title: Challenges and remediation for Patient Safety Indicators in the transition to ICD-10-CM.
abstract: Reporting of hospital adverse events relies on Patient Safety Indicators (PSIs) using International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes. The US transition to ICD-10-CM in 2015 could result in erroneous comparisons of PSIs. Using the General Equivalent Mappings (GEMs), we compared the accuracy of ICD-9-CM coded PSIs against recommended ICD-10-CM codes from the Centers for Medicaid/Medicare Services (CMS). We further predict their impact in a cohort of 38,644 patients (1,446,581 visits and 399 hospitals). We compared the predicted results to the published PSI related ICD-10-CM diagnosis codes. We provide the first report of substantial hospital safety reporting errors with five direct comparisons from the 23 types of PSIs (transfusion and anesthesia related PSIs). One PSI was excluded from the comparison between code sets due to reorganization, while 15 additional PSIs were inaccurate to a lesser degree due to the complexity of the coding translation. The ICD-10-CM translations proposed by CMS pose impending risks for (1) comparing safety incidents, (2) inflating the number of PSIs, and (3) increasing the variability of calculations attributable to the abundance of coding system translations. Ethical organizations addressing 'data-, process-, and system-focused' improvements could be penalized using the new ICD-10-CM Agency for Healthcare Research and Quality PSIs because of apparent increases in PSIs bearing the same PSI identifier and label, yet calculated differently. Here we investigate which PSIs would reliably transition between ICD-9-CM and ICD-10-CM, and those at risk of under-reporting and over-reporting adverse events while the frequency of these adverse events remain unchanged.
authors.affiliation: Institute for Interventional Health Informatics, University of Illinois at Chicago, Chicago, Illinois, USA University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA Departments of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, Illinois, USA Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Boyd
authors.affiliation: Departments of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, Illinois, USA Department of Chemistry, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Young Min
authors.initials: YM
authors.lastname: Yang
authors.affiliation: Department of Medicine, University of Arizona, Tucson, Arizona, USA Biomedical Informatics Service Group, Arizona Health Science Center, University of Arizona, Tucson, Arizona, USA.
authors.forename: Jianrong
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Medicine, University of Arizona, Tucson, Arizona, USA Biomedical Informatics Service Group, Arizona Health Science Center, University of Arizona, Tucson, Arizona, USA.
authors.forename: Colleen
authors.initials: C
authors.lastname: Kenost
authors.affiliation: Institute for Interventional Health Informatics, University of Illinois at Chicago, Chicago, Illinois, USA University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Mike D
authors.initials: MD
authors.lastname: Burton
authors.affiliation: University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Becker
authors.affiliation: Institute for Interventional Health Informatics, University of Illinois at Chicago, Chicago, Illinois, USA University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Yves A
authors.initials: YA
authors.lastname: Lussier
mesh_terms: D006801:Humans; D038801:International Classification of Diseases; D008490:Medical Informatics; D061214:Patient Safety; D019984:Quality Indicators, Health Care
keywords: ICD-10-cm; adverse events; clinical informatics; hospitals; network topology; patient safety indicators