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Reliability of Medicare Hospital Discharge Records: Report of a Study (1977)
Institute of Medicine (IOM)

Page
115
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Page
115
Front Matter (R1-R6)
Table of Contents (R7-R8)
Foreword (R9-R10)
Introduction (1-4)
Study Methods (5-22)
Analysis (23-60)
Summary and Recommendations (61-70)
Appendix A Bibliography (71-72)
Appendix B Sample Letter to Hospital Administrators (73-74)
Appendix C Diagnostic Codes Included as Components of the Sample of Medicare Records (75-84)
Appendix D IOM Re-abstracting Form, General Instructions for Field Team, and Specific Instructions for IOM Re-abstracting Form (85-104)
Appendix E Informal Checklist (105-106)
Appendix F Reliability of Field Work (107-114)
Appendix G Percent of Abstracts with no Discrepancy for each Diagnosis Included as a Component of the Sample of Medicare Records (115-120)
Appendix H Net and Gross Difference Rates in Designation of Principal Diagnosis (Based on Four-Digit Comparisons of Specific Diagnosis) (121-124)
Appendix I General Comparison of Assessment of the Reliability of Medicare Records Maintained by the Health Care Financing Administration and Hospital Discharge Abstracts Compiled by Private Abstract Services (125-126)
Appendix J Comparison of the Reliability of HCFA Medicare Records and Private Abstract Service Medicare Abstracts for Selected Diagnoses Common to both Studies (127-128)
Appendix K Standard Errors and Confidence Intervals for Statistics Based on Medicare Data (129-131)
Appendix L Standard Errors and Confidence Intervals for Statistics Based on Data from Private Abstracting Services (132-133)
Appendix M Selected Examples of Principal Procedures not Listed in CPT, as Determined by the IOM Field Team Members (134-134)

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OCR for page 115
Append ix G PERCENT OF ABSTRACTS WITH NO DISCREPANCY FOR EACH DIAGNOS IS INCLUDED AS A COMPONENT OF THE SAMPLE OF ~DICARE RECORDS* Diagno sis rel ated group Sub- groups 1. Ischemic heart disease except AMI Speci f ic . · . alagnos~ s Re sidual . . . alagnosls Cerebrovascul ar di seases Specific . . . alagnosls Residual . . . alagnosls 3. Fractures Spec i fic . . ~ .lagnosls Residual t ~ ~ a 1agnosls Chron ic i schem ic heart disease Subacute ischemic heart disease ~ satellite) Angina pec torts Asymptomat ic ischemic heart di sease Cerebrovascular di seases* None Fracture, neck of femur* Fracture of other and unspecified parts of femur satellite) 115 .. Percent with no discrep- ancy N - Total un- weighted 36.8 352 34.1 21.6 8 - 58.5 320 - 62.0 6

OCR for page 116
Diagno sis rel ated group - Di seases of the eye Spec i fic . . c .lagnosls Re sidual . . . alagnosls Sub- groups Frac ture o f skull, spine, and trunk Fracture of upper 1 imb Frac tures of lower 1 imb; excludes fractures of femur Catarac t* Inf lammatory di seases of the eye Other diseases and conditions 0 f the eye; excludes cataract and bl inane s s Ac ute myoc ard i al in f arc t ion Spec i fic . . . alagnosls Residual diagnosis 6. 116 Append ix G Total Perc ent wi th no discrep- weighted ancy un- N 79 .2 39 56.9 34 51.6 21 97 .4 242 60.8 75.3 57.6 Acute myoc ard ial in f arc t ion none Hernia of abdominal cavity Spec i fic . . . alagnosls Inguinal hernia without mention of ob struction 6 88.1 15 65.8 211 96.7 140

OCR for page 117
117 Append ix G . . D~agno S1S rel ated group Sub- groups Percent Total wi th no un- discrep- weighted ancy N . . . Residual . . d 1agnosls 7. Diabetes mellitus Spec if ic . . c ,lagnosls Residual . . . alagnosls Inguinal hernia with ob s true t ion ~ satel 1 ite) Other hernia o f abdominal cavity without mention of obstruction Other hernia o f re s idual abdom in al cavity with ob- s true t ion Diabete s* mel 1 itus none 8. Diseases of the prostate Spec i fic e @ ~ .lagnosls Residual . . . alagnosls 9. Pneumonia Spec i fic . . c .lagnosls Hyperplasia of prostate Pro statiti s and other disease s of the prostate Broncho pnelm~onia organism not specified and pneumonia organism and type not spec i f fed 85.9 14 74.7 57 81.4 5 49.7 224 87.1 229 75.9 17.6 8 2 86 .3 46 72.5 163

OCR for page 118
118 Append ix G Percent Total . . . . Diagnosis with no un- related Sub- discrep- weighted Residual Pneumonia, 100.0 3 diagnosis type and 44.2 9 organism 0.0 1 specified 100.0 1 0.0 1 10. Diseases of the gall bladder and bile duct Spec if ic Cholel ithiasis 66 .3 135 diagnosis and chole- 52.2 49 cystitis* Residual Other diseases 30.9 10 diagnosis of the gall bladder and bile duct 11. Miscellaneous diseases of the intestine and peritoneum Specific d iagnosi s Inte st in al oh struction without mention of hem ia 58.1 97 Residual Peritonitis, 64.9 5 diagnosis peritoneal 0 .0 1 adhesions, and 46 .8 102 other di seases or the inte st ine and per i toneum 12. Heart failure Spec i fic c diagnoses Congestive heart failure and left ventr icul ar failure 58.5 88

OCR for page 119
119 Append ix G Percent Total Diagno sis with no un- related Sub- discrep- weighted group groups ancy N Residual Acute heart 24. 4 diagnosis failure, undefined 5 13. Enteritis, diverticula, and functional disorders of intestine Specific . · . alagnosls Diverticulosis of intestine 86.5 138 Residual Noninfectious 37.5 2 diagnosis gastroentiritis and colitis, except ulcerative Chronic 79 .2 7 enteritis and ulcerative colitis Functional dis- orders of in- testine 14. Bronchitis 79.2 20 Specific Bronchitis 89.8 146 . . . alagnosls Residual . . dlagno sits None 15 . Mat ignant neoplasm of the respiratory system Specific Malignant neo- 79.9 141 diagnosis prams of bronchus and 1 ung

OCR for page 120
120 Append ix Diagno sis ret ated Sub- group - groups Percent Total wi th no un- di screp- weighted ancy -N Re sidual . . dlagnosls Primary malig- nant neoplasm ~ . or respiratory system except o f bronchus and 1 ung - 22.6 15.8 3 54.0 15 - 2 *Indicates specific or "target" diagnosis used in prior re-abstracting - study .

Representative terms from entire chapter:

diagno sis