AI Article Synopsis
- This study highlights the need to investigate misclassification of confounders in hospital care quality assessments, particularly for caesarean sections (CS).
- Data from Italy's Hospital Information System was analyzed, revealing that high fetal head (HFH) misclassification was prevalent and often correlated with CS outcomes, suggesting potential opportunistic coding practices.
- The research concluded that differential misclassification of confounders can significantly affect risk-adjusted estimates, indicating a need for thorough examination of coding practices across different hospitals and regions.
Article Abstract
Background: Despite extensive studies on exposure and disease misclassification, few studies have investigated misclassification of confounders. This study aimed to identify differentially misclassified confounders in a comparative evaluation of hospital care quality and to quantify their impact on hospital-specific risk-adjusted estimates, focusing on the appropriateness of caesarean sections (CS).
Methods: We gathered data from the Hospital Information System in Italy for women admitted in 2005-2010. We estimated adjusted proportions of CS with logistic regression models. Among several confounders, we focused on high fetal head at term (HFH), which is seldom objectively documentable in medical records.
Results: A total of 540 maternity units were compared. The median HFH prevalence was 0.9%, ranging from 0 to 70%. In some units, HFH was coded so frequently that it was unlikely to reflect a natural heterogeneity. This "over-coding" was conditional on the outcome because it occurred more frequently for women that underwent CS. This suggested an opportunistic coding to justify the choice of a CS. HFH misclassification was not randomly distributed over Italy; it had an excess in the Campania region where, in some units, the proportion of HFHs gradually increased from 2005 to 2010 (e.g., from 0 to 26%), but the national average remained constant (2.5%). The inclusion of the misclassified diagnosis in the models favored those hospitals that codified in a less-than-fair manner.
Conclusions: Our findings emphasized the importance of rigorously inspecting for differential misclassification of confounders. Their validity may be subject to substantial heterogeneity over hospitals, over time and geographical areas.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4210510 | PMC |
| http://dx.doi.org/10.1186/1471-2458-14-1049 | DOI Listing |
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