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Palliative care coding practices in Canada since the introduction of guidelines and the HSMR indicator

Omid Fekri1, Joseph Emmanuel Amuah1, Viachaslau Herasimovich1

  • 1Canadian Institute for Health Information, Toronto, Ontario, Canada.

BMJ Open
|November 25, 2015
PubMed

Insights

The national palliative care (PC) coding standard improved patient identification and services. While PC coding influences the hospital standardised mortality ratio (HSMR), its impact is modest, with other factors driving HSMR improvements.

Area of Science:

  • Health Services Research
  • Palliative Care
  • Health Informatics

Background:

  • The implementation of a national palliative care (PC) coding standard aimed to improve the identification of patients receiving PC services.
  • Understanding the impact of this standard on coding practices and its relationship with hospital performance indicators like the hospital standardised mortality ratio (HSMR) is crucial.

Purpose of the Study:

  • To examine palliative care (PC) coding practices following the introduction of a national coding standard.
  • To assess the association between PC coding practices and hospital standardised mortality ratio (HSMR) results.

Main Methods:

  • Analysis of approximately 16 million hospital discharges from the Canadian Institute for Health Information (CIHI) Discharge Abstract Database (2006-2013).
  • Assessment of PC coding frequency, adherence to guidelines, and in-hospital mortality rates.
  • Calculation of a variant HSMR-PC including PC cases to compare with the standard HSMR.

Main Results:

  • Palliative care (PC) coding frequency increased from 0.78% to 1.12% of separations, with improved adherence to guidelines.
  • National HSMR declined by 22% and HSMR-PC by 17%, with modest differences between the two measures.
  • Crude mortality among HSMR cases decreased, and overall in-hospital mortality saw significant reductions.

Conclusions:

  • The national coding standard successfully increased the identification of palliative care patients and services.
  • Improvements in HSMR are driven by multiple factors including reduced in-hospital mortality and increased coded comorbidities.
  • Palliative care coding has a modest influence on the HSMR indicator, with other drivers playing a more significant role.
Abstract

Keywords:
Clinical codingHSMRHealth services researchHospital mortalityPALLIATIVE CARE

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