title: Validating administrative data for the detection of adverse events in older hospitalized patients.
abstract: Older hospitalized patients are at risk of experiencing adverse events including, but not limited to, hospital-acquired pressure ulcers, fall-related injuries, and adverse drug events. A significant challenge in monitoring and managing adverse events is lack of readily accessible information on their occurrence.
  
  
  OBJECTIVE
  The objective of this retrospective cross-sectional study was to validate diagnostic codes for pressure ulcers, fall-related injuries, and adverse drug events found in routinely collected administrative hospitalization data.
  
  
  METHODS
  All patients 65 years of age or older discharged between April 1, 2009 and March 31, 2011 from a provincial academic health sciences center in Canada were eligible for inclusion in the validation study. For each of the three types of adverse events, a random sample of 50 patients whose records were positive and 50 patients whose records were not positive for an adverse event was sought for review in the validation study (n=300 records in total). A structured health record review was performed independently by two health care providers with experience in geriatrics, both of whom were unaware of the patient's status with respect to adverse event coding. A physician reviewed 40 records (20 reviewed by each health care provider) to establish interrater agreement.
  
  
  RESULTS
  A total of 39 pressure ulcers, 56 fall-related injuries, and 69 adverse drug events were identified through health record review. Of these, 34 pressure ulcers, 54 fall-related injuries, and 47 adverse drug events were also identified in administrative data. Overall, the diagnostic codes for adverse events had a sensitivity and specificity exceeding 0.67 (95% confidence interval [CI]: 0.56-0.99) and 0.89 (95% CI: 0.72-0.99), respectively.
  
  
  CONCLUSIONS
  It is feasible and valid to identify pressure ulcers, fall-related injuries, and adverse drug events in older hospitalized patients using routinely collected administrative hospitalization data. The information is relatively inexpensive and easy to access with no impact on clinical staff.
authors.affiliation: Performance Excellence Portfolio, Capital District Health Authority, Halifax, Nova Scotia, Canada ; Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Stacy
authors.initials: S
authors.lastname: Ackroyd-Stolarz
authors.affiliation: Geriatric Medicine, Capital District Health Authority, Halifax, Nova Scotia, Canada ; College of Pharmacy and Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada ; Department of Pharmacy at Capital District Health Authority, Halifax, Nova Scotia, Canada.
authors.forename: Susan K
authors.initials: SK
authors.lastname: Bowles
authors.affiliation: South Shore Family Health, Bridgewater, Nova Scotia, Canada.
authors.forename: Lorri
authors.initials: L
authors.lastname: Giffin
keywords: adverse drug events; fall-related injuries; geriatrics; patient safety; pressure ulcers