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Squitieri L, Waxman DA, Mangione CM, Saliba D, Ko CY, Needleman J, Ganz DA, et al.
Health services research. Date of publication 2018 Aug 1;volume 53 Suppl 1():2970-2987.
1. Health Serv Res. 2018 Aug;53 Suppl 1:2970-2987. doi: 10.1111/1475-6773.12822. Epub 2018 Jan 25. Evaluation of the Present-on-Admission Indicator among Hospitalized Fee-for-Service Medicare Patients with a Pressure Ulcer Diagnosis: Coding Patterns and Impact on Hospital-Acquired Pressure Ulcer Rates. Squitieri L(1)(2), Waxman DA(3)(4), Mangione CM(1)(5)(6), Saliba D(1)(3)(7)(8), Ko CY(6)(9)(10), Needleman J(6), Ganz DA(3)(6)(7)(11). Author information: (1)UCLA Robert Wood Johnson Clinical Scholars Program, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA. (2)Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA. (3)Health Unit, RAND, Santa Monica, CA. (4)Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA. (5)Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA. (6)Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA. (7)Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA. (8)JH Borun Center, UCLA, Los Angeles, CA. (9)Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA. (10)Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA. (11)Division of Geriatrics, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA. OBJECTIVES: To evaluate national present-on-admission (POA) reporting for hospital-acquired pressure ulcers (HAPUs) and examine the impact of quality measure exclusion criteria on HAPU rates. DATA SOURCES/STUDY SETTING: Medicare inpatient, outpatient, and nursing facility data as well as independent provider claims (2010-2011). STUDY DESIGN: Retrospective cross-sectional study. DATA COLLECTION/EXTRACTION METHODS: We evaluated acute inpatient hospital admissions among Medicare fee-for-service (FFS) beneficiaries in 2011. Admissions were categorized as follows: (1) no pressure ulcer diagnosis, (2) new pressure ulcer diagnosis, and (3) previously documented pressure ulcer diagnosis. HAPU rates were calculated by varying patient exclusion criteria. PRINCIPAL FINDINGS: Among admissions with a pressure ulcer diagnosis, we observed a large discrepancy in the proportion of admissions with a HAPU based on hospital-reported POA data (5.2 percent) and the proportion with a new pressure ulcer diagnosis based on patient history in billing claims (49.7 percent). Applying quality measure exclusion criteria resulted in removal of 91.2 percent of admissions with a pressure injury diagnosis from HAPU rate calculations. CONCLUSIONS: As payers and health care organizations expand the use of quality measures, it is important to consider how the measures are implemented, coding revisions to improve measure validity, and the impact of patient exclusion criteria on provider performance evaluation. © Health Research and Educational Trust. DOI: 10.1111/1475-6773.12822 PMCID: PMC6056601 PMID: 29552746 [Indexed for MEDLINE]
Appears in following Topics:
Pressure Ulcers/Injuries - Classification/Staging