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Related Experiment Videos

The hazards of stroke case selection using administrative data.

Dean M Reker1, Amy K Rosen, Helen Hoenig

  • 1Kansas City VA Medical Center and Center on Aging, University of Kansas Medical Center, Kansas, USA. dean.reker@med.va.gov

Medical Care
|January 22, 2002
PubMed
Summary

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Different methods for identifying stroke patients using administrative data can significantly alter mortality outcome results. This impacts provider profiling and highlights the need for standardized definitions in stroke research.

Area of Science:

  • Health Services Research
  • Medical Informatics
  • Public Health

Background:

  • Administrative data and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes are widely used for patient outcome research, especially mortality.
  • Various ICD-9-CM sampling algorithms exist for identifying stroke patients, leading to potential inconsistencies.

Purpose of the Study:

  • To evaluate the impact of different sampling strategies (high sensitivity vs. high specificity) on modeling stroke mortality.
  • To assess how these strategies affect performance indicators for patient networks.

Main Methods:

  • Developed risk adjustment models for two stroke cohorts using distinct ICD-9-CM algorithms.
  • Calculated standard mortality ratios in a validation sample to measure network performance.

Related Experiment Videos

  • Selected VHA inpatients with stroke from 1997 (development) and 1998 (validation) based on diagnostic codes.

    • Main Results:

    • Model development and validation yielded consistent performance metrics (c-statistics 0.74-0.75, R2 0.07-0.09, concordance 73%-74%).
    • Despite consistent model performance, network performance rankings differed by 5+ positions for 7 out of 22 networks.

    Conclusions:

    • Using administrative data to assess stroke mortality poses challenges due to varying ICD-9-CM algorithms for patient identification.
    • Provider profiling results can be inconsistent without a standardized definition of stroke patients.