title: Using Record Linkage to Improve Race Data Quality for American Indians and Alaska Natives in Two Pacific Northwest State Hospital Discharge Databases.
abstract: OBJECTIVE
  To evaluate and adjust for American Indian and Alaska Native (AI/AN) racial misclassification in two hospital discharge datasets in the Pacific Northwest.
  
  
  METHODS
  Oregon (2010-2011) and Washington (2011) hospital discharge datasets were linked with the Northwest Tribal Registry (NTR), a registry of AI/AN individuals who accessed services at Indian health facilities in the Northwest.
  
  
  METHODS
  Record linkage was used to match state hospital records to the NTR. A state record was considered misclassified if it matched the NTR and was coded as non-AI/AN or missing race data. Effect of misclassification was evaluated by comparing prelinkage and postlinkage, age-adjusted hospital discharge rates.
  
  
  METHODS
  Researchers used Link Plus 2.0 software (Atlanta, GA, USA) for linkages and SAS 9.4 (Cary, NC, USA) for statistical analyses.
  
  
  RESULTS
  In Oregon, 55.4 percent of matching records were misclassified (66.5 percent miscoded white, and 22.1 percent were missing race information). In Washington, 44.9 percent of matching records were misclassified (61.8 percent miscoded white, and 32.7 percent were missing race information). Linkage increased ascertainment of AI/AN hospitalizations by 31.8 percent in Oregon and 33.9 percent in Washington. Linkage increased the rate ratio (RR) for AI/AN hospitalizations in comparison to non-Hispanic whites (NHW) from 0.81 to 1.07 in Oregon, and from 1.21 to 1.62 in Washington.
  
  
  CONCLUSIONS
  Correction of race in hospital discharge datasets through linkage with a reference file of known AI/AN individuals is an important first step before analytic research on AI/AN health care in the Pacific Northwest can be accomplished with administrative datasets.
authors.affiliation: Northwest Portland Area Indian Health Board, Portland, OR.
authors.forename: Kristyn M
authors.initials: KM
authors.lastname: Bigback
authors.affiliation: OCHIN, Portland, OR.
authors.forename: Megan
authors.initials: M
authors.lastname: Hoopes
authors.affiliation: Northwest Portland Area Indian Health Board, Portland, OR.
authors.forename: Jenine
authors.initials: J
authors.lastname: Dankovchik
authors.affiliation: Seattle Indian Health Board, Seattle, WA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Knaster
authors.affiliation: Northwest Portland Area Indian Health Board, Portland, OR.
authors.forename: Victoria
authors.initials: V
authors.lastname: Warren-Mears
authors.affiliation: Northwest Portland Area Indian Health Board, Portland, OR.
authors.forename: Sujata
authors.initials: S
authors.lastname: Joshi
authors.affiliation: Northwest Portland Area Indian Health Board, Portland, OR.
authors.forename: Thomas
authors.initials: T
authors.lastname: Weiser
mesh_terms: D000465:Algorithms; D005260:Female; D006302:Health Services Research; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D004930:Inuit / Q000706:statistics & numerical data*; D008297:Male; D008498:Medical Record Linkage; D009922:Oregon; D010351:Patient Discharge; D058996:Quality Improvement; D012042:Registries; D014861:Washington
keywords: American Indian/Alaska Native; Hospital discharge; Oregon; Pacific Northwest; Washington; data quality; disparities; hospitalizations; racial misclassification