General Obstetrics and Gynecology: Obstetrics
Accuracy of obstetric diagnoses and procedures in hospital discharge data

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Objective

The objective of the study was to estimate the validity of obstetric procedures and diagnoses in California patient discharge data.

Study design

We randomly sampled 1611 deliveries from 52 of 267 California hospitals that performed more than 678 eligible deliveries in 1992 to 1993. We compared hospital-reported procedures and diagnoses against our recoding of the same records.

Results

Cesarean, forceps, and vacuum delivery were accurately reported, with sensitivities and positive predictive values exceeding 90%. Episiotomy was underreported (70% sensitivity). Cesarean indications were reported with at least 60% sensitivity, except uterine inertia, herpes, and long labor. Among comorbidities, sensitivity exceeded 60% for chorioamnionitis, diabetes, premature labor, preeclampsia, and intrauterine death. Sensitivity was poor (less than 60%) for anemia, asthma, thyroid disorders, mental disorders, drug abuse, genitourinary infections, obesity, fibroids, excessive fetal growth, hypertension, premature rupture, polyhydramnios, and postdates.

Conclusion

The validity of hospital-reported obstetric procedures and diagnoses varies, with moderate to high accuracy for some codes but poor accuracy for others.

Section snippets

Material and methods

This study was undertaken as part of the California Hospital Outcomes Program, a legislatively mandated effort to improve the quality of hospital care and respond to the needs of purchasers and consumers by publishing risk-adjusted outcomes reports. These reports are based on the Patient Discharge Data Set, which includes an abstract of every discharge from every nonfederal licensed hospital in California. Each abstract lists the patient's birth date, sex, race, ZIP code, encrypted social

Results

We received 1614 of the 1662 records that we requested from the participating hospitals (97.1%). Three of these records did not actually represent deliveries; 1611 records were abstracted (30.3% primary cesarean, 18.9% repeat cesarean, 51.0% vaginal). This cohort had a weighted mean (SD) age of 28.0 (6.5) years and a racial/ethnic composition similar to the target population (55% white, 8% African American, 8% Asian, 29% Hispanic, 0.1% Native American, 0.8% “other”).

Table I, Table III, Table V

Comment

The current study may represent the most comprehensive published analysis of the validity of obstetric diagnosis and procedure codes on hospital discharge abstracts in the United States. After recoding 1611 obstetric records from 52 hospitals, we found that validity varied widely across procedures and conditions. Surgical procedures such as cesarean and instrumented vaginal delivery were accurately reported, with sensitivities and PPVs exceeding 90%. Episiotomy was underreported, particularly

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    Supported by the California Office of Statewide Health Planning and Development, Agreement 00-0162.

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