Capturing diagnosis-timing in ICD-coded hospital data: recommendations from the WHO ICD-11 topic advisory group on quality and safety

Purpose To develop a consensus opinion regarding capturing diagnosis-timing in coded hospital data. Methods As part of the World Health Organization International Classification of Diseases-11th Revision initiative, the Quality and Safety Topic Advisory Group is charged with enhancing the capture of quality and patient safety information in morbidity data sets. One such feature is a diagnosis-timing flag. The Group has undertaken a narrative literature review, scanned national experiences focusing on countries currently using timing flags, and held a series of meetings to derive formal recommendations regarding diagnosis-timing reporting. Results The completeness of diagnosis-timing reporting continues to improve with experience and use; studies indicate that it enhances risk-adjustment and may have a substantial impact on hospital performance estimates, especially for conditions/procedures that involve acutely ill patients. However, studies suggest that its reliability varies, is better for surgical than medical patients (kappa in hip fracture patients of 0.7-1.0 versus kappa in pneumonia of 0.2-0.6) and is dependent on coder training and setting. It may allow simpler and more precise specification of quality indicators. Conclusions As the evidence indicates that a diagnosis-timing flag improves the ability of routinely collected, coded hospital data to support outcomes research and the development of quality and safety indicators, the Group recommends that a classification of ‘arising after admission' (yes/no), with permitted designations of ‘unknown or clinically undetermined', will facilitate coding while providing flexibility when there is uncertainty. Clear coding standards and guidelines with ongoing coder education will be necessary to ensure reliability of the diagnosis-timing fla

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

The relevance of particulate organic carbon (POC) for carbon composition in the pore water of drained and rewetted fens of the "Donauried" (South-Germany)

International audienceNumerous studies have dealt with carbon (C) concentrations in Histosols, but there are no studies quantifying the relative importance of all individual C components in pore waters. For this study, measurements were made of all the carbon components (i.e., particulate organic carbon, POC; dissolved organic carbon, DOC; dissolved inorganic carbon, DIC; dissolved methane, CH4) in the soil pore water of a calcareous fen under three different water management regimes (re-wetted, deeply and moderately drained). Pore water was collected weekly or biweekly (April 2004 to April 2006) at depths between 10 and 150 cm. The main results obtained were: (1) DIC (94?280 mg C l?1) was the main C-component. (2) POC and DOC concentrations in the pore water (14?125 mg C l?1 vs. 41?95 mg C l?1) were pari passu. (3) Dissolved CH4 was the smallest C component (0.005?0.9 mg C l?1). Interestingly, about 30% of the POM particles were colonized by microbes indicating that they are active in the internal C transfer in the soil profile ("C-Shuttles"). Consequently, it was concluded that POC is at least as important as DOC for internal soil C turnover. There is no reason to assume significant biochemical differences between POC and DOC as they only differ in size. Therefore, both POC and DOC fractions are essential components of C budgets of peatlands. Furthermore dissolved CO2 in all forms of DIC apparently is an important part of peatland C-balances

EU Peatlands: Current Carbon Stocks and Trace Gas Fluxes

Peatlands in Europe has formed a significant sink for atmospheric CO2 since the last glacial maximum. Currently they are estimated to hold ca. 42 Gt carbon in the form of peat and are therefore a considerable component in the European carbon budget. Due to the generally wet soil conditions in peatlands they are also significant emitters of the strong greenhouse gas (GHG) methane (CH4) and in some cases also of nitrous oxide (N2O). The EU funded CarboEurope-GHG Concerted Action attempts to develop a reliable and complete greenhouse gas budget for Europe and this report aims to provide a review and synthesis of the available information about GHG exchanges in European peatlands and their underlying processes. A best estimate for all the European countries shows that some are currently sinks for atmospheric CO2 while others are sources. In contrast, for CH4 and N2O, only the sources are relevant. Whilst some countries are CO2 sinks, all countries are net GHG emitters from peatlands. The results presented, however, carry large uncertainties, which cannot be adequately quantified yet. One outstanding uncertainty is the distribution of land use types, particular in Russia, the largest European peat nation. The synthesis of GHG exchange, nevertheless, indicates some interesting features. Russia hosts an estimated 41% of European peatlands and contributes most to all GHG exchanges (CO2: 25%, CH4: 52%, N2O: 26%, Total: 37%). Germany is the second-largest emitter (12% of European total) although it contains only 3.2% of European peatlands. The reason is the use of most of the peatland area for intensive cropland and grassland. The largest CO2 emitters are countries with large agricultural peatland areas (Russia, Germany, Belarus, Poland), the largest N2O emitters are those with large agricultural fen areas (Russia, Germany, Finland). In contrast, the largest CH4 emitters are concentrated in regions with large areas of intact mires, namely Russia and Scandinavia. High average emission densities above 3.5 t C-equiv. ha-1 are found in the Southeast Mediterranean, Germany and the Netherlands where agricultural use of peatlands is intense. Low average emission densities below 0.3 t C-equiv. ha-1 occur where mires and peatland forests dominate, e.g. Finland and the UK. This report concludes by pointing at key gaps in our knowledge about peatland carbon stocks and GHG exchanges which include insufficient basic information on areal distribution of peatlands, measurements of peat depth and also a lack of flux datasets providing full annual budgets of GHG exchanges

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

Capturing diagnosis-timing in ICD-coded hospital data: recommendations from the WHO ICD-11 topic advisory group on quality and safety.

PURPOSE: To develop a consensus opinion regarding capturing diagnosis-timing in coded hospital data. METHODS: As part of the World Health Organization International Classification of Diseases-11th Revision initiative, the Quality and Safety Topic Advisory Group is charged with enhancing the capture of quality and patient safety information in morbidity data sets. One such feature is a diagnosis-timing flag. The Group has undertaken a narrative literature review, scanned national experiences focusing on countries currently using timing flags, and held a series of meetings to derive formal recommendations regarding diagnosis-timing reporting. RESULTS: The completeness of diagnosis-timing reporting continues to improve with experience and use; studies indicate that it enhances risk-adjustment and may have a substantial impact on hospital performance estimates, especially for conditions/procedures that involve acutely ill patients. However, studies suggest that its reliability varies, is better for surgical than medical patients (kappa in hip fracture patients of 0.7-1.0 versus kappa in pneumonia of 0.2-0.6) and is dependent on coder training and setting. It may allow simpler and more precise specification of quality indicators. CONCLUSIONS: As the evidence indicates that a diagnosis-timing flag improves the ability of routinely collected, coded hospital data to support outcomes research and the development of quality and safety indicators, the Group recommends that a classification of 'arising after admission' (yes/no), with permitted designations of 'unknown or clinically undetermined', will facilitate coding while providing flexibility when there is uncertainty. Clear coding standards and guidelines with ongoing coder education will be necessary to ensure reliability of the diagnosis-timing flag

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

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