Skip to main content
PMC home page
Quality & Safety in Health Care logoLink to Quality & Safety in Health Care
. 2003 Dec;12(Suppl 2):ii58–ii63. doi: 10.1136/qhc.12.suppl_2.ii58

Administrative data based patient safety research: a critical review

C Zhan, M Miller
PMCID: PMC1765777  PMID: 14645897

Abstract

Administrative data are readily available, inexpensive, computer readable, and cover large populations. Despite coding irregularities and limited clinical details, administrative data supplemented by tools such as the Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs) could serve as a screen for potential patient safety problems that merit further investigation, offer valuable insights into adverse impacts and risks of medical errors and, to some extent, provide benchmarks for tracking progress in patient safety efforts at local, state, or national levels.

Full Text

The Full Text of this article is available as a PDF (154.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bates D. W., Miller E. B., Cullen D. J., Burdick L., Williams L., Laird N., Petersen L. A., Small S. D., Sweitzer B. J., Vander Vliet M. Patient risk factors for adverse drug events in hospitalized patients. ADE Prevention Study Group. Arch Intern Med. 1999 Nov 22;159(21):2553–2560. doi: 10.1001/archinte.159.21.2553. [DOI] [PubMed] [Google Scholar]
  2. Bates D. W., O'Neil A. C., Petersen L. A., Lee T. H., Brennan T. A. Evaluation of screening criteria for adverse events in medical patients. Med Care. 1995 May;33(5):452–462. doi: 10.1097/00005650-199505000-00002. [DOI] [PubMed] [Google Scholar]
  3. Bates D. W., Spell N., Cullen D. J., Burdick E., Laird N., Petersen L. A., Small S. D., Sweitzer B. J., Leape L. L. The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. JAMA. 1997 Jan 22;277(4):307–311. [PubMed] [Google Scholar]
  4. Classen D. C., Pestotnik S. L., Evans R. S., Lloyd J. F., Burke J. P. Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA. 1997 Jan 22;277(4):301–306. [PubMed] [Google Scholar]
  5. DesHarnais S. I., McMahon L. F., Jr, Wroblewski R. T., Hogan A. J. Measuring hospital performance. The development and validation of risk-adjusted indexes of mortality, readmissions, and complications. Med Care. 1990 Dec;28(12):1127–1141. [PubMed] [Google Scholar]
  6. Deyo R. A., Cherkin D. C., Ciol M. A. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992 Jun;45(6):613–619. doi: 10.1016/0895-4356(92)90133-8. [DOI] [PubMed] [Google Scholar]
  7. Elixhauser A., Steiner C., Harris D. R., Coffey R. M. Comorbidity measures for use with administrative data. Med Care. 1998 Jan;36(1):8–27. doi: 10.1097/00005650-199801000-00004. [DOI] [PubMed] [Google Scholar]
  8. Feinstein A. R. ICD, POR, and DRG. Unsolved scientific problems in the nosology of clinical medicine. Arch Intern Med. 1988 Oct;148(10):2269–2274. doi: 10.1001/archinte.148.10.2269. [DOI] [PubMed] [Google Scholar]
  9. Ghali W. A., Hall R. E., Rosen A. K., Ash A. S., Moskowitz M. A. Searching for an improved clinical comorbidity index for use with ICD-9-CM administrative data. J Clin Epidemiol. 1996 Mar;49(3):273–278. doi: 10.1016/0895-4356(95)00564-1. [DOI] [PubMed] [Google Scholar]
  10. Hannan E. L., Kilburn H., Jr, Lindsey M. L., Lewis R. Clinical versus administrative data bases for CABG surgery. Does it matter? Med Care. 1992 Oct;30(10):892–907. doi: 10.1097/00005650-199210000-00002. [DOI] [PubMed] [Google Scholar]
  11. Hsia D. C., Krushat W. M., Fagan A. B., Tebbutt J. A., Kusserow R. P. Accuracy of diagnostic coding for Medicare patients under the prospective-payment system. N Engl J Med. 1988 Feb 11;318(6):352–355. doi: 10.1056/NEJM198802113180604. [DOI] [PubMed] [Google Scholar]
  12. Hughes J. S., Iezzoni L. I., Daley J., Greenberg L. How severity measures rate hospitalized patients. J Gen Intern Med. 1996 May;11(5):303–311. doi: 10.1007/BF02598273. [DOI] [PubMed] [Google Scholar]
  13. Iezzoni L. I. Assessing quality using administrative data. Ann Intern Med. 1997 Oct 15;127(8 Pt 2):666–674. doi: 10.7326/0003-4819-127-8_part_2-199710151-00048. [DOI] [PubMed] [Google Scholar]
  14. Iezzoni L. I., Daley J., Heeren T., Foley S. M., Fisher E. S., Duncan C., Hughes J. S., Coffman G. A. Identifying complications of care using administrative data. Med Care. 1994 Jul;32(7):700–715. doi: 10.1097/00005650-199407000-00004. [DOI] [PubMed] [Google Scholar]
  15. Iezzoni L. I., Daley J., Heeren T., Foley S. M., Hughes J. S., Fisher E. S., Duncan C. C., Coffman G. A. Using administrative data to screen hospitals for high complication rates. Inquiry. 1994 Spring;31(1):40–55. [PubMed] [Google Scholar]
  16. Iezzoni L. I., Foley S. M., Heeren T., Daley J., Duncan C. C., Fisher E. S., Hughes J. A method for screening the quality of hospital care using administrative data: preliminary validation results. QRB Qual Rev Bull. 1992 Nov;18(11):361–371. doi: 10.1016/s0097-5990(16)30557-7. [DOI] [PubMed] [Google Scholar]
  17. Jensen A. G., Wachmann C. H., Poulsen K. B., Espersen F., Scheibel J., Skinhøj P., Frimodt-Møller N. Risk factors for hospital-acquired Staphylococcus aureus bacteremia. Arch Intern Med. 1999 Jul 12;159(13):1437–1444. doi: 10.1001/archinte.159.13.1437. [DOI] [PubMed] [Google Scholar]
  18. Johantgen M., Elixhauser A., Bali J. K., Goldfarb M., Harris D. R. Quality indicators using hospital discharge data: state and national applications. Jt Comm J Qual Improv. 1998 Feb;24(2):88–105. doi: 10.1016/s1070-3241(16)30364-9. [DOI] [PubMed] [Google Scholar]
  19. Kovner Christine, Jones Cheryl, Zhan Chunliu, Gergen Peter J., Basu Jayasree. Nurse staffing and postsurgical adverse events: an analysis of administrative data from a sample of U.S. hospitals, 1990-1996. Health Serv Res. 2002 Jun;37(3):611–629. doi: 10.1111/1475-6773.00040. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Lawthers A. G., McCarthy E. P., Davis R. B., Peterson L. E., Palmer R. H., Iezzoni L. I. Identification of in-hospital complications from claims data. Is it valid? Med Care. 2000 Aug;38(8):785–795. doi: 10.1097/00005650-200008000-00003. [DOI] [PubMed] [Google Scholar]
  21. Leape Lucian L. Reporting of adverse events. N Engl J Med. 2002 Nov 14;347(20):1633–1638. doi: 10.1056/NEJMNEJMhpr011493. [DOI] [PubMed] [Google Scholar]
  22. Leatherman S., Peterson E., Heinen L., Quam L. Quality screening and management using claims data in a managed care setting. QRB Qual Rev Bull. 1991 Nov;17(11):349–359. doi: 10.1016/s0097-5990(16)30485-7. [DOI] [PubMed] [Google Scholar]
  23. Mark D. H. Race and the limits of administrative data. JAMA. 2001 Jan 17;285(3):337–338. doi: 10.1001/jama.285.3.337. [DOI] [PubMed] [Google Scholar]
  24. McCarthy E. P., Iezzoni L. I., Davis R. B., Palmer R. H., Cahalane M., Hamel M. B., Mukamal K., Phillips R. S., Davies D. T., Jr Does clinical evidence support ICD-9-CM diagnosis coding of complications? Med Care. 2000 Aug;38(8):868–876. doi: 10.1097/00005650-200008000-00010. [DOI] [PubMed] [Google Scholar]
  25. Miller M. R., Elixhauser A., Zhan C., Meyer G. S. Patient Safety Indicators: using administrative data to identify potential patient safety concerns. Health Serv Res. 2001 Dec;36(6 Pt 2):110–132. [PMC free article] [PubMed] [Google Scholar]
  26. Miller Marlene R., Elixhauser Anne, Zhan Chunliu. Patient safety events during pediatric hospitalizations. Pediatrics. 2003 Jun;111(6 Pt 1):1358–1366. doi: 10.1542/peds.111.6.1358. [DOI] [PubMed] [Google Scholar]
  27. Mitchell J. B., Bubolz T., Paul J. E., Pashos C. L., Escarce J. J., Muhlbaier L. H., Wiesman J. M., Young W. W., Epstein R. S., Javitt J. C. Using Medicare claims for outcomes research. Med Care. 1994 Jul;32(7 Suppl):JS38–JS51. [PubMed] [Google Scholar]
  28. Needleman Jack, Buerhaus Peter, Mattke Soeren, Stewart Maureen, Zelevinsky Katya. Nurse-staffing levels and the quality of care in hospitals. N Engl J Med. 2002 May 30;346(22):1715–1722. doi: 10.1056/NEJMsa012247. [DOI] [PubMed] [Google Scholar]
  29. Riley G., Lubitz J., Gornick M., Mentnech R., Eggers P., McBean M. Medicare beneficiaries: adverse outcomes after hospitalization for eight procedures. Med Care. 1993 Oct;31(10):921–949. doi: 10.1097/00005650-199310000-00005. [DOI] [PubMed] [Google Scholar]
  30. Romano P. S., Chan B. K. Risk-adjusting acute myocardial infarction mortality: are APR-DRGs the right tool? Health Serv Res. 2000 Mar;34(7):1469–1489. [PMC free article] [PubMed] [Google Scholar]
  31. Romano P. S., Roos L. L., Jollis J. G. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol. 1993 Oct;46(10):1075–1090. doi: 10.1016/0895-4356(93)90103-8. [DOI] [PubMed] [Google Scholar]
  32. Romano Patrick S., Chan Benjamin K., Schembri Michael E., Rainwater Julie A. Can administrative data be used to compare postoperative complication rates across hospitals? Med Care. 2002 Oct;40(10):856–867. doi: 10.1097/00005650-200210000-00004. [DOI] [PubMed] [Google Scholar]
  33. Romano Patrick S., Geppert Jeffrey J., Davies Sheryl, Miller Marlene R., Elixhauser Anne, McDonald Kathryn M. A national profile of patient safety in U.S. hospitals. Health Aff (Millwood) 2003 Mar-Apr;22(2):154–166. doi: 10.1377/hlthaff.22.2.154. [DOI] [PubMed] [Google Scholar]
  34. Roos L. L., Brazauskas R. Outcomes and quality assurance: facilitating the use of administrative data. Qual Assur Health Care. 1990;2(1):77–88. doi: 10.1093/intqhc/2.1.77. [DOI] [PubMed] [Google Scholar]
  35. Silber J. H., Rosenbaum P. R., Trudeau M. E., Even-Shoshan O., Chen W., Zhang X., Mosher R. E. Multivariate matching and bias reduction in the surgical outcomes study. Med Care. 2001 Oct;39(10):1048–1064. doi: 10.1097/00005650-200110000-00003. [DOI] [PubMed] [Google Scholar]
  36. Simborg D. W. DRG creep: a new hospital-acquired disease. N Engl J Med. 1981 Jun 25;304(26):1602–1604. doi: 10.1056/NEJM198106253042611. [DOI] [PubMed] [Google Scholar]
  37. Weingart S. N., Iezzoni L. I., Davis R. B., Palmer R. H., Cahalane M., Hamel M. B., Mukamal K., Phillips R. S., Davies D. T., Jr, Banks N. J. Use of administrative data to find substandard care: validation of the complications screening program. Med Care. 2000 Aug;38(8):796–806. doi: 10.1097/00005650-200008000-00004. [DOI] [PubMed] [Google Scholar]
  38. Wennberg J., Gittelsohn Small area variations in health care delivery. Science. 1973 Dec 14;182(4117):1102–1108. doi: 10.1126/science.182.4117.1102. [DOI] [PubMed] [Google Scholar]

Articles from Quality & safety in health care are provided here courtesy of BMJ Publishing Group

RESOURCES