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Consistency of pressure injury documentation across interfacility transfers
  1. Lee Squitieri1,2,
  2. David A Ganz3,4,5,
  3. Carol M Mangione1,6,7,
  4. Jack Needleman7,
  5. Patrick S Romano8,
  6. Debra Saliba1,4,5,9,
  7. Clifford Y Ko7,10,11,
  8. Daniel A Waxman5,12
  1. 1UCLA Robert Wood Johnson Clinical Scholars Program, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  2. 2Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
  3. 3Division of Geriatrics, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  4. 4Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
  5. 5Health Unit, RAND, Santa Monica, California, USA
  6. 6Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  7. 7Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
  8. 8Department of Medicine, University of California, Davis, Sacramento, California, USA
  9. 9JH Borun Center, UCLA, Los Angeles, California, USA
  10. 10Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  11. 11Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
  12. 12Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  1. Correspondence to Dr Lee Squitieri; Lee.Squitieri{at}gmail.com

Abstract

Background Hospital-acquired pressure injuries (HAPIs) are publicly reported in the USA and used to adjust Medicare payment to acute inpatient facilities. Current methods used to identify HAPIs in administrative claims rely on hospital-reported present-on-admission (POA) data instead of prior patient health information.

Objective To study the reliability of claims data for HAPIs and pressure injury (PI) stage by evaluating diagnostic coding agreement across interfacility transfers.

Methods Using the 2012 100% Medicare Provider and Analysis Review file, we identified all fee-for-service acute inpatient discharge records with a PI diagnosis among Medicare patients 65 years and older. We then identified additional facility claims (eg, acute inpatient, long-stay inpatient or skilled nursing facility) belonging to the same patient who had either (1) admission within 1day of hospital discharge or (2) discharge within 1day of hospital admission. Multivariable logistic regression and stratified kappa statistics were used to measure coding agreement between transferring and receiving facilities in the presence or absence of a PI diagnosis at the time of patient transfer and PI stage category (early vs advanced).

Results In our comparison of claims data between transferring and receiving facilities, we observed poor agreement in the presence or absence of a PI diagnosis at the time of transfer (36.3%, kappa=0.03) and poor agreement in PI stage category (74.3%, kappa=0.17). Among transfers with a POA PI reported by the receiving hospital, only 34.0% had a PI documented at the prior transferring facility.

Conclusions The observed discordance in PI documentation and staging between transferring and receiving facilities may indicate inaccuracy of HAPI identification in claims data. Future research should evaluate the accuracy of hospital-reported POA data and its impact on PI quality measurement.

  • Transitions In Care
  • Quality Measurement
  • Patient Safety
  • Health Policy
  • Financial Incentives

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Footnotes

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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