An observational study to determine the utility of hospital administrative data to support case finding of English patients at higher risk of severe healthcare-related harm

Hogan, H.; Cooke-O�Dowd, N.; Chattopadhyay, K.; van der Meulen, J.; Sherlaw-Johnson, C.; Black, N.

Abstract

Objectives: To identify ways of using routine hospital data to improve the efficiency of retrospective reviews of case records for identifying avoidable severe harm

Design: Development and testing of thresholds and criteria for two indirect indicators of healthcare-related harm (long length of stay [LOS] and emergency readmission) to determine the yield of specified harms coded in Hospital Episode Statistics (HES).

Setting: Acute NHS hospitals in England

Participants: HES for acute myocardial infarction (AMI), bowel cancer surgery and hip replacement admissions from 2014-15

Interventions: Case-mix-adjusted linear regression models were used to determine expected LOS. Different thresholds were examined to determine the association with harm. Screening criteria for readmission included time to readmission, length of readmission and diagnoses in initial admission and readmission. The association with harm was examined for each criterion.

Results: The proportions of AMI cases with a harm code increased from 14% among all cases to 47% if a threshold of three times the expected LOS was used. For hip replacement the respective increase was from 10% to 51%. However as the number of patients at these higher thresholds was small, the overall proportion of harm identified is relatively small (15%, 19%, 9% and 8% among AMI, urgent bowel surgery, elective bowel surgery and hip replacement cohorts respectively). Selection of the time to readmission had an effect on the yield of harms but this varied with condition. At least 50% of surgical patients had a harm code if readmitted within 7 days compared with 21% of AMI patients.

Conclusions: Our approach would select a substantial number of patients for case record review. Many of these cases would contain no evidence of healthcare-related harm. In practice, Trusts may choose how many reviews it is feasible to do in advance and then select random samples of cases that satisfy the screening criteria.

Citation

Hogan, H., Cooke-O’Dowd, N., Chattopadhyay, K., van der Meulen, J., Sherlaw-Johnson, C., & Black, N. (2019). An observational study to determine the utility of hospital administrative data to support case finding of English patients at higher risk of severe healthcare-related harm. BMJ Open, 9(6), Article 025372. https://doi.org/10.1136/bmjopen-2018-025372

• Journal Article Type: Article
• Acceptance Date: May 23, 2019
• Online Publication Date: Jun 21, 2019
• Publication Date: Jun 21, 2019
• Deposit Date: May 29, 2019
• Publicly Available Date: May 31, 2019
• Journal: BMJ Open
• Electronic ISSN: 2044-6055
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 9
• Issue: 6
• Article Number: 025372
• DOI: https://doi.org/10.1136/bmjopen-2018-025372
• Keywords: General Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/2106369
• Publisher URL: https://bmjopen.bmj.com/content/9/6/e025372