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Related Experiment Video

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Using clinical data to predict high-cost performance coding issues associated with pressure ulcers: a multilevel

William V Padula1, Robert D Gibbons2,3, Peter J Pronovost4,5

  • 1Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Journal of the American Medical Informatics Association : JAMIA
|August 20, 2016
PubMed
Summary

Hospital-acquired pressure ulcers (HAPUs) are a significant concern. Inaccurate coding, particularly for spinal cord injuries, leads to penalties and affects patient care quality.

Keywords:
Braden ScaleMedicareelectronic health recordmixed-effects regression modelpredictive modelingpressure ulcerspinal cord injury

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Area of Science:

  • Healthcare Informatics
  • Patient Safety
  • Medical Coding Accuracy

Background:

  • Hospital-acquired pressure ulcers (HAPUs) are associated with high mortality rates (11.6%), significant treatment costs, and Medicare reimbursement penalties.
  • Accurate coding of HAPUs, as defined by Agency for Healthcare Research and Quality Patient-Safety Indicator 3 (PSI-03), is crucial for hospital performance metrics.

Purpose of the Study:

  • To leverage electronic health records (EHRs) for predicting pressure ulcer development in hospitalized patients.
  • To identify specific coding inaccuracies that contribute to inappropriate PSI-03 flags and potential Medicare penalties.

Main Methods:

  • Analysis of EHR data from an academic medical center (2011-2014), including demographics, diagnoses, medications, and provider orders.
  • Utilized random forests for data dimensionality reduction and multilevel logistic regression to assess HAPU incidence predictors.
  • Defined HAPUs based on PSI-03 criteria, excluding cases present on admission or related to paralysis.

Main Results:

  • Identified spinal cord injury (ICD-9 907.2) as a major risk factor for HAPUs (OR = 14.3), with 71% of these cases inappropriately coded without paralysis, triggering PSI-03 flags.
  • Other significant risk factors included bed confinement (ICD-9 V49.84, OR = 3.1) and provider-ordered pre-albumin lab tests (OR = 2.5).
  • The study analyzed 21,153 patients, identifying 1549 PSI-03 cases.

Conclusions:

  • Spinal cord injuries represent a high-risk group for HAPUs and are frequently miscoded, leading to erroneous PSI-03 designations.
  • The developed statistical model shows potential for predicting HAPUs during hospitalization.
  • Inaccurate medical coding practices negatively impact hospital performance evaluations and financial reimbursements.