Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
J Hosp Med. 2024 Jun;19(6):505-507. doi: 10.1002/jhm.13351. Epub 2024 Apr 1.
Significant variation in coding intensity among hospitals has been observed and can lead to reimbursement inequities and inadequate risk adjustment for quality measures. Reliable tools to quantify hospital coding intensity are needed. We hypothesized that coded sepsis rates among patients hospitalized with common infections may serve as a useful surrogate for coding intensity and derived a hospital-level sepsis coding intensity measure using prevalence of "sepsis" primary diagnoses among patients hospitalized with urinary tract infection, cellulitis, and pneumonia. This novel measure was well correlated with the hospital mean number of discharge diagnoses, which has historically been used to quantify hospital-level coding intensity. However, it has the advantage of inferring hospital coding intensity without the strong association with comorbidity that the mean number of discharge diagnoses has. Our measure may serve as a useful tool to compare coding intensity across institutions.
我们观察到医院之间的编码强度存在显著差异，这可能导致报销不公平和质量措施的风险调整不足。需要可靠的工具来量化医院的编码强度。我们假设，在因常见感染住院的患者中，编码的败血症发生率可能是编码强度的有用替代指标，并使用尿路感染、蜂窝织炎和肺炎患者的“败血症”主要诊断的患病率来推导医院层面的败血症编码强度指标。该新指标与医院出院诊断的平均值高度相关，这在历史上一直被用于量化医院层面的编码强度。然而，它具有推断医院编码强度的优势，而没有出院诊断平均值与合并症的强烈关联。我们的指标可以作为一种有用的工具，用于比较不同机构之间的编码强度。
