[Hospital morbidity statistics: the accuracy of the diagnosis reported in the discharge registry book].
BACKGROUND
The registry book of admission and discharges (RBD) is operative in most public and private hospitals of this country. Currently its reformation is contemplated, consisting in a modification of the minimal set of basic data and its computerization. The aim of the present study was to evaluate the accuracy of the discharge diagnosis recorded in the RBD and to analyze the possible factors implicated in the current quality level.


METHODS
In a sample of 9 hospitals from the Seville province, 2,634 discharges were selected with a stratified sampling process which was proportional to the number of discharges in each stratum during 1985. The accuracy of the diagnosis recorded in the RBD was estimated by comparing it with that in the clinical record (CR).


RESULTS
The accuracy indexes showed that, for the large diagnostic groups, only in 45% of discharges the diagnosis coincided in both documents. The accuracy increased to 89% when the estimation was made after excluding those discharges where the diagnosis was not recorded in the RBD and/or in the CR (n = 1303).


CONCLUSIONS
The fulfillment of the RBD appears as the main error source, followed by the selection of the major diagnosis and its transcription in the different documents of the circuit. It is concluded that a precondition for the success of a reformed RBD is to guarantee the fulfillment of data.
Martínez Jiménez
R
R
Servicio Andaluz de Salud, Consejería de Salud y Consumo, Junta de Andalucía.
García Benavides
F
F
D003933:Diagnosis; D006760:Hospitalization / Q000706:statistics & numerical data*; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012042:Registries / Q000592:standards* / Q000706:statistics & numerical data; D013030:Spain
Estadísticas de morbididad hospitalaria: exactitud del diagnóstico notificado en el libro de registro de altas.