Abstract
BackgroundWith few exceptions the International Statistical Classification of Diseases (ICD) codes for diagnoses and official coding guidelines do not distinguish pre-existing conditions from complications or comorbidities which occur during hospitalization. However, information on diagnosis timing is relevant with regard to the case’s severity, resource consumption and quality of care. In this study we analyzed the diagnostic value and reliability of the present-on-admission (POA) indicator using routinely collected health data.MethodsWe included all inpatient cases of the department of medicine during 2016 with a diagnosis of deep vein thrombosis, decubitus ulcer or delirium. Swiss coding guidelines of 2016 and the definitions of the Swiss medical statistics of hospitals were analyzed to evaluate the potential to encode information on diagnosis timing. The diagnoses were revised by applying the information present-on-admission by a coding specialist and by a medical expert, serving as Gold Standard. The diagnostic value and reliability were evaluated.ResultsThe inter-rater reliability for POA of all diagnoses was 0.7133 (Cohen’s kappa), but differed between diagnosis groups (0.558–0.7164). The rate of POA positive of the total applied by the coding specialist versus the expert was similar, but differed between diagnoses. In group “thrombosis” SEN was 0.95, SPE 0.75, PPV 0.97 and NPV 0.60, in group “decubitus ulcer” SEN 0.89, SPE 0.82, PPV 0.89 and NPV 0.82, in group “delirium” SEN 0.91, SPE 0.65, PPV 0.71 and NPV 0.88 For all diagnoses SEN 0.92, SPE 0.73, PPV 0.87, NPV 0.82, summing up the cases of all diagnosis groups.ConclusionsCoding the POA indicator identified diagnoses which were pre-existent with insufficient reliability on individual patient’s level. The overall fair to sufficient diagnostic quality is appropriate for screening and benchmarking performance on population level. As the medical statistics of hospitals carries no variable on pre-existing conditions, the novel approach to apply the POA indicator to diagnoses gives more information on quality of hospital care and complexity of cases. By preparing documentation for POA reporting diagnostic quality must be increased before implementation for risk-assessment or reimbursement on the individual patient’s level.
Highlights
With few exceptions the International Statistical Classification of Diseases (ICD) codes for diagnoses and official coding guidelines do not distinguish pre-existing conditions from complications or comorbidities which occur during hospitalization
The Swiss medical statistics of hospitals contains ICD-10 German Modification 2014 (ICD-10 GM 2014) diagnoses including flags for laterality and secondary codes for causation it gives no information on diagnosis timing [1, 2]
The aim of the study was first to show that by attributing the indicator POA more information on the assessment of diagnosis timing can be obtained from administrative data compared to the limited requirements of the Swiss medical statistics of hospitals of 2016, second to analyze the diagnostic value and reliability of the indicator when encoded by coding specialists compared to the judgement of a medical expert and third to demonstrate the reliability and validity of POA when applied to different diagnosis groups
Summary
With few exceptions the International Statistical Classification of Diseases (ICD) codes for diagnoses and official coding guidelines do not distinguish pre-existing conditions from complications or comorbidities which occur during hospitalization. The encoded data of inpatient stays in Switzerland are submitted to the Federal Office of Statistics (BFS) on an annual basis for publication of epidemiological and economic health care statistics. They allow the classification of cases for reimbursement of acute inpatient care into Swiss Diagnosis Related Groups (Swiss DRG). A variable for diagnosis timing has been introduced as “diagnosis onset type” in Australia, “present-on-admission” in the United States of America (US), “diagnosis type” Canada and recently as “present-on-admission” in Austria [6, 7] It is internationally recommended by the Word Health Organization (WHO) [3] and on national scale by Initiative Qualitätsmedizin (IQM) [8]
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