Hospital chart review provided more accurate comorbidity information than data from a general practitioner survey or an administrative database

Preen, David B.; Holman, C. D'Arcy J.; Lawrence, David M.; Baynham, Natalya J.; Semmens, James B.

doi:10.1016/j.jclinepi.2004.03.016

« Previous Next »Journal of Clinical Epidemiology
Volume 57, Issue 12 , Pages 1295-1304, December 2004

Hospital chart review provided more accurate comorbidity information than data from a general practitioner survey or an administrative database

David B. Preen
- Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia
- Corresponding author. Tel.: +61 8 6488 1307; fax: +61 8 6488 1188.
C. D'Arcy J. Holman
- Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia
David M. Lawrence
- Centre for Developmental Health, Curtin University of Technology, 100 Roberts Road, Subiaco WA 6008, Australia
Natalya J. Baynham
- Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia
James B. Semmens
- Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia

Accepted 15 March 2004.

Abstract

Background and objective

The accuracy of comorbidity data within the Western Australian Data Linkage System was evaluated by means of comparison with hospital charts and a general practitioner (GP) survey.

Methods

Patients (n=2,037) with a hospital admission from 1991 to 1996 were selected. Linked data were extracted for 100 comorbidities, categorized into 16 diagnostic chapters, for each hospital admission within a 5-year period. Clinical chart review and a GP survey were performed. Comorbidity occurrence in each data source and false-positive and false-negative diagnoses were ascertained.

Results

Administrative data contained 45.5% of comorbidity recorded in hospital charts and underascertained secondary conditions for all 16 diagnostic chapters. False-positive diagnoses were low for most conditions (range: 0–1.5%); however, a high occurrence of false negatives existed for all comorbidity chapters (range: 16.3–91.3%). GP-identified comorbidity was 20.0% greater than that found using administrative data but, with the exceptions of injury–poisoning and cutaneous–subcutaneous diseases, was less (42.0%) than that observed from hospital charts.

Conclusion

Our results indicate that when accurate comorbidity data are crucial to health outcome research, hospital chart review (as opposed to using administrative data) may be required. Furthermore, surveying GPs, at least in Australia, appears an unsatisfactory alternative to hospital charts for obtaining retrospective comorbidity information.

Keywords: Medical record linkage, Administrative data, Hospital morbidity, Comorbidity, Validation