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Use of statewide administrative database in assessing a regional trauma system
LETTERS TO THE EDITOR
Use of Statewide Administrative Database in Assessing a Regional Trauma System
work of creating and maintaining a valid clinical database before significant conclusions are developed? REFERENCES
Joshua Burack, MD, FACS Brooklyn, NY
1. Reilly JJ, Chin B, Berkowitz J, et al. Use of a state-wide administrative database in assessing a regional trauma system: the New York City experience. J Am Coll Surg 2004;198:509–518. 2. Hannan EL, Kiburn H, O’Donnell JF, et al. Adult open heart surgery in New York state: an analysis of risk factors and hospital mortality rates. JAMA 1990;264:2768–2774. 3. Coronary artery bypass surgery in New York State 1993–1995. Albany: New York State Department of Health; 1997.
I have read the article authored by Dr Reilly and colleagues1 comparing outcomes at trauma centers and nontrauma centers in New York City. I am surprised to see such an important conclusion, “discharge from a trauma center exerted an unfavorable impact on adjusted mortality risk,” derived from an administrative New York Statewide Planning and Research Cooperative System (SPARCS) database. The much-heralded New York State Cardiac Surgery Cardiac Reporting System (CSRS), the inventor of “report card medicine,” discarded the unreliable and nonaudited administrative data contained in the SPARCS database 14 years ago. In reference to the SPARCS system, the seminal report concluded, “it appears that the CSRS (Cardiac Surgery Reporting System) data provide a significant improvement in comparison to typical discharge or claims data.”2 Adoption of a clinical database marked the end of the use of federal or administrative data in reporting of cardiac surgical results in New York State. All reports generated from the New York State Department of Health about cardiac surgical outcomes have relied on a clinical database, collected by clinicians and audited by the Department of Health. In the article by Reilly and colleagues,1 the claim that SPARCS data were used to formulate the 1993 to 1995 Coronary Artery Surgery in New York State Report is false.3 Cardiac surgeons have realized that important conclusions about operative survival require careful analysis of a clinical database, whether it be the New York State CSRS, the Northern New England Cardiovascular Disease Study Group, the Veterans Administration Cooperative study, or the flagship Society of Thoracic Surgeons database, with over 2 million patients entered. Despite the disclaimer in the title and the body of the article, I am concerned that the important outcomes conclusions about the treatment of trauma patients are drawn from unreliable data. Might it be more cautious to do the hard
© 2004 by the American College of Surgeons Published by Elsevier Inc.
Reply James J Reilly, MD, FACS Brooklyn, NY We agree with Dr Burack that a clinical database to evaluate outcomes of injured patients in New York City would be a valuable asset to hospitals that provide their care and to public policy planners. Certainly the New York State Cardiac Surgery Reporting System (CSRS) database’s utility is derived in part by the homogeneity of the task, examining only two types of procedures, coronary artery bypass graft and valve replacement, and adjusting for relatively simple and unambiguous risk adjustment parameters. Clinical databases to capture the complexity of trauma exist (the Trauma Registry of the American College of Surgeons database), but mandating data submission for all injured patients from all hospitals in New York City, or any region, would be a daunting task, requiring government mandates and crucial local resources. Our article discusses at some length the shortcomings of administrative databases, such as the New York Statewide Planning and Research Cooperative System, and the importance of approaching its analytic powers with caution. We have, for example, avoided analyzing individual hospitals, physicians, or both, a capability exhibited by the CSRS database. Rather, we simply aggregated our data into two large groups of hospitals, trauma centers and nontrauma centers, and asked whether mortality rates for several broad clinical classes of injury type, adjusted for age, gender, and
666
ISSN 1072-7515/04/$30.00 doi:10.1016/j.jamcollsurg.2004.06.011
Use of Statewide Administrative Database in Assessing a Regional Trauma System
work of creating and maintaining a valid clinical database before significant conclusions are developed? REFERENCES
Joshua Burack, MD, FACS Brooklyn, NY
1. Reilly JJ, Chin B, Berkowitz J, et al. Use of a state-wide administrative database in assessing a regional trauma system: the New York City experience. J Am Coll Surg 2004;198:509–518. 2. Hannan EL, Kiburn H, O’Donnell JF, et al. Adult open heart surgery in New York state: an analysis of risk factors and hospital mortality rates. JAMA 1990;264:2768–2774. 3. Coronary artery bypass surgery in New York State 1993–1995. Albany: New York State Department of Health; 1997.
I have read the article authored by Dr Reilly and colleagues1 comparing outcomes at trauma centers and nontrauma centers in New York City. I am surprised to see such an important conclusion, “discharge from a trauma center exerted an unfavorable impact on adjusted mortality risk,” derived from an administrative New York Statewide Planning and Research Cooperative System (SPARCS) database. The much-heralded New York State Cardiac Surgery Cardiac Reporting System (CSRS), the inventor of “report card medicine,” discarded the unreliable and nonaudited administrative data contained in the SPARCS database 14 years ago. In reference to the SPARCS system, the seminal report concluded, “it appears that the CSRS (Cardiac Surgery Reporting System) data provide a significant improvement in comparison to typical discharge or claims data.”2 Adoption of a clinical database marked the end of the use of federal or administrative data in reporting of cardiac surgical results in New York State. All reports generated from the New York State Department of Health about cardiac surgical outcomes have relied on a clinical database, collected by clinicians and audited by the Department of Health. In the article by Reilly and colleagues,1 the claim that SPARCS data were used to formulate the 1993 to 1995 Coronary Artery Surgery in New York State Report is false.3 Cardiac surgeons have realized that important conclusions about operative survival require careful analysis of a clinical database, whether it be the New York State CSRS, the Northern New England Cardiovascular Disease Study Group, the Veterans Administration Cooperative study, or the flagship Society of Thoracic Surgeons database, with over 2 million patients entered. Despite the disclaimer in the title and the body of the article, I am concerned that the important outcomes conclusions about the treatment of trauma patients are drawn from unreliable data. Might it be more cautious to do the hard
© 2004 by the American College of Surgeons Published by Elsevier Inc.
Reply James J Reilly, MD, FACS Brooklyn, NY We agree with Dr Burack that a clinical database to evaluate outcomes of injured patients in New York City would be a valuable asset to hospitals that provide their care and to public policy planners. Certainly the New York State Cardiac Surgery Reporting System (CSRS) database’s utility is derived in part by the homogeneity of the task, examining only two types of procedures, coronary artery bypass graft and valve replacement, and adjusting for relatively simple and unambiguous risk adjustment parameters. Clinical databases to capture the complexity of trauma exist (the Trauma Registry of the American College of Surgeons database), but mandating data submission for all injured patients from all hospitals in New York City, or any region, would be a daunting task, requiring government mandates and crucial local resources. Our article discusses at some length the shortcomings of administrative databases, such as the New York Statewide Planning and Research Cooperative System, and the importance of approaching its analytic powers with caution. We have, for example, avoided analyzing individual hospitals, physicians, or both, a capability exhibited by the CSRS database. Rather, we simply aggregated our data into two large groups of hospitals, trauma centers and nontrauma centers, and asked whether mortality rates for several broad clinical classes of injury type, adjusted for age, gender, and
666
ISSN 1072-7515/04/$30.00 doi:10.1016/j.jamcollsurg.2004.06.011