Navigation Links
Is patient coding making hospitals appear better than they are?
Date:4/25/2010

In this week's BMJ, Nigel Hawkes, freelance journalist and Director of Straight Statistics, a campaign for the better use of statistical data, investigates how the way that patients are allocated diagnostic codes by a hospital can have a big effect on a hospital's performance.

It follows two articles published by the BMJ last week arguing that using death rates to judge hospital performance is a bad idea.

It began, says Hawkes, when Mid Staffordshire Foundation NHS Trust was branded "appalling" by the Care Quality Commission, yet was rated in the top ten for quality of care by health analysts Dr Foster in their 2009 Good Hospital Guide. Further investigations into lower than average death rates from broken hips at Mid Staffordshire was put down to "improved coding procedures."

Could such coding changes be affecting Dr Foster's performance evaluations, flattering hospital-standardised mortality ratios (HMSRs) and making hospitals appear much better than they are, asks Hawkes?

Diagnostic coding is used by hospitals to record the conditions suffered by patients admitted to them for treatment, he explains. If a hospital uses an increasing number of codes year by year, it implies that more patients with more severe conditions are being treated. But if the death rate remains constant while the severity index increases, it appears that the hospital is doing better at keeping people alive.

Research by CHKS, a rival health analytical company, shows that the number of codes has been creeping up over recent years, yet crude death rates in English hospitals show virtually no change over the past five years. There is also a big variation in the average number of diagnostic codes per patient from hospital to hospital.

How has this happened, asks Hawkes? One explanation might be the increasing proportion of patients classified as needing palliative care. CHKS figures show the number of deaths coded Z51.5 (the code used for palliative care) was under 400 a month in 2004, but had reached more than 1,800 a month by June 2009.

Patients coded Z51.5 are assumed to have come into hospital to die, so performance calculations make allowance for that. This means that a few heavy users of the Z51.5 code could have reduced their HSMRs from 110 (above average) to 90 (below average) simply by increasing the frequency of use of the palliative care code.

Although Hawkes cannot prove that any hospital is doing this, he says "there is no question that the situation is open to manipulation by trusts."

Dr Foster Intelligence, the company responsible for the Good Hospital Guide, believes that HSMRs remain a good measure of the quality of care, if used alongside other measures. CHKS, by contrast, believes that while they may be a useful tool within a hospital, they are unsuitable on their own for comparisons between hospitals while such big coding variations exist.

The clash of evidence between the Good Hospital Guide and the Care Quality Commission embarrassed the Department of Health and a review of the use of HSMRs in England is now underway.


'/>"/>

Contact: Emma Dickinson
edickinson@bmjgroup.com
44-207-383-6529
BMJ-British Medical Journal
Source:Eurekalert

Related medicine news :

1. Targeted therapy prolongs life in patients with HER2-positive breast cancer
2. Physical Therapist, Money Launderer and Patient Recruiter Plead Guilty in Connection With Multiple Detroit Health Care Fraud Schemes
3. Aspen Dental Opens 44 New Offices, Welcomes 340,000 New Patients in 2009
4. Blood Thinner Combos Risky for Heart Attack Patients
5. Patients with mild gallstone pancreatitis can undergo surgery sooner, shortening hospital stays
6. Brain Scans Suggest Some Vegetative Patients May Be Aware
7. Inflammation marker related to obesity is elevated in patients with pancreatic cancer
8. Penn State Hershey Medical Center to Provide Complimentary AT&T Wi-Fi in Patient Rooms
9. Adding Chemo to Tamoxifen Helps Some Breast Cancer Patients
10. Livonia Optometrist Offers New Technology - and New Hope - to Patients ... Free of Charge
11. HD For More Than Your TV – New Technologies Offer Patients High Definition Vision At Any Age
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:10/12/2017)... ... , ... IsoComforter, Inc. ( https://isocomforter.com ), one of the Nation’s ... design of the shoulder pad. The shoulder pad provides optimal support and full ... while using cold therapy. By utilizing ice and water that is circulated from an ...
(Date:10/12/2017)... ... October 12, 2017 , ... Information about ... intend to develop to enable prevention of a major side effect of chemotherapy ... especially in pediatric patients. For cisplatin, hearing loss is FDA listed on-label as ...
(Date:10/12/2017)... ... October 12, 2017 , ... Leading pediatric oncology experts at ... for the 49th Congress of the International Society of Paediatric Oncology (SIOP) ... Center for Cancer and Blood Disorders at Children’s National, and Stephen P. ...
(Date:10/12/2017)... ... ... Health Literacy Innovations (HLI), creator of the Health Literacy ... Patient Education Network (CPEN), an independent professional organization that shares best practices in ... , As CPEN’s strategic partner, HLI will help support CPEN members by sharing ...
(Date:10/12/2017)... D.C. (PRWEB) , ... October 12, 2017 , ... ... Cal Dining at the University of California Berkeley, and other leading institutions in ... the buying power of institutions to change the way animals are raised for ...
Breaking Medicine News(10 mins):
(Date:9/27/2017)... and NEW YORK , Sept. 27, 2017  DarioHealth ... and big data solutions, today announced that its MyDario product is expected ... local TV listings for when The Dr. Oz Show airs in your ... The nine-time Emmy ... ...
(Date:9/23/2017)... Sept. 22, 2017 Janssen Biotech, Inc. (Janssen) ... letter from the U.S. Food and Drug Administration (FDA) ... sirukumab for the treatment of moderately to severely active ... clinical data are needed to further evaluate the safety ... active RA. ...
(Date:9/19/2017)... 19, 2017 HistoSonics, Inc., a venture-backed medical device company developing a non-invasive, robotically ... announced three leadership team developments today:   ... ... Tom ... Veteran medical device executive Josh Stopek , PhD, who ...
Breaking Medicine Technology: