Health state information derived from secondary databases is affected by multiple sources of bias

• Published in: Journal of clinical epidemiology Vol. 60; no. 7; pp. 734 - 741
• Main Authors: Terris, Darcey D, Litaker, David G, Koroukian, Siran M
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2007; Elsevier; Elsevier Limited
• Subjects: Administrative data; African Americans; Bias; Biological and medical sciences; Cardiovascular disease; Data Collection - methods; Data Collection - standards; Databases, Factual; Delivery of Health Care; Environmental factors; Epidemiology; General aspects; Health services utilization; Health Status; Heart attacks; Humans; Influence; Internal Medicine; Medical record system; Medical Records Systems, Computerized - standards; Medical sciences; Methodology; Miscellaneous; Models, Theoretical; Myocardial infarction; Patient Acceptance of Health Care; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Adjustment; Validity; Womens health; Administrative data; Databases; Health status; Methodology; Risk adjustment; Medical record system; Human; Myocardial infarction; Multiple; Cardiovascular disease; Risk; Information; Myocardial disease; Epidemiology; Source; Medicine; Heart disease; Risk factor; Database; Medical record; Public health
• ISSN: 0895-4356; 1878-5921
• DOI: 10.1016/j.jclinepi.2006.08.012

Abstract Objective Secondary databases are used in descriptive studies of patient subgroups; evaluation of associations between individual characteristics and diagnosis, prognosis, and/or service utilization rates; and studies of the quality of health care delivered. This article identifies sources of bias for health state characteristics stored in secondary databases that arise from patients' encounters with health systems, highlighting sources of bias that arise from organizational and environmental factors. Study Design and Setting Potential sources of bias, from patient access of services and diagnosis, through encoding and filing of patient information in secondary databases, are discussed. A patient presenting with acute myocardial infarction is used as an illustrative example. Results The accuracy of health state characteristics derived from secondary databases is a function of both the quality and quantity of information collected before data entry and is dependent on complex interactions between patients, clinicians, and the structures and systems surrounding them. Conclusion The use of health state information included in secondary databases requires that estimates of potential bias from all sources be included in the analysis and presentation of results. By making this common practice in the field, greater value can be achieved from secondary database analyses.