Study finds that administrative billing data accurately captures perinatal risk factors and clinical outcomes

A retrospective study recently published in Pediatrics found that a statewide administrative database containing billing and coding information for newborn discharges accurately captured risk factors and outcomes for perinatal patients. This suggests that administrative databases may be effectively used to analyze performance metrics and accelerate data quality improvement efforts locally.

Administrative databases contain readily available data on discharge diagnosis and procedure codes primarily used for billing and financial purposes. In contrast, clinical databases contain high-quality comprehensive data but are labor intensive and expensive to maintain, according to the Agency for Healthcare Research and Quality.

To examine the accuracy of billing codes for capturing key risk factors and outcomes, researchers at Stanford University in Palo Alto, California, linked key perinatal risk factors and outcomes from the California Perinatal Quality Care Collaborative (CPQCC) database to relevant billing codes from administrative maternal and newborn inpatient discharge records. Administrative data was taken from the Office of Statewide Health Planning and Development (OSHPD) database, which includes ICD-10-CM, CPT, and ICD-10-PCS codes as well as birth, newborn discharge, and maternal delivery data for perinatal patients.

Researchers compared clinical and administrative data for 50,631 patients who gave birth between 2006 and 2012. A probabilistic record linkage was performed, which determined overlap in the data based on reported infant date of birth, maternal date of birth, infant sex, birth weight, birth location, infant disposition, infant discharge date, and birth order.

The primary outcome was whether perinatal risk factors and outcomes reported in CPQCC database were coded and billed for in the OSHPD database. Overall, researchers found that risk factors and outcomes that are highly prevalent or easy to define, including mortality, mechanical ventilation, and retinopathy of prematurity surgery, revealed the most reliable coding in the OSHPD database. Conversely, diagnoses with complicated definitions, such as maternal chorioamnionitis, fetal distress, and chronic lung disease, were less frequently coded.

Several perinatal risk factors and outcomes were highly congruent between the administrative and clinical database. Based on this finding, researchers conclude that statewide administrative databases such as the CPQCC database may be used in future studies to examine common risk factors and maternal outcomes. Researchers also concluded that subjective risk factors and outcomes are appropriate targets for data improvement initiatives.