Using ICD-10-AM Codes to Characterise Hospital-Acquired Complications

Abstract

This paper describes the limitations of using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) to characterise patient harm in hospitals. Limitations were identified during a project to use diagnoses flagged by Victorian coders as hospital-acquired to devise a classification of 144 categories of hospital acquired diagnoses (the Classification of Hospital Acquired Diagnoses or CHADx). CHADx is a comprehensive data monitoring system designed to allow hospitals to monitor their complication rates month-to-month using a standard method. Difficulties in identifying a single event from linear sequences of codes due to the absence of code linkage were the major obstacles to developing the classification. Obstetric and perinatal episodes also presented challenges in distinguishing condition onset, that is, whether conditions were present on admission or arose after formal admission to hospital. Used in the appropriate way, the CHADx allows hospitals to identify areas for future patient safety and quality initiatives. The value of timing information and code linkage should be recognised in the planning stages of any future electronic systems.

Adverse event rates as measures of hospital performance

“…For application of the 'C' prefix (indicating a 'complication') the coder must ascertain that there was no evidence of the condition existing prior to admission -that is, the C-prefix is used only for a diagnosis arising after admission [33]. The Victorian complication prefix has been validated by a number of studies [17,21,[34][35][36][37]. Most explanatory variables describe characteristics of the patient, in particular medical complexity, and characteristics of the surgical episode.…”

Comparação De Estratégias Para Detecção De Condições Adquiridas Em Hospital Público Segundo O Sistema De Grupos Diagnósticos Relacionados (DRG)

“…Apesar de termos comparado apenas os dois modelos para CAs/HACs, pudemos observar quatro métodos para rastreio de CAs hospitalares: (i) modelo americano (HACs), (ii) modelo australiano (Michel, Nghiem & Jackson, 2009;Jackson, Michel, Roberts, Jorm & Wakefield, 2009), (iii) modelo brasileiro (aplicado no HGIP, para CAs, DRG-BR) e (iv) modelo belga (Heede et al, 2006). O modelo americano tem como base as HACs propostas pelo CMS (Wald et al, 2012).…”

“…Já em relação à política australiana, que pretende uma implementação de uso de CID-10-AM para rastreamento de CAs, no estudo de Michel et al (2009), há ênfase de que o benefício de monitorar a gama de CAs utilizando a Classification of Hospital Acquired Diagnoses (CHADx) é balanceado pela probabilidade de dupla contagem de "eventos" que superestimariam a taxa de complicações específicas, comparando-se assim, a outros métodos. Apesar disso, há maior quantidade de códigos potencialmente danosos rastreados, além de permitir que CAs mais graves e de alta taxa de incidência tenham prioridade na prevenção de condições adquiridas.…”

Intrahospital transfers and adverse patient outcomes: An analysis of administrative health data

“…There are many ways to measure patient outcomes using administrative data, such as using ICD codes to measure hospital‐acquired complications (Michel, Nghiem, & Jackson, ) and adverse medication events (Parikh et al., ), the Nursing Sensitive Outcomes approach (Needleman, Buerhaus, Mattke, Stewart, & Zelevinsky, ; Needleman et al., ) or the Elixhauser and Charlson comorbidity indices to measure comorbidity (Chu, Ng, & Wu, ; van Walraven, Austin, Jennings, Quan, & Forster, ). In this study, we adopted the Classification of Hospital Acquired Diagnoses (CHADx) approach (Jackson, Duckett, Shepheard, & Baxter, ; Jackson, Michel, Roberts, Jorm, & Wakefield, ; Michel et al., ). This system was initially developed by the Australian Centre for Economic Research on Health, under sponsorship from the Australian Commission on Safety and Quality in Health Care, to provide hospitals with a mechanism to identify complications of care using routinely collected data from the medical record (Jackson et al., , ).…”

“…The CHADx uses data coded according to ICD‐10‐AM to group complications into 17 classes (e.g., adverse drug events and postprocedural complications) and 145 subclasses. The approach avoids duplication and distinguishes between hospital‐acquired complications and comorbidities present on admission and those acquired in hospital (Michel et al., ).…”