ABDMP: Local and National Resources: Data Collection Process/Data Quality

Arizona Birth Defects Monitoring Program

Data Collection Process:

Case Finding Procedure:	Case finding is a strategy used to identify potential cases of infants who may have a reportable birth defect, diagnosed within the first year of life. This requires that the Arizona Birth Defects Monitoring Program (ABDMP) staff merge the lists of potential cases from various data sources to eliminate duplicates and assure complete case ascertainment. A final list is prepared for the corresponding medical facility with a request to retrieve charts for review.
Abstracting:	Reporting rules (Arizona Administrative Code Title 9, Chapter 4) define the access of the ABDMP to information on infants who may birth defects from various data sources. The ABDMP staff to review the charts and abstract the cases, which meet the criteria for inclusion (see Case Definition).
Coding:	The ABDMP staff code the birth defects using British Pediatric Association (BPA) codes.
Data Entry	The abstracts are entered into the oracle data base after being checked or completeness and accuracy.

Data Quality:

The usefulness of ABDMP depends upon the quality of its data. International standards for completeness and accuracy rates are established at 95% for each component. To assure that ABDMP has usable data, it is necessary to quality control the data for completeness and accuracy.

The data quality process involves routine quality control, an audit of the case finding, a re-abstraction study, and an audit of the data entry.

Routine Quality Control:	The first level of quality control involves the review by the ABDMP Program Manager of all (100%) of the abstracts prepared by the abstractors for completeness and accuracy prior to data entry. A complete item-by-item inspection is undertaken to determine if the required data is recorded and the data is accurate and consistent. In addition, each recorded diagnosis with its confirmation and its selected BPA code is reviewed for accuracy by referring to the information entered in the Results of Diagnostic Tests and Procedures Narrative section of the abstract and by referring to the coding instructions for reportable congenital anomalies. Resolution of any errors, omissions, or inconsistencies is accomplished during the discussions with the responsible abstractors. When a case is identified from several facilities, the abstracts of that case are merged. The Program Manager analyzes the findings to look for the final diagnoses and make corrections to the abstracts.
Case Finding Audit:	Annually 20% of the hospitals/facilities are randomly selected for case finding audits. A case finding list is prepared from a sample of the hospital's Disease Index and other case finding sources for comparison with the original case finding list created. If more than 5% of the probable cases do not appear on the original case finding list, a 100% audit will be conducted, and the ABDMP staff will receive additional training to improve the case finding process used.
Re-Abstraction Study:	Annually 10 to 50% of the abstracts from 20% of the hospitals/facilities are randomly selected for the re-abstracting study (the percentage of abstracts selected for audit depends on the size of the hospital/facility). The quality assurance person (QAP) reviews each chart and re-abstracts reportable data to evaluate the following: Appropriateness of reporting the case (Is it reportable?) Completeness of the abstract (Are omissions accounted for?) Accuracy of the data Accuracy of the codes The QAP will review the discrepancies with the responsible abstractors. If the re-abstraction study shows that the frequency of completeness and/or accuracy is less than 95% in any hospital/facility, then a 100% audit on the possible cases will be conducted in that facility.
Data Entry Verification:	The QAP verifies the data entry of a sample of abstracts (20%) of the year of interest by accessing the ABDMP automated system to compare what was entered to what was recorded on each abstract. If the frequency of accuracy is less than 95%, then a 100% audit will be performed on the data entry. To achieve and maintain quality of data and to be cost-effective, the ABDMP provides to the staff complete documentation of abstracting and coding rules, formal and informal training and timely feedback.