Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, 95 Bertmount Ave, Toronto, ON, M4M 2X8, Canada.
Health Serv Res. 2012 Jun;47(3 Pt 1):984-1007. doi: 10.1111/j.1475-6773.2011.01340.x. Epub 2011 Oct 27.
To examine the impact of diagnostic coding error on estimates of hospital costs attributable to adverse events.
Original and reabstracted medical records of 9,670 complex medical and surgical admissions at 11 hospital corporations in Ontario from 2002 to 2004. Patient specific costs, not including physician payments, were retrieved from the Ontario Case Costing Initiative database.
Adverse events were identified among the original and reabstracted records using ICD10-CA (Canadian adaptation of ICD10) codes flagged as postadmission complications. Propensity score matching and multivariate regression analysis were used to estimate the cost of the adverse events and to determine the sensitivity of cost estimates to diagnostic coding error.
Estimates of the cost of the adverse events ranged from $16,008 (metabolic derangement) to $30,176 (upper gastrointestinal bleeding). Coding errors caused the total cost attributable to the adverse events to be underestimated by 16 percent. The impact of coding error on adverse event cost estimates was highly variable at the organizational level.
Estimates of adverse event costs are highly sensitive to coding error. Adverse event costs may be significantly underestimated if the likelihood of error is ignored.
研究诊断编码错误对不良事件所致医院成本估计的影响。
2002 年至 2004 年，在安大略省的 11 家医院对 9670 例复杂的内科和外科住院患者的原始和重新摘录病历进行了研究。从安大略病例成本核算倡议数据库中检索了患者特定的成本，但不包括医生的报酬。
使用 ICD10-CA（ICD10 的加拿大适应性）编码在原始和重新摘录的记录中识别不良事件，这些编码标记为入院后并发症。采用倾向评分匹配和多变量回归分析来估计不良事件的成本，并确定成本估计对诊断编码错误的敏感性。
不良事件的成本估计范围从 16008 美元（代谢紊乱）到 30176 美元（上消化道出血）。编码错误导致不良事件的总归因成本低估了 16%。编码错误对不良事件成本估计的影响在组织层面上差异很大。
不良事件成本的估计对编码错误非常敏感。如果忽略错误的可能性，不良事件的成本可能会被严重低估。
