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BMC Health Services Research

, 16:605

Quality, performance, safety and outcomes

Abstract

BackgroundAssessment of quality of care in patients with myocardial infarction MI should be based on data that effectively enable determination of quality. With the need to simplify measurement techniques, the question arises whether routine data can be used for this purpose. We therefore compared data from a German sickness fund AOK with data from the Berlin Myocardial Infarction Registry BMIR.

MethodsWe included patients hospitalised for treatment of MI in Berlin from 2009-2011. We matched 2305 patients from AOK and BMIR by using deterministic record linkage with indirect identifiers. For matched patients we compared the frequency in documentation between AOK and BMIR for quality assurance variables and calculated the kappa coefficient KC as a measure of agreement.

ResultsThere was almost perfect agreement in documentation between AOK and BMIR data for matched patients for: catheter laboratory KC: 0.874, ST elevation MI KC: 0.826, diabetes KC: 0.818, percutaneous coronary intervention KC: 0.860 and hospital mortality KC: 0.952. The remaining variables compared showed moderate or less than moderate agreement KC < 0.6, and were grouped in Category II with less frequent documentation in AOK for risk factors and aspects of patients’ history; in Category III with more frequent documentation in AOK for comorbidities; and in Category IV for medication at and after hospital discharge.

ConclusionsRoutine data are primarily collected and defined for reimbursement purposes. Quality assurance represents merely a secondary use. This explains why only a limited number of variables showed almost perfect agreement in documentation between AOK and BMIR. If routine data are to be used for quality assessment, they must be constantly monitored and further developed for this new application. Furthermore, routine data should be complemented with registry data by well-established methods of record linkage to realistically reflect the situation – also for those quality-associated variables not collected in routine data.

KeywordsHealth services research Routine administrative data Quality of care Hospital performance Myocardial infarction AbbreviationsAOKAllgemeine Ortskrankenkasse name of the sickness fund

ATCAnatomical Therapeutic Chemical Classification System

BMIRBerlin Myocardial Infarction Registry

CHFCongestive heart failure

DRGDiagnosis-related Groups

KCKappa Coefficient

MIMyocardial Infarction

NSTEMIwithout persistent ST-segment elevation Myocardial Infarction

OPSOperation- und Prozedurenschlüssel Code for Operations and Procedures

PCIPercutaneous coronary intervention

POAPresent on Admission indicators

STEMIST-segment elevation Myocardial Infarction

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Autor: Birga Maier - Katrin Wagner - Steffen Behrens - Leonhard Bruch - Reinhard Busse - Dagmar Schmidt - Helmut Schühlen - Rolan

Fuente: https://link.springer.com/







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