Transcript Overview of the Quality and Safety TAG Initiative

Update from the
Quality and Safety TAG
William Ghali
Harold Pincus
Safety and Quality
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An ICD-11 ‘use case’
Overlaps with the mortality, morbidity, and
case mix use cases
A horizontal theme that applies across
chapters
Numerous existing safety/quality indicators
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HSMR
PSI
Other measures (e.g, Charlson, Elixhauser)
The need for a Q&S TAG
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The world has changed, with quality measurement
becoming central for health system accountability and
improvement
ICD-10 is limited in capturing Q&S information
ICD-11 creates unique opportunities for capturing Q&S
data with greater reliability, validity and efficiency
Areas of attention:
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Chapters 19/20 (injury and external causes)
Horizontal content review across chapters
Coding rules
Volume 2 of ICD-11
Applicability of ICD-10 indicators in ICD-11
Quality and Safety
TAG Work Plan
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Co-chaired by William Ghali, U Calgary and
Harold Pincus, Columbia University, NY
Membership from N. America, Europe, and
Australia
Funding from CPSI, CIHI, and AHRQ
In-kind support from UofC & Columbia
Work catalyzed by a number of face-to-face
meetings (8 so far)
Coding rules
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Main condition
Diagnosis timing
Clustering
Coding rules
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Main condition
Diagnosis timing
Clustering
Coding rules
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Main condition
Diagnosis timing
Clustering
Canadian Hospital Discharge
Data
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Diagnosis type indicator:
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Type M: Most responsible diagnosis
Type 1: Important diagnoses present at
admission
Type 2: Arising some time after
admission
Type 3: Secondary diagnoses, present at
admission
Coding rules
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Main condition
Diagnosis timing
Clustering
Clustering of diagnoses
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Essential to the Q&S
use case
Mechanisms already
exist in ICD-10
But needs to be
ubiquitous
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Endorsed by RSG
Suffix/prefix codes?
Other approaches?
Revision of Chapters 19/20
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Healthcare-related
injury
New information (logic)
model
Clustering mechanism
essential
Revisions now reflected
in ICD-beta
Revision of Chapters 19/20
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Four sources of harm:
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Medications & substances
Procedures
Devices
Other aspects of care
For each:
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Cause of harm (Ch 20)
Mode/mechanism (Ch 20)
Actual harm (Ch 1-19)
A clinical example
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A patient presents with an intracranial hemorrhage
arising while on warfarin anticoagulation. INR found
to be 7.0 and careful history reveals patient to have
accidentally taken double doses over several days.
A clinical example
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A patient presents with an intracranial hemorrhage
arising while on warfarin anticoagulation. INR found
to be 7.0 and careful history reveals patient to have
accidentally taken double doses over several days.
Clustered Coding?
A clinical example
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A patient presents with an intracranial hemorrhage
arising while on warfarin anticoagulation. INR found
to be 7.0 and careful history reveals patient to have
accidentally taken double doses over several days.
Clustered Coding?
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Code for the cause of harm (warfarin)
Code for mode/mechanism (overdose of substance)
Code for actual harm (intracranial hemorrhage)
A clinical example
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A patient presents with an intracranial hemorrhage
arising while on warfarin anticoagulation. INR found
to be 7.0 and careful history reveals patient to have
accidentally taken double doses over several days.
Clustered Coding?
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Code for the cause of harm (warfarin)
Code for mode/mechanism (overdose of substance)
Code for actual harm (intracranial hemorrhage)
Concepts linked through clustering mechanism
Field trials
Stakeholder survey
Clinical Episode Coding Trial
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https://redcap.cru.ucalgary.ca/surveys/
?s=A3NbrtXDA5
Code – Recode Trial
Quality and Safety TAG
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An exciting mandate
Real potential for ICD enhancement
Academic publications
Quality and Safety TAG
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An exciting mandate
Real potential for ICD enhancement
Academic publications
Knowledge exchange
Dialogue/interaction with RSG and all
other TAGs crucial…
Questions or comments?
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[email protected]
[email protected]