Administrative Data Should Be Questioned
Hospital discharge data (=administrative data) have been used for some time in order to measure the quality of hospital treatments. In this context, Mansky in a recently published review article pointed out the good validity of administrative data. By contrast, a systematic qualitative review found that the sensitivity of quality indicators—drawn from administrative data—is usually poor (1). This is also the case for risk scores, which take into account a number of comorbidities.
On this background, Nimptsch and Mansky (2) write that national hospital discharge data in Germany provide an opportunity—because of their completeness— for analyzing even rare events, such as deaths after cholecystectomies and herniotomies. The authors conclude that death rates after such procedures could be reduced.
The clinical epidemiologist Richard Lilford was one of the first to point out how poorly suited deaths are as a measure for assessing the quality of hospitals. Hogan et al. concluded (3) that “any metric based on mortality is unlikely to reflect the quality of a hospital.” This prompted The BMJ to publish an editorial alongside the research, entitled: “The death of death rates?” In our opinion, the list of suggestions made by Nimptsch and Mansky is lacking one crucial item: adequate staffing levels (4).
Prof. Dr. Dr. med. Ernst Hanisch
Viszeral- und Thoraxchirurgie, Asklepios Klinik Langen
Dr. med. Thomas Friedrich Weigel
Chirurgie I, Heilig Geist Hospital Bingen
Conflict of interest statement
The authors declare that no conflict of interest exists.
|1.||Hanisch E, Weigel TF, Buia A, Bruch HP: The validity of routine data on quality assurance—a qualitative systematic review. Chirurg 2016; 87: 56–61 CrossRef MEDLINE|
|2.||Nimptsch U, Mansky T: Deaths following cholecystectomy and herniotomy—an analysis of nationwide German hospital discharge data from 2009 to 2013. Dtsch Arztebl Int 2015; 112: 535–43 VOLLTEXT|
|3.||Hogan H, Zipfel R, Neuburger J, Hutchings A, Darzi A, Black N: Avoidability of hospital deaths and association with hospital-wide mortality ratios: retrospective case record review and regression analysis. BMJ 2015; 351: h3239 CrossRef MEDLINE PubMed Central|
|4.||Aiken LH, Sloane DM, Bruyneel L, et al.: Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet 2014; 383: 1824–30. CrossRef|