Comorbidities, complications, and coding bias: does the number of diagnosis codes matter in predicting in-hospital mortality?

Article Abstract:

Physicians incompletely record the secondary diagnoses and accompanying illnesses (comorbidities) of hospital patients. Among 162,790 patients 65 years or older who were admitted to California hospitals for a stroke, pneumonia, a heart attack or congestive heart failure, the average number of diagnoses recorded was 5.5 on hospital discharge forms that can hold 25 diagnostic codes. Patients with secondary diagnoses such as cardiac arrest, irregular heart beat, congestive heart failure, pneumonia and respiratory failure had a higher risk of dying in the hospital. Patients with secondary diagnoses of diabetes, hypertension, previous heart attack, chest pain and premature heart beats had a lower risk of dying in the hospital. These conditions normally would be expected to increase the risk of death, but are considered inappropriate comorbidities to certain conditions by Medicare. Physicians may record more secondary diagnoses in the medical records of patients who die than in those of patients who survive. Increasing the number of fields on discharge forms may not ensure more complete medical records.

Evaluation, Reports, Design and construction, Identification and classification, Hospital patients, Databases, Diagnosis, Hospital records

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General internal medicine

Article Abstract:

A large trial of the cholesterol-lowering drug pravastatin revealed that the drug reduced the risk of heart attack or death from coronary artery disease by 31%. However, several studies showed that short-term nifedipine increased the risk of heart attack in patients with hypertension. The PEPI trial found that progestin added to estrogen can protect postmenopausal women from heart disease and endometrial cancer. But some data show that estrogen replacement therapy may increase a woman's risk of breast cancer. Screening mammography appears to reduce mortality from breast cancer in women over 50 but not in those 40 to 49 years old. The Diabetes Control and Complications Trial showed that tight glucose control can prevent the development of some complications of diabetes but can also cause more episodes of hypoglycemia. People with type II diabetes appear to benefit from drug therapy combined with diet, and metformin can safely lower blood sugar with few side effects.

Health aspects, Care and treatment, Research, Complications and side effects, Heart attack, Hormone therapy, Type 1 diabetes, Internal medicine, Nifedipine

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A 58-Year-Old Woman Dissatisfied With Her Care

Article Abstract:

Society needs to invest money in designing a health care system that will reduce the risk of medical errors and increase patient satisfaction. Most medical errors are caused by system failures, not by incompetent health care workers.

Analysis, Patient satisfaction, Medical care, Quality management, Medical care quality, Medical errors

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