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Pull back the curtain: External data validation is an essential element of quality improvement benchmark reporting
Jill Lynn Jakubus1, Shauna L Di Pasquo, Judy N Mikhail
1From the Department of Surgery (J.L.J., J.N.M., A.H.C.-N., M.R.H.), University of Michigan, Ann Arbor; Department of Surgery (S.L.D.P.), Beaumont Hospital-Farmington Hills, Farmington Hills, Michigan; and Department of Surgery (P.C.J.), Indiana University, Indianapolis, Indiana.
The Journal of Trauma and Acute Care Surgery
|January 9, 2020
Summary
External data validation significantly improved trauma center data accuracy and reliability. This enhancement bolsters the integrity of risk-adjusted models and quality improvement initiatives.
Area of Science:
- Healthcare Quality Improvement
- Trauma Center Performance Measurement
- Data Management in Healthcare
Background:
- Accurate and reliable data are crucial for credible risk-adjusted modeling and hospital benchmarking.
- A lack of evidence assessing data reliability and accuracy can compromise benchmarking integrity.
- External data validation is essential for ensuring data validity and reliability in trauma center benchmarking.
Purpose of the Study:
- To evaluate the impact of an external data validation program on data validity and reliability.
- To assess changes in data accuracy and reliability over time in trauma centers.
- To determine the effect of improved data quality on risk-adjustment modeling and benchmarking.
Main Methods:
- A collaborative quality initiative involving 29 trauma centers from March 2010 to December 2018.
- Validation of 127,238 total variables using reabstraction and comparison with contemporaneous documentation.
- Assessment of data accuracy via mean error rate and reliability using Cohen's kappa estimates.
Main Results:
- The initial validation visit showed the highest mean error rate (6.2%), with subsequent visits demonstrating statistically significant decreases.
- Mean hospital error rates improved from 8.0% in 2010 to 3.2% in 2018.
- 90% of variables achieved substantial reliability (kappa ≥0.61), with 39% showing a significant interval decrease in error rate.
Conclusions:
- External data validation programs correlate with increased data accuracy and reliability in trauma centers.
- Improved data reliability enhances the validity of risk-adjustment models.
- Enhanced data quality provides more reliable feedback for quality improvement programs.
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