Adherence to Methodological Standards in Research Using the National Inpatient Sample

被引:555
作者
Khera, Rohan [1 ]
Angraal, Suveen [2 ]
Couch, Tyler [1 ]
Welsh, John W. [2 ]
Nallamothu, Brahmajee K. [3 ]
Girotra, Saket [4 ]
Chan, Paul S. [5 ,6 ]
Krumholz, Harlan M. [2 ,7 ,8 ]
机构
[1] Univ Texas Southwestern Med Ctr Dallas, Div Cardiol, Dallas, TX 75390 USA
[2] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, 20 York St, New Haven, CT 06504 USA
[3] Univ Michigan, Dept Internal Med, Div Cardiol, Ann Arbor, MI 48109 USA
[4] Univ Iowa, Dept Internal Med, Div Cardiovasc Med, Carver Coll Med, Iowa City, IA 52242 USA
[5] St Lukes Mid Amer Heart & Vasc Inst, Kansas City, MO USA
[6] Univ Missouri, Kansas City, MO 64110 USA
[7] Yale Sch Med, Dept Internal Med, Sect Cardiovasc Med, New Haven, CT USA
[8] Yale Sch Publ Hlth, Dept Hlth Policy & Management, New Haven, CT USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2017年 / 318卷 / 20期
基金
美国国家卫生研究院;
关键词
D O I
10.1001/jama.2017.17653
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
IMPORTANCE Publicly available data sets hold much potential, but their unique design may require specific analytic approaches. OBJECTIVE To determine adherence to appropriate research practices for a frequently used large public database, the National Inpatient Sample (NIS) of the Agency for Healthcare Research and Quality (AHRQ). DESIGN, SETTING, AND PARTICIPANTS In this observational study of the 1082 studies published using the NIS from January 2015 through December 2016, a representative sample of 120 studies was systematically evaluated for adherence to practices required by AHRQ for the design and conduct of research using the NIS. EXPOSURES None. MAIN OUTCOMES AND MEASURES All studies were evaluated on 7 required research practices based on AHRQ's recommendations and compiled under 3 domains: (1) data interpretation (interpreting data as hospitalization records rather than unique patients); (2) research design (avoiding use in performing state-, hospital-, and physician-level assessments where inappropriate; not using nonspecific administrative secondary diagnosis codes to study in-hospital events); and (3) data analysis (accounting for complex survey design of the NIS and changes in data structure over time). RESULTS Of 120 published studies, 85%(n = 102) did not adhere to 1 or more required practices and 62%(n = 74) did not adhere to 2 or more required practices. An estimated 925 (95% CI, 852-998) NIS publications did not adhere to 1 or more required practices and 696 (95% CI, 596-796) NIS publications did not adhere to 2 or more required practices. A total of 79 sampled studies (68.3%[95% CI, 59.3%-77.3%]) among the 1082 NIS studies screened for eligibility did not account for the effects of sampling error, clustering, and stratification; 62 (54.4%[95% CI, 44.7%-64.0%]) extrapolated nonspecific secondary diagnoses to infer in-hospital events; 45 (40.4%[95% CI, 30.9%-50.0%]) miscategorized hospitalizations as individual patients; 10 (7.1%[95% CI, 2.1%-12.1%]) performed state-level analyses; and 3 (2.9% [95% CI, 0.0%-6.2%]) reported physician-level volume estimates. Of 27 studies (weighted; 218 studies [95% CI, 134-303]) spanning periods of major changes in the data structure of the NIS, 21 (79.7%[95% CI, 62.5%-97.0%]) did not account for the changes. Among the 24 studies published in journals with an impact factor of 10 or greater, 16 (67%) did not adhere to 1 or more practices, and 9 (38%) did not adhere to 2 or more practices. CONCLUSIONS AND RELEVANCE In this study of 120 recent publications that used data from the NIS, the majority did not adhere to required practices. Further research is needed to identify strategies to improve the quality of research using the NIS and assess whether there are similar problems with use of other publicly available data sets.
引用
收藏
页码:2011 / 2018
页数:8
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