"Variation in Diagnostic Coding of Patients With Pneumonia and Its Asso" by Penny Pekow, Aruna Priya et al.
 

Variation in Diagnostic Coding of Patients With Pneumonia and Its Association With Hospital Risk-Standardized Mortality Rates: A Cross-sectional Analysis

Author Department

Medicine

Document Type

Article, Peer-reviewed

Publication Date

3-2014

Abstract

BACKGROUND:

Most U.S. hospitals publicly report 30-day risk-standardized mortality rates for pneumonia. Rates exclude severe cases, which may be assigned a secondary diagnosis of pneumonia and a principal diagnosis of sepsis or respiratory failure. By assigning sepsis and respiratory failure codes more liberally, hospitals might improve their reported performance.

OBJECTIVE:

To examine the effect of the definition of pneumonia on hospital mortality rates.

DESIGN:

Cross-sectional study.

SETTING:

329 U.S. hospitals.

PATIENTS:

Adults hospitalized for pneumonia (as a principal diagnosis or secondary diagnosis paired with a principal diagnosis of sepsis or respiratory failure) between 2007 and 2010.

MEASUREMENTS:

Proportion of patients with pneumonia coded with a principal diagnosis of sepsis or respiratory failure and risk-standardized mortality rates excluding versus including a principal diagnosis of sepsis or respiratory failure.

RESULTS:

When the definition of pneumonia was limited to patients with a principal diagnosis of pneumonia, the risk-standardized mortality rate was significantly better than the mean in 4.3% of hospitals and significantly worse in 6.4%. When the definition was broadened to include patients with a principal diagnosis of sepsis or respiratory failure, this rate was better than the mean in 11.9% of hospitals and worse in 22.8% and the outlier status of 28.3% of hospitals changed. Among hospitals in the highest quintile of proportion of patients coded with a principal diagnosis of sepsis or respiratory failure, outlier status under the broader definition improved in 7.6% and worsened in 40.9%. Among those in the lowest quintile, 20.0% improved and none worsened.

LIMITATION:

Only inpatient mortality was studied.

CONCLUSION:

Variation in use of the principal diagnosis of sepsis or respiratory failure may bias efforts to compare hospital performance regarding pneumonia outcomes.

PRIMARY FUNDING SOURCE:

Agency for Healthcare Research and Quality.

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