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Administrative Hospitalization Database Validation of Cardiac Procedure Codes

Lee, Douglas S. MD, PhD*,†,‡; Stitt, Audra MSc*; Wang, Xuesong MSc*; Yu, Jeffery S. BSc*; Gurevich, Yana MD, MPH§; Kingsbury, Kori J. MSN; Austin, Peter C. PhD*,‡,¶; Tu, Jack V. MD, PhD*,‡,#

doi: 10.1097/MLR.0b013e3182329778
Applied Methods

Background: Although cardiac procedures are commonly used to treat cardiovascular disease, they are costly. Administrative data sources could be used to track cardiac procedures, but sources of such data have not been validated against clinical registries.

Objectives: To examine accuracy of cardiac procedure coding in administrative databases versus a prospective clinical registry.

Sample: We examined a total of 182,018 common cardiac procedures including percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) surgery, valve surgery, and cardiac catheterization procedures during fiscal years 2005 and 2006 across 18 cardiac centers in Ontario, Canada.

Research Design: Accuracy of codes in the Canadian Institute for Health Information (CIHI) administrative databases were compared with the clinical registry of the Cardiac Care Network.

Results: Comparing 17,511 CIHI and 17,404 registry procedures for CABG surgery, the positive predictive value (PPV) of CIHI-coded CABG surgery was 97%. In 6229 CIHI-coded and 5885 registry-coded valve surgery procedures, the PPV of the administrative data source was 96%. Comparing 38,527 PCI procedures in CIHI to 38,601 in the registry, the PPV of CIHI was 94%. Among 119,751 CIHI-coded and 111,725 registry-coded cardiac catheterization procedures, the PPV of administrative data was 94%. When the procedure date window was expanded from the same day to ±1 days, the PPV was 96% (PCI) and exceeded 98% (CABG surgery), 97% (valve surgery), and 95% (cardiac catheterization).

Conclusions: Using a clinical registry as the gold standard, the coding accuracy of common cardiac procedures in the CIHI administrative database was high.

*Institute for Clinical Evaluative Sciences

Division of Cardiology, University Health Network—Toronto General Hospital

Department of Health Policy, Management, and Evaluation

§Canadian Institute for Health Information Research and Analysis Division

Cardiac Care Network of Ontario

Dalla Lana School of Public Health

#Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

Supported by an operating grant from the Public Health Agency of Canada, clinician-scientist award from the Canadian Institutes of Health Research (D.S.L.), career investigator award from the Heart and Stroke Foundation of Ontario (P.C.A., J.V.T.) and a Canada Research Chair in Health Services Research (J.V.T.). The Institute for Clinical Evaluative Sciences is supported in part by a grant from the Ontario Ministry of Health and Long Term Care. The opinions, results, and conclusions are those of the authors and no endorsement by the Ontario Ministry of Health and Long Term Care, by the Canadian Institute for Health Information, or by the Institute for Clinical Evaluative Sciences is intended or should be inferred.

The authors declare no conflict of interest.

Reprints: Douglas S. Lee, MD, PhD, Institute for Clinical Evaluative Sciences, G-106, 2075 Bayview Avenue, Toronto, ON, Canada M4N 3M5 (e-mail:

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