Effectiveness and Outcomes in Health Care Proceedings of an Invitational Conference (1990) / Chapter Skim
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13 Administrative Data in Effectiveness Studies: The Prostatectomy Assessment
13 Administrative Data in Effectiveness Studies: The Prostatectomy Assessment
Pages 80-93
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From page 80... ...
To illustrate their potential uses, their strengths, and their limitations, we describe the role that administrative data have played in the ongoing assessment of treatments for benign prostatic hyperplasia, one of the more common conditions affecting elderly men. OVERVIEW OF THE PROSTATECTOMY ASSESSMENT Analyses of administrative health care data bases have long documented marked variations in population-based rates of prostatectomy (2,3~.
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From page 81... ...
For patients without evidence of actual or impending renal dysfunction, the primary indication for the procedure should be improvements in functional status and quality of life. According to this theory, watchful waiting is a reasonable option.
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From page 82... ...
The probabilities for other outcomes-such as incontinence, impotence, and postoperative symptom relief and improvement in functional status required the development of new measurement instruments and the implementation of a prospective interview study of patients undergoing prostatectomy in Maine (6~. The findings of the literature review, the claims-based analyses, and the interview study provided sufficient data to assess the efficacy of watchful waiting versus transurethral prostatectomy (TURP)
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From page 83... ...
They thus represent a generalizable approach to the use of administrative data bases for cohort studies. CASE IDENTIFICATION AND VARIABLES All patients were initially identified on the basis of computerized hospital discharge abstracts or physician claims documenting a prostatectomy during the various study periods encompassed by the assessments.
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From page 84... ...
. USES OF ADMINISTRATIVE DATA IN PROSTATECTOMY ASSESSMENT VARIATIONS IN UTILIZATION RATES First, and perhaps most important, studies of small-area variations in prostatectomy rates provided the initial stimulus for the research project and were critical to engaging the interest of practicing urologists in the assessment.
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From page 85... ...
In all, almost one-quarter of patients had significant adverse outcomes in the 90 days following prostatectomy. TABLE 2 Mortality Rates Following Prostatectomy Among Medicare Enrollees Who Were New England Resident Patients Without Indication of Prostate or Bladder Cancer, 1984-1986 Patient Dead Patient Dead Within 30 Days Within 90 days Cases of Surgery of Surgery Age Group (No.)
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From page 86... ...
First, the completeness and accuracy of the coding in claims data bases has been questioned (18,19~. However, if the accuracy of the data could be confirmed and if administrative safeguards were enacted to ensure their complete and accurate documentation, then claims-based measures could be used to monitor the outcomes of care for patients undergoing prostatectomy.
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From page 87... ...
Also, the risk of death following TURP was consistently higher at five and eight years, the relative risk of TURP to open being 1.2 to 1.3 at eight years. There remained the possibility that physicians were selecting only relatively healthy patients for the open procedure and that increased severity of illness among TURP patients might explain the excess mortality observed.
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From page 88... ...
- .0.41 (0.22, 0.74) NOTE: Cox regression results based on linked claims and anesthesia data bases.
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From page 89... ...
For example, physicians may record characteristics of patients differently, based on their own assumptions about the relative safety of TURP compared to open prostatectomy. Nevertheless, because of the large numbers of patients undergoing TURP and the potential public health importance of the observed increased mortality following TURP, the evidence we found should not be TABLE 5 Relative Risk of Death for Patients Receiving Transurethral (TURP)
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From page 90... ...
Potential sources of supplemental data include those reported here, existing clinical data bases, and medical records. It is also feasible to obtain names and addresses so that individuals could be surveyed to ascertain outcomes not recorded in either the claims themselves or the medical records, such as functional status and quality of life.
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From page 91... ...
Consequently, we should determine efficient, flexible means of supplementing the data base. These might include not only facilitating access to medical records to supplement claims data, but also developing strategies for routine posttreatment interviews to determine functional status and quality of life.
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From page 92... ...
The Potential Use of Health Care Financing Administration Data Sets for Health Care Services Research. Health Care Financing Review 5 :93-98, 1983.
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From page 93... ...
A New Method for Classifying Prognostic Comorbidity in Longitudinal Studies: Development and Validation. Journal of Chronic Diseases 40:373-383, 1987.
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