Assessment of care quality in department of general surgery : Usefulness of administrative database

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Imen Samaali
Samia Ben Osman
Riadh Bedoui
Ibtissem Bouasker
Youssef Chaker
Ramzi Nouira
Chadli Dziri

Abstract

Background: Administrative database, used previously for control of cost, patient flow and invoicing, offer to researchers a large sample of patients representative of population providing interesting informations in the field of descriptive and analytic epidemiology with less cost.
Aim: To assess the usefulness of administrative database for quality of care and research.
Methods: It was a prospective study concerning 4690 hospitalisations in Department B of General Surgery of hôpital Charles Nicolle during a period of 18 months, between June 1st, 2008 and December 31st, 2009. A descriptive analysis followed by a pronostic study with a univariate and multivariate analysis was performed.
Résultats : Our study showed the usefulness of an administrative database in assessing the quality of care, it allowed us to determine postoperative mortality rate (2.7%), deep morbidity (2.5%), parietal morbidity (1.2%), medical complications (6%), nosocomial infections (3.6%) and re intervention (2.7%), with independent predictive factors of these events. To reduce the incidence of these events we should reduce length of pre-operative stay, prevent intra operative accidents, avoid intra operative bleeding in order to reduce intra operative transfusions and avoid as far as possible the stay in ICU Independent predictors of post trauma death are multiple trauma [OR: 6.14, 95% (from 1.68 to 16.94), p = 0.002], a traumatized patient in distress on arrival [OR: 8.74, 95% (3.59 -27.77), p = 0.000] and overall medical complications [OR: 13.18, 95% (from 4.01 to 31.25), p=0.000]. The ISS is a good discriminative indice to assess the severity and life-threatening risk.
Conclusion: Administrative databases provide information on the efficiency of care, it helps to realise observational studies on large samples representative of the population at low cost. They are veryuseful in the research, despite the lack of clinical data.

Keywords:

Quality, care, general surgery, administrative databases, prognosis, Evaluation assessment

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References

  1. Anonyme. Comment définir la qualité en santé ? In Leclet H ; Vilcot C. la qualité en santé : 150 questions pour agir Paris : AFNOR 2007 : 55-6.
  2. Anonyme. Est ce que la qualité hospitalière peut se mesurer ? In Leclet H, Vilcot C. La qualité en santé : 150 questions pour agir Paris : AFNOR 2007 : 237-8.
  3. Wray NP, Ashton CM, Kuykendall DH, Hollingsworth JC. Using administrative databases to evaluate the quality of medical care: A conceptual framework. Soc Si Med 1995 ; 40 :1707-15.
  4. Urbach DR. Using administrative data to assess outcome: challenges and limitations. Clinical Congress 2003; 29: 26-28.
  5. Clifford Y. What can we learn from studies using administrative databases? Clinical Congress 2003; 24: 29-30.
  6. Sonja E, Hall C, D'Arcy J, Holman JF, Semmens JB. Improving the evidence base for promoting quality and equity of surgical care using population-based linkage of administrative health records. International Journal for Quality in Health Care 2005; 17: 415-20.
  7. Güller U. Surgical outcomes research based on administrative data: inferior or complementary to prospective randomized clinical trials? World J Surg 2006; 30: 255-66.
  8. Wartak J, Fenna D, Gelfand ET, Callaghan JC. Computerized database for coronary bypass. J. Cardiovasc Surg 1984 ; 25 : 337-43.
  9. Romano PS, Roos LL, Luft HS, Jollis JG, Doliszny K. A comparaison of administrative versus clinical data: Coronary artery bypasses surgery as an example. Ischemic heart disease patient outcomes research team. J Clin Epidemiol 1994; 47:249-60.
  10. Pasquali SK, Jacobs JP, Shook GJ, O'Brien SM, Hall M, Jacobs ML et al. Linking clinical registery data with administrative data using indirect identifiers: implementation and validation in the congenital heart surgery population. Am Heart J 2010; 160: 1099-104.
  11. Maraschini A, Seccareccia F, D'Errigo P, Rosato S, Badoni G, Casali G et al.Role of gender and age on early mortality after coronary artery bypass graft in different hospitals: Data from a national administrative database. Interactive Cardiovascular and Thoracic Surgery 2010; 11: 537-42.
  12. Yeung ST, Davis AM, Soric R. Factors influencing inpatient rehabilitation lenght of stay following revision hip replacements: A retrospective study. BMC Musculoskeletal disorders 2010 ; 11 :252.
  13. Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Community-based appraisal of laparoscopic abdominal surgery in Japan. J Surg Res 2011; 165: e1-13.
  14. Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K et al.Quantitative assessment of the advantages of laparoscopic gastrectomy and the impact of volume-related hospital characteristics on resource use and outcomes of gastrectomy patients in Japan. Ann Surg 2011 ; 253 : 64-70.
  15. Manish M, Tiwari MD, Matthew R, et al. Differences in outcomes of laparoscopic gastric bypass. Surg Obes Relat Dis 2011; 7: 277- 82.
  16. Chabra S, Gleason CA, Seidel K, Williams MA. Rising prevalence of gastroschisis in Washington State. J Toxicol Environ Health A 2011; 74: 336-45.
  17. Hammond J, Kozma C, Hart JC, Nigam S, Daskiran M, Paris A et al. Rates of venous thromboembolism among patients with major surgery for cancer. Ann Surg Oncol 2011; 15: 1602-10.
  18. Merli GJ, Malangone E, Lin J, Lamerato L, Stern L. Real-world practices to prevent venous thromboembolism with pharmacological prophylaxis in US orthpedic surgery patients: an analysis of an integrated healthcare database. J Thromb Thrombolysis 2011; 32: 89-95.
  19. Amin AN, Lenhart G, Princis N, Lin J, Thompson S, Johnston S. Retrospective administrative database study of the time period of venous thromboembolism risk during and following hospitalization for major orthopaedic or abdominal surgery in real-world US patients. Hosp Pract 2011 ; 39 :7-17.
  20. Shanu K, Kurd MHS, Ole J, Hoffstad MA, Warren B, Bilker D et al. Evaluation of the use of prognostic information for the care of individuals with venous leg ulcers or diabetic neuropathic foot ulcers. Wound repair regen 2009 ; 17 : 318-25.
  21. Gerbier S, Bouzbid S, Pradat E, Baulieux J, Lepage A, Berland M et al. Use of the french medico'administrative database to detect nosocomial infections i the university hospital of Lyon. Rev Epidimiol santé publique 2011 ; 59 : 3-14.
  22. Pérez-Nunez R, Hijar-Medina M, Heredia-Pi I, Jones S, Silveira- Rodrigues EM. Economic impact of fatal and nonfatal road traffic injuries in Belize in 2007. Rev Panam Salud Publica 2010 ; 28 : 326-36.
  23. Leung KKG, Ho W, Tong KHD, Yuen WK. Outcome of severly injured trauma patients at designated trauma centre in the Hong Kong special administrative region Chin Med J 2010 ; 123:1251- 4.
  24. Adamina M, Güller U, Weber WP, Oertli D. Propensity scores and the surgeon. Br J Surg 2006; 93: 389-94.