Diagnosis-dependent misclassification of infections using administrative data variably affected incidence and mortality estimates in ICU patients

Gedeborg, Rolf; Furebring, Mia; Michaëlsson, Karl

doi:10.1016/j.jclinepi.2006.05.013

Cited by 68 publications

(78 citation statements)

References 30 publications

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“…In The Netherlands and Sweden, this methodology missed some pneumonias, particularly in patients with prolonged hospital admissions. 30,31 In the United States and particularly in our hospital, however, ICD-9 codes have demonstrated reasonable sensitivity for diagnosis of CAP. 32,33 The specifi city of our technique was augmented by manual review of chest radiology reports.…”

Section: Resultsmentioning

confidence: 87%

CURB-65 Pneumonia Severity Assessment Adapted for Electronic Decision Support

Jones

Bewick

et al. 2011

Chest

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Section: Resultsmentioning

confidence: 87%

CURB-65 Pneumonia Severity Assessment Adapted for Electronic Decision Support

Jones

Bewick

et al. 2011

Chest

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“…The data are subject to coding errors and omissions of important diagnoses and complications, conditions that could have affected our results. 32 However, the coding errors might occur across all patient groups, a possibility that offsets the possible impact of the errors. Although detailed chart reviews could provide more reliable data, chart reviews are time-consuming and labor intensive.…”

Section: Wwwajcconlineorgmentioning

confidence: 99%

Respiratory Dysfunction in Patients With Sepsis: Protective Effect of Diabetes Mellitus

Yang

Salam

Ong

et al. 2011

American Journal of Critical Care

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Background Sepsis is a common complication in patients with diabetes mellitus. In a Western population, risk of respiratory dysfunction was lower in diabetic patients with sepsis. Objective To compare organ dysfunction, particularly respiratory dysfunction, between sepsis patients with and without diabetes mellitus in an Asian population. Method Hospital discharge data were collected for the period 2004 through 2008. Patients with sepsis, diabetes mellitus, and organ dysfunction were identified by using the International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Australian Modification codes. Results Of the 383 238 patients hospitalized during the 5 years, 2943 of the 9221 who had sepsis also had diabetes (31.9%).The most common organ dysfunctions in patients with sepsis were renal (31.5%), cardiovascular (19.2%), and respiratory (10.9%). Among patients with sepsis, respiratory dysfunction was less likely in patients with diabetes (9.4%) than in those without (11.6%; P = .002), but renal dysfunction was more likely in patients with diabetes (46.5%) than in those without (24.4%; P < .001). However, only 27.6% of patients with diabetes had a respiratory source of sepsis compared with 33.4% in patients without diabetes (P < .001). Among patients with sepsis, diabetes mellitus was a significant and independent predictor of respiratory dysfunction (odds ratio, 0.80; 95% confidence interval, 0.66–0.98) after adjustments for age, sex, ethnicity, admission to intensive care, number of comorbid conditions, and other infection sources. Conclusion Among an Asian population, respiratory dysfunction in patients with sepsis is less likely to develop in those with diabetes than in those without diabetes.

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“…The hospital discharge data was also at risk of coding errors and omissions of important diagnoses and complications, which may affect the disease complexity estimates. 37 In our study this was partly mitigated by the quality control processes instituted by the hospital and government agencies that use this data for planning and health care financing purposes. As all the data came from a single hospital, there was less risk of coding discrepancies and nonuniformity in calculating hospitalization costs.…”

Section: Discussionmentioning

confidence: 96%

Bringing generalists into the hospital: Outcomes of a family medicine hospitalist model in Singapore

Lee

Yang

et al. 2011

Journal of Hospital Medicine

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The authors declare that no financial or other relationships exist that might lead to a conflict of interest.Disclosure: Nothing to report. PURPOSE:The aim of this study was to assess a newly introduced hospitalist care model in a Singapore hospital. Clinical outcomes of the family medicine hospitalists program were compared with the traditional specialists-based model using the hospital's administrative database. METHODS:Retrospective cohort study of hospital discharge database for patients cared for by family medicine hospitalists and specialists in 2008. Multivariate analysis models were used to compare the clinical outcomes and resource utilization between patients cared for by family medicine hospitalists and specialist with adjustment for demographics, and comorbidities. RESULTS:Of 3493 hospitalized patients in 2008 who met the criteria of the study, 601 patients were under the care of family medicine hospitalists. As compared with patients cared for by specialists, patients cared for by family medicine hospitalists had a shorter hospital length of stay (adjusted LOS, geometric mean, GM, 4.4 vs. 5.3 days; P < 0.001) and lower hospitalization costs (adjusted cost, GM, $2250.7 vs. $2500.0; P¼ 0.003), but a similar in-patient mortality rate (4.2% vs. 5.3%, P¼ 0.307) and 30-day all-cause unscheduled readmission rate (7.5% vs. 8.4%, P¼ 0.231) after adjustment for age, ethnicity, gender, intensive care unit (ICU) admission, numbers of organ failures, and comorbidities. CONCLUSION:The family medicine hospitalist model was associated with reductions in hospital LOS and cost of care without adversely affecting mortality or 30-day all-cause readmission rate. These findings suggest that the hospitalist care model can be adapted for health systems outside North America and may produce similar beneficial effects in care efficiency and cost savings.

show abstract

Diagnosis-dependent misclassification of infections using administrative data variably affected incidence and mortality estimates in ICU patients

Cited by 68 publications

References 30 publications

CURB-65 Pneumonia Severity Assessment Adapted for Electronic Decision Support

CURB-65 Pneumonia Severity Assessment Adapted for Electronic Decision Support

Respiratory Dysfunction in Patients With Sepsis: Protective Effect of Diabetes Mellitus

Bringing generalists into the hospital: Outcomes of a family medicine hospitalist model in Singapore

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