Squitieri L, Waxman DA, Mangione CM, Saliba D, Ko CY, Needleman J, Ganz DA, et al.
Health services research. Date of publication 2018 Aug 1;volume 53 Suppl 1():2970-2987.
1. Health Serv Res. 2018 Aug;53 Suppl 1:2970-2987. doi: 10.1111/1475-6773.12822.
Epub 2018 Jan 25.
Evaluation of the Present-on-Admission Indicator among Hospitalized
Fee-for-Service Medicare Patients with a Pressure Ulcer Diagnosis: Coding
Patterns and Impact on Hospital-Acquired Pressure Ulcer Rates.
Squitieri L(1)(2), Waxman DA(3)(4), Mangione CM(1)(5)(6), Saliba D(1)(3)(7)(8),
Ko CY(6)(9)(10), Needleman J(6), Ganz DA(3)(6)(7)(11).
Author information:
(1)UCLA Robert Wood Johnson Clinical Scholars Program, Department of Medicine,
David Geffen School of Medicine at UCLA, Los Angeles, CA.
(2)Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck
School of Medicine, University of Southern California, Los Angeles, CA.
(3)Health Unit, RAND, Santa Monica, CA.
(4)Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los
Angeles, CA.
(5)Division of General Internal Medicine and Health Services Research, Department
of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
(6)Department of Health Policy and Management, UCLA Fielding School of Public
Health, Los Angeles, CA.
(7)Geriatric Research, Education and Clinical Center, Veterans Affairs Greater
Los Angeles Healthcare System, Los Angeles, CA.
(8)JH Borun Center, UCLA, Los Angeles, CA.
(9)Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles,
CA.
(10)Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare
System, Los Angeles, CA.
(11)Division of Geriatrics, Department of Medicine, David Geffen School of
Medicine at UCLA, Los Angeles, CA.
OBJECTIVES: To evaluate national present-on-admission (POA) reporting for
hospital-acquired pressure ulcers (HAPUs) and examine the impact of quality
measure exclusion criteria on HAPU rates.
DATA SOURCES/STUDY SETTING: Medicare inpatient, outpatient, and nursing facility
data as well as independent provider claims (2010-2011).
STUDY DESIGN: Retrospective cross-sectional study.
DATA COLLECTION/EXTRACTION METHODS: We evaluated acute inpatient hospital
admissions among Medicare fee-for-service (FFS) beneficiaries in 2011. Admissions
were categorized as follows: (1) no pressure ulcer diagnosis, (2) new pressure
ulcer diagnosis, and (3) previously documented pressure ulcer diagnosis. HAPU
rates were calculated by varying patient exclusion criteria.
PRINCIPAL FINDINGS: Among admissions with a pressure ulcer diagnosis, we observed
a large discrepancy in the proportion of admissions with a HAPU based on
hospital-reported POA data (5.2 percent) and the proportion with a new pressure
ulcer diagnosis based on patient history in billing claims (49.7 percent).
Applying quality measure exclusion criteria resulted in removal of 91.2 percent
of admissions with a pressure injury diagnosis from HAPU rate calculations.
CONCLUSIONS: As payers and health care organizations expand the use of quality
measures, it is important to consider how the measures are implemented, coding
revisions to improve measure validity, and the impact of patient exclusion
criteria on provider performance evaluation.
© Health Research and Educational Trust.
DOI: 10.1111/1475-6773.12822
PMCID: PMC6056601
PMID: 29552746 [Indexed for MEDLINE]
