Is there value in using physician billing claims along with other administrative health care data to document the burden of adolescent injury? An exploratory investigation with comparison to self-reports in Ontario, Canada.
BACKGROUND
Administrative health care databases may be particularly useful for injury surveillance, given that they are population-based, readily available, and relatively complete. Surveillance based on administrative data, though, is often restricted to injuries that result in hospitalization. Adding physician billing data to administrative data-based surveillance efforts may improve comprehensiveness, but the feasibility of such an approach has rarely been examined. It is also not clear how injury surveillance information obtained using administrative health care databases compares with that obtained using self-report surveys. This study explored the value of using physician billing data along with hospitalization data for the surveillance of adolescent injuries in Ontario, Canada. We aimed i) to document the burden of adolescent injury using administrative health care data, focusing on the relative contribution of physician billing information; and ii) to explore data quality issues by directly comparing adolescent injuries identified in administrative and self-report data.


METHODS
The sample included adolescents aged 12 to 19 years who participated in the 1996-1997 cross-sectional Ontario Health Survey, and whose survey responses were linked to administrative health care datasets (N = 2067). Descriptive analysis was used to document the burden of injuries as a proportion of all physician care by gender and location of care, and to examine the distribution of both administratively-defined and self-reported activity-limiting injuries according to demographic characteristics. Administratively-defined and self-reported injuries were also directly compared at the individual level.


RESULTS
Approximately 10% of physician care for the sample was identified as injury-related. While 18.8% of adolescents had self-reported injury in the previous year, 25.0% had documented administratively-defined injury. The distribution of injuries according to demographic characteristics was similar across data sources, but congruence was low at the individual level. Possible reasons for discrepancies between the data sources included recall errors in the survey data and errors in the physician billing data algorithm.


CONCLUSIONS
If further validated, physician billing data could be used along with hospital inpatient data to make an important and unique contribution to adolescent injury surveillance. The limitations inherent in different datasets highlight the need to continue rely on multiple information sources for complete injury surveillance information.
Potter
Beth K
BK
Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada. bpotter@uottawa.ca
Manuel
Douglas
D
Speechley
Kathy N
KN
Gutmanis
Iris A
IA
Campbell
M Karen
MK
Koval
John J
JJ
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D017281:Cost of Illness; D005260:Female; D006302:Health Services Research; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D009819:Office Visits / Q000191:economics* / Q000706:statistics & numerical data; D009864:Ontario / Q000453:epidemiology; D010350:Patient Credit and Collection; D011159:Population Surveillance / Q000379:methods*; D015995:Prevalence; D012650:Self Disclosure; D014947:Wounds and Injuries / Q000145:classification / Q000191:economics / Q000453:epidemiology*
J Clin Epidemiol. 2001 Feb;54(2):136-41
11166528
J Clin Epidemiol. 2000 Feb;53(2):183-94
10729691
Inj Prev. 2002 Mar;8(1):83-6
11928983
Int J Technol Assess Health Care. 2002 Summer;18(3):705-10
12391960
Epidemiology. 2004 Jul;15(4):428-32
15232403
J Epidemiol Community Health. 1992 Feb;46(1):26-32
1573356
J Clin Epidemiol. 1993 Feb;46(2):181-91
8437034
MMWR Morb Mortal Wkly Rep. 1992 Dec;41 Suppl:181-90
1344256
Am J Public Health. 1994 Apr;84(4):599-605
8154563
J Clin Epidemiol. 1996 Sep;49(9):989-95
8780606
Accid Anal Prev. 1996 Jul;28(4):443-51
8870771
Inj Prev. 1996 Mar;2(1):16-20
9346048
Arch Dis Child. 1998 Feb;78(2):108-10
9579149
Inj Prev. 1999 Jun;5(2):142-4
10385836
Inj Prev. 1999 Sep;5(3):166-7
10518261
Inj Prev. 1999 Sep;5(3):208-13
10518269
Am J Prev Med. 2000 Apr;18(3):215-8
10722987
Inj Prev. 2001 Mar;7(1):70-3
11289540