accuracy of the discharge destination field in administrative data for identifying transfer to a long-term acute care hospital放电目的地在管理数据的精度确定转移到一个长期的急症护理医院.pdfVIP

Kahn and Iwashyna BMC Research Notes 2010, 3:205 /1756-0500/3/205 SHORT REPORT Open Access Accuracy of the discharge destination field in administrative data for identifying transfer to a long-term acute care hospital Jeremy M Kahn 1*, Theodore J Iwashyna2 Abstract Background: Long-term acute care hospitals (LTACs) provide specialized care for patients recovering from severe acute illness. In order to facilitate research into LTAC utilization and outcomes, we studied whether or not the discharge destination field in administrative data accurately identifies patients transferred to an LTAC following acute care hospitalization. Findings: We used the 2006 hospitalization claims for United States Medicare beneficiaries to examine the performance characteristics of the discharge destination field in the administrative record, compared to the reference standard of directly observing LTAC transfers in the claims. We found that the discharge destination field was highly specific (99.7%, 95 percent CI: 99.7% - 99.8%) but modestly sensitive (77.3%, 95 percent CI: 77.0% - 77.6%), with corresponding low positive predictive value (72.6%, 95 percent CI: 72.3% - 72.9%) and high negative predictive value (99.8%, 95 percent CI: 99.8% - 99.8%). Sensitivity and specificity were similar when limiting the analysis to only intensive care unit patients and mechanically ventilated patients, two groups with higher rates of LTAC utilization. Performance characteristics were slightly better when limiting the analysis to Pennsylvania, a state with relatively high LTAC penetration. Conclusions: The discharge destination field in administrative data can result in misclassification when used to identify patients transferred to long-term acute care hospitals. Directly observing transfers in the claims is the preferable method, although