Using Present-On-Admission Coding to Improve Exclusion Rules for Quality Metrics: The Case of Failure-to-Rescue

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Research Topic: 

The Agency for Healthcare Research and Quality (AHRQ) patient safety indicator "death among surgical inpatients with serious treatable complications" (or failure-to-rescue) uses rules to exclude complications thought to be present-on-admission (POA). However, exclusion rules were developed with limited information on whether complications were POA. This study examines whether the accuracy of failure-to-rescue exclusion rules can be improved with data with good POA indicators.

The research team concluded that failure-to-rescue is a robust quality measure, sensitive to nursing across alternative exclusion rule specifications. Despite expanded POA coding, exclusion-based rules are needed to analyze datasets not coded for POA, legacy datasets, and datasets with poor POA coding. POA-informed construction of exclusions significantly improves rules identifying POA complications.

Citation

Needleman J, Buerhaus PI, Vanderboom C, Harris M. Using Present-On-Admission Coding to Improve Exclusion Rules for Quality Metrics: The Case of Failure-to-Rescue. Med Care. 2013 May 23.

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