How many diagnosis fields are needed to capture safety events in administrative data? Findings and recommendations from the WHO ICD-11 Topic Advisory Group on Quality and Safety

Objective As part of the WHO ICD-11 development initiative, the Topic Advisory Group on Quality and Safety explores meta-features of morbidity data sets, such as the optimal number of secondary diagnosis fields. Design The Health Care Quality Indicators Project of the Organization for Economic Co-Operation and Development collected Patient Safety Indicator (PSI) information from administrative hospital data of 19-20 countries in 2009 and 2011. We investigated whether three countries that expanded their data systems to include more secondary diagnosis fields showed increased PSI rates compared with six countries that did not. Furthermore, administrative hospital data from six of these countries and two American states, California (2011) and Florida (2010), were analysed for distributions of coded patient safety events across diagnosis fields. Results Among the participating countries, increasing the number of diagnosis fields was not associated with any overall increase in PSI rates. However, high proportions of PSI-related diagnoses appeared beyond the sixth secondary diagnosis field. The distribution of three PSI-related ICD codes was similar in California and Florida: 89-90% of central venous catheter infections and 97-99% of retained foreign bodies and accidental punctures or lacerations were captured within 15 secondary diagnosis fields. Conclusions Six to nine secondary diagnosis fields are inadequate for comparing complication rates using hospital administrative data; at least 15 (and perhaps more with ICD-11) are recommended to fully characterize clinical outcomes. Increasing the number of fields should improve the international and intra-national comparability of data for epidemiologic and health services research, utilization analyses and quality of care assessmen

Application of patient safety indicators internationally: a pilot study among seven countries

Objective To explore the potential for international comparison of patient safety as part of the Health Care Quality Indicators project of the Organization for Economic Co-operation and Development (OECD) by evaluating patient safety indicators originally published by the US Agency for Healthcare Research and Quality (AHRQ). Design A retrospective cross-sectional study. Setting Acute care hospitals in the USA, UK, Sweden, Spain, Germany, Canada and Australia in 2004 and 2005/2006. Data sources Routine hospitalization-related administrative data from seven countries were analyzed. Using algorithms adapted to the diagnosis and procedure coding systems in place in each country, authorities in each of the participating countries reported summaries of the distribution of hospital-level and overall (national) rates for each AHRQ Patient Safety Indicator to the OECD project secretariat. Results Each country's vector of national indicator rates and the vector of American patient safety indicators rates published by AHRQ (and re-estimated as part of this study) were highly correlated (0.821-0.966). However, there was substantial systematic variation in rates across countries. Conclusions This pilot study reveals that AHRQ Patient Safety Indicators can be applied to international hospital data. However, the analyses suggest that certain indicators (e.g. ‘birth trauma', ‘complications of anesthesia') may be too unreliable for international comparisons. Data quality varies across countries; undercoding may be a systematic problem in some countries. Efforts at international harmonization of hospital discharge data sets as well as improved accuracy of documentation should facilitate future comparative analyses of routine database

ICD-11 for quality and safety: overview of the who quality and safety topic advisory group

This paper outlines the approach that the WHO's Family of International Classifications (WHO-FIC) network is undertaking to create ICD-11. We also outline the more focused work of the Quality and Safety Topic Advisory Group, whose activities include the following: (i) cataloguing existing ICD-9 and ICD-10 quality and safety indicators; (ii) reviewing ICD morbidity coding rules for main condition, diagnosis timing, numbers of diagnosis fields and diagnosis clustering; (iii) substantial restructuring of the health-care related injury concepts coded in the ICD-10 chapters 19/20, (iv) mapping of ICD-11 quality and safety concepts to the information model of the WHO's International Classification for Patient Safety and the AHRQ Common Formats; (v) the review of vertical chapter content in all chapters of the ICD-11 beta version and (vi) downstream field testing of ICD-11 prior to its official 2015 release. The transition from ICD-10 to ICD-11 promises to produce an enhanced classification that will have better potential to capture important concepts relevant to measuring health system safety and quality—an important use case for the classificatio

Klimarelevanz von Mooren und Anmooren in Deutschland: Ergebnisse aus dem Verbundprojekt "Organische Böden in der Emissionsberichterstattung"

[Projektziel] Ziel des Projekts war es, deutschlandweit aktuelle Daten zu Flächen organischer Böden, Nutzung, Wasserständen und Treibhausgasemissionen zu erheben und somit die aktuelle Treibhausgasbilanz der organischen Böden in Deutschland zu quantifizieren

Treibhausgasemissionen aus organischen Böden im deutschen Treibhausgasinventar: Methodenentwicklung und Ergebnisse

Entwässerte organische Böden sind in vielen Ländern, darunter auch in Deutschland, eine starke Quelle anthropogener Treibhausgase (THG). Daher müssen sie bei der Berichterstattung gemäß UNFCCC und Kyoto-Protokoll angemessen berücksichtigt werden. Hier beschreiben wir die Methodik, Daten und Ergebnisse der deutschen detaillierten Tier-3-Methodik zur Berichterstattung anthropogener Treibhausgasemissionen aus entwässerten organischen Böden, die für das deutsche Treibhausgasinventar entwickelt und angewandt wurden. Der Ansatz basiert auf nationalen Daten und bietet das Potenzial, Änderungen der Landnutzung und des Wassermanagements zu verfolgen, falls Zeitreihen zu relevanten Aktivitätsdaten vorliegen. Die Aktivitätsdaten umfassen hochauflösende Karten zu Klima, Landnutzung, organischen Böden und vom mittleren jährlichen Grundwasserflurabstand. Die Grundwasserkarte wurde durch ein statistisches Modell aus Daten von > 1000 Standorten abgeleitet. Die THG-Emissionen beruhen auf einem einzigartigen Datensatz mit mehr als 200 THG-Bilanzen für fast alle Kombinationen von Landnutzungskategorien und Typen organischer Böden. Die Messungen wurden mit vollständig harmonisierten Protokollen durchgeführt. Nicht-lineare Funktionen beschreiben die Abhängigkeit der Kohlendioxid- und Methan-Flüsse vom mittleren jährlichen Grundwasserstand und, wenn erforderlich, von der Landnutzung. Die daraus resultierenden "angewandten Emissionsfaktoren" für jede Landnutzungskategorie berücksichtigen sowohl die Unsicherheit der nicht-linearen Funktionen als auch die Verteilung der Grundwasserstände in jeder Landnutzungskategorie. Da keine einfachen funktionellen Zusammenhänge für die Lachgasemissionen gefunden wurden, wurden die entsprechenden Emissionsfaktoren daher als Mittelwerte der Messwerte jeder Landnutzungskategorie berechnet. Für kleinere THG-Quellen wie Methanemissionen aus Gräben und Austräge von gelöstem organischem Kohlenstoff wurden IPCC-Standard-Emissionsfaktoren verwendet