1 Shepheard Health Management Consultants, Australia.
2 Victorian Agency for Health Information, Australia.
Health Inf Manag. 2019 May;48(2):76-86. doi: 10.1177/1833358318770282. Epub 2018 Apr 24.
The Council of Australian Governments has focused the attention of health service managers and state health departments on a list of hospital-acquired complications (HACs) proposed as the basis of funding adjustments for poor quality of hospital inpatient care. These were devised for the Australian Commission on Safety and Quality in Health Care as a subset of their earlier classification of hospital-acquired complications (CHADx) and designed to be used by health services to monitor safety performance for their admitted patients.
To improve uptake of both classification systems by clarifying their purposes and by reconciling the ICD-10-AM code sets used in HACs and the Victorian revisions to the CHADx system (CHADx+).
Frequency analysis of individual clinical codes with condition onset flag (COF 1) included in both classification systems using the Victorian Admitted Episodes Dataset for 2014/2015 ( n = 2,623,275 separations). Narrative description of the resulting differences in definition of "adverse events" embodied in the two systems.
As expected, a high proportion of ICD-10-AM codes used in the HACs also appear in CHADx+, and given the wider scope of CHADx+, it uses a higher proportion of all COF 1 diagnoses than HACs (82% vs. 10%). This leads to differing estimates of rates of adverse events: 2.12% of cases for HACs and 11.13% for CHADx+. Most CHADx classes (70%) are not covered by the HAC system; discrepancies result from the exclusion from HACs of several major CHADx+ groups and from a narrower definition of detailed HAC classes compared with CHADx+. Case exclusion criteria in HACs (primarily mental health admissions) resulted in a very small proportion of discrepancies (0.13%) between systems.
Issues of purpose and focus of these two Australian systems, HACs for clinical governance and CHADx+ for local quality improvement, explain many of the differences between them, and their approach to preventability, and risk stratification.
A clearer delineation between these two systems using routinely coded hospital data will assist funders, clinicians, quality improvement professionals and health information managers to understand discrepancies in case identification between them and support their different information needs.
澳大利亚政府理事会已将卫生服务管理者和州立卫生部的注意力集中在一系列医院获得性并发症（HACs）上，这些并发症被提议作为调整因住院患者医疗质量差而导致的资金的基础。这些并发症是由澳大利亚安全与质量卫生保健委员会设计的，作为其早期分类的医院获得性并发症（CHADx）的子集，旨在供卫生服务机构用于监测其住院患者的安全绩效。
通过阐明其目的并协调 HACs 和维多利亚州对 CHADx 系统（CHADx+）的修订中使用的 ICD-10-AM 代码集，提高这两个分类系统的采用率。
使用 2014/2015 年维多利亚州入院病例数据集（n = 2,623,275 例）对两个分类系统中包含的个体临床代码（条件起始标志 COF 1）进行频率分析。描述两个系统中所包含的“不良事件”定义的差异。
正如预期的那样，HACs 中使用的大量 ICD-10-AM 代码也出现在 CHADx+中，由于 CHADx+的范围更广，它使用的所有 COF 1 诊断的比例高于 HACs（82% 对 10%）。这导致了不良事件发生率的不同估计：HACs 为 2.12%，CHADx+为 11.13%。大多数 CHADx 类（70%）未被 HAC 系统涵盖；差异源于将几个主要的 CHADx+组排除在 HACs 之外，以及与 CHADx+相比，对详细 HAC 类的定义更窄。HACs 中的病例排除标准（主要是心理健康入院）导致系统之间的差异非常小（0.13%）。
这两个澳大利亚系统，HACs 用于临床治理和 CHADx+用于本地质量改进，其目的和重点的问题解释了它们之间的许多差异，以及它们对可预防和风险分层的方法。
使用常规编码的医院数据更清晰地划分这两个系统将有助于资助者、临床医生、质量改进专业人员和卫生信息管理人员了解它们之间在病例识别方面的差异，并支持他们不同的信息需求。
