Using Administrative Diagnostic Data to Assess the Quality of Hospital Care: Pitfalls and Potential of ICD-9-CM

Author(s):  
Lisa I. Iezzoni

AbstractDiagnostic information within administrative data bases is generally in the form of lnternational Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. The purpose of this article is to introduce ICD-9-CM, to review its strengths and limitations, and to suggest ways that it can be used through administrative files for assessing the quality of hospital care.

2020 ◽  
Vol 48 (3) ◽  
pp. 203-212 ◽  
Author(s):  
Jennifer R Reilly ◽  
Mark A Shulman ◽  
Annie M Gilbert ◽  
Bismi Jomon ◽  
Robin J Thompson ◽  
...  

Accurately measuring the incidence of major postoperative complications is essential for funding and reimbursement of healthcare providers, for internal and external benchmarking of hospital performance and for valid and reliable public reporting of outcomes. Actual or surrogate outcomes data are typically obtained by one of three methods: clinical quality registries, clinical audit, or administrative data. In 2017 a perioperative registry was developed at the Alfred Hospital and mapped to administrative and clinical data. This study investigated the statistical agreement between administrative data (International Statistical Classification of Diseases and Related Health Problems (10th edition) Australian Modification codes) and clinical audit by anaesthetists in identifying major postoperative complications. The study population included 482 high-risk surgical patients referred to the Alfred Hospital anaesthesia postoperative service over two years. Clinical audit was conducted to determine the presence of major complications and these data were compared to administrative data. The main outcome was statistical agreement between the two methods, as defined by Cohen’s kappa statistic. Substantial agreement was observed for five major complications, moderate agreement for three, fair agreement for six and poor agreement for two. Sensitivity and positive predictive value ranged from 0 to 100%. Specificity was above 90% for all complications. There was important variation in inter-rater agreement. For four of the five complications with substantial agreement between administrative data and clinical audit, sensitivity was only moderate (61.5%–75%). Using International Statistical Classification of Diseases and Related Health Problems (10th edition) Australian Modification codes to identify postoperative complications at our hospital has high specificity but is likely to underestimate the incidence compared to clinical audit. Further, retrospective clinical audit itself is not a highly reliable method of identifying complications. We believe a perioperative clinical quality registry is necessary to validly and reliably measure major postoperative complications in Australia for benchmarking of hospital performance and before public reporting of outcomes should be considered.


2007 ◽  
Vol 5 (10) ◽  
pp. 1081-1091 ◽  
Author(s):  
William Breitbart ◽  
Yesne Alici-Evcimen

Fatigue is a common and highly distressing symptom of cancer associated with reduced quality of life and considerable psychological and functional morbidity. The reported prevalence of cancer-related fatigue ranges from 4% to 91%, depending on the specific cancer population studied and the methods of assessment. Cancer-related fatigue has typically been underreported, underdiagnosed, and undertreated. Fatigue and depression may coexist in cancer patients, and considerable overlap of symptoms occurs. This is partly the reason for the interest in examining the role of psychotropic medications in treating fatigue. Clarifying the relationship between depression and fatigue is necessary to effectively evaluate and treat cancer-related fatigue. Even with International Classification of Diseases criteria, differentiating cancer-related fatigue is difficult. Psychotropic drugs that have been studied for cancer-related fatigue include psychostimulants, wakefulness-promoting agents, and anti-depressants. Methylphenidate has been studied most and seems to be effective and well tolerated despite common side effects. Some preliminary data support using modafinil in cancer-related fatigue with less concern about tolerance or dependence. Antidepressant studies have shown mixed results. Paroxetine seems to show benefit for fatigue primarily when it is a symptom of clinical depression. Bupropion, a norepinephrine/dopamine reuptake inhibitor, may have psychostimulant-like effects, and therefore may be more beneficial for treating fatigue. However, studies are currently limited. Randomized, placebo-controlled trials with specific agents are needed to further assess the efficacy and tolerability of psychotropic medications in the treatment of cancer-related fatigue.


1992 ◽  
Vol 18 (11) ◽  
pp. 361-371 ◽  
Author(s):  
Lisa I. Iezzoni ◽  
Susan M. Foley ◽  
Timothy Heeren ◽  
Jennifer Daley ◽  
Charles C. Duncan ◽  
...  

Author(s):  
А.А. Пальцын

Саркопения (старческое уменьшение силы и массы мышц) прогрессировала в распространенности и тяжести проявления вместе с прогрессом медицины и развитием цивилизации. На заре человечества проблемы не было, поскольку до саркопении не доживали. Затем в течение многих тысяч лет с малым количеством стариков в популяции и отвлечением внимания инфекционными эпидемиями медицине было «не до неё». Следствия быстрого старения человечества в конце XX и начале XXI веков вывели саркопению из тени в разряд самых актуальных проблем современной медицины. Саркопения приобрела своё название около 30 лет назад, год назад вошла в международную классификацию болезней, а сегодня уже называется гериатрическим гигантом. Взлет популярности закономерен и достоин ещё большего внимания по двум причинам. Во-первых. Саркопенией обусловлены многие беды старости: физическая слабость, депрессия, боли, снижение качества жизни, оптимизма, трудоспособности, рост травматизма, инвалидность, утрата независимости, смертность. Во-вторых. Саркопения затрудняет и снижает двигательную активность, чем способствует развитию наиболее распространенных болезней, эпидемий неинфекционной природы: гипертонической болезни, атеросклероза, диабета, рака, деменции, воспалений, остеопороза. Профилактика и лечение саркопении отодвигает или предотвращает приход её «спутников». Sarcopenia is a senile reduction in muscular force and mass. Sarсopenia prevalence and severity of manifestations have progressed together with the progress of medicine and development of the civilization. In the infancy of mankind, the problem was absent since people did not live to sarcopenia. Then for many thousand years, when old people were not numerous in the population, medicine was distracted by infectious epidemics and not interested in sarcopenia. Consequences of rapid aging of the population during the late 20th and early 21st centuries have brought sarcopenia from the shadows to the foreground as one of the most urgent problems of modern medicine. Sarcopenia acquired its name about 30 years ago, was included into the international classification of diseases a year ago, and today it is already called the geriatric giant. This increase in popularity is logical, and sarcopenia is worth even more extensive exploring for two reasons. First, sarcopenia causes many troubles of old age, such as physical weakness, depression, pains; impaired quality of life, optimism, and working capacity; more frequent traumas and disability; loss of independence; and high mortality. Second, sarcopenia complicates and reduces physical activity and, thereby, contributes to development of common diseases and non-infectious epidemics, including hypertension, atherosclerosis, diabetes, cancer, dementia, inflammations, osteoporosis. Prevention and treatment of sarcopenia delays or prevents the arrival of its «satellites».


2017 ◽  
Vol 24 (2) ◽  
pp. 157-160 ◽  
Author(s):  
Ben Beck ◽  
Christina L Ekegren ◽  
Peter Cameron ◽  
Mark Stevenson ◽  
Rodney Judson ◽  
...  

Accurate coding of injury event information is critical in developing targeted injury prevention strategies. However, little is known about the validity of the most universally used coding system, the International Classification of Diseases (ICD-10), in characterising crash counterparts in pedal cycling events. This study aimed to determine the agreement between hospital-coded ICD-10-AM (Australian modification) external cause codes with self-reported crash characteristics in a sample of pedal cyclists admitted to hospital following bicycle crashes. Interview responses from 141 injured cyclists were mapped to a single ICD-10-AM external cause code for comparison with ICD-10-AM external cause codes from hospital administrative data. The percentage of agreement was 77.3% with a κ value of 0.68 (95% CI 0.61 to 0.77), indicating substantial agreement. Nevertheless, studies reliant on ICD-10 codes from administrative data should consider the 23% level of disagreement when characterising crash counterparts in cycling crashes.


2020 ◽  
Vol 2 (2) ◽  
pp. 17-21
Author(s):  
MARCELO ANTUNES MARCIANO ◽  
Eliezer Knob Souza

– The medical equipments (EM) are increasingly decisive and essential in modern medicine and medical and hospital care. For the EM contribute effectively and to the health organizations to use them more productively, it is necessary to carry out the management of the life cycle of the same. A decisive factor in this cycle of life is to know when a piece of equipment must be replaced. It is observed the absence of defined and clear methods to assist in the clinical engineering and hospital management, in deciding and prioritizing which EM need to be replaced. This work demonstrates a practical application in an equipment park. As a result, the classification of EM as the prioritization of substitution was obtained with respect to diversity, quantity and cost of the equipment shown to be replaced. The application of this method may contribute to increased quality of installed equipment and budget planning of hospital investments.


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