Administrative versus clinical data for coronary artery bypass graft surgery report cards: the view from California.
OBJECTIVE
The objective of this study was to compare the performance of a risk model for isolated coronary artery bypass graft (CABG) surgery based on administrative data with that of a clinical risk model in predicting mortality and identifying hospital performance outliers.


METHODS
Clinical data records from the California CABG Mortality Reporting Program for 38,230 isolated CABG patients undergoing surgery in 2000-2001 were linked to records in the California patient discharge data (PDD) abstract. Risk factors based on administrative data that mirrored clinical risk factors were developed using the condition present at admission indicator in the PDD to separate preoperative acute conditions from complications of surgery. Using logistic regression, risk model performance across data sources was compared along with hospital risk-adjusted mortality ranks and quality ratings.


RESULTS
The administrative data showed lower prevalence of risk factors when compared with the clinical data. The clinical risk model had somewhat better discrimination (C = 0.824) than the administrative model (C = 0.799). The clinical model yielded 17 outliers and the administrative model 16 with agreement on 12 hospitals' status. Performance of the administrative risk model was minimally affected by removal of information from prior admissions and removal of risk factors not confirmed in the clinical record.


CONCLUSIONS
Unique properties of the California administrative data, including the ability to distinguish acute preoperative risk factors from complications of surgery, permitted construction of an administrative risk model that predicts mortality on par with most published clinical models. Despite this, the administrative model identified slightly different hospital outliers, which may indicate somewhat biased assessments of hospital patient risk.
Parker
Joseph P
JP
Healthcare Outcomes Center, California Office of Statewide Health Planning and Development, 818 K Street, Sacramento, CA 95814, USA. jparker@oshpd.ca.gov
Li
Zhongmin
Z
Damberg
Cheryl L
CL
Danielsen
Beate
B
Carlisle
David M
DM
D002140:California / Q000453:epidemiology; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000458:organization & administration*; D012042:Registries / Q000706:statistics & numerical data*; D012307:Risk Factors