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The impact of changes in coding on mortality reports using the example of sepsis
Catherine Atkin1, Tanya Pankhurst2, David McNulty3
1PIONEER, HDR-UK Health Data Research Hub in Acute Care, Institute of Inflammation and Ageing, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Edgbaston, Birmingham, B15 2GW, UK. c.atkin@nhs.net.
BMC Medical Informatics and Decision Making
|August 1, 2022
Summary
New NHS Digital sepsis coding guidance in 2017 and 2018 impacted reported mortality. Changes in coding practice, not clinical improvements, influenced sepsis outcomes and mortality rates across England.
Area of Science:
- Healthcare policy and clinical coding practices.
- Epidemiology of sepsis and hospital-acquired infections.
- Health services research and outcomes analysis.
Background:
- NHS Digital introduced new sepsis coding guidance in April 2017, with modifications in April 2018.
- Observed variations in sepsis-associated mortality rates across different healthcare centers during this period.
- Hypothesis that coding practice changes, rather than clinical improvements, influenced reported mortality figures.
Purpose of the Study:
- To investigate the impact of changes in sepsis coding practices on reported mortality rates.
- To determine if observed changes in sepsis outcomes were attributable to coding modifications or clinical quality improvements.
- To analyze the relationship between coding changes, patient case-mix, and mortality trends in English hospitals.
Main Methods:
- Analysis of Hospital Episode Statistics (Admitted Patient Care dataset) for NHS hospitals in England (April 2016 - March 2020).
- Inclusion of adult hospital admissions with sepsis coded using International Classification of Diseases 10 (ICD-10) codes.
- Assessment of patient comorbidities using ICD-10 codes and statistical analysis of case-mix, hospital, and year as random effects.
Main Results:
- Over 1 million hospital episodes with coded sepsis diagnoses were analyzed.
- A significant increase in sepsis admissions coded as the primary diagnosis was observed after April 2017.
- A small reduction in overall sepsis-associated mortality was noted across England post-coding guidance change, with no center-specific clinical improvements identified.
Conclusions:
- Altered sepsis coding practices significantly affected patient case-mix and selection, with variations between centers.
- Observed changes in center-specific sepsis mortality were linked to coding practice shifts, not necessarily clinical interventions.
- Caution is advised when interpreting sepsis outcomes in England, especially from single-center studies, due to system-wide coding effects.
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