title: Appropriateness of ICD-coded diagnostic inpatient hospital discharge data for medical practice assessment. A systematic review.
abstract: OBJECTIVE
  We performed a systematic review to investigate the quality of diagnostic hospital discharge data (DHDD) in order to gain insight in the usefulness of these data for medical practice assessment. We investigated the methods used to evaluate data quality, factors that determine data quality and its consequences for medical practice assessment.
  
  
  METHODS
  We selected studies in which both completeness (or sensitivity: SENS) and correctness (or positive predictive value: PPV) were measured. We used the random-effects model to calculate mean SENS and PPV and to explore the effect of a number of covariates.
  
  
  RESULTS
  The 101 included studies were very heterogeneous. We distinguished six typical study designs. We found a mean SENS of 0.67 (95%CI: 0.62-0.73) and PPV of 0.76 (95%CI: 0.73-0.79); SENS was significantly lower for comorbidity and complication studies than for some single disease studies. PPV was significantly higher for Scandinavian countries than for other countries. Recoding compared to re-abstracting of the medical record as a gold standard gave a significantly lower PPV. Diagnostic data were considered appropriate by the authors of the studies for quality of care purposes when both SENS and PPV were at least 0.85. Only 13% of the studies fulfilled this criterion.
  
  
  CONCLUSIONS
  Variability in quality of care between settings can easily be overshadowed by variability in data quality. However, the use of DHDD by physicians to evaluate their own medical practice may be useful. But only if physicians are willing to critically interpret the meaning of the information for their medical practice assessment.
authors.affiliation: School of Health Care, Windesheim University of Applied Sciences, Zwolle, The Netherlands. h.prins@windesheim.nl
authors.forename: H
authors.initials: H
authors.lastname: Prins
authors.forename: A
authors.initials: A
authors.lastname: Hasman
mesh_terms: D015897:Comorbidity; D003431:Cross-Cultural Comparison; D057286:Electronic Health Records; D006801:Humans; D038801:International Classification of Diseases; D009426:Netherlands; D010351:Patient Discharge; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D015203:Reproducibility of Results