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Int J Qual Health Care. 2014 Oct;26(5):511-5. doi: 10.1093/intqhc/mzu064. Epub 2014 Jul 2.

International variation in the definition of 'main condition' in ICD-coded health data.

Author information

1
Department of Community Health Sciences, University of Calgary, Calgary, Canada.
2
Canadian Institute for Health Information, Ottawa, Canada.
3
Ottawa Hospital Research Institute and Institute for Clinical Evaluative Sciences, Ottawa, Canada.
4
Health Council of Canada, Toronto, Canada.
5
Departments of Internal Medicine and Pediatrics, and Center for Healthcare Policy and Research, University of California Davis, Davis, USA.
6
Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia Department of Medicine, Southern Clinical School, Monash University, Melbourne, Australia.
7
Institut Universitaire de Médecine Sociale et Préventive, Centre, Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
8
Nordic WHO FIC Collaborating Centre, Oslo, Norway.
9
Faculty of Industrial Engineering and Health Care, Niederrhein University of Applied Sciences, Reinarzstrasse 49, Krefeld, Germany.
10
Department of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York, NY, USA.
11
Department of Community Health Sciences, University of Calgary, Calgary, Canada Department of Medicine, University of Calgary, Calgary, Canada.

Abstract

Hospital-based medical records are abstracted to create International Classification of Disease (ICD) coded discharge health data in many countries. The 'main condition' is not defined in a consistent manner internationally. Some countries employ a 'reason for admission' rule as the basis for the main condition, while other countries employ a 'resource use' rule. A few countries have recently transitioned from one of these approaches to the other. The definition of 'main condition' in such ICD data matters when it is used to define a disease cohort to assign diagnosis-related groups and to perform risk adjustment. We propose a method of harmonizing the international definition to enable researchers and international organizations using ICD-coded health data to aggregate or compare hospital care and outcomes across countries in a consistent manner. Inter-observer reliability of alternative harmonization approaches should be evaluated before finalizing the definition and adopting it worldwide.

KEYWORDS:

benchmarking; international classification of disease; measurement of quality; standards

PMID:
24990594
PMCID:
PMC4207866
DOI:
10.1093/intqhc/mzu064
[Indexed for MEDLINE]
Free PMC Article
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