Mortality rates as a measure of quality and safety, "caveat emptor".
The objective of this study was to demonstrate the impact of a single ICD-9 (International Statistical Classification of Diseases and Related Health Problems, Version 9) code on the observed-to-expected mortality ratios for acute care hospitals, calculated using administrative data. The study was a retrospective analysis of mortality data and prospective measurement of the impact of a change in coding on expected mortality rates. Measurement included overall mortality observed-to-expected mortality index for 2 hospitals and rate of use of the palliative care ICD-9 code. The main result was that both retrospective and prospective applications of this single ICD-9 code significantly reduced observed-to-expected mortality ratios. Both regulators and hospitals need to be aware of the impact of the quality of coding on publicly reported quality and patient safety data.
Klugman
Robert
R
University of Massachusetts Medical School, Worcester, MA, USA. robert.klugman@umassmemorial.org
Allen
Lisa
L
Benjamin
Evan M
EM
Fitzgerald
Janice
J
Ettinger
Walter
W
D016208:Databases, Factual / Q000706:statistics & numerical data*; D005568:Forms and Records Control / Q000706:statistics & numerical data*; D006748:Hospital Departments / Q000458:organization & administration; D017052:Hospital Mortality; D006801:Humans; D038801:International Classification of Diseases; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010166:Palliative Care / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000706:statistics & numerical data; D017751:Safety Management / Q000706:statistics & numerical data; D015996:Survival Rate; D014481:United States