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Differential misclassification of confounders in comparative evaluation of hospital care quality: caesarean sections in Italy.
- Source :
-
BMC public health [BMC Public Health] 2014 Oct 08; Vol. 14, pp. 1049. Date of Electronic Publication: 2014 Oct 08. - Publication Year :
- 2014
-
Abstract
- 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).<br />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.<br />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.<br />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.
- Subjects :
- Adult
Confounding Factors, Epidemiologic
Female
Hospitalization
Hospitals statistics & numerical data
Humans
Italy epidemiology
Logistic Models
Middle Aged
Models, Theoretical
Pregnancy
Prevalence
Cesarean Section statistics & numerical data
Hospitals standards
Obstetric Labor Complications surgery
Quality of Health Care statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2458
- Volume :
- 14
- Database :
- MEDLINE
- Journal :
- BMC public health
- Publication Type :
- Academic Journal
- Accession number :
- 25297561
- Full Text :
- https://doi.org/10.1186/1471-2458-14-1049