Problems in health data analysis: The Maryland permanent pacemaker experience in 1979 and 1980

In a recent report the Maryland statewide health data base, which is derived from "face sheet" data, was used to determine the appropriateness of permanent pacemaker insertion. In the present study the same indications were utilized and both the complete medical records and the face sheet were reviewed for those patients who had been classified as having permanent pacemakers inserted for inappropriate or questionable reasons. In 32 hospitals, 75% of the records were reviewed (610 of 817 patients). Although coded as having received permanent pacemakers, 16% had received temporary pacemakers, battery change, and the like. Diagnoses justifying permanent pacemaker insertion had been omitted in 53% of the face sheets, and coding errors were found in 39%. Although none of the 610 medical records reviewed had a valid indication for permanent pacemaker insertion listed on the face sheet, complete medical record review demonstrated valid indications in 95%. Inherent difficulties arise in attempting to list rigid indications for permanent pacemaker insertion. The face sheet does not provide adequate data for assessing the appropriateness of permanent pacemaker insertion.