Clinical Data Analysis and Reporting System (CDARS) Data is Not

Accurate Enough for Clinical Audit on Postoperative Complications

A study on the accuracy of CDARS

TL Kwan, A Wai, WC YuenCentral Surgical Audit Unit,

Hospital Authority, Hong Kong

Evaluate the Quality of Medical Care

Structure

Process

Outcome

Avedis Donabedian

Common Outcome Measures in Clinical Audit

Mortality (30-day / In-hospital)

Survival (Overall / Symptom-free / Recurrence-free)

Length of StayMorbidity MobilityPatient Satisfaction

Outcomes are influenced by

DefinitionsData QualityPatient Case-mixQuality of CareChance

Data Quality is a Crucial Factor in defining the Quality

of whole audit project

Overview of CDARS

CDARS CMS /IE5+

DataWarehouse

CMS

IPAS

OPAS

Dx, Px, Specialist I/C, MO I/C, OTRS

Radiology Examination

Patient DemographicsEpisode Movements

PHS/CDDH

LIS

RIS

Lab test with standardized units

Appointments & AttendancesInformation

AEIS

Drug Dispensed

Attendances Information

OBCIS Obstetric Information

The Accuracy and Completeness of CDARS had not been Verified

Accuracy of Morbidity Data in CDARS

Case Notes Review by investigators

CDARS

Patients

Elective Oesophagectomies for Squamous Cell Carcinoma of Oesophagus performed in all HA Hospitals (1/7/2001 to 31/7/2005)

Morbidity of Oesophagectomy

PneumoniaChylothoraxAnastomotic Leakage

Results

545 patients in 14 HA hospitals 227 out of 543 patients had at least one complication (41.8%)

Case Notes Review Vs CDARS

132

23

4726

924

Pneumonia Chylothorax Anastomotic Leakage

Case Notes Review CDARS

Pick-up rates

Case Note

ReviewCDARS

Pick-up rate

(CDARS)

Pneumonia 132 26 20%

Chylothorax 23 9 39%

Anastomotic Leakage 47 24 51%

Conclusion

Pick-up rates of common postoperative complications by CDARS were lowImportance of data verificationUnless the reporting mechanism of complications can be improved, extraction of complications data directlyfrom CDARS will not be useful