Background: The California (CA) Office of Statewide Health Planning and Development (OSHPD) collects three types of patient-level administrative data: patient discharge (PDD), ambulatory surgery (AS), and emergency room (ER). CA hospitals are mandated to submit clinical data to OSHPD for all adult coronary artery bypass graft (CABG) surgeries. This submission is usually a subset of hospital’s Society of Thoracic Surgeons Adult Cardiac Surgery Database submissions. In addition, OSHPD receives clinical data from the National Cardiac Data Registry CathPCI for CA hospitals certified to perform elective PCIs without onsite surgery available. OSHPD implements various data quality efforts to ensure accuracy in each data source, including using data from administrative registries to confirm clinical data and using data from clinical registries to confirm administrative data.
Methods: The clinical CABG data submitted to OSHPD is linked to the PDD. The resulting discrepancy reports are shared with hospitals to assist them when revising their data. The reports show discrepancies in over- and under-reporting of CABG cases, isolated and non-isolated CABGs, and post-op complications. For PCI reporting, clinical data from the CathPCI registry is compared to the PDD, AS, and ER to look for discrepancies.
Results: For the 2016 CABG data, discrepancy reports issued to 126 hospitals submitting clinical CABG data to OSHPD showed potential under-reporting of 417 CABGs that appeared in the PDD but were not submitted in the clinical data. The report showed an additional 437 CABGs that were submitted in the clinical data, but did not appear in the PDD. Hospital review and response to these reports resulted in an overall increase of 296 CABGs to the clinical database. Discrepancy reports also alerted hospitals to 66 cases where a post-operative stroke occurred but was not reported in the clinical database. Hospital review resulted in 22 post-operative strokes added to the clinical registry. The 2016 CathPCI data for CA certified elective PCI hospitals showed potential under reporting of PCIs in PDD, AS, and ER. Possible missing PCIs ranged from 0.4% to 21.6% per hospital. OSHPD worked with staff at the clinical data and administrative data units at these hospitals to understand the discrepancies. The main issue identified was that AS data submitted by some hospitals used alternate coding (Healthcare Common Procedure Coding System) and failed to convert these codes to Current Procedural Terminology codes as required. The findings plan to be used in an outreach effort to all CA hospital submitting administrative PCI data to OSHPD to ensure accurate reporting.
Conclusion: Comparing administrative and clinical data registries data is an effective quality tool to identify discrepancies in each source of data. Sharing discrepancies with hospitals results in improved understanding of data standards and data quality.