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Insight from 19-State Analysis: Improving State Hospital Discharge Data

This study analyzes 19-state hospital discharge data to identify issues and provide recommendations for improving data quality. It explores coding standards, data problems, and the need for standardized codes.

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Insight from 19-State Analysis: Improving State Hospital Discharge Data

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  1. Improving State Hospital Discharge Data: Insight from a 19-State AnalysisBruce A LawrenceHarold B WeissTed R Millerlawrence@pire.org

  2. E-coded 19-State Hospital Discharge Data Set, 1997 >50% of the US population

  3. Coding Standards in 23 States

  4. Intensively Cleaned Dxs & E Codes • 17.7 M discharges • Selected injuries by Dx or E code • 6.8% (1.21 M) injury discharges • Dropped late effects & rehab admits • 1.13 M acute injury discharges • 93.4% of injuries were acute: ranged from 90% in NH & WA to 96% in NJ

  5. 88.1% E Coded >90% 85-89% 75-79% 65-70%

  6. 5.1% E Coded As Other/ Unspecified 1.6%-2.9% 3.0%-4.9% 5.0-7.0% 11.9%

  7. 230,000 cases where the principal diagnosis was not acute injury: 22.3% of all acute injuries

  8. Searched All Fields for a Valid Primary Injury Diagnosis • Primary injury diagnosis is generally of good quality • 98.1% specific, including just 2.7% not in the 800-995 range • 1.1% other/unspecified • 0.8% E code but no injury Dx • 4.1%-4.4% E code but no injury Dx in UT & VA; 20% self-inflicted

  9. Common Data Problems • Invalid Dxs & E codes - Isolated typos - Systematic facility-specific miscoding • Misuse of E codes - Falls that do not cause treated injury - Overexertion for heart/respiratory conditions - Intracranial hemorrhage coded as illness to increase reimbursement • Inconsistency between Dx & E codes for substances involved in poisoning • Duplicate records: the old record is not deleted when a record is updated/corrected

  10. 5 of 22 states had readmission tags or encrypted patient IDs: 4%-8% are readmits

  11. Conclusion • Need to clean state HDS data & related HCUP National Inpatient Sample injury data before using them: hard w/o hospital IDs - major HCUP NIS limitation • Other/unspecified E codes or E codes w/o injury Dxs are problems in some states • 6.6% of injury discharges are late effects or rehab • 4%-8% of acute injury discharges are readmissions

  12. The principal Dx field codes a complication rather than the underlying injury in 17-22% of cases. We advise scanning 3 Dxs + E codes to identify injury discharges. A study is needed to see if cases with complications codes listed first have bad long-term outcome • Only 2.7% of E-coded cases had primary injury Dxs below 800. These typically were back injury, cellulitis & abscess, maternal injury, coma, or anoxic brain damage. • Need standardized US codes for payer type • States need to adopt the standard codes that have been established

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