CODING OF ACUTE MYOCARDIAL-INFARCTION - CLINICAL AND POLICY IMPLICATIONS
CODING OF ACUTE MYOCARDIAL-INFARCTION - CLINICAL AND POLICY IMPLICATIONS
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DOI：
10.7326/0003-4819-109-9-745
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发表时间：
1988-11-01
影响因子：
39.2
通讯作者：
LEVINE, PA
中科院分区：
文献类型：
--
作者：
IEZZONI, LI;BURNSIDE, S;LEVINE, PA
研究目的：评价教学医院与非教学医院急性心肌梗死诊断编码的适宜性。设计：回顾性分析随机抽样的医疗记录，寻找入院期间急性心肌梗死发生和积极治疗的证据。环境：波士顿市区有五所三级教学医院，五所其他教学医院和五所非教学医院。病例：1984年10月至1985年9月间，随机抽取出院诊断为急性心肌梗死的住院患者。测量和主要结果：1003例患者中，260例不符合急性心肌梗死的临床标准。在三级医院，175家（41.7%）不合格，而在非教学机构，26家（9.1%）不合格。在很大一部分不合格的病例中，患者入院是为了排除急性心肌梗死的诊断；虽然明确地“排除了”，但还是指定了急性心肌梗死的代码。66例来自教学医院的病例不符合条件，因为患者在心肌梗死后的平稳过程中只接受了冠状动脉造影。近三分之一的患者在血管造影入院前5至8周发生梗死。结论：急性心肌梗死出院诊断不正确的病例可能集中在教学医院。这一发现可能会对医疗保险诊断相关的团体支付系统以及政府和其他研究工作产生影响，这些研究工作利用这些数据来推断医院护理的质量。
Study Objective: To evaluate the appropriateness of diagnostic coding of acute myocardial infarction across teaching and nonteaching hospitals. Design: Retrospective review of a random sample of medical records to find evidence of the occurrence and active treatment of acute myocardial infarction during the admission. Setting: Five tertiary teaching, five other teaching, and five nonteaching hospitals in metropolitan Boston. Cases: Random sample of hospital admissions assigned a discharge diagnosis of acute myocardial infarction between October 1984 and September 1985. Measurement and Main Results: Of the 1003 cases reviewed, 260 did not meet the clinical criteria for acute myocardial infarction. At tertiary hospitals, 175 (41.7%) failed to qualify, compared with 26 (9.1%) at nonteaching facilities. In a large fraction of the disqualified cases, the patients had been admitted to exclude the diagnosis of acute myocardial infarction; although explicitly "ruled out," an acute myocardial infarction code was assigned. Sixty-six cases from teaching hospitals did not qualify because the patient had been admitted only for coronary angiography after an uneventful postmyocardial infarction course. Almost one-third of these patients had had their infarcts from 5 to 8 weeks before the angiography admission. Conclusions: Cases with an inappropriate discharge diagnosis of acute myocardial infarction may be concentrated in teaching hospitals. This finding could have implications for Medicare''s diagnosis-related group payment system and governmental and other research efforts that use these data for such purposes as drawing inferences about the quality of hospital care.