Development of a validation algorithm for 'present on admission' flagging

Jackson, Terri J., Michel, Jude L., Roberts, Rosemary, Shepheard, Jennie, Cheng, Diana, Rust, Julie and Perry, Catherine (2009) Development of a validation algorithm for 'present on admission' flagging. BMC Medical Informatics and Decision Making, 9 1: 48.1-48.8. doi:10.1186/1472-6947-9-48

Author Jackson, Terri J.
Michel, Jude L.
Roberts, Rosemary
Shepheard, Jennie
Cheng, Diana
Rust, Julie
Perry, Catherine
Title Development of a validation algorithm for 'present on admission' flagging
Journal name BMC Medical Informatics and Decision Making   Check publisher's open access policy
ISSN 1472-6947
Publication date 2009-12-01
Sub-type Article (original research)
DOI 10.1186/1472-6947-9-48
Open Access Status DOI
Volume 9
Issue 1
Start page 48.1
End page 48.8
Total pages 8
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Formatted abstract
Background: The use of routine hospital data for understanding patterns of adverse outcomes has been limited in the past by the fact that pre-existing and post-admission conditions have been indistinguishable. The use of a 'Present on Admission' (or POA) indicator to distinguish pre-existing or co-morbid conditions from those arising during the episode of care has been advocated in the US for many years as a tool to support quality assurance activities and improve the accuracy of risk adjustment methodologies. The USA, Australia and Canada now all assign a flag to indicate the timing of onset of diagnoses. For quality improvement purposes, it is the 'not-POA' diagnoses (that is, those acquired in hospital) that are of interest.
Methods: Our objective was to develop an algorithm for assessing the validity of assignment of 'not-POA' flags. We undertook expert review of the International Classification of Diseases, 10th Revision, Australian Modification (ICD-10-AM) to identify conditions that could not be plausibly hospital-acquired. The resulting computer algorithm was tested against all diagnoses flagged as complications in the Victorian (Australia) Admitted Episodes Dataset, 2005/06. Measures reported include rates of appropriate assignment of the new Australian 'Condition Onset' flag by ICD chapter, and patterns of invalid flagging.
Results: Of 18,418 diagnosis codes reviewed, 93.4% (n = 17,195) reflected agreement on status for flagging by at least 2 of 3 reviewers (including 64.4% unanimous agreement; Fleiss' Kappa: 0.61). In tests of the new algorithm, 96.14% of all hospital-acquired diagnosis codes flagged were found to be valid in the Victorian records analysed. A lower proportion of individual codes was judged to be acceptably flagged (76.2%), but this reflected a high proportion of codes used <5 times in the data set (789/1035 invalid codes).
Conclusion: An indicator variable about the timing of occurrence of diagnoses can greatly expand the use of routinely coded data for hospital quality improvement programmes. The data-cleaning instrument developed and tested here can help guide coding practice in those health systems considering this change in hospital coding. The algorithm embodies principles for development of coding standards and coder education that would result in improved data validity for routine use of non-POA information.
Keyword Administrative data
Patient safety
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ
Additional Notes Article #48 pp.1-8

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 7 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 8 times in Scopus Article | Citations
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Created: Sun, 10 Jan 2010, 10:09:18 EST