Why are so many men pregnant?
A lot of reliance is placed on hospital coding, the three or four-letter codes that are used as a shorthand to categorise the conditions suffered by patients. They are used to pay hospitals’ bills, to measure their performance, and as a source for statistical analyses of hospital activity and the changing burden of disease. They’re vitally important, says the Royal College of Physicians.
But a letter in this week’s BMJ indicates that any confidence in the accuracy of codes may be misplaced. A team from Imperial College found that in 2009-10, nearly 20,000 adults were coded as having attended paediatric outpatient services, and 3,000 patients under 19 were apparently treated in geriatric clinics.
Even more striking, between 15,000 and 20,000 men have been admitted to obstetric wards each year since 2003, and almost 10,000 to gynaecology wards. Nearly 20,000 midwife “episodes” – NHS jargon for completed treatments – were with men. The “pregnant man” advertisement created by Saatchi and Saatchi for the Health Education Council in the 1970s (pictured) was evidently prophetic as well as memorable.
“These statistics seem to reveal some interesting service developments” says the team led by Dr Lauren Brennan, “but although we applaud innovation we suspect that the numbers may, at least partly, reflect data errors.”
Coding is notoriously shifty, as we have reported here and here. In one famous case, a hospital coded an entire year’s births as stillbirths and had to be excluded from the statistics altogether. But that, at least, was noticed. One wonders how many cases of miscoding go completely undetected. Plenty, on the basis of this study.
Anonymous (not verified) wrote,
Tue, 10/04/2012 - 16:15
Has Imperial College identified those "men" who are babies born in hospital (age 0) where the hospital includes them with the mother because they are well? (Technically incorrect but not uncommon and trivially easy to exclude) Are they using ward type, main specialty, treatment speciality or clinical code? If they are relying on clinical coding have they checked the HRG returned, a UZ01Z should be returned which mean no payment under PbR, I suspect that will be improving coding quality.
What is the underlying coding error rate, even implyed by this? The ONS suggests 600,000 - 700,000 births per year http://www.ons.gov.uk/ons/rel/vsob1/birth-statistics--england-and-wales-... but aren't the figurea above for admissions, how many more. Is that errors <3%, <2%. if you clean up well babies is that lower, can we imputer and error rate from the data overall?
What is an acceptable rate, assuming a) it will almost impossible to reach zero, b) this data is not used to directly treat patients, c) improving coding quality uses money that could be spent on direct patient care (i.e. does data need to be good enough to be usuable in efficient service design and planning but no better?)
marian (not verified) wrote,
Wed, 11/04/2012 - 07:59
how interesting - codes that mislead usd in statistics that mislead
Chris Roebuck, HES Programme Manager, HSCIC (not verified) wrote,
Thu, 12/04/2012 - 13:52
I read the BMJ letter with interest and applaud this initiative to encourage greater understanding of clinical data. The Health and Social Care Information Centre (HSCIC), which manages HES, liaises closely with organisations to encourage submission of complete data, offer guidance and training on HES data and seek to minimise inaccuracies, but there is still room for improvement; and we’re very keen to increase our engagement with clinicians about hospital data.
HES is rich in detail and potentially can be a powerful driver for decision-making, as Dr Brennan rightly points out. Her study demonstrates this in several ways. It is an interesting and correct assertion that thousands of male finished consultant episodes (FCEs) were recorded under the obstetrics, gynaecological and midwifery specialisms. At first glance this would appear out of the ordinary.
However when we analysed the date further, by age as well as gender; almost all male FCES related to new-born or very young babies: with 96 per cent relating to babies less than one week old.
We are very keen to support initiatives such as this and always willing to offer our assistance with correct interpretation of data.
PatrikD (not verified) wrote,
Thu, 17/05/2012 - 10:24
I assume this data also includes kids getting treated for a scraped knee while visiting grandpa in a geriatric clinic, and things such as that.
I wouldn't be surprised if there were actually a good explanation for most of those counterintuitive entries.
Suek (not verified) wrote,
Fri, 25/05/2012 - 07:39
Has anyone considered that fertility work is generally done under the auspices of a gynecologist and this includes male infertility, so if a man is having a fertility-related procedure, it may need to be coded to the gynecology dept so that department gets the income.
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