Identifying In-Hospital Venous Thromboembolism (VTE)
- 1 February 2008
- journal article
- research article
- Published by Wolters Kluwer Health in Medical Care
- Vol. 46 (2) , 127-132
- https://doi.org/10.1097/mlr.0b013e3181589b92
Abstract
Efforts to identify hospital-acquired complications from claims data by applying exclusion rules to discharge diagnosis codes exhibit low positive predictive value (PPV). The PPV improves when a variable is added to each secondary diagnosis to indicate whether the condition was "present-on-admission" (POA) or "hospital-acquired". Such indicator variables will soon be required for Medicare reimbursement. No estimates are available, however, of the proportion of hospital-acquired complications that are missed (sensitivity) using either exclusion rules or indicator variables. We estimated sensitivity, specificity, PPV, and negative predictive value (NPV) of claims-based approaches using the Rochester Epidemiology Project (REP) venous thromboembolism (VTE) cohort as a "gold standard." All inpatient encounters by Olmsted County, Minnesota, residents at Mayo Clinic-affiliated hospitals 1995-1998 constituted the at-risk-population. REP-identified hospital-acquired VTE consisted of all objectively-diagnosed VTE among County residents 1995-1998, whose onset of symptoms occurred during inpatient stays at these hospitals, as confirmed by detailed review of County residents' provider-linked medical records. Claims-based approaches used billing data from these hospitals. Of 37,845 inpatient encounters, 98 had REP-identified hospital-acquired VTE; 47 (48%) were medical encounters. NPV and specificity were >99% for both claims-based approaches. Although indicator variables provided higher PPV (74%) compared with exclusion rules (35%), the sensitivity for exclusion rules was 74% compared with only 38% for indicator variables. Misclassification was greater for medical than surgical encounters. Utility and accuracy of claims data for identifying hospital-acquired conditions, including POA indicator variables, requires close attention be paid by clinicians and coders to what is being recorded.Keywords
This publication has 22 references indexed in Scilit:
- Modifying DRG-PPS to Include Only Diagnoses Present on AdmissionMedical Care, 2007
- Finally Present on Admission but Needs AttentionMedical Care, 2007
- Failure to RescueMedical Care, 2007
- Accuracy of Hospital Report Cards Based on Administrative DataHealth Services Research, 2006
- Does Date Stamping ICD‐9‐CM Codes Increase the Value of Clinical Information in Administrative Data?Health Services Research, 2005
- ICD-9-CM codes poorly indentified venous thromboembolism during pregnancyJournal of Clinical Epidemiology, 2004
- Uptake of new treatment strategies for deep vein thrombosis: an international auditInternational Journal for Quality in Health Care, 2004
- Distinguishing hospital complications of care from pre-existing conditionsInternational Journal for Quality in Health Care, 2004
- The Threat to Medical-Records ResearchNew England Journal of Medicine, 1997
- Identifying Complications of Care Using Administrative DataMedical Care, 1994