Print this pageConcurrent Complication Tracking Versus the Standard Hospital Discharge Data Set In Determining Vascular Surgery Morbidity and Mortality
Daniel J Bertges1, Adam K Cloud1, Janet S. Stiles1, John H Ratliff2, Rebecca R Zubis2, Michael A Ricci1, Georg Steinthorsson1, Andrew C Stanley1, Steven R Shackford1
1Fletcher Allen Health Care, Burlington, VT;2Medical Center Hospital Vermont, Burlington, VT
Introduction and Objectives:
Morbidity and mortality (M&M) data from the standard hospital discharge data set (HDDS) are increasingly used for clinical outcomes research and for benchmarking of hospital and provider performance. The accuracy of the HDDS, however, has never been validated.
Methods:
We compared M&M data derived from the HDDS to complications recorded concurrently by our institutions' Surgical Activity Tracking System (SATS) for one year (10/1/03-9/30/04). SATS is a prospective database of complications within 30-days of surgery recorded by a mid-level provider and adjudicated by peer review for all patients admitted to the vascular service.
Results:
In 529 patients no complications were detected by either SATS or HDDS. In 194 patients there were 23 deaths and 281 complications. Of the 281 complications, 136 (48.4%) were recorded by both systems; SATS missed 30 complications recorded in HDDS (10.7%), while HDDS missed 115 complications recorded in SATS (40.9%). Of the 23 deaths, SATS recorded all, but HDDS missed 5 (21.7%) that occurred after discharge but within the 30-day reporting period.
Conclusions:
From these data we conclude that HDDS substantially under reports vascular M&M data. Such under reporting has significant implications not only regarding the use of the HDDS for clinical outcomes research, but also for DRG assignment and hospital reimbursement for complicated cases.