Cram Peter, Bozic Kevin J, Callaghan John J, Lu Xin, Li Yue
Division of General Internal Medicine, University of Toronto, Toronto, ON, Canada; University Health Network/Mount Sinai Hospital, Toronto, ON, Canada; Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California.
J Arthroplasty. 2014 May;29(5):923-928.e2. doi: 10.1016/j.arth.2013.11.002. Epub 2013 Nov 8.
Administrative data are commonly used to evaluate total joint arthroplasty, but analyses have historically been limited by the inability to capture which conditions were present-on-admission (POA). In 2007 Medicare began allowing hospitals to submit POA information. We used Medicare Part A data from 2008 to 2009 to examine POA coding for three common complications (pulmonary embolism [PE], hemorrhage/hematoma, and infection) for primary and revision total knee arthroplasty (TKA). POA information was complete for 60%-75% of complications. There was no evidence that higher TKA volume hospitals or major teaching hospitals were more likely to accurately code POA data. The percentage of complications coded as POA ranged from 6.4% (PE during index admission for primary TKA) to 68.8% (infection during index admission for revision TKA). Early experience suggests that POA coding can significantly enhance the value of Medicare data for evaluating TKA outcomes.
行政数据通常用于评估全关节置换术，但以往的分析因无法获取入院时存在的病情（POA）而受到限制。2007年，医疗保险开始允许医院提交POA信息。我们使用2008年至2009年医疗保险A部分的数据，来检查初次和翻修全膝关节置换术（TKA）三种常见并发症（肺栓塞[PE]、出血/血肿和感染）的POA编码情况。60%-75%的并发症的POA信息完整。没有证据表明TKA手术量较高的医院或大型教学医院更有可能准确编码POA数据。编码为POA的并发症百分比范围从6.4%（初次TKA索引住院期间的PE）到68.8%（翻修TKA索引住院期间的感染）。早期经验表明，POA编码可以显著提高医疗保险数据在评估TKA结果方面的价值。
