Cargando…

Differential misclassification of confounders in comparative evaluation of hospital care quality: caesarean sections in Italy

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Di Martino, Mirko, Fusco, Danilo, Colais, Paola, Pinnarelli, Luigi, Davoli, Marina, Perucci, Carlo Alberto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4210510/
https://www.ncbi.nlm.nih.gov/pubmed/25297561
http://dx.doi.org/10.1186/1471-2458-14-1049
_version_ 1782341386129899520
author Di Martino, Mirko
Fusco, Danilo
Colais, Paola
Pinnarelli, Luigi
Davoli, Marina
Perucci, Carlo Alberto
author_facet Di Martino, Mirko
Fusco, Danilo
Colais, Paola
Pinnarelli, Luigi
Davoli, Marina
Perucci, Carlo Alberto
author_sort Di Martino, Mirko
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1471-2458-14-1049) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-4210510
institution National Center for Biotechnology Information
language English
publishDate 2014
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-42105102014-10-29 Differential misclassification of confounders in comparative evaluation of hospital care quality: caesarean sections in Italy Di Martino, Mirko Fusco, Danilo Colais, Paola Pinnarelli, Luigi Davoli, Marina Perucci, Carlo Alberto BMC Public Health Research Article 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1471-2458-14-1049) contains supplementary material, which is available to authorized users. BioMed Central 2014-10-08 /pmc/articles/PMC4210510/ /pubmed/25297561 http://dx.doi.org/10.1186/1471-2458-14-1049 Text en © Di Martino et al.; licensee BioMed Central Ltd. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Di Martino, Mirko
Fusco, Danilo
Colais, Paola
Pinnarelli, Luigi
Davoli, Marina
Perucci, Carlo Alberto
Differential misclassification of confounders in comparative evaluation of hospital care quality: caesarean sections in Italy
title Differential misclassification of confounders in comparative evaluation of hospital care quality: caesarean sections in Italy
title_full Differential misclassification of confounders in comparative evaluation of hospital care quality: caesarean sections in Italy
title_fullStr Differential misclassification of confounders in comparative evaluation of hospital care quality: caesarean sections in Italy
title_full_unstemmed Differential misclassification of confounders in comparative evaluation of hospital care quality: caesarean sections in Italy
title_short Differential misclassification of confounders in comparative evaluation of hospital care quality: caesarean sections in Italy
title_sort differential misclassification of confounders in comparative evaluation of hospital care quality: caesarean sections in italy
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4210510/
https://www.ncbi.nlm.nih.gov/pubmed/25297561
http://dx.doi.org/10.1186/1471-2458-14-1049
work_keys_str_mv AT dimartinomirko differentialmisclassificationofconfoundersincomparativeevaluationofhospitalcarequalitycaesareansectionsinitaly
AT fuscodanilo differentialmisclassificationofconfoundersincomparativeevaluationofhospitalcarequalitycaesareansectionsinitaly
AT colaispaola differentialmisclassificationofconfoundersincomparativeevaluationofhospitalcarequalitycaesareansectionsinitaly
AT pinnarelliluigi differentialmisclassificationofconfoundersincomparativeevaluationofhospitalcarequalitycaesareansectionsinitaly
AT davolimarina differentialmisclassificationofconfoundersincomparativeevaluationofhospitalcarequalitycaesareansectionsinitaly
AT peruccicarloalberto differentialmisclassificationofconfoundersincomparativeevaluationofhospitalcarequalitycaesareansectionsinitaly