Comparison of Mortality Risk Adjustment Using a Clinical Data Algorithm (American College of Surgeons National Surgical Quality Improvement Program) and an Administrative Data Algorithm (Solucient) at the Case Level Within a Single Institution

• Published in: Journal of the American College of Surgeons Vol. 205; no. 6; pp. 767 - 777
• Main Authors: Hall, Bruce Lee, MD, PhD, MBA, FACS, Hirbe, Mitzi, RHIA, CPHQ, Waterman, Brian, MPH, Boslaugh, Sarah, PhD, MPH, Dunagan, Wm Claiborne, MD, MS
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.2007; Elsevier Science
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Algorithms; Biological and medical sciences; Child; Child, Preschool; Epidemiology; Female; Forms and Records Control; General aspects; Hospital Mortality; Hospitals, Teaching - standards; Hospitals, Teaching - statistics & numerical data; Hospitals, Urban - standards; Hospitals, Urban - statistics & numerical data; Humans; Infant; Male; Medical Audit; Medical sciences; Middle Aged; Missouri - epidemiology; Outcome Assessment (Health Care) - methods; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality Indicators, Health Care; Risk Adjustment; Surgery; Surgical Procedures, Operative - mortality; Urban Population; United States; North America; America; Missouri; NSQIP; O/E ratio; ratio of observed-to-expected mortality; Risk-Adjusted Mortality Index (Solucient); American College of Surgeons NSQIP; ACS-NSQIP; National Surgical Quality Improvement Program; RAMI; Medical data; Program; American; Mortality; Administrative data; Risk; Institution; Algorithm; Decision tree; Epidemiology; Surgeon; Medicine; Improvement; Treatment; Surgery; Quality; Risk factor; Comparative study
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2007.08.013

Background There is great interest in efficiently evaluating health care quality, but there is controversy over the use of administrative versus clinical data methods. We sought to compare actual mortality with risk-adjusted expected mortality in a sample population calculated by two different methods; one based on preexisting administrative records and one based on chart reviews. Study Design We examined a sample of patients (n = 1,234) undergoing surgical procedures at an academic teaching hospital during 1 year. The first risk-adjustment method was that used by the National Surgical Quality Improvement Program, which is based on dedicated medical record review. The second method was that used by Solucient, LLC, which is based on preexisting administrative records. Results The ratio of observed to expected mortality for this population set was higher using the National Surgical Quality Improvement Program algorithm (1.1; 95% CI, 0.8 to 1.5) than using the Solucient algorithm (0.9; 95% CI, 0.6 to 1.2) but neither estimate was notably different from 1.0. Similarly, when observed to expected mortality ratios were calculated separately for each quartile of mortality, there were no marked differences within quartiles, although minor differences with potential importance were noted. Fit was comparable by age categories, gender, and American Society of Anesthesiologists’ categories. A number of actual deaths had higher predicted mortality scores using the Solucient algorithm. Conclusions Risk-adjusted mortality estimates were comparable using administrative or clinical data. Minor performance differences might still have implications. Because of the potential lower cost of using administrative data, this type of algorithm can be an efficient alternative and should continue to be investigated.