Diagnostic value and reliability of the present-on-admission indicator in different diagnosis groups: pilot study at a Swiss tertiary care center

Abstract Background With few exceptions the International Statistical Classification of Diseases (ICD) codes for diagnoses and official coding guidelines do not distinguish pre-existing conditions from complications or comorbidities which occur during hospitalization. However, information on diagnosis timing is relevant with regard to the case’s severity, resource consumption and quality of care. In this study we analyzed the diagnostic value and reliability of the present-on-admission (POA) indicator using routinely collected health data. Methods We included all inpatient cases of the department of medicine during 2016 with a diagnosis of deep vein thrombosis, decubitus ulcer or delirium. Swiss coding guidelines of 2016 and the definitions of the Swiss medical statistics of hospitals were analyzed to evaluate the potential to encode information on diagnosis timing. The diagnoses were revised by applying the information present-on-admission by a coding specialist and by a medical expert, serving as Gold Standard. The diagnostic value and reliability were evaluated. Results The inter-rater reliability for POA of all diagnoses was 0.7133 (Cohen’s kappa), but differed between diagnosis groups (0.558–0.7164). The rate of POA positive of the total applied by the coding specialist versus the expert was similar, but differed between diagnoses. In group “thrombosis” SEN was 0.95, SPE 0.75, PPV 0.97 and NPV 0.60, in group “decubitus ulcer” SEN 0.89, SPE 0.82, PPV 0.89 and NPV 0.82, in group “delirium” SEN 0.91, SPE 0.65, PPV 0.71 and NPV 0.88 For all diagnoses SEN 0.92, SPE 0.73, PPV 0.87, NPV 0.82, summing up the cases of all diagnosis groups. Conclusions Coding the POA indicator identified diagnoses which were pre-existent with insufficient reliability on individual patient’s level. The overall fair to sufficient diagnostic quality is appropriate for screening and benchmarking performance on population level. As the medical statistics of hospitals carries no variable on pre-existing conditions, the novel approach to apply the POA indicator to diagnoses gives more information on quality of hospital care and complexity of cases. By preparing documentation for POA reporting diagnostic quality must be increased before implementation for risk-assessment or reimbursement on the individual patient’s level. Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Karen Triep [verfasserIn] Thomas Beck [verfasserIn] Jacques Donzé [verfasserIn] Olga Endrich [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2019

Schlagwörter:	Present on admission Routinely collected health data Diagnostic value Quality indicator Complications and comorbidities Quality of inpatient care

Übergeordnetes Werk:	In: BMC Health Services Research - BMC, 2003, 19(2019), 1, Seite 10
Übergeordnetes Werk:	volume:19 ; year:2019 ; number:1 ; pages:10

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.1186/s12913-018-3858-3

Katalog-ID:	DOAJ050756508

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520			\|a Abstract Background With few exceptions the International Statistical Classification of Diseases (ICD) codes for diagnoses and official coding guidelines do not distinguish pre-existing conditions from complications or comorbidities which occur during hospitalization. However, information on diagnosis timing is relevant with regard to the case’s severity, resource consumption and quality of care. In this study we analyzed the diagnostic value and reliability of the present-on-admission (POA) indicator using routinely collected health data. Methods We included all inpatient cases of the department of medicine during 2016 with a diagnosis of deep vein thrombosis, decubitus ulcer or delirium. Swiss coding guidelines of 2016 and the definitions of the Swiss medical statistics of hospitals were analyzed to evaluate the potential to encode information on diagnosis timing. The diagnoses were revised by applying the information present-on-admission by a coding specialist and by a medical expert, serving as Gold Standard. The diagnostic value and reliability were evaluated. Results The inter-rater reliability for POA of all diagnoses was 0.7133 (Cohen’s kappa), but differed between diagnosis groups (0.558–0.7164). The rate of POA positive of the total applied by the coding specialist versus the expert was similar, but differed between diagnoses. In group “thrombosis” SEN was 0.95, SPE 0.75, PPV 0.97 and NPV 0.60, in group “decubitus ulcer” SEN 0.89, SPE 0.82, PPV 0.89 and NPV 0.82, in group “delirium” SEN 0.91, SPE 0.65, PPV 0.71 and NPV 0.88 For all diagnoses SEN 0.92, SPE 0.73, PPV 0.87, NPV 0.82, summing up the cases of all diagnosis groups. Conclusions Coding the POA indicator identified diagnoses which were pre-existent with insufficient reliability on individual patient’s level. The overall fair to sufficient diagnostic quality is appropriate for screening and benchmarking performance on population level. As the medical statistics of hospitals carries no variable on pre-existing conditions, the novel approach to apply the POA indicator to diagnoses gives more information on quality of hospital care and complexity of cases. By preparing documentation for POA reporting diagnostic quality must be increased before implementation for risk-assessment or reimbursement on the individual patient’s level.
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allfields	10.1186/s12913-018-3858-3 doi (DE-627)DOAJ050756508 (DE-599)DOAJ0febfc12d90c4a9f899a4cd8e8fe71e3 DE-627 ger DE-627 rakwb eng RA1-1270 Karen Triep verfasserin aut Diagnostic value and reliability of the present-on-admission indicator in different diagnosis groups: pilot study at a Swiss tertiary care center 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background With few exceptions the International Statistical Classification of Diseases (ICD) codes for diagnoses and official coding guidelines do not distinguish pre-existing conditions from complications or comorbidities which occur during hospitalization. However, information on diagnosis timing is relevant with regard to the case’s severity, resource consumption and quality of care. In this study we analyzed the diagnostic value and reliability of the present-on-admission (POA) indicator using routinely collected health data. Methods We included all inpatient cases of the department of medicine during 2016 with a diagnosis of deep vein thrombosis, decubitus ulcer or delirium. Swiss coding guidelines of 2016 and the definitions of the Swiss medical statistics of hospitals were analyzed to evaluate the potential to encode information on diagnosis timing. The diagnoses were revised by applying the information present-on-admission by a coding specialist and by a medical expert, serving as Gold Standard. The diagnostic value and reliability were evaluated. Results The inter-rater reliability for POA of all diagnoses was 0.7133 (Cohen’s kappa), but differed between diagnosis groups (0.558–0.7164). The rate of POA positive of the total applied by the coding specialist versus the expert was similar, but differed between diagnoses. In group “thrombosis” SEN was 0.95, SPE 0.75, PPV 0.97 and NPV 0.60, in group “decubitus ulcer” SEN 0.89, SPE 0.82, PPV 0.89 and NPV 0.82, in group “delirium” SEN 0.91, SPE 0.65, PPV 0.71 and NPV 0.88 For all diagnoses SEN 0.92, SPE 0.73, PPV 0.87, NPV 0.82, summing up the cases of all diagnosis groups. Conclusions Coding the POA indicator identified diagnoses which were pre-existent with insufficient reliability on individual patient’s level. The overall fair to sufficient diagnostic quality is appropriate for screening and benchmarking performance on population level. As the medical statistics of hospitals carries no variable on pre-existing conditions, the novel approach to apply the POA indicator to diagnoses gives more information on quality of hospital care and complexity of cases. By preparing documentation for POA reporting diagnostic quality must be increased before implementation for risk-assessment or reimbursement on the individual patient’s level. Present on admission Routinely collected health data Diagnostic value Quality indicator Complications and comorbidities Quality of inpatient care Public aspects of medicine Thomas Beck verfasserin aut Jacques Donzé verfasserin aut Olga Endrich verfasserin aut In BMC Health Services Research BMC, 2003 19(2019), 1, Seite 10 (DE-627)331018756 (DE-600)2050434-2 14726963 nnns volume:19 year:2019 number:1 pages:10 https://doi.org/10.1186/s12913-018-3858-3 kostenfrei https://doaj.org/article/0febfc12d90c4a9f899a4cd8e8fe71e3 kostenfrei http://link.springer.com/article/10.1186/s12913-018-3858-3 kostenfrei https://doaj.org/toc/1472-6963 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2129 GBV_ILN_2190 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 19 2019 1 10
spelling	10.1186/s12913-018-3858-3 doi (DE-627)DOAJ050756508 (DE-599)DOAJ0febfc12d90c4a9f899a4cd8e8fe71e3 DE-627 ger DE-627 rakwb eng RA1-1270 Karen Triep verfasserin aut Diagnostic value and reliability of the present-on-admission indicator in different diagnosis groups: pilot study at a Swiss tertiary care center 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background With few exceptions the International Statistical Classification of Diseases (ICD) codes for diagnoses and official coding guidelines do not distinguish pre-existing conditions from complications or comorbidities which occur during hospitalization. However, information on diagnosis timing is relevant with regard to the case’s severity, resource consumption and quality of care. In this study we analyzed the diagnostic value and reliability of the present-on-admission (POA) indicator using routinely collected health data. Methods We included all inpatient cases of the department of medicine during 2016 with a diagnosis of deep vein thrombosis, decubitus ulcer or delirium. Swiss coding guidelines of 2016 and the definitions of the Swiss medical statistics of hospitals were analyzed to evaluate the potential to encode information on diagnosis timing. The diagnoses were revised by applying the information present-on-admission by a coding specialist and by a medical expert, serving as Gold Standard. The diagnostic value and reliability were evaluated. Results The inter-rater reliability for POA of all diagnoses was 0.7133 (Cohen’s kappa), but differed between diagnosis groups (0.558–0.7164). The rate of POA positive of the total applied by the coding specialist versus the expert was similar, but differed between diagnoses. In group “thrombosis” SEN was 0.95, SPE 0.75, PPV 0.97 and NPV 0.60, in group “decubitus ulcer” SEN 0.89, SPE 0.82, PPV 0.89 and NPV 0.82, in group “delirium” SEN 0.91, SPE 0.65, PPV 0.71 and NPV 0.88 For all diagnoses SEN 0.92, SPE 0.73, PPV 0.87, NPV 0.82, summing up the cases of all diagnosis groups. Conclusions Coding the POA indicator identified diagnoses which were pre-existent with insufficient reliability on individual patient’s level. The overall fair to sufficient diagnostic quality is appropriate for screening and benchmarking performance on population level. As the medical statistics of hospitals carries no variable on pre-existing conditions, the novel approach to apply the POA indicator to diagnoses gives more information on quality of hospital care and complexity of cases. By preparing documentation for POA reporting diagnostic quality must be increased before implementation for risk-assessment or reimbursement on the individual patient’s level. Present on admission Routinely collected health data Diagnostic value Quality indicator Complications and comorbidities Quality of inpatient care Public aspects of medicine Thomas Beck verfasserin aut Jacques Donzé verfasserin aut Olga Endrich verfasserin aut In BMC Health Services Research BMC, 2003 19(2019), 1, Seite 10 (DE-627)331018756 (DE-600)2050434-2 14726963 nnns volume:19 year:2019 number:1 pages:10 https://doi.org/10.1186/s12913-018-3858-3 kostenfrei https://doaj.org/article/0febfc12d90c4a9f899a4cd8e8fe71e3 kostenfrei http://link.springer.com/article/10.1186/s12913-018-3858-3 kostenfrei https://doaj.org/toc/1472-6963 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2129 GBV_ILN_2190 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 19 2019 1 10
allfields_unstemmed	10.1186/s12913-018-3858-3 doi (DE-627)DOAJ050756508 (DE-599)DOAJ0febfc12d90c4a9f899a4cd8e8fe71e3 DE-627 ger DE-627 rakwb eng RA1-1270 Karen Triep verfasserin aut Diagnostic value and reliability of the present-on-admission indicator in different diagnosis groups: pilot study at a Swiss tertiary care center 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background With few exceptions the International Statistical Classification of Diseases (ICD) codes for diagnoses and official coding guidelines do not distinguish pre-existing conditions from complications or comorbidities which occur during hospitalization. However, information on diagnosis timing is relevant with regard to the case’s severity, resource consumption and quality of care. In this study we analyzed the diagnostic value and reliability of the present-on-admission (POA) indicator using routinely collected health data. Methods We included all inpatient cases of the department of medicine during 2016 with a diagnosis of deep vein thrombosis, decubitus ulcer or delirium. Swiss coding guidelines of 2016 and the definitions of the Swiss medical statistics of hospitals were analyzed to evaluate the potential to encode information on diagnosis timing. The diagnoses were revised by applying the information present-on-admission by a coding specialist and by a medical expert, serving as Gold Standard. The diagnostic value and reliability were evaluated. Results The inter-rater reliability for POA of all diagnoses was 0.7133 (Cohen’s kappa), but differed between diagnosis groups (0.558–0.7164). The rate of POA positive of the total applied by the coding specialist versus the expert was similar, but differed between diagnoses. In group “thrombosis” SEN was 0.95, SPE 0.75, PPV 0.97 and NPV 0.60, in group “decubitus ulcer” SEN 0.89, SPE 0.82, PPV 0.89 and NPV 0.82, in group “delirium” SEN 0.91, SPE 0.65, PPV 0.71 and NPV 0.88 For all diagnoses SEN 0.92, SPE 0.73, PPV 0.87, NPV 0.82, summing up the cases of all diagnosis groups. Conclusions Coding the POA indicator identified diagnoses which were pre-existent with insufficient reliability on individual patient’s level. The overall fair to sufficient diagnostic quality is appropriate for screening and benchmarking performance on population level. As the medical statistics of hospitals carries no variable on pre-existing conditions, the novel approach to apply the POA indicator to diagnoses gives more information on quality of hospital care and complexity of cases. By preparing documentation for POA reporting diagnostic quality must be increased before implementation for risk-assessment or reimbursement on the individual patient’s level. Present on admission Routinely collected health data Diagnostic value Quality indicator Complications and comorbidities Quality of inpatient care Public aspects of medicine Thomas Beck verfasserin aut Jacques Donzé verfasserin aut Olga Endrich verfasserin aut In BMC Health Services Research BMC, 2003 19(2019), 1, Seite 10 (DE-627)331018756 (DE-600)2050434-2 14726963 nnns volume:19 year:2019 number:1 pages:10 https://doi.org/10.1186/s12913-018-3858-3 kostenfrei https://doaj.org/article/0febfc12d90c4a9f899a4cd8e8fe71e3 kostenfrei http://link.springer.com/article/10.1186/s12913-018-3858-3 kostenfrei https://doaj.org/toc/1472-6963 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2129 GBV_ILN_2190 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 19 2019 1 10
allfieldsGer	10.1186/s12913-018-3858-3 doi (DE-627)DOAJ050756508 (DE-599)DOAJ0febfc12d90c4a9f899a4cd8e8fe71e3 DE-627 ger DE-627 rakwb eng RA1-1270 Karen Triep verfasserin aut Diagnostic value and reliability of the present-on-admission indicator in different diagnosis groups: pilot study at a Swiss tertiary care center 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background With few exceptions the International Statistical Classification of Diseases (ICD) codes for diagnoses and official coding guidelines do not distinguish pre-existing conditions from complications or comorbidities which occur during hospitalization. However, information on diagnosis timing is relevant with regard to the case’s severity, resource consumption and quality of care. In this study we analyzed the diagnostic value and reliability of the present-on-admission (POA) indicator using routinely collected health data. Methods We included all inpatient cases of the department of medicine during 2016 with a diagnosis of deep vein thrombosis, decubitus ulcer or delirium. Swiss coding guidelines of 2016 and the definitions of the Swiss medical statistics of hospitals were analyzed to evaluate the potential to encode information on diagnosis timing. The diagnoses were revised by applying the information present-on-admission by a coding specialist and by a medical expert, serving as Gold Standard. The diagnostic value and reliability were evaluated. Results The inter-rater reliability for POA of all diagnoses was 0.7133 (Cohen’s kappa), but differed between diagnosis groups (0.558–0.7164). The rate of POA positive of the total applied by the coding specialist versus the expert was similar, but differed between diagnoses. In group “thrombosis” SEN was 0.95, SPE 0.75, PPV 0.97 and NPV 0.60, in group “decubitus ulcer” SEN 0.89, SPE 0.82, PPV 0.89 and NPV 0.82, in group “delirium” SEN 0.91, SPE 0.65, PPV 0.71 and NPV 0.88 For all diagnoses SEN 0.92, SPE 0.73, PPV 0.87, NPV 0.82, summing up the cases of all diagnosis groups. Conclusions Coding the POA indicator identified diagnoses which were pre-existent with insufficient reliability on individual patient’s level. The overall fair to sufficient diagnostic quality is appropriate for screening and benchmarking performance on population level. As the medical statistics of hospitals carries no variable on pre-existing conditions, the novel approach to apply the POA indicator to diagnoses gives more information on quality of hospital care and complexity of cases. By preparing documentation for POA reporting diagnostic quality must be increased before implementation for risk-assessment or reimbursement on the individual patient’s level. Present on admission Routinely collected health data Diagnostic value Quality indicator Complications and comorbidities Quality of inpatient care Public aspects of medicine Thomas Beck verfasserin aut Jacques Donzé verfasserin aut Olga Endrich verfasserin aut In BMC Health Services Research BMC, 2003 19(2019), 1, Seite 10 (DE-627)331018756 (DE-600)2050434-2 14726963 nnns volume:19 year:2019 number:1 pages:10 https://doi.org/10.1186/s12913-018-3858-3 kostenfrei https://doaj.org/article/0febfc12d90c4a9f899a4cd8e8fe71e3 kostenfrei http://link.springer.com/article/10.1186/s12913-018-3858-3 kostenfrei https://doaj.org/toc/1472-6963 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2129 GBV_ILN_2190 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 19 2019 1 10
allfieldsSound	10.1186/s12913-018-3858-3 doi (DE-627)DOAJ050756508 (DE-599)DOAJ0febfc12d90c4a9f899a4cd8e8fe71e3 DE-627 ger DE-627 rakwb eng RA1-1270 Karen Triep verfasserin aut Diagnostic value and reliability of the present-on-admission indicator in different diagnosis groups: pilot study at a Swiss tertiary care center 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background With few exceptions the International Statistical Classification of Diseases (ICD) codes for diagnoses and official coding guidelines do not distinguish pre-existing conditions from complications or comorbidities which occur during hospitalization. However, information on diagnosis timing is relevant with regard to the case’s severity, resource consumption and quality of care. In this study we analyzed the diagnostic value and reliability of the present-on-admission (POA) indicator using routinely collected health data. Methods We included all inpatient cases of the department of medicine during 2016 with a diagnosis of deep vein thrombosis, decubitus ulcer or delirium. Swiss coding guidelines of 2016 and the definitions of the Swiss medical statistics of hospitals were analyzed to evaluate the potential to encode information on diagnosis timing. The diagnoses were revised by applying the information present-on-admission by a coding specialist and by a medical expert, serving as Gold Standard. The diagnostic value and reliability were evaluated. Results The inter-rater reliability for POA of all diagnoses was 0.7133 (Cohen’s kappa), but differed between diagnosis groups (0.558–0.7164). The rate of POA positive of the total applied by the coding specialist versus the expert was similar, but differed between diagnoses. In group “thrombosis” SEN was 0.95, SPE 0.75, PPV 0.97 and NPV 0.60, in group “decubitus ulcer” SEN 0.89, SPE 0.82, PPV 0.89 and NPV 0.82, in group “delirium” SEN 0.91, SPE 0.65, PPV 0.71 and NPV 0.88 For all diagnoses SEN 0.92, SPE 0.73, PPV 0.87, NPV 0.82, summing up the cases of all diagnosis groups. Conclusions Coding the POA indicator identified diagnoses which were pre-existent with insufficient reliability on individual patient’s level. The overall fair to sufficient diagnostic quality is appropriate for screening and benchmarking performance on population level. As the medical statistics of hospitals carries no variable on pre-existing conditions, the novel approach to apply the POA indicator to diagnoses gives more information on quality of hospital care and complexity of cases. By preparing documentation for POA reporting diagnostic quality must be increased before implementation for risk-assessment or reimbursement on the individual patient’s level. Present on admission Routinely collected health data Diagnostic value Quality indicator Complications and comorbidities Quality of inpatient care Public aspects of medicine Thomas Beck verfasserin aut Jacques Donzé verfasserin aut Olga Endrich verfasserin aut In BMC Health Services Research BMC, 2003 19(2019), 1, Seite 10 (DE-627)331018756 (DE-600)2050434-2 14726963 nnns volume:19 year:2019 number:1 pages:10 https://doi.org/10.1186/s12913-018-3858-3 kostenfrei https://doaj.org/article/0febfc12d90c4a9f899a4cd8e8fe71e3 kostenfrei http://link.springer.com/article/10.1186/s12913-018-3858-3 kostenfrei https://doaj.org/toc/1472-6963 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2129 GBV_ILN_2190 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 19 2019 1 10
language	English
source	In BMC Health Services Research 19(2019), 1, Seite 10 volume:19 year:2019 number:1 pages:10
sourceStr	In BMC Health Services Research 19(2019), 1, Seite 10 volume:19 year:2019 number:1 pages:10
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	Present on admission Routinely collected health data Diagnostic value Quality indicator Complications and comorbidities Quality of inpatient care Public aspects of medicine
isfreeaccess_bool	true
container_title	BMC Health Services Research
authorswithroles_txt_mv	Karen Triep @@aut@@ Thomas Beck @@aut@@ Jacques Donzé @@aut@@ Olga Endrich @@aut@@
publishDateDaySort_date	2019-01-01T00:00:00Z
hierarchy_top_id	331018756
id	DOAJ050756508
language_de	englisch
fullrecord	<?xml version="1.0" encoding="UTF-8"?><collection xmlns="http://www.loc.gov/MARC21/slim"><record><leader>01000caa a22002652 4500</leader><controlfield tag="001">DOAJ050756508</controlfield><controlfield tag="003">DE-627</controlfield><controlfield tag="005">20230308154742.0</controlfield><controlfield tag="007">cr uuu---uuuuu</controlfield><controlfield tag="008">230227s2019 xx \|\|\|\|\|o 00\| \|\|eng c</controlfield><datafield tag="024" ind1="7" ind2=" "><subfield code="a">10.1186/s12913-018-3858-3</subfield><subfield code="2">doi</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-627)DOAJ050756508</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-599)DOAJ0febfc12d90c4a9f899a4cd8e8fe71e3</subfield></datafield><datafield tag="040" ind1=" " ind2=" "><subfield code="a">DE-627</subfield><subfield code="b">ger</subfield><subfield code="c">DE-627</subfield><subfield code="e">rakwb</subfield></datafield><datafield tag="041" ind1=" " ind2=" "><subfield code="a">eng</subfield></datafield><datafield tag="050" ind1=" " ind2="0"><subfield code="a">RA1-1270</subfield></datafield><datafield tag="100" ind1="0" ind2=" "><subfield code="a">Karen Triep</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="245" ind1="1" ind2="0"><subfield code="a">Diagnostic value and reliability of the present-on-admission indicator in different diagnosis groups: pilot study at a Swiss tertiary care center</subfield></datafield><datafield tag="264" ind1=" " ind2="1"><subfield code="c">2019</subfield></datafield><datafield tag="336" ind1=" " ind2=" "><subfield code="a">Text</subfield><subfield code="b">txt</subfield><subfield code="2">rdacontent</subfield></datafield><datafield tag="337" ind1=" " ind2=" "><subfield code="a">Computermedien</subfield><subfield code="b">c</subfield><subfield code="2">rdamedia</subfield></datafield><datafield tag="338" ind1=" " ind2=" "><subfield code="a">Online-Ressource</subfield><subfield code="b">cr</subfield><subfield code="2">rdacarrier</subfield></datafield><datafield tag="520" ind1=" " ind2=" "><subfield code="a">Abstract Background With few exceptions the International Statistical Classification of Diseases (ICD) codes for diagnoses and official coding guidelines do not distinguish pre-existing conditions from complications or comorbidities which occur during hospitalization. However, information on diagnosis timing is relevant with regard to the case’s severity, resource consumption and quality of care. In this study we analyzed the diagnostic value and reliability of the present-on-admission (POA) indicator using routinely collected health data. Methods We included all inpatient cases of the department of medicine during 2016 with a diagnosis of deep vein thrombosis, decubitus ulcer or delirium. Swiss coding guidelines of 2016 and the definitions of the Swiss medical statistics of hospitals were analyzed to evaluate the potential to encode information on diagnosis timing. The diagnoses were revised by applying the information present-on-admission by a coding specialist and by a medical expert, serving as Gold Standard. The diagnostic value and reliability were evaluated. Results The inter-rater reliability for POA of all diagnoses was 0.7133 (Cohen’s kappa), but differed between diagnosis groups (0.558–0.7164). The rate of POA positive of the total applied by the coding specialist versus the expert was similar, but differed between diagnoses. In group “thrombosis” SEN was 0.95, SPE 0.75, PPV 0.97 and NPV 0.60, in group “decubitus ulcer” SEN 0.89, SPE 0.82, PPV 0.89 and NPV 0.82, in group “delirium” SEN 0.91, SPE 0.65, PPV 0.71 and NPV 0.88 For all diagnoses SEN 0.92, SPE 0.73, PPV 0.87, NPV 0.82, summing up the cases of all diagnosis groups. Conclusions Coding the POA indicator identified diagnoses which were pre-existent with insufficient reliability on individual patient’s level. The overall fair to sufficient diagnostic quality is appropriate for screening and benchmarking performance on population level. As the medical statistics of hospitals carries no variable on pre-existing conditions, the novel approach to apply the POA indicator to diagnoses gives more information on quality of hospital care and complexity of cases. 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callnumber-first	R - Medicine
author	Karen Triep
spellingShingle	Karen Triep misc RA1-1270 misc Present on admission misc Routinely collected health data misc Diagnostic value misc Quality indicator misc Complications and comorbidities misc Quality of inpatient care misc Public aspects of medicine Diagnostic value and reliability of the present-on-admission indicator in different diagnosis groups: pilot study at a Swiss tertiary care center
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topic_title	RA1-1270 Diagnostic value and reliability of the present-on-admission indicator in different diagnosis groups: pilot study at a Swiss tertiary care center Present on admission Routinely collected health data Diagnostic value Quality indicator Complications and comorbidities Quality of inpatient care
topic	misc RA1-1270 misc Present on admission misc Routinely collected health data misc Diagnostic value misc Quality indicator misc Complications and comorbidities misc Quality of inpatient care misc Public aspects of medicine
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title	Diagnostic value and reliability of the present-on-admission indicator in different diagnosis groups: pilot study at a Swiss tertiary care center
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title_full	Diagnostic value and reliability of the present-on-admission indicator in different diagnosis groups: pilot study at a Swiss tertiary care center
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author_browse	Karen Triep Thomas Beck Jacques Donzé Olga Endrich
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title_sort	diagnostic value and reliability of the present-on-admission indicator in different diagnosis groups: pilot study at a swiss tertiary care center
callnumber	RA1-1270
title_auth	Diagnostic value and reliability of the present-on-admission indicator in different diagnosis groups: pilot study at a Swiss tertiary care center
abstract	Abstract Background With few exceptions the International Statistical Classification of Diseases (ICD) codes for diagnoses and official coding guidelines do not distinguish pre-existing conditions from complications or comorbidities which occur during hospitalization. However, information on diagnosis timing is relevant with regard to the case’s severity, resource consumption and quality of care. In this study we analyzed the diagnostic value and reliability of the present-on-admission (POA) indicator using routinely collected health data. Methods We included all inpatient cases of the department of medicine during 2016 with a diagnosis of deep vein thrombosis, decubitus ulcer or delirium. Swiss coding guidelines of 2016 and the definitions of the Swiss medical statistics of hospitals were analyzed to evaluate the potential to encode information on diagnosis timing. The diagnoses were revised by applying the information present-on-admission by a coding specialist and by a medical expert, serving as Gold Standard. The diagnostic value and reliability were evaluated. Results The inter-rater reliability for POA of all diagnoses was 0.7133 (Cohen’s kappa), but differed between diagnosis groups (0.558–0.7164). The rate of POA positive of the total applied by the coding specialist versus the expert was similar, but differed between diagnoses. In group “thrombosis” SEN was 0.95, SPE 0.75, PPV 0.97 and NPV 0.60, in group “decubitus ulcer” SEN 0.89, SPE 0.82, PPV 0.89 and NPV 0.82, in group “delirium” SEN 0.91, SPE 0.65, PPV 0.71 and NPV 0.88 For all diagnoses SEN 0.92, SPE 0.73, PPV 0.87, NPV 0.82, summing up the cases of all diagnosis groups. Conclusions Coding the POA indicator identified diagnoses which were pre-existent with insufficient reliability on individual patient’s level. The overall fair to sufficient diagnostic quality is appropriate for screening and benchmarking performance on population level. As the medical statistics of hospitals carries no variable on pre-existing conditions, the novel approach to apply the POA indicator to diagnoses gives more information on quality of hospital care and complexity of cases. By preparing documentation for POA reporting diagnostic quality must be increased before implementation for risk-assessment or reimbursement on the individual patient’s level.
abstractGer	Abstract Background With few exceptions the International Statistical Classification of Diseases (ICD) codes for diagnoses and official coding guidelines do not distinguish pre-existing conditions from complications or comorbidities which occur during hospitalization. However, information on diagnosis timing is relevant with regard to the case’s severity, resource consumption and quality of care. In this study we analyzed the diagnostic value and reliability of the present-on-admission (POA) indicator using routinely collected health data. Methods We included all inpatient cases of the department of medicine during 2016 with a diagnosis of deep vein thrombosis, decubitus ulcer or delirium. Swiss coding guidelines of 2016 and the definitions of the Swiss medical statistics of hospitals were analyzed to evaluate the potential to encode information on diagnosis timing. The diagnoses were revised by applying the information present-on-admission by a coding specialist and by a medical expert, serving as Gold Standard. The diagnostic value and reliability were evaluated. Results The inter-rater reliability for POA of all diagnoses was 0.7133 (Cohen’s kappa), but differed between diagnosis groups (0.558–0.7164). The rate of POA positive of the total applied by the coding specialist versus the expert was similar, but differed between diagnoses. In group “thrombosis” SEN was 0.95, SPE 0.75, PPV 0.97 and NPV 0.60, in group “decubitus ulcer” SEN 0.89, SPE 0.82, PPV 0.89 and NPV 0.82, in group “delirium” SEN 0.91, SPE 0.65, PPV 0.71 and NPV 0.88 For all diagnoses SEN 0.92, SPE 0.73, PPV 0.87, NPV 0.82, summing up the cases of all diagnosis groups. Conclusions Coding the POA indicator identified diagnoses which were pre-existent with insufficient reliability on individual patient’s level. The overall fair to sufficient diagnostic quality is appropriate for screening and benchmarking performance on population level. As the medical statistics of hospitals carries no variable on pre-existing conditions, the novel approach to apply the POA indicator to diagnoses gives more information on quality of hospital care and complexity of cases. By preparing documentation for POA reporting diagnostic quality must be increased before implementation for risk-assessment or reimbursement on the individual patient’s level.
abstract_unstemmed	Abstract Background With few exceptions the International Statistical Classification of Diseases (ICD) codes for diagnoses and official coding guidelines do not distinguish pre-existing conditions from complications or comorbidities which occur during hospitalization. However, information on diagnosis timing is relevant with regard to the case’s severity, resource consumption and quality of care. In this study we analyzed the diagnostic value and reliability of the present-on-admission (POA) indicator using routinely collected health data. Methods We included all inpatient cases of the department of medicine during 2016 with a diagnosis of deep vein thrombosis, decubitus ulcer or delirium. Swiss coding guidelines of 2016 and the definitions of the Swiss medical statistics of hospitals were analyzed to evaluate the potential to encode information on diagnosis timing. The diagnoses were revised by applying the information present-on-admission by a coding specialist and by a medical expert, serving as Gold Standard. The diagnostic value and reliability were evaluated. Results The inter-rater reliability for POA of all diagnoses was 0.7133 (Cohen’s kappa), but differed between diagnosis groups (0.558–0.7164). The rate of POA positive of the total applied by the coding specialist versus the expert was similar, but differed between diagnoses. In group “thrombosis” SEN was 0.95, SPE 0.75, PPV 0.97 and NPV 0.60, in group “decubitus ulcer” SEN 0.89, SPE 0.82, PPV 0.89 and NPV 0.82, in group “delirium” SEN 0.91, SPE 0.65, PPV 0.71 and NPV 0.88 For all diagnoses SEN 0.92, SPE 0.73, PPV 0.87, NPV 0.82, summing up the cases of all diagnosis groups. Conclusions Coding the POA indicator identified diagnoses which were pre-existent with insufficient reliability on individual patient’s level. The overall fair to sufficient diagnostic quality is appropriate for screening and benchmarking performance on population level. As the medical statistics of hospitals carries no variable on pre-existing conditions, the novel approach to apply the POA indicator to diagnoses gives more information on quality of hospital care and complexity of cases. By preparing documentation for POA reporting diagnostic quality must be increased before implementation for risk-assessment or reimbursement on the individual patient’s level.
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title_short	Diagnostic value and reliability of the present-on-admission indicator in different diagnosis groups: pilot study at a Swiss tertiary care center
url	https://doi.org/10.1186/s12913-018-3858-3 https://doaj.org/article/0febfc12d90c4a9f899a4cd8e8fe71e3 http://link.springer.com/article/10.1186/s12913-018-3858-3 https://doaj.org/toc/1472-6963
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The rate of POA positive of the total applied by the coding specialist versus the expert was similar, but differed between diagnoses. In group “thrombosis” SEN was 0.95, SPE 0.75, PPV 0.97 and NPV 0.60, in group “decubitus ulcer” SEN 0.89, SPE 0.82, PPV 0.89 and NPV 0.82, in group “delirium” SEN 0.91, SPE 0.65, PPV 0.71 and NPV 0.88 For all diagnoses SEN 0.92, SPE 0.73, PPV 0.87, NPV 0.82, summing up the cases of all diagnosis groups. Conclusions Coding the POA indicator identified diagnoses which were pre-existent with insufficient reliability on individual patient’s level. The overall fair to sufficient diagnostic quality is appropriate for screening and benchmarking performance on population level. As the medical statistics of hospitals carries no variable on pre-existing conditions, the novel approach to apply the POA indicator to diagnoses gives more information on quality of hospital care and complexity of cases. 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Diagnostic value and reliability of the present-on-admission indicator in different diagnosis groups: pilot study at a Swiss tertiary care center

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