Should diagnosis codes from emergency department data be used for case selection for emergency department key performance indicators?
Stuart C. Howell A , Rachael A. Wills A and Trisha C. Johnston A BA Statistical Analysis and Linkage Team, Queensland Health, GPO Box 48, Brisbane, Qld 4001, Australia.
B Corresponding author. Email: trisha_johnston@health.qld.gov.au
Australian Health Review 38(1) 38-43 https://doi.org/10.1071/AH13026
Submitted: 22 January 2013 Accepted: 30 September 2013 Published: 6 December 2013
Abstract
Objective The aim of the present study was to assess the suitability of emergency department (ED) discharge diagnosis for identifying patient cohorts included in the definitions of key performance indicators (KPIs) that are used to evaluate ED performance.
Methods Hospital inpatient episodes of care with a principal diagnosis that corresponded to an ED-defined KPI were extracted from the Queensland Hospital Admitted Patient Data Collection (QHAPDC) for the year 2010–2011. The data were then linked to the corresponding ED patient record and the diagnoses applied in the two settings were compared.
Results The asthma and injury cohorts produced favourable results with respect to matching the QHAPDC principal diagnosis with the ED discharge diagnosis. The results were generally modest when the QHAPDC principal diagnosis was upper respiratory tract infection, poisoning and toxic effects or a mental health diagnosis, and were quite poor for influenza.
Conclusions There is substantial variation in the capture of patient cohorts using discharge diagnosis as recorded on Queensland Hospital Emergency Department data.
What is known about the topic? There are several existing KPIs that are defined according to the diagnosis recorded on ED data collections. However, there have been concerns over the quality of ED diagnosis in Queensland and other jurisdictions, and the value of these data in identifying patient cohorts for the purpose of assessing ED performance remains uncertain.
What does this paper add? This paper identifies diagnosis codes that are suitable for use in capturing the patient cohorts that are used to evaluate ED performance, as well as those codes that may be of limited value.
What are the implications for practitioners? The limitations of diagnosis codes within ED data should be understood by those seeking to use these data items for healthcare planning and management or for research into healthcare quality and outcomes.
References
[1] Johnston T, Endo T. Data quality issues impacting on reporting on presentations to emergency departments in Queensland hospitals: data quality issues in emergency department data 2007/08 update. Brisbane: Health Statistics Centre, Queensland Health; 2009. Available at http://www.health.qld.gov.au/hic/tech_report/ED2.pdf [verified 18 October 2013][2] Emergency Department Data Collection. Data quality statement. 2010. Adelaide: SA Health. Available at https://www.santdatalink.org.au/available_datasets [verified 18 October 2013]
[3] Information Management and Reporting Directorate. Emergency department data collection data dictionary, Version 1.0. Perth: WA Health; 2007 Available at http://health.wa.gov.au/healthdata/docs/EDDC_dictionary.pdf [verified 18 October 2013]
[4] Centre for Health Record Linkage. Emergency department data collection. Sydney: NSW Department of Health; 2011. Available at http://www.cherel.org.au/data-dictionaries#section2 [verified 18 October 2013]
[5] Access Improvement Service. EDIS reference tables [draft]. Brisbane: Queensland Health; 2012.
[6] National Casemix and Classification Centre. The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM). Wollongong: National Casemix and Classification Centre; 2012.
[7] National Centre for Classification in Health. Australian coding standards for ICD-10-AM and ACHI, 7th edn. Lidcombe: National Centre for Classification in Health; 2010.
[8] Data Collections Unit. 2011–2012 Queensland Hospital Admitted Patient Data Collection (QHAPDC). Manual of instructions and procedures for the reporting of QHAPDC data, Version 1. Brisbane: Queensland Health; 2011.
[9] Australasian College for Emergency Medicine and Australian Council on Healthcare Standards Performance and Outcomes Service. Draft emergency medicine indicators: clinical indicators user’s manual v5.0. 2011.
[10] Access Improvement Service. XXX. Brisbane: Queensland Health. 2012. Available at http://qheps.health.qld.gov.au/patientflow/performance.htm [verified 18 October 2013]
[11] National Mental Health Performance Subcommittee. Mental Health Alcohol and Other Drugs Directorate. The Fourth National Mental Health Plan Measurement Strategy. 2011. Brisbane: Queensland Health. Available at http://www.health.gov.au/internet/mhsc/publishing.nsf/Content/BDA139CFA06F6EC8CA257A61000078A3/$File/meas.pdf [verified 18 October 2013]
[12] Independent Hospital Pricing Authority. The pricing framework of Australian Public Hospital services. 2012. Available at http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/pricing-framework-lp [verified 18 October 2013]
[13] Independent Hospital Pricing Authority. Activity based funding. URG Grouper user guide. ABF data grouping and modelling. 0000. Available at http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/45151D40E8573B1CCA25796E0013F415/$File/URG%20Grouper%20-%20User%20documentation%20v1.2.0.0.pdf [verified 18 October 2013]
[14] Hansen DP, Kemp ML, Mills SR, Mercer MA, Frosdick PA, Lawley MJ. Developing a national emergency department data reference set based on SNOMED CT. Med J Aust 2011; 194 S8–10.
| 21401491PubMed |
[15] Australian Classification of Health Interventions (ACHI). National Casemix and Classification Centre. Wollongong: ACHI; 2011
