Identifying complications of care using administrative data.
The Complications Screening Program (CSP) is a method using standard hospital discharge abstract data to identify 27 potentially preventable in-hospital complications, such as post-operative pneumonia, hemorrhage, medication incidents, and wound infection. The CSP was applied to over 1.9 million adult medical/surgical cases using 1988 California discharge abstract data. Cases with complications were significantly older and more likely to die, and they had much higher average total charges and lengths of stay than other cases (P < 0.0001). For most case types, 13 chronic conditions, defined using diagnosis codes, increased the relative risks of having a complication after adjusting for patient age. Cases at larger hospitals and teaching facilities generally had higher complication rates. Logistic regression models to predict complications using demographic, administrative, clinical, and hospital characteristics variables, had modest power (C statistics = 0.64 to 0.70). The CSP requires further evaluation before using it for purposes other than research.
Iezzoni
L I
LI
Department of Medicine, Harvard Medical School, Beth Israel Hospital, Boston, MA 02215.
Daley
J
J
Heeren
T
T
Foley
S M
SM
Fisher
E S
ES
Duncan
C
C
Hughes
J S
JS
Coffman
G A
GA
D000328:Adult; D000465:Algorithms; D002140:California / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007049:Iatrogenic Disease; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008508:Medication Errors / Q000706:statistics & numerical data*; D016017:Odds Ratio; D010351:Patient Discharge; D011183:Postoperative Complications / Q000453:epidemiology*; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012372:ROC Curve; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology