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Comorbilidades, complicaciones y sesgo de codificación. ¿Importa el número de códigos de diagnóstico para predecir la
L I Iezzoni1, S M Foley, J Daley
1Department of Medicine, Harvard Medical School, Beth Israel Hospital, Boston, MA 02215.
JAMA
|April 22, 1992
Resumen
El aumento de los códigos de diagnóstico puede no mejorar la evaluación del riesgo del paciente. Los estudios muestran que incluso con más códigos, condiciones como la diabetes se relacionaron con un menor riesgo de muerte, lo que sugiere un sesgo de codificación.
Área de la Ciencia:
- Informática de la salud Informática de la salud.
- Epidemiología Clínica Epidemiología clínica.
- La bioestadística es la bioestadística.
Sus antecedentes:
- Las bases de datos administrativas de salud a menudo limitan los diagnósticos secundarios, lo que puede sesgar las evaluaciones de riesgo del paciente.
- El programa Medicare está aumentando los códigos de diagnóstico para mejorar la integridad de la codificación y mejorar la evaluación de riesgos.
Objetivo del estudio:
- Investigar el impacto de la codificación de diagnóstico expandido en la precisión de las evaluaciones de riesgo del paciente, específicamente el riesgo de muerte.
- Evaluar si el aumento del número de códigos de diagnóstico disponibles mejora la evaluación del riesgo de mortalidad del paciente.
Principales métodos:
- Utilizado 1988 datos abstractos de alta del hospital de California que permiten hasta 25 diagnósticos.
- Se evaluó la relación entre 29 diagnósticos secundarios específicos y el riesgo de muerte hospitalaria en pacientes de edad avanzada (≥65 años).
- Incluidos los pacientes hospitalizados por accidente cerebrovascular, neumonía, infarto agudo del miocardio o insuficiencia cardíaca congestiva.
Principales resultados:
- Paradójicamente, varias afecciones crónicas o comórbidas (por ejemplo, diabetes, infarto de miocardio previo) se asociaron con un menor riesgo de muerte en el hospital.
- Los hallazgos sugieren que los diagnósticos esperados que aumentan el riesgo se codificaron con menos frecuencia en pacientes que murieron.
Conclusiones:
- El sesgo contra la codificación de enfermedades crónicas o comórbidas en los resúmenes de alta de pacientes fallecidos probablemente explica los resultados paradójicos observados.
- El simple aumento del número de códigos de diagnóstico disponibles puede no mejorar efectivamente la integridad de la codificación o la precisión de la evaluación del riesgo.
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