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: In addition to a reduction in crude mortality, we observe changes in risk-adjustment variables included in the HSMR model. Increases in patient population groups with more pre-admission conditions led to a higher likelihood of expected in-hospital mortality. There are pronounced trends when comparing Charlson Index groups over time (figure 3). Provincial results show consistent declines in HSMR cases without comorbidities (Charlson group 0). Increases in Charlson groups 1 and 2 indicate a greater proportion of patients with significant comorbidities.
Affiliation: Canadian Institute for Health Information, Toronto, Ontario, Canada.