Analysis of routine hospital administrative data (including hospital episode statistics) to assess variation in process and outcomes in gastroenterology

Bowering, Katherine
Analysis of routine hospital administrative data (including hospital episode statistics) to assess variation in process and outcomes in gastroenterology. Doctor of Philosophy thesis, University of Liverpool.

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Background and Aims To explore outcomes following gastrointestinal endoscopy using a clinical dataset and then routinely collected administrative data linked to death registry data. Predictors of outcome were studied and variations in crude mortality were analysed. Methods Endoscopy cases from a single tertiary centre were identified retrospectively using a clinical endoscopy database. Sedation levels, type of procedure and demographic data were analysed. Adverse events following the procedures, including mortality were assessed before and after changes in sedation practice were introduced. For subsequent chapters national administrative data in the form of Hospital Episode Statistics (HES) were linked to the Office of National Statistics Death Registry. Data from 2006 – 2008 were analysed. Episodes of care containing codes for therapeutic endoscopic procedures were extracted (Endoscopic retrograde cholangio-pancreatography (ERCP) and percutaneous endoscopic gastrostomy (PEG)). Finally, episodes of care containing new stroke diagnoses were extracted to analyse the use of percutaneous gastrostomies in the stroke population in England. Factors associated with death following endoscopy were identified. Crude and case-mix adjusted mortality were analysed at institutional level. Results 7,234 endoscopy cases were identified from the endoscopy clinical database. Following changes in sedation practice 7,071 cases were assessed. Significant reductions in sedation doses were achieved but mortality rates did not fall (0.7% in 2004 and 0.8% in 2006 (p=0.5)). 40,938 episodes of care containing ERCP procedures were identified within the HES data. Logistic regression analysis confirmed age, sex, cancer, emergency admission, and non-cancer co-morbidity as independent predictors of 30-day death after ERCP. Adjusted odds ratios for age were 6.2 for ≥85 yrs vs.

Item Type: Thesis (Doctor of Philosophy)
Additional Information: Doctor of Medicine qualification Date: 2014-01 (completed)
Uncontrolled Keywords: Hospital Episode Statistics, Gastroenterology, ERCP, PEG, endoscopy
Subjects: ?? RA ??
Divisions: Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User: Symplectic Admin
Date Deposited: 06 Aug 2014 09:05
Last Modified: 16 Dec 2022 04:41
DOI: 10.17638/00015135
  • Bodger, Keith
  • Pearson, Mike