Brazilian Hospital Database System as risk adjustment in performance indicators

Objective To analyze the use of the Brazilian Hospital Database (SIH/SUS) o n risk adjustment of hospital mortality, and to evaluate the usefulness of the Charlson comorbidity index (CCI)for risk adjustment of indicators calcu lated with the available data from the SIH/SUS. Methods The comorbidity index was applied on 40,299 patients admitted in ho spital in Rio de Janeiro, Brazil. CCI determines specific. values to 17 cli nical conditions to measure the burden of the patient's comorbidity, nor ta king into consideration the main diagnosis. Multiple logistic regression wa s applied to assess the impact Of CCI in estimating the probability of`dyin g. Results CCI M as greater than zero in only 5.7% admissions. When combined w ith age (combined CCI), the percentage of cases with a value greater than z ero increased considerably. These models, however, showed to have a low sen sitivity: Conclusions Despite comorbidity is an important predictor for the risk of d ying, it was observed that this is nor re good discriminatory variable of c ase severity in the studied database. This maybe due to incomplete diagnost ic information in the database. In the SIH/SUS data. age is the most import ant predictor of the risk of dying. However despite the limited quality of diagnostic information in SIH/SUS, the use of CCI combined with age fbr adj ustment of the risk of dying is recommended in measures using this database .