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Published on: January 8, 2020
[Variations in patient data coding affect hospital standardized mortality ratio (HSMR)].
Wim F van den Bosch1, Joseph Silberbusch, Klaas J Roozendaal
1St. Antonius Ziekenhuis, Bestuursstaf, Nieuwegein, The Netherlands. w.bosch@antoniusziekenhuis.nl
Coding variations in hospital standardized mortality ratio (HSMR) calculations significantly impact results. Differences in coding main diagnoses, admission urgency, and comorbidities between hospitals were identified, affecting HSMR outcomes.
Area of Science:
- Healthcare Informatics
- Health Services Research
- Medical Record Analysis
Context:
- Hospital standardized mortality ratio (HSMR) is a key performance indicator.
- Accurate coding is crucial for reliable HSMR calculations.
- Inter-hospital variations in coding practices can distort performance metrics.
Purpose:
- To investigate coding variations impacting HSMR.
- To quantify variability in coding main diagnoses, admission urgency, and comorbidities.
- To identify measures for reducing coding variation.
Summary:
- Retrospective analysis of 6 Dutch hospitals (2003-2007) examined coding variations in HSMR parameters.
- Significant inter-hospital variability was found in excluded admissions, emergency admission coding (34-93%), and comorbidity counts (0.9-3.0 per admission).
- Coding variations stem from differing interpretations of rules, capacity, record quality, and documentation timeliness.
Impact:
- Coding variations in diagnoses, urgency, and comorbidities significantly impact hospital HSMR outcomes.
- Identified variations highlight the need for standardized coding practices.
- Addressing coding inconsistencies is essential for accurate hospital performance evaluation.
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