@article{6737bcbcb9cd4508ae343d9375289704,
title = "The impact of clinical vs administrative claims coding on hospital risk-adjusted outcomes",
abstract = "Background: Comorbid condition and hospital risk-adjusted outcomes prevalence were compared based on clinical registry vs administrative claims data. Hypothesis: Risk-adjusted outcomes will vary depending on the source of comorbidity data used. Methods: Clinical data from hospitalized Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association (ACC/AHA) Guidelines (CRUSADE) non-ST-segment elevation myocardial infarction (NSTEMI) patients ≥65 years was linked to Medicare claims. Eight common comorbid conditions were coded and compared between registry data (derived from medical record review) and claims data; hospital-level observed vs expected ratios and outlier status for 30-day readmission and mortality were calculated using logistic generalized estimating equations for clinical vs claims data. Results: Of 68 199 NSTEMI patients, 48.1% were female, 86.9% were white, and median age was 78. Degree of agreement between data sources for comorbid condition prevalence was 67.8% for myocardial infarction and 89.3% for diabetes. Overall, multivariable model performance was similar: Medicare mortality c-statistics is 0.69 vs CRUSADE is 0.71; readmission c-statistics is 0.59 for both. Hospital ratings were similar regardless of data source (mortality, R2 = 0.97863; readmission, R2 = 0.97858). Eighty-two hospitals were mortality outliers in claims-based models; of these, 70 were outliers in registry-based models. Forty-five hospitals were readmission outliers in claims-based models; of these, 39 were outliers in registry-based models. Conclusions: There were significant differences in individual comorbid condition prevalence when derived from registries vs claims, but hospital-level outcomes were comparable.",
keywords = "administrative claims, clinical registries, comorbid conditions, hospital risk-adjusted outcomes",
author = "O'Brien, {Emily C.} and Shuang Li and Laine Thomas and Wang, {Tracy Y.} and Roe, {Matthew T.} and Peterson, {Eric D.}",
note = "Funding Information: information CRUSADE was funded by Millennium Pharmaceuticals, Schering-Plough Corporation, and the Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership. This work was supported internally by the Duke Clinical Research Institute.; Duke Clinical Research Institute; Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership; Schering-Plow Corporation; Millennium PharmaceuticalsThe authors would like to thank the CRUSADE Registry staff and participants for their important contributions to this work. The authors would like to thank Erin Campbell, MS, for her editorial contributions to this manuscript. Ms Campbell did not receive compensation for her contributions, except for her employment at the institution where this study was conducted. CRUSADE was funded by Millennium Pharmaceuticals, Schering-Plow Corporation, and the Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership. This work was supported internally by the Duke Clinical Research Institute. Funding Information: The first three authors declare no potential conflict of interests. Tracy Y. Wang reports research funding from AstraZeneca, Bristol-Myers Squibb, Heartscape Technologies, Inc., Lilly, Sanofi-Aventis, Schering-Plow Corporation, and The Medicines Company (all significant); educational activities or lectures for AstraZeneca (modest); consulting for American College of Cardiology (significant) and Medco (modest). Matthew T. Roe reports research funding from Eli Lilly, Revalesio, Sanofi-Aventis, American College of Cardiology, American Heart Association; and consulting or honoraria from Astra Zeneca, Sanofi-Aventis, Janssen Pharmaceuticals, Merck, Regeneron, and Daiichi-Sankyo. All conflicts of interest are listed at www.dcri. org. Eric D. Peterson reports receiving research grants from Lilly, Johnson & Johnson, Bristol-Myers Squibb, Sanofi-Aventis, and Merck-Schering Plow partnership; and serving as principal investigator of the data analytic center for the AHA/American Stroke Association's (ASA) GWTG. Funding Information: CRUSADE was funded by Millennium Pharmaceuticals, Schering-Plow Corporation, and the Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership. This work was supported internally by the Duke Clinical Research Institute. Funding Information: CRUSADE was funded by Millennium Pharmaceuticals, Schering-Plough Corporation, and the Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership. This work was supported internally by the Duke Clinical Research Institute. ; Duke Clinical Research Institute; Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership; Schering-Plow Corporation; Millennium Pharmaceuticals Publisher Copyright: {\textcopyright} 2018 Wiley Periodicals, Inc.",
year = "2018",
month = sep,
doi = "10.1002/clc.23059",
language = "English (US)",
volume = "41",
pages = "1225--1231",
journal = "Clinical Cardiology",
issn = "0160-9289",
publisher = "John Wiley and Sons Inc.",
number = "9",
}