학술논문
Performance of ICD-10-AM codes for quality improvement monitoring of hospital-acquired pneumonia in a haematology-oncology casemix in Victoria, Australia.
Document Type
Article
Source
Subject
*RISK factors of pneumonia
*PREDICTIVE tests
*MEDICAL care use
*RISK assessment
*DIAGNOSIS related groups
*CLINICAL medicine
*CROSS infection
*RESEARCH funding
*HEALTH policy
*SCIENTIFIC observation
*KEY performance indicators (Management)
*CANCER patients
*RETROSPECTIVE studies
*HOSPITALS
*CHI-squared test
*LONGITUDINAL method
*MEDICAL coding
*ELECTRONIC health records
*QUALITY assurance
*MANAGEMENT of medical records
*CONFIDENCE intervals
*NOSOLOGY
*MEDICAL care costs
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Language
ISSN
1833-3583
Abstract
Background: The Australian hospital-acquired complication (HAC) policy was introduced to facilitate negative funding adjustments in Australian hospitals using ICD-10-AM codes. Objective: The aim of this study was to determine the positive predictive value (PPV) of the ICD-10-AM codes in the HAC framework to detect hospital-acquired pneumonia in patients with cancer and to describe any change in PPV before and after implementation of an electronic medical record (EMR) at our centre. Method: A retrospective case review of all coded pneumonia episodes at the Peter MacCallum Cancer Centre in Melbourne, Australia spanning two time periods (01 July 2015 to 30 June 2017 [pre-EMR period] and 01 September 2020 to 28 February 2021 [EMR period]) was performed to determine the proportion of events satisfying standardised surveillance definitions. Results: HAC-coded pneumonia occurred in 3.66% (n = 151) of 41,260 separations during the study period. Of the 151 coded pneumonia separations, 27 satisfied consensus surveillance criteria, corresponding to an overall PPV of 0.18 (95% CI: 0.12, 0.25). The PPV was approximately three times higher following EMR implementation (0.34 [95% CI: 0.19, 0.53] versus 0.13 [95% CI: 0.08, 0.21]; p =.013). Conclusion: The current HAC definition is a poor-to-moderate classifier for hospital-acquired pneumonia in patients with cancer and, therefore, may not accurately reflect hospital-level quality improvement. Implementation of an EMR did enhance case detection, and future refinements to administratively coded data in support of robust monitoring frameworks should focus on EMR systems. Implications: Although ICD-10-AM data are readily available in Australian healthcare settings, these data are not sufficient for monitoring and reporting of hospital-acquired pneumonia in haematology-oncology patients. [ABSTRACT FROM AUTHOR]