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- Title
Variation in diagnostic coding of patients with pneumonia and its association with hospital risk-standardized mortality rates: a cross-sectional analysis.
- Authors
Rothberg, Michael B; Pekow, Penelope S; Priya, Aruna; Lindenauer, Peter K
- Abstract
<bold>Background: </bold>Most U.S. hospitals publicly report 30-day risk-standardized mortality rates for pneumonia. Rates exclude severe cases, which may be assigned a secondary diagnosis of pneumonia and a principal diagnosis of sepsis or respiratory failure. By assigning sepsis and respiratory failure codes more liberally, hospitals might improve their reported performance.<bold>Objective: </bold>To examine the effect of the definition of pneumonia on hospital mortality rates.<bold>Design: </bold>Cross-sectional study.<bold>Setting: </bold>329 U.S. hospitals.<bold>Patients: </bold>Adults hospitalized for pneumonia (as a principal diagnosis or secondary diagnosis paired with a principal diagnosis of sepsis or respiratory failure) between 2007 and 2010.<bold>Measurements: </bold>Proportion of patients with pneumonia coded with a principal diagnosis of sepsis or respiratory failure and risk-standardized mortality rates excluding versus including a principal diagnosis of sepsis or respiratory failure.<bold>Results: </bold>When the definition of pneumonia was limited to patients with a principal diagnosis of pneumonia, the risk-standardized mortality rate was significantly better than the mean in 4.3% of hospitals and significantly worse in 6.4%. When the definition was broadened to include patients with a principal diagnosis of sepsis or respiratory failure, this rate was better than the mean in 11.9% of hospitals and worse in 22.8% and the outlier status of 28.3% of hospitals changed. Among hospitals in the highest quintile of proportion of patients coded with a principal diagnosis of sepsis or respiratory failure, outlier status under the broader definition improved in 7.6% and worsened in 40.9%. Among those in the lowest quintile, 20.0% improved and none worsened.<bold>Limitation: </bold>Only inpatient mortality was studied.<bold>Conclusion: </bold>Variation in use of the principal diagnosis of sepsis or respiratory failure may bias efforts to compare hospital performance regarding pneumonia outcomes.<bold>Primary Funding Source: </bold>Agency for Healthcare Research and Quality.
- Publication
Annals of Internal Medicine, 2014, Vol 160, Issue 6, p380
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/M13-1419