The accuracy of Medicare's hospital claims data: progress has been made, but problems remain.

Fisher, Elliot S.; Whaley, Fredrick S.; Krushat, W M; Malenka, David J.; Fleming, Craig; Baron, John A.; Hsia, David C.

doi:10.2105/ajph.82.2.243

Cited by 654 publications

(350 citation statements)

References 31 publications

(4 reference statements)

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“…By using an administrative database, we find inherent and well known shortcomings [10,11]. The main shortcomings are related to the little and not very specific clinic information contained, especially as regards to the treatments given to the patient, patient´s precedents and risk factors.…”

Section: Discussionmentioning

confidence: 99%

Breast cancer mortality in Spain: Has it really declined for all age groups?

et al. 2012

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Introduction: Incidence in Spain due to breast cancer has increased over the last few years, nevertheless mortality has decreased, especially since 1992. Despite this general decrease in mortality, the intensity has been different in all age groups. The main objective of this paper is to fit the mortality due to breast cancer for different age groups in Spain during Results: We found an evident decreasing trend during the last few years of the fit (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008), furthermore we expect a decrease in the mortality due to breast cancer during the years of the forecast. Despite this decrease, the mortality rates have different intensities for each age group. Younger and central ages groups can notice an evident decreasing trend and extend it to forecast, on the other hand, for older age groups the trend in mortality seems to be stable.

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Section: Discussionmentioning

confidence: 99%

Breast cancer mortality in Spain: Has it really declined for all age groups?

et al. 2012

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“…Disease surveillance and quality‐of‐care studies frequently use information from administrative claims databases, such as Medicare, by identifying patients with specific conditions based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) codes. Studies comparing the accuracy of ICD‐9‐CM codes with medical record review find variations in agreement depending on code selection,2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 as well as patient characteristics, such as age, race/ethnicity,10, 11 sex,11 and length of hospitalization 3. Aside from teaching hospital status10 and hospital departments,16 potential variations in accuracy based on other hospital characteristics are largely unknown.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of ICD‐9‐CM Codes by Hospital Characteristics and Stroke Severity: Paul Coverdell National Acute Stroke Program

Chang

Lichtman

Goldstein

et al. 2016

JAHA

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BackgroundEpidemiological and health services research often use International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) codes to identify patients with clinical conditions in administrative databases. We determined whether there are systematic variations between stroke patient clinical diagnoses and ICD‐9‐CM codes, stratified by hospital characteristics and stroke severity.Methods and ResultsWe used the records of patients discharged from hospitals participating in the Paul Coverdell National Acute Stroke Program in 2013. Within this stroke‐enriched cohort, we compared agreement between the attending physician's clinical diagnosis and principal ICD‐9‐CM code and determined whether disagreements varied by hospital characteristics (presence of a stroke unit, stroke team, number of hospital beds, and hospital location). For patients with a documented National Institutes of Health Stroke Scale score at admission, we assessed whether diagnostic agreement varied by stroke severity. Agreement was generally high (>89%); differences between the physician diagnosis and ICD‐9‐CM codes were primarily attributed to discordance between ischemic stroke and transient ischemic attack (TIA), and subarachnoid and intracerebral hemorrhage. Agreement was higher for patients in metropolitan hospitals with stroke units, stroke teams, and >200 beds (all P<0.001). Agreement was lowest (60.3%) for rural hospitals with ≤200 beds and without stroke units or teams. Agreement was also lower for milder (94.9%) versus more‐severe (96.4%) ischemic strokes (P<0.001).ConclusionsWe identified disagreements in stroke/TIA coding by hospital characteristics and stroke severity, particularly for milder ischemic strokes. Such systematic variations in ICD‐9‐CM coding practices can affect stroke case identification in epidemiological studies and may have implications for hospital‐level quality metrics.

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“…In a landmark coding validation study, Fisher, et al, (1992) reabstracted and reassigned ICD-9-CM diagnosis and procedure codes from a national cross-section 6 of medical records. They sought to provide an assessment of coding accuracy of specific diagnoses and procedures.…”

Section: Related Studiesmentioning

confidence: 99%

“…They determined that the percentage of agreement between the principal diagnosis on the re-abstracted record and the original hospital record, when analyzed at sublevels of classification, improved slightly, but the accuracy of diagnosis and procedure coding varied substantially across conditions. They concluded that variability in the accuracy of diagnosis coding continued to pose a problem that must be overcome if classification research is to achieve its full potential (Fisher, et al, 1992).…”

Section: Related Studiesmentioning

confidence: 99%

Assessment of preferences for classification detail in medical information: is uniformity better?

Lorence

Spink

2003

Information Processing & Management

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The growing acceptance of evidence-based decision making in healthcare organizations has resulted in recognition of information classification and retrieval as a key area of both strategic and operational management. In the emerging information-intensive healthcare environment, healthcare managers are beginning to understand the increased need for formal, continuous information classification and coding in health services, creating a need for enhanced information retrieval, delivery of services and quality management. Variation in classification preferences across practice settings poses healthcare quality management problems for evidence-based medicine in such an environment. This paper reports results from a major national study into the perceived variation reported by health information managers related to the relevance-efficiency trade-offs of information classification across regions and practice settings. This study provides: (1) a benchmark of the degree of such variation, examining how classification preferences vary across organization types, regions, and management indicators, and (2) the extent to which managers prefer more descriptive classification systems, despite nationwide mandates to adopt greater non-descriptive categorization of information. Findings suggest that due to major regional variation, stringent national information standards may be counterproductive for some healthcare practice settings and geographic locations. Implications for healthcare information classification and retrieval are further examined and discussed.

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The accuracy of Medicare's hospital claims data: progress has been made, but problems remain.

Cited by 654 publications

References 31 publications

Breast cancer mortality in Spain: Has it really declined for all age groups?

Breast cancer mortality in Spain: Has it really declined for all age groups?

Accuracy of ICD‐9‐CM Codes by Hospital Characteristics and Stroke Severity: Paul Coverdell National Acute Stroke Program

Assessment of preferences for classification detail in medical information: is uniformity better?

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