Importance of coding co-morbidities for APR-DRG assignment: Focus on cardiovascular and respiratory diseases

Souza, Júlio; Santos, João Vasco; Bolón-Canedo, Verónica; Betanzos, A. Alonso; Alves, Domingos

doi:10.1177/1833358319840575

Cited by 25 publications

(22 citation statements)

References 33 publications

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“…The diagnosis-related group (DRG) included estimators of resource consumption and costs, known as relative weights [20]. The DRG system attributes a relative weight to each DRG based on its cost, with the value of 1 representing the mean global cost.…”

Section: Plos Onementioning

confidence: 99%

Care complexity individual factors associated with adverse events and in-hospital mortality

et al. 2020

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Introduction Measuring the impact of care complexity on health outcomes, based on psychosocial, biological and environmental circumstances, is important in order to detect predictors of early deterioration of inpatients. We aimed to identify care complexity individual factors associated with selected adverse events and in-hospital mortality. Methods A multicenter, case-control study was carried out at eight public hospitals in Catalonia, Spain, from January 1, 2016 to December 31, 2017. All adult patients admitted to a ward or a step-down unit were evaluated. Patients were divided into the following groups based on the presence or absence of three adverse events (pressure ulcers, falls or aspiration pneumonia) and in-hospital mortality. The 28 care complexity individual factors were classified in five domains (developmental, mental-cognitive, psycho-emotional, sociocultural and comorbidity/complications). Adverse events and complexity factors were retrospectively reviewed by consulting patients' electronic health records. Multivariate logistic analysis was performed to identify factors associated with an adverse event and in-hospital mortality. Results A total of 183,677 adult admissions were studied. Of these, 3,973 (2.2%) patients experienced an adverse event during hospitalization (1,673 [0.9%] pressure ulcers; 1,217 [0.7%] falls and 1,236 [0.7%] aspiration pneumonia). In-hospital mortality was recorded in 3,996 patients (2.2%). After adjustment for potential confounders, the risk factors independently associated with both adverse events and in-hospital mortality were: mental status impairments, impaired adaptation, lack of caregiver support, old age, major chronic disease, hemodynamic instability, communication disorders, urinary or fecal incontinence, vascular

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Section: Plos Onementioning

confidence: 99%

Care complexity individual factors associated with adverse events and in-hospital mortality

et al. 2020

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“…16 The a priori identified confounding variables included intensive care unit admission, malignancy, surgery, Charlson Comorbidity Index with age, BMI, concomitant aspirin use, length of stay, and the All Patient-Refined Diagnosis-Related Groups severity-of-illness categories. 17 A 2-tailed test of statistical significance set at P <0.05 was used for the statistical analyses.…”

Section: Methodsmentioning

confidence: 99%

Safety of High-Dose Unfractionated Heparin for Prophylaxis of Venous Thromboembolism in Hospitalized Obese Patients

2020

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Background Optimal dosing of unfractionated heparin (UFH) for thromboprophylaxis in the obese patient population is uncertain because of their high-risk, prothrombotic state and a complexity of pharmacokinetic considerations. Literature on the appropriateness of the use of a higher dose UFH regimen remains unclear and inconsistent. Objective To evaluate the safety of the use of 7500 units every 8 hours ( high-dose) of subcutaneous UFH compared with the use of 5000 units every 8 hours ( standard-dose) of subcutaneous UFH for thromboprophylaxis in obese patients (defined as BMI ≥30 kg/m2). Methods In a retrospective cohort study, 326 adult patients were included, with a BMI ≥30 kg/m2, who were admitted to a large, urban academic medical center between September 1, 2015, and September 1, 2018. Patients received either high-dose or standard-dose UFH for at least 48 hours. The primary end point was the incidence rate of bleeding events, defined as a ≥2-g/dL fall in hemoglobin level or receipt of transfusion of 2 or more units of packed red blood cells (pRBCs) from the start of the UFH order. Results The incidence rate of bleeding was significantly higher in those who received high-dose UFH (43%) compared with those who received standard-dose UFH (29%; P = 0.008). No significant difference was found between venous thromboembolism event rates. Conclusion and Relevance High-dose UFH was associated with an increased bleeding event rate compared with standard-dose UFH in patients with a BMI ≥30 kg/m2. This raises safety concerns about the appropriateness of utilizing this regimen in this population.

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“…Clearly, the problem of missing and inaccurate documentation is concerning, but the studies above that describe the problem did not clearly document the impact of missing data. A study by Souza et al, one of the best papers, examined the fiscal consequences of missing data [7]. Interestingly, although the study was done in Portugal, the Portuguese health system uses DRGs, which are used in the US and elsewhere.…”

Section: Quality Of Ehr Datamentioning

confidence: 99%

Findings from the Health Information Management Section of the 2020 International Medical Informatics Association Yearbook

Bloomrosen¹,

Berner

2020

Yearb Med Inform

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Objectives: To summarize the recent literature and research and present a selection of the best papers published in 2019 in the field of Health Information Management (HIM) and Health Informatics. Methods: A systematic review of the literature was performed by the two section editors with the help of a medical librarian. The search through bibliographic databases for HIM-related papers was achieved using both MeSH headings and keywords in titles and abstracts. A shortlist of 15 candidate best papers was first selected by section editors before being peer-reviewed by independent external reviewers. Results: Over half of the 15 papers addressed the issue of data quality in the electronic health record (EHR). In addition to the focus on data quality, there were papers on other topics of long-standing interest to the field of HIM. These topics include privacy, security, and confidentiality of health information, comparability of different coding vocabularies, classifications and terminologies, and the HIM workforce. Finally, there were papers on newer topics for the HIM field, including mobile Health (mHealth), EHR use by public health departments, and usability of different strategies for displaying information in the EHR. Conclusions: Traditional HIM concerns about HIM practice and workforce as well as issues about data in the EHR including data quality, coding, and privacy and confidentiality continue to be a large part of the HIM research literature. However, newer topics which reflect innovative and emerging technologies, usability assessments, and the application of the EHR outside the traditional clinical setting are starting to appear and more research is needed on these newer areas.

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Importance of coding co-morbidities for APR-DRG assignment: Focus on cardiovascular and respiratory diseases

Cited by 25 publications

References 33 publications

Care complexity individual factors associated with adverse events and in-hospital mortality

Care complexity individual factors associated with adverse events and in-hospital mortality

Safety of High-Dose Unfractionated Heparin for Prophylaxis of Venous Thromboembolism in Hospitalized Obese Patients

Findings from the Health Information Management Section of the 2020 International Medical Informatics Association Yearbook

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