Hospitalists in the News

Evaluating and Improving Present-On-Admission for Performance Reporting
Liz Goldman

Having accurate assessments of hospital quality is a critical step to improving the quality of hospital care. Liz Goldman's research will evaluate the accuracy of present-on-admission indicators, a strategy that two states are using to improve hospital assessments based on administrative data and Medicare and other payers are using to withhold payments for “preventable adverse events.” In Aim 1, Liz Goldman will use the California Patient Discharge Data Audit in which 1658 medical records from 2005 were externally reviewed as a gold standard against which she will compare the accuracy of present-on-admission coding by hospitals. In Aim 2, she will use the California Patient Discharge Data and its audit to determine if certain hospital types such as teaching hospitals or small rural hospitals are associated with inaccuracies in coding of present-on-admission and simulate the effect of inaccuracies on hospital assessments comparing hospital death rates for heart attacks. In Aim 3, she will explore the use of clinical laboratory data to help create data checks that states and other auditors can use to assess accuracy of present-on-admission coding without extensive chart review. This research will form the basis for future work to assess whether this strategy to use clinical data to assess the accuracy of present-on-admission coding will be more clinically acceptable to providers and stakeholders than current tools.