Methods Inf Med 2013; 52(01): 3-17
DOI: 10.3414/ME12-01-0022
Review Article
Schattauer GmbH

Appropriateness of ICD-coded Diagnostic Inpatient Hospital Discharge Data for Medical Practice Assessment[*]

A Systematic Review
H. Prins
1  School of Health Care, Windesheim University of Applied Sciences, Zwolle, The Netherlands
A. Hasman
2  Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

received: 25 March 2012

accepted: 20 September 2012

Publication Date:
20 January 2018 (online)


Objectives: We performed a systematic review to investigate the quality of diagnostic hospital discharge data (DHDD) in order to gain insight in the usefulness of these data for medical practice assessment. We investigated the methods used to evaluate data quality, factors that determine data quality and its consequences for medical practice assessment.

Methods: We selected studies in which both completeness (or sensitivity: SENS) and correctness (or positive predictive value: PPV) were measured. We used the random-effects model to calculate mean SENS and PPV and to explore the effect of a number of covariates.

Results: The 101 included studies were very heterogeneous. We distinguished six typical study designs. We found a mean SENS of 0.67 (95%CI: 0.62– 0.73) and PPV of 0.76 (95%CI: 0.73– 0.79); SENS was significantly lower for comorbidity and complication studies than for some single disease studies. PPV was significantly higher for Scandinavian countries than for other countries. Recoding compared to re-abstracting of the medical record as a gold standard gave a significantly lower PPV. Diagnostic data were considered appropriate by the authors of the studies for quality of care purposes when both SENS and PPV were at least 0.85. Only 13% of the studies fulfilled this criterion.

Conclusions: Variability in quality of care between settings can easily be overshadowed by variability in data quality. However, the use of DHDD by physicians to evaluate their own medical practice may be useful. But only if physicians are willing to critically interpret the meaning of the information for their medical practice assessment.

* Supplementary online material published on our website