the Health Care Financing Administration based on administrative data prompted the formation of registries such as the Northern New England Cardiovascular Disease Study Group registry and the STS Adult Cardiac Surgery Database 25, 26. These data sets were designed to foster complete case ascertainment

References (32)

  • Medicare.gov. Hospital Compare. Available at: www.hospitalcompare.hhs.gov. Accessed January...
  • OptumHealth. Complex Medical Conditions. Available at:...
  • J.D. Kugler et al.

    Development of a pediatric cardiology quality improvement collaborative: from inception to implementation. From the Joint Council on Congenital Heart Disease Quality Improvement Task Force

    Congenit Heart Dis

    (2009)
  • Agency for Healthcare Research and Quality, US Department of Health and Human Services. Pediatric quality indicators....
  • National Quality Forum. 0339 RACHS-1 pediatric heart surgery mortality (REVISED), 0340 Pediatric heart surgery volume...
  • M.L. Jacobs et al.

    Databases for assessing the outcomes of the treatment of patients with congenital and paediatric cardiac disease—the perspective of cardiac surgery

    Cardiol Young

    (2008)
  • Cited by (37)

    • Risk Stratification for Congenital Heart Surgery for ICD-10 Administrative Data (RACHS-2)

      2022, Journal of the American College of Cardiology
      Citation Excerpt :

      The RACHS-2 system allows for nearly 100% capture of congenital heart surgical volumes with ∼1% false positives. This represents marked improvement over previous administrative methods, which captured 80% to 90% of cases with variable precision.1-3,23-25 Some of the improvements are attributable to increased precision of the ICD-10 coding, which, unlike ICD-9, is anatomically based.

    • The Value of Longitudinal Follow-Up and Linked Registries

      2021, Journal of the American College of Cardiology
    • Hospital Costs Related to Early Extubation After Infant Cardiac Surgery

      2019, Annals of Thoracic Surgery
      Citation Excerpt :

      Specifically by merging clinical PHN CLS data with administrative data from CHA through linking on indirect identifiers, we were able to understand the impact of the quality improvement initiative not only on clinical outcomes but costs of care as well. Similar techniques have been used to merge cost data with trial datasets and registry data [8, 15–18] and highlight how this methodology can foster investigations not otherwise possible with isolated datasets alone. The methods used in the present analysis can be applied to other quality initiatives to support more comprehensive understanding of healthcare value and the impact of various initiatives geared toward optimizing both clinical outcomes and costs of care.

    View all citing articles on Scopus
    View full text