Pneumonia coding practices may skew hospital performance outcomes

Main Point:

Variations in coding practices related to pneumonia cases may bias efforts to compare quality of care among hospitals.

Published in:

Annals of Internal Medicine

Study Further:

Pneumonia is the most common reason for emergency hospitalization in the United States, making it an appropriate target for quality improvement initiatives and public reporting of hospital quality. Hospital risk-standardized mortality rates for pneumonia are publicly reported but exclude more severe cases of pneumonia, which are coded as sepsis or respiratory failure with pneumonia as a secondary diagnosis.

Researchers studied hospital records for 329 U.S. hospitals to examine the effect of the definition of pneumonia on hospital mortality rates. The records showed that the risk-standardized mortality rate tended to increase when sepsis or respiratory failure were included in a broader definition of pneumonia in hospitals that assigned these codes to a greater proportion of patients and to decrease when hospitals applied these codes to a smaller proportion of cases.

The researchers conclude that performance measures based on pneumonia coding may misclassify some hospitals and weaken confidence in public reporting.

Reference:

M.B. Rothberg, P.S. Pekow, A. Priya, and P.K. Lindenauer. Variation in Diagnostic Coding of Patients With Pneumonia and Its Association With Hospital Risk-Standardized Mortality Rates: A Cross-sectional Analysis. Annals of Internal Medicine (2014), 160(6), 380-388. http://www.annals.org/article.aspx?doi=10.7326/M13-1419