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Identifying hospital-wide harm: a set of ICD-9–CM-coded conditions associated with increased cost, length of stay, and risk of mortality.

Bankowitz RA, Doyle B, Duan M, et al. Identifying hospital-wide harm: a set of ICD-9-CM-coded conditions associated with increased cost, length of stay, and risk of mortality. Am J Med Qual. 2014;29(5):373-80. doi:10.1177/1062860613503896.

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December 17, 2014
Bankowitz RA, Doyle B, Duan M, et al. Am J Med Qual. 2014;29(5):373-80.

This study used hospital administrative data to identify a set of hospital-acquired conditions associated with preventable harm (e.g., increased mortality rates, longer length of stay, and higher cost) beyond the standard Centers for Medicare and Medicaid Services indicators using ICD-9 codes. Researchers identified a set of 138 hospital-acquired conditions, which they found to be present in 16% of inpatient admissions, much higher than the 1% of admissions in which standard hospital-acquired conditions are present. The authors suggest that current practice identifies only a small proportion of hospital-acquired complications. Although the study's proposed approach identifies more complications (i.e., increased sensitivity), not all of them can be attributed with certainty to the quality of hospital care (i.e., decreased specificity). A previous AHRQ WebM&M interview underscored the need to accurately determine preventability when withholding payment for unsafe care, raising some concerns about an approach with less specificity.

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Bankowitz RA, Doyle B, Duan M, et al. Identifying hospital-wide harm: a set of ICD-9-CM-coded conditions associated with increased cost, length of stay, and risk of mortality. Am J Med Qual. 2014;29(5):373-80. doi:10.1177/1062860613503896.