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International variation in the definition of 'main condition' in ICD-coded health data.
Quan H1,
Moskal L2,
Forster AJ3,
Brien S4,
Walker R1,
Romano PS5,
Sundararajan V6,
Burnand B7,
Henriksson G8,
Steinum O8,
Droesler S9,
Pincus HA10,
Ghali WA11.
- 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.
© The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.
KEYWORDS:
benchmarking; international classification of disease; measurement of quality; standards
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