Assessing Quality of Care for Hospitalized Medicare Patients with Hip FractureUsing Coded Diagnoses from the Medicare Provider Analysis and Review Files

摘要

The study assessed the validity of using Medicare hospital claims data toidentify adverse events following repair of hip fracture. The study identified adverse events from diagnostic and procedure codes (International Classification of Diseases, 9th Revision, Clinical Modification) taken from claims records and compared them with events identified from medical record abstracts. The medical record abstracts were considered the gold standard: the comparison was to determine the accuracy and completeness of claims data for identifying adverse events. The report found many discrepancies between the claims data and the medical record abstracts. Some conditions, such as pneumonia, hip joint infection, and pulmonary embolism showed good agreement. The report noted that ICD-9-CM codes were less likely to be assigned if the patient was discharged dead. It also noted that many of the diagnostic codes used by HCFA to define adverse events frequently referred to conditions predating the operation. These conditions are actually comorbidities rather than adverse events. The report contains several recommendations for improving HCFA's method of identifying adverse events.