Improving the accuracy of HES comorbidity codes by better documentation in surgical admission proforma

Navid, Ahmad; Hajibandeh, Shahin; Mohan, Jayarama; Hajibandeh, Shahab

doi:10.12968/hmed.2015.76.12.707

Cited by 12 publications

(7 citation statements)

References 7 publications

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“…The accuracy of the clinical coding underlying the diagnostic and procedural coding can be a concern but accuracy rates are improving and the routinely collected data are robust for research 28 . Secondary diagnoses are likely under‐recorded but are accurate when included 29,30 . This study is unable to quantify the morbidity of untreated disease outside of hospital.…”

Section: Discussionmentioning

confidence: 98%

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The use of, and outcomes for, inflammatory bowel disease services during the Covid‐19 pandemic: a nationwide observational study

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Sahnan

Worley

et al. 2022

Aliment Pharmacol Ther

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Background Inflammatory bowel disease (IBD) services have been particularly affected by the Covid‐19 pandemic. Delays in referral to secondary care and access to investigations and surgery have been exacerbated. Aims To investigate the use of and outcomes for emergency IBD care during the Covid‐19 pandemic. Methods Nationwide observational study using administrative data for England (2015‐2020) comparing cohorts admitted from 1 January 2015, to 31 January 2020 (pre‐pandemic) and from 1 February 2020, to 31 January 2021 (pandemic). Autoregressive integrated moving average forecast models were run to estimate the counterfactual IBD admissions and procedures for February 2020 to January 2021. Results Large decreases in attendances to hospital for emergency treatment were observed for both acute ulcerative colitis (UC, 16.4%) and acute Crohn’s disease (CD, 8.7%). The prevalence of concomitant Covid‐19 during the same episode was low [391/16 494 (2.4%) and 349/15 613 (2.2%), respectively]. No significant difference in 30‐day mortality was observed. A shorter median length of stay by 1 day for acute IBD admissions was observed (P < 0.0001). A higher rate of emergency readmission within 28 days for acute UC was observed (14.1% vs 13.4%, P = 0.012). All IBD procedures and investigations showed decreases in volume from February 2020 to January 2021 compared with counterfactual estimates. The largest absolute deficit was in endoscopy (17 544 fewer procedures, 35.2% reduction). Conclusion There is likely a significant burden of untreated IBD in the community. Patients with IBD may experience clinical harm or protracted decreases in quality of life if care is not prioritised.

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Section: Discussionmentioning

confidence: 98%

“… 28 Secondary diagnoses are likely under‐recorded but are accurate when included. 29 , 30 This study is unable to quantify the morbidity of untreated disease outside of hospital. Some of the procedures that have not been performed due to the pandemic may no longer be indicated and the deficits are overestimated.…”

Section: Discussionmentioning

confidence: 99%

The use of, and outcomes for, inflammatory bowel disease services during the Covid‐19 pandemic: a nationwide observational study

Deputy

Sahnan

Worley

et al. 2022

Aliment Pharmacol Ther

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“…This Charlson Index was constructed based on diagnoses codes recorded at the indexed admission and during previous admissions that occurred within 1 year. Because the Charlson Index may be affected by changes in how health conditions are recorded in HES, 34 we entered interaction terms between the Charlson Index and financial year into our logistic regression model. Length of stay was entered into the risk-adjustment process, as every extra day spent in hospital was found to be associated with an increased risk of incurring an adverse health event, 35 possibly affecting the patients’ likelihood of recovery, but it might also indicate disease severity in the absence of any other adequate measures recorded within the HES database.…”

Section: Methodsmentioning

confidence: 99%

National trends in emergency readmission rates: a longitudinal analysis of administrative data for England between 2006 and 2016

et al. 2018

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ObjectiveTo assess trends in 30-day emergency readmission rates across England over one decade.DesignRetrospective study design.Setting150 non-specialist hospital trusts in England.Participants23 069 134 patients above 18 years of age who were readmitted following an initial admission (n=62 584 297) between April 2006 and February 2016.Primary and secondary outcomesWe examined emergency admissions that occurred within 30 days of discharge from hospital (‘emergency readmissions’) as a measure of healthcare quality. Presented are overall readmission rates, and disaggregated by the nature of the indexed admission, including whether it was elective or emergency, and by clinical health condition recorded. All rates were risk-adjusted for patient age, gender, ethnicity, socioeconomic status, comorbidities and length of stay.ResultsThe average risk-adjusted, 30-day readmission rate increased from 6.56% in 2006/2007 to 6.76% (P<0.01) in 2012/2013, followed by a small decrease to 6.64% (P<0.01) in 2015/2016. Emergency readmissions for patients discharged following elective procedures decreased by 0.13% (P<0.05), whereas those following emergency admission increased by 1.27% (P<0.001). Readmission rates for hip or knee replacements decreased (−1.29%; P<0.001); for acute myocardial infarction (−0.04%; P<0.49), stroke (+0.62%; P<0.05), chronic obstructive pulmonary disease (+0.41%; P<0.05) and heart failure (+0.15%; P<0.05) remained stable; and for pneumonia (+2.72%; P<0.001), diabetes (+7.09%; P<0.001), cholecystectomy (+1.86%; P<0.001) and hysterectomy (+2.54%; P<0.001) increased.ConclusionsOverall, emergency readmission rates in England remained relatively stable across the observation period, with trends of slight increases contained post 2012/2013. However, there were large variations in trends across clinical areas, with some experiencing marked increases in readmission rates. This highlights the need to better understand variations in outcomes across clinical subgroups to allow for targeted interventions that will ensure highest standards of care provided for all patients.

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“…Improving the protocol for documenting comorbidities with clinicians and providing further training to administrative clerks could enhance the assessment of comorbidities using HES. [41]…”

Section: Discussionmentioning

confidence: 99%

Reproducibility, reliability and validity of population-based administrative health data for the assessment of cancer non-related comorbidities

et al. 2017

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BackgroundPatients with comorbidities do not receive optimal treatment for their cancer, leading to lower cancer survival. Information on individual comorbidities is not straightforward to derive from population-based administrative health datasets. We described the development of a reproducible algorithm to extract the individual Charlson index comorbidities from such data. We illustrated the algorithm with 1,789 laryngeal cancer patients diagnosed in England in 2013. We aimed to clearly set out and advocate the time-related assumptions specified in the algorithm by providing empirical evidence for them.MethodsComorbidities were assessed from hospital records in the ten years preceding cancer diagnosis and internal reliability of the hospital records was checked. Data were right-truncated 6 or 12 months prior to cancer diagnosis to avoid inclusion of potentially cancer-related comorbidities. We tested for collider bias using Cox regression.ResultsOur administrative data showed weak to moderate internal reliability to identify comorbidities (ICC ranging between 0.1 and 0.6) but a notably high external validity (86.3%). We showed a reverse protective effect of non-cancer related Chronic Obstructive Pulmonary Disease (COPD) when the effect is split into cancer and non-cancer related COPD (Age-adjusted HR: 0.95, 95% CI:0.7–1.28 for non-cancer related comorbidities). Furthermore, we showed that a window of 6 years before diagnosis is an optimal period for the assessment of comorbidities.ConclusionTo formulate a robust approach for assessing common comorbidities, it is important that assumptions made are explicitly stated and empirically proven. We provide a transparent and consistent approach useful to researchers looking to assess comorbidities for cancer patients using administrative health data.

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Improving the accuracy of HES comorbidity codes by better documentation in surgical admission proforma

Cited by 12 publications

References 7 publications

The use of, and outcomes for, inflammatory bowel disease services during the Covid‐19 pandemic: a nationwide observational study

The use of, and outcomes for, inflammatory bowel disease services during the Covid‐19 pandemic: a nationwide observational study

National trends in emergency readmission rates: a longitudinal analysis of administrative data for England between 2006 and 2016

Reproducibility, reliability and validity of population-based administrative health data for the assessment of cancer non-related comorbidities

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