Australian Centre for Economic Research on Health, University of Queensland, Brisbane, QLD, Australia.
Med J Aust. 2009 Nov 16;191(10):544-8. doi: 10.5694/j.1326-5377.2009.tb03307.x.
To develop a tool to allow Australian hospitals to monitor the range of hospital-acquired diagnoses coded in routine data in support of quality improvement efforts.
Secondary analysis of abstracted inpatient records for all episodes in acute care hospitals in Victoria for the financial year 2005-06 (n=2.032 million) to develop a classification system for hospital-acquired diagnoses; each record contains up to 40 diagnosis fields coded with the ICD-10-AM (International Classification of Diseases, 10th revision, Australian modification).
The Classification of Hospital Acquired Diagnoses (CHADx) was developed by: analysing codes with a "complications" flag to identify high-volume code groups; assessing their salience through an iterative review by health information managers, patient safety researchers and clinicians; and developing principles to reduce double counting arising from coding standards.
The dataset included 126,940 inpatient episodes with any hospital-acquired diagnosis (complication rate, 6.25%). Records had a mean of three flagged diagnoses; including unflagged obstetric and neonatal codes, 514,371 diagnoses were available for analysis. Of these, 2.9% (14,898) were removed as comorbidities rather than complications, and another 118,640 were removed as redundant codes, leaving 380,833 diagnoses for grouping into CHADx classes. We used 4345 unique codes to characterise hospital-acquired conditions; in the final CHADx these were grouped into 144 detailed subclasses and 17 "roll-up" groups.
Monitoring quality improvement requires timely hospital-onset data, regardless of causation or "preventability" of each complication. The CHADx uses routinely abstracted hospital diagnosis and condition-onset information about in-hospital complications. Use of this classification will allow hospitals to track monthly performance for any of the CHADx indicators, or to evaluate specific quality improvement projects.
开发一种工具，使澳大利亚医院能够监测常规数据中编码的医院获得性诊断范围，以支持质量改进工作。
对维多利亚州急性保健医院 2005-06 财政年度所有住院病例的住院记录进行二次分析（n=203.2 万），以开发医院获得性诊断的分类系统；每个记录包含多达 40 个诊断字段，用 ICD-10-AM（国际疾病分类，第 10 版，澳大利亚修改版）编码。
通过分析带有“并发症”标志的代码来识别高容量代码组，开发一种分类系统（CHADx）；通过卫生信息经理、患者安全研究人员和临床医生的迭代审查评估其显著性；并制定原则以减少因编码标准而导致的重复计数。
数据集包括 126940 例有任何医院获得性诊断的住院病例（并发症发生率为 6.25%）。记录平均有三个标记的诊断；包括未标记的产科和新生儿代码，共有 514371 个诊断可用于分析。其中，2.9%（14898 个）被视为合并症而不是并发症，另外 118640 个被视为冗余代码，留下 380833 个诊断用于分组到 CHADx 类别中。我们使用了 4345 个独特的代码来描述医院获得性疾病；在最终的 CHADx 中，这些疾病被分为 144 个详细的子类和 17 个“汇总”组。
监测质量改进需要及时的医院发病数据，无论每个并发症的原因或“可预防”性如何。CHADx 使用常规提取的医院诊断和发病信息来描述医院内并发症。使用这种分类方法，医院可以跟踪任何 CHADx 指标的每月绩效，或评估特定的质量改进项目。
