Reliability of Medicare Hospital Discharge Records Report of a Study (1977) / Chapter Skim
Currently Skimming:
Summary and Recommendations
Summary and Recommendations
Pages 61-70
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 61... ...
, since baseline data were not gathered prior to implementing the PSRO program. The study is a logical extension of an earlier TOM examination of the reliability of hospital utilization data compiled by private abstracting services and based on abstracts of medical records.
|
From page 62... ...
Despite these limitations, it is possible to draw some rather firm conclusions about the accuracy of information on diagnoses and procedures contained on the Medicare record and the factors that appear to influence reliability. The credibility of the findings is heightened by the striking similarity to the findings of the earlier study of the reliability of utilization data processed by private abstracting firms.
|
From page 63... ...
This was particularly evident for chronic ischemic heart disease, acute myocardial infarction, diabetes, congestive heart failure, and intestinal obstruction without mention of hernia. Since the presence of additional diagnoses influences the accuracy of data, adjustments in analysis might be made if the fact of co-morbidity were accurately noted on the Medicare claim form.
|
From page 64... ...
For most diagnoses with high discrepancy rates and a likelihood of co-morbidity where the TOM abstract was found to be correct (especially chronic ischemic heart disease, diabetes, and congestive heart failure) , discrepancies occurred primarily because of erroneous selection of principal diagnosis (an ordering discrepancy)
|
From page 65... ...
More specifically, when there were discrepancies between the Medicare record and IOM abstract, the information on principal diagnosis submitted by the hospital on the claim form did not accurately reflect the patient's condition for about seventy percent of the cases. Comparable figures for principal procedure were about forty-three percent for all claims for which discrepancies were detected and about fiftyfive percent when the analysis was confined to cases for which the Medicare record indicated that a procedure had been perforated.
|
From page 66... ...
ION admission rates were higher in the earlier study as well -- again, with the notable exception of chronic ischemic heart disease. 'The earlier study also suggested that diagnostic-specific lengths-ofstay based on abstract service data may over-estimate the average stay; consistent differences for length-of-stay were not detected in the Medicare study.
|
From page 67... ...
Because of the frequent difficulty encountered by the field team in determining which of several diagnoses should be regarded as principal, the care with which the physician completed the record was also considered as an influential structural variable, even though it was not measured directly. The cumulative effect of both studies elicits serious reservations about the adequacy of existing hospital utilization data on diagnoses and procedures.
|
From page 68... ...
4. If the Medicare data are to be used by Professional Standards Review Organizations for either routine review activities or program evaluation, many of the recommendations from the earlier study are also appropriate here.
|
From page 69... ...
8. If the current hospital practice of determining principal diagnosis and principal procedure by referring to the first-listed item on the face sheet of the medical record continues, several steps should be taken to assure that the first-listed item is appropriately selected.
|
From page 70... ...
The National Center for Health Statistics' Hospital Discharge Survey has recently incorporated dHDuS definitions for principal diagnosis and principal procedure. Therefore, the Department's activities might begin with an assessment of the reliability of that information and an exploration of the potential for expanding the survey to include information needed for management, reimbursement, program evaluation, and epidemiological purposes.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.