A Canadian comparison of data sources for coronary artery bypass surgery outcome "report cards"

Background Prior comparisons of administrative versus clinical data for cre ating coronary artery bypass graft (CABG) surgery outcome "report cards" ar e all From the United States and yield inconsistent conclusions regarding t he validity of administrative data report cards. In this study, we compared 2 CABG surgery outcome report cards For Ontario, Canada. one derived from clinical data from the Cardiac Care Network of Ontario and one derived From administrative data from the Canadian Institute for Health Information. Methods Data from 4 fiscal years, 1992-93 through 1995-96, were used. The C anadian Institute for Health Information report card was derived from admin istrative data only. The Cardiac Care Network report card drew on prospecti vely collected clinical information that included variables such as left ve ntricular ejection fraction but also required linkages to the Canadian inst itute for Health Information data for ascertainment of selected comorbiditi es and in-hospital mortality rates. Logistic regression models were used to calculate risk-adjusted death rates for each of the 9 hospitals performing CABG surgery in Ontario. Results The risk-adjusted death rates were quite similar between data sourc es for 7 of the 9 hospitals. For 2 hospitals, rather large absolute differe nces in adjusted death rates of 0.58% and 0.64% were seen between report ca rds. There was a strong correlation between data sources for risk-adjusted hospital death rates (intraclass correlation coefficient = 0.927, P < .001) and for rankings of adjusted hospital death rates (Spearman correlation co efficient = 0.828, P = .02). Conclusion These results from Ontario, Canada, reveal general similarities between administrative and clinical data report cards for CABG surgery. How ever, clinical data are likely needed if individual hospitals are to be pub licly scrutinized in outcome report cards.