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Effect of Present-on-Admission (POA) Reporting Accuracy on Hospital Performance Assessments Using Risk-Adjusted
L Elizabeth Goldman1, Philip W Chu2, Peter Bacchetti3
1Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA.
Health Services Research
|October 7, 2014
Summary
Present-on-admission (POA) reporting significantly impacts hospital acute myocardial infarction (AMI) mortality rankings. These changes are substantial and not primarily due to reporting inaccuracies, affecting 25% of hospitals evaluated.
Area of Science:
- Health Services Research
- Healthcare Quality Improvement
- Cardiovascular Outcomes Research
Background:
- Accurate hospital performance assessment is crucial for quality improvement.
- Present-on-admission (POA) indicators are used to adjust for patient severity.
- The impact of POA reporting accuracy on mortality assessments needs further evaluation.
Purpose of the Study:
- To evaluate how the accuracy of present-on-admission (POA) reporting affects hospital 30-day acute myocardial infarction (AMI) mortality assessments.
- To determine the influence of POA indicators on hospital performance rankings.
Main Methods:
- Utilized California patient discharge data (PDD) and vital statistics death files (n=2005).
- Compared hospital performance rankings using an established AMI model with a model incorporating POA indicators.
- Conducted simulation analysis factoring POA indicator accuracy into hospital performance assessment.
Main Results:
- Hospital performance rankings differed by ≥10 percent for 67 of 268 hospitals (25%) when comparing the established model with the POA indicator model.
- POA reporting inaccuracy (overreporting/underreporting) had minimal additional impact on rank differences.
- POA overreporting contributed to 4% of rank differences; underreporting contributed to <1%.
Conclusions:
- Incorporating POA indicators into risk-adjusted models significantly impacts hospital AMI mortality rankings.
- The substantial impact on rankings is not primarily attributable to inaccuracies in POA hospital reporting.
- POA indicators are essential for accurate risk adjustment in AMI mortality assessments.
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