Palliative care coding practices in Canada since the introduction of guidelines and the HSMR indicator.
Bottom Line: National HSMR declined by 22% during the study period, compared with a 17% decline in HSMR-PC.Provincial results for HSMR-PC are not significantly different from regular HSMR calculation.Aside from PC coding practices, we note numerous independent drivers of improving HSMR results, notably, a significant reduction of in-hospital mortality, and increase in admissions accompanied by a greater number of coded comorbidities.
Affiliation: Canadian Institute for Health Information, Toronto, Ontario, Canada.Show MeSH
Related in: MedlinePlus
Mentions: Beginning in 2006–2007, the percentage of all hospitalisations coded with an MRDx of PC varied across provinces from 0.5% to 1.4% (figure 1). After years of fluctuation in provincial PC coding rates, the introduction of coding standards in 2008–2009 led to mostly stabilised rates, beginning in 2009–2010. The Atlantic provinces of Newfoundland and Labrador and Nova Scotia, which have small populations and few facilities, accounted for the largest increase and the greatest volatility in PC coding. Between 2010–2011 and 2012–2013, provincial rates of PC coding in the MRDx field mostly declined or remained stable (except in Newfoundland and Labrador). The percentage of PC cases as a proportion of in-hospital deaths mirrors the trend of overall PC coding. We observe an increase during the guideline uptake period, and a subsequent plateau beginning 2009–2010 (see online supplementary table S1 and figure A).
Affiliation: Canadian Institute for Health Information, Toronto, Ontario, Canada.