title: Palliative care coding practices in Canada since the introduction of guidelines and the HSMR indicator.
abstract: OBJECTIVE
  This study examines palliative care (PC) coding practices since the introduction of a national coding standard and assesses a potential association with hospital standardised mortality ratio (HSMR) results.
  
  
  METHODS
  Acute-care hospitals in Canada.
  
  
  METHODS
  ∼16 million hospital discharges recorded in Canadian Institute for Health Information (CIHI)'s Discharge Abstract Database from April 2006 to March 2013.
  
  
  METHODS
  In-hospital mortality, patient characteristics and service utilisation among all hospitalisations, HSMR cases and palliative patients.
  
  
  METHODS
  We assessed all separations in the Discharge Abstract Database between fiscal years 2006-2007 and 2012-2013 for PC cases at national, provincial and facility levels. In-hospital mortality was measured among all hospitalisations (including HSMR cases) and palliative patients. We calculated a variant HSMR-PC that included PC cases.
  
  
  RESULTS
  There was an increase in the frequency of PC coding over the study period (from 0.78% to 1.12% of all separations), and year-over-year improvement in adherence to PC coding guidelines. Characteristics and resource utilisation of PC patients remained stable within provinces. Crude mortality among HSMR cases declined from 8.7% to 7.3%. National HSMR declined by 22% during the study period, compared with a 17% decline in HSMR-PC. Provincial results for HSMR-PC are not significantly different from regular HSMR calculation.
  
  
  CONCLUSIONS
  The introduction of a national coding standard resulted in increased identification of palliative patients and services. Aside from PC coding practices, we note numerous independent drivers of improving HSMR results, notably, a significant reduction of in-hospital mortality, and increase in admissions accompanied by a greater number of coded comorbidities. While PC impacts the HSMR indicator, its influence remains modest.
authors.affiliation: Canadian Institute for Health Information, Toronto, Ontario, Canada.
authors.forename: Omid
authors.initials: O
authors.lastname: Fekri
authors.affiliation: Canadian Institute for Health Information, Toronto, Ontario, Canada.
authors.forename: Joseph Emmanuel
authors.initials: JE
authors.lastname: Amuah
authors.affiliation: Canadian Institute for Health Information, Toronto, Ontario, Canada.
authors.forename: Viachaslau
authors.initials: V
authors.lastname: Herasimovich
authors.affiliation: Canadian Institute for Health Information, Toronto, Ontario, Canada.
authors.forename: Zeerak
authors.initials: Z
authors.lastname: Chaudhary
authors.affiliation: Canadian Institute for Health Information, Toronto, Ontario, Canada.
authors.forename: Kira
authors.initials: K
authors.lastname: Leeb
authors.affiliation: Canadian Institute for Health Information, Toronto, Ontario, Canada.
authors.forename: Yana
authors.initials: Y
authors.lastname: Gurevich
mesh_terms: D002170:Canada; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D010166:Palliative Care / Q000592:standards* / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care / Q000592:standards*
keywords: Clinical coding; HSMR; Health services research; Hospital mortality; PALLIATIVE CARE