Impact of diagnosis-timing indicators on measures of safety, comorbidity, and case mix groupings from administrative data sources
Impact of diagnosis-timing indicators on measures of safety, comorbidity, and case mix groupings from administrative data sources
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DOI：
10.1097/mlr.0b013e3180618b7f
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发表时间：
2007-08-01
期刊：
影响因子：
3
通讯作者：
Culbertson, Richard
中科院分区：
文献类型：
--
作者：
Naessens, James M.;Campbell, Claudia R.;Culbertson, Richard
背景：许多识别医院并发症的尝试依赖于来自账单数据的二次诊断。为了有意义，诊断代码必须区分入院后的诊断和入院前的诊断。目的：评估入院时诊断对患者安全性、合并症、严重程度指标和医疗保险报销的病例组合分组的影响。设计：各种基于诊断的临床和性能指标在入院时存在和不存在诊断的情况下的横截面关联。设置：2005年马约诊所罗切斯特医院出院患者（N = 60 599）：所有住院患者，包括外科、内科、儿科、产科、精神科和康复科患者。约33%的患者旅行超过IN英里的护理。主要结果测量：医院患者的安全指标，合并症，严重程度。结果：90%以上的诊断是在入院时出现的，而27.1%的住院患者有二级诊断编码在医院。大约三分之一的出院安全指标被标记，因为在入院时已经存在诊断，更有可能是转诊患者。相比之下，87%的术后出血、22%的术后髋部骨折和54%的伤口内异物被编码为住院条件。住院期间观察到的严重程度变化不到8%的出院。略高于3%的出院被分配到更高的权重诊断相关groups的基础上，在医院complication.Conclusions：在一般情况下，许多患者的安全指标不可靠地识别不良医院事件，特别是当应用于学术转诊中心。除非另有说明，入院后记录的疾病对合并症和严重程度指标或医疗保险报销的影响最小。
Context: Many attempts to identify hospital complications rely on secondary diagnoses from billing data. To be meaningful, diagnosis codes must distinguish between diagnoses after admission and those existing before admission.Objective: To assess the influence of diagnoses at admission on patient safety, comorbidity, severity measures, and case mix groupings for Medicare reimbursement.Design: Cross-sectional association of various diagnosis-based clinical and performance measures with and without diagnosis present on admission.Setting: Hospital discharges from Mayo Clinic Rochester hospitals in 2005 (N = 60 599).Patients: All hospital inpatients including surgical, medical, pediatric, maternity, psychiatric, and rehabilitation patients. About 33% of patients traveled more than IN miles for care.Main Outcome Measures: Hospital patient safety indicators, comorbidity, severity. and case mix measures with and without diagnoses present at admission.Results: Over 90% of all diagnoses were present at admission whereas 27.1% of all inpatients had a secondary diagnosis coded in-hospital. About one-third of discharges with a safety indicator were flagged because of a diagnosis already present at admission, more likely among referral patients. In contrast, 87% of postoperative hemorrhage, 22% of postoperative hip fractures, and 54% of foreign bodies left in wounds were coded as in-hospital conditions. Severity changes during hospitalization were observed in less than 8% of discharges. Slightly over 3% of discharges were assigned to higher weight diagnosis-related groups based on an in-hospital complication.Conclusions: In general, many patient safety indicators do not reliably identify adverse hospital events, especially when applied to academic referral centers. Except as noted, conditions recorded after admission have minimal impact on comorbidity and severity measures or on Medicare reimbursement.