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5/ANN Health Working Papers DELSA/HE A/WD/HW P (2009) Unclassified DELSA/HEA/WD/HWP(2009)5/ANN Organisation de Coopération et de Développement Économiques Organisation for Economic Co-operation and Development 23-Nov-2009 ___________________________________________________________________________________________ English text only DIRECTORATE FOR EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS HEALTH COMMITTEE Unclassified DELSA/HEA/WD/HWP(2009)5/ANN Health Working Papers HEALTH CARE QUALITY INDICATORS PROJECT, PATIENT SAFETY INDICATORS REPORT 2009 ANNEX Saskia Drösler Technical Manual for Facilitaing Cross-National Comparisions for Patient Safety Indicators - This document represents a revised and updated version of OECD Technical Paper No. 19 for the set of patient safety indicators calculated for the 2008-2009 data collection of the OECD Health Care Quality Indicators project. English text only JT03274834 Document complet disponible sur OLIS dans son format d'origine Complete document available on OLIS in its original format DELSA/HEA/WD/HWP(2009)5/ANN DIRECTORATE FOR EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS www.oecd.org/els OECD HEALTH WORKING PAPERS http://www.oecd.org/els/health/workingpapers This series is designed to make available to a wider readership health studies prepared for use within the OECD. Authorship is usually collective, but principal writers are named. The papers are generally available only in their original language – English or French – with a summary in the other. Comment on the series is welcome, and should be sent to the Directorate for Employment, Labour and Social Affairs, 2, rue André-Pascal, 75775 PARIS CEDEX 16, France. The opinions expressed and arguments employed here are the responsibility of the author(s) and do not necessarily reflect those of the OECD. Applications for permission to reproduce or translate all or part of this material should be made to: Head of Publications Service OECD 2, rue André-Pascal 75775 Paris, CEDEX 16 France Copyright OECD 2009 2 DELSA/HEA/WD/HWP(2009)5/ANN TABLE OF CONTENTS INTRODUCTION .......................................................................................................................................... 4 METHODOLOGICAL ISSUES ..................................................................................................................... 5 Introduction ................................................................................................................................................. 5 Cross walking from ICD-9 to ICD-10 ......................................................................................................... 6 Process of Calculation ................................................................................................................................. 7 QUICK STEP OVERVIEW OF ESSENTIAL TASKS FOR DATA PREPARATION ............................. 11 DETAILED DEFINITIONS OF INDICATORS .......................................................................................... 13 Catheter-related bloodstream infection, secondary diagnosis field per 100 discharges (PSI 7) ............... 13 Postoperative pulmonary embolism (PE) or deep vein thrombosis (DVT), secondary diagnosis field per 100 discharges (PSI 12) ............................................................................................................................. 15 Postoperative sepsis, secondary diagnosis field per 100 discharges (PSI 13) ........................................... 17 Accidental puncture or laceration, secondary diagnosis field per 100 discharges (PSI 15) ...................... 20 Foreign body left in during procedure, secondary diagnosis field per 100 discharges (PSI 5) ................. 23 Obstetric trauma – vaginal delivery with instrument, any diagnosis or procedure field per 100 vaginal deliveries (PSI 18) ..................................................................................................................................... 26 APPENDIX 1. DENOMINATOR CALCULATION CODE LISTS ........................................................... 32 APPENDIX 2. VIRTUAL MDC-ASSIGNMENT ....................................................................................... 91 SUMMARY OF REVISIONS .................................................................................................................... 102 REFERENCES ........................................................................................................................................... 103 3 DELSA/HEA/WD/HWP(2009)5/ANN INTRODUCTION 1. This technical manual was prepared to assist countries in calculating the Patient Safety Indicators included in the OECD Health Care Quality Indicator data collection for 2008-2009. 2. It provides detailed practical advice on calculating each indicator in a selected set of Patient Safety Indicators (PSI) utilising national hospital administrative databases. 3. The selected indicators are set out in Table 1. Table 1. Selected patient safety indicators for 2008-2009 HCQI data collection Area Indicator name Hospital-acquired infections Catheter-related bloodstream infection (PSI 7) Postoperative pulmonary embolism (PE) or deep vein thrombosis (DVT) (PSI 12) Operative and post-operative Postoperative sepsis (PSI 13) complications Accidential puncture or laceration (PSI 15) Sentinel events Foreign body left in during procedure (PSI 5) Obstetric trauma – vaginal delivery with instrument (PSI 18) Obstetrics Obstetric trauma – vaginal delivery without instrument (PSI 19) 4. These indicators are derived from the Quality Indicators developed by the US Agency for Healthcare Research and Quality. AHRQ’s Patient Safety Indicators (PSIs) are a set of indicators providing information on potential in hospital complications and adverse events following surgeries, procedures, and childbirth. The PSIs were developed after a comprehensive literature review, analysis of ICD-9-CM codes, clinician panel review, implementation of risk adjustment, and empirical analyses (AHRQ, 2006). 5. For each of these indicators, the manual provides: • Generic coding and calculation instructions related to national hospital administrative databases, • Cross walk from ICD 9 to ICD 10 codes for each indicator, • Detailed definitions for calculation of indicators, and • Flow charts for visualising the calculation process. 4 DELSA/HEA/WD/HWP(2009)5/ANN METHODOLOGICAL ISSUES Introduction 6. The methodology for facilitating internationally comparable Patient Safety Indicators set out in this manual contains two key elements: • Cross-walk between the key disease classifications • Detailed process of calculation 7. The Patient Safety Indicators dealt with in this manual are specified according to certain diagnosis and, in some instances, procedure codes. There are currently different medical classifications in use for coding diagnosis; the ICD-9 (International Classification of Diseases) classification which is no longer updated by the World Health Organisation (WHO) is the precursor of the present ICD-10 classification. OECD member countries use ICD-9 (e.g. Spain, USA) as well as ICD-10 (e.g. Australia, Canada, Germany). For that reason this manual contains both versions of the coding system. 8. Usually countries do not use the original version of a classification published by the WHO but modify it according to their needs. Country modifications are still consistent with the WHO version, keeping the structure of the classification tree. In some chapters of the ICD classification the country versions are more extensive than the WHO version while in others they are not. This manual does not cover all the different country versions of the ICD. 9. The technical specifications of diagnosis in this manual are based on the ICD-10-WHO, 2006 and on the ICD-9-CM1. Therefore countries seeking to utilise this manual must ensure that before applying the definitions the defined codes for inclusion or exclusion criteria are currently in use. Otherwise the definitions at hand must be extended to include the subgroups added in the country modifications. 10. For example, Table 2 shows that one three-digit WHO code for decubitus ulcer corresponds to 8 four-digit codes in Canada, 5 four-digit codes in Australia and 50 five-digit German codes. To calculate the numerator for the indicator decubitus ulcer, all country specific subgroups of the listed WHO code L89 must be taken into account. 1 Definitions in ICD-9-CM are adopted from AHRQ (2003). 5 DELSA/HEA/WD/HWP(2009)5/ANN Table 2. Examples of country versions ICD-10-GM ICD-10 ICD-10-CA ICD-10-AM (Germany, 2006), a 5th digit WHO (Canada, 2006) (Australia, 2006) has to be used to specify (2006) the location (10 subgroups) Decubitus ulcer limited to erythema Decubitus [pressure] L89.0 only [redness] without skin ulcer, stage I breakdown (Stage 1) Decubitus ulcer limited to breakdown Decubitus [pressure] Decubitus ulcer Stage 1 L89.1 of skin (Stage 2) ulcer, stage II Decubitus ulcer with fat layer Decubitus [pressure] Decubitus ulcer Stage 2 L89.2 exposed (Stage 3) ulcer, stage III L89 Decubitus ulcer with depth involving Decubitus [pressure] Decubitus ulcer Stage 3 L89.3 Decubitus muscle (Stage 4) ulcer, stage IV ulcer Decubitus ulcer with depth involving Decubitus ulcer Stage 4 L89.4 bone (Stage 5) Decubitus ulcer with joint space L89.5 involvement (Stage 5) Decubitus ulcer with necrosis L89.8 involving muscle or bone (Stage X) Decubitus ulcer without mention of Decubitus [pressure] Decubitus ulcer, unspecified L89.9 severity ulcer, unspecified 11. There are several criteria which are
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