SECTION 2: MEASUREMENT Administrative Data for Quality Improvement

This article discusses the use of administrative data for quality improvement in perinatal and neonatal medicine. We review the nature of administrative data and focus on hospital discharge abstract data as the primary source of hospitaland community-based assessments. Although discharge abstract data lack the richness of primary data, these data are the most accessible comparative data source for examining all patients admitted to a hospital. When aggregated to the state level as occurs in more than 30 states, hospital discharge data reflects hospital utilization and outcomes for an entire geographic population at the state and community level. This article reviews some of the weaknesses of administrative data and then focuses how these data can be used for hospitaland community-based assessment of perinatal care citing as examples the measures of perinatal process and outcome used by the National Perinatal Information Center in its Quality/Efficiency Reports for member hospitals and a study of perinatal high-risk care in the State of Florida. The use of discharge abstract data for performance measurement at either the hospital or the system level requires a thorough understanding of how to select a patient group, its characteristics, the intervention, and the outcomes relevant to that patient group. In the perinatal arena, the National Perinatal Information Center has selected and presents those measures that rely on data items shown to be the most reliable based on validity studies and clinician opinion, delineation of the intervention, and the measurement of what occurred. As hospitals respond to the recent pressures of the Joint Commission on Accreditation of Healthcare Organizations and other quality assurance entities, the accuracy of the discharge data will improve. With accepted caution, these data sets are invaluable to researchers studying comparative populations over time or across large geographic areas. Pediatrics 1999;103:291–301; administrative data, claims data, hospital discharge data, secondary data, process measurement, outcome measurement, population studies. ABBREVIATIONS. UB, uniform bill; HCFA, Health Care Financing Administration; UHDDS, Uniform Hospital Discharge Data Set; NAHDO, National Association of Health Data Organizations; HCUP, Health Care Utilization Project; AHCPR, Agency for Health Care Policy Research; NPIC, National Perinatal Information Center; ICD-9-CM, International Classification of Diseases, 9th Revision Clinical Modification; VBAC, vaginal birth after cesarean section; QA, quality assurance; IVH, intraventricular hemorrhage; JCAHO, Joint Commission on Accreditation of Healthcare Organizations; IUGR, intrauterine growth retardation. The purpose of this article is to discuss the uses of administrative data, specifically hospital discharge abstract data, for quality improvement in neonatal and perinatal medicine. Because clinicians may not be familiar with the nature of this type of data, the article begins with a discussion of the definition of administrative data (also known as secondary data) including the source of the data and the items that are most often included. We then discuss the problems with administrative data so that all readers are familiar with its limitations. Finally, we focus on how these data can be used from two perspectives—that of the hospital and that of the population. In the former case the users are the hospitals’ staff including administrative and clinical staff; and in the latter the users include: insurers, state public health officials, and a wide ranges of other parties interested in issues of quality of care. We highlight how, despite the many limitations of this data, it can be used to examine a range of issues of interest to neonatal and perinatal clinicians, administrators, and policy makers. WHAT IS ADMINISTRATIVE DATA? Administrative data are data sets that have been created in the health services area for purposes that are usually related to billing for services. They are also called secondary data sets because they are generated as a by-product of a nonresearch activity. An example of primary data is data collected for a clinical trial or medical record data. Administrative data, like primary data, exist at the patient level and can be aggregated to the provider, the community, or the state. There are two major types of administrative databases that are used in health services research: claims data and hospital discharge abstract data. They both include information on the reason the patient sought services in the form of a diagnosis and information on the charges for those services. In the case of inpatient care they include the duration of the care. Although this article focuses only on hospital discharge abstract data, in this section we will provide some basic information about each type. Claims data files are created by payers from bills From the National Perinatal Information Center, Providence, Rhode Island. *Vice President(s); ‡President; and §Research Associate(s), National Perinatal Information Center. Received for publication Sep 9, 1998; accepted Sep 9, 1998. Address correspondence to Rachel M. Schwartz, MPH, Vice President, National Perinatal Information Center, One State St, Suite 102, Providence,