Accuracy of the all patient refined diagnosis related groups classification system in congenital heart surgery.

TitleAccuracy of the all patient refined diagnosis related groups classification system in congenital heart surgery.
Publication TypeJournal Article
Year of Publication2014
AuthorsParnell AS, Shults J, J Gaynor W, Leonard MB, Dai D, Feudtner C
JournalAnn Thorac Surg
Volume97
Issue2
Pagination641-50
Date Published2014 Feb
ISSN1552-6259
KeywordsCardiac Surgical Procedures, Child, Preschool, Cohort Studies, Diagnosis-Related Groups, Female, Heart Defects, Congenital, Humans, Infant, Infant, Newborn, Male, Reproducibility of Results, Retrospective Studies
Abstract

BACKGROUND: Administrative data are increasingly used to evaluate clinical outcomes and quality of care in pediatric congenital heart surgery (CHS) programs. Several published analyses of large pediatric administrative data sets have relied on the All Patient Refined Diagnosis Related Groups (APR-DRG, version 24) diagnostic classification system. The accuracy of this classification system for patients undergoing CHS is unclear.

METHODS: We performed a retrospective cohort study of all 14,098 patients 0 to 5 years of age undergoing any of six selected congenital heart operations, ranging in complexity from isolated closure of a ventricular septal defect to single-ventricle palliation, at 40 tertiary-care pediatric centers in the Pediatric Health Information Systems database between 2007 and 2010. Assigned APR-DRGs (cardiac versus noncardiac) were compared using χ2 or Fisher's exact tests between those patients admitted during the first day of life versus later and between those receiving extracorporeal membrane oxygenation support versus those not. Recursive partitioning was used to assess the greatest determinants of APR-DRG type in the model.

RESULTS: Every patient admitted on day 1 of life was assigned to a noncardiac APR-DRG (p<0.001 for each procedure). Similarly, use of extracorporeal membrane oxygenation was highly associated with misclassification of CHS patients into a noncardiac APR-DRG (p<0.001 for each procedure). Cases misclassified into a noncardiac APR-DRG experienced a significantly increased mortality (p<0.001).

CONCLUSIONS: In classifying patients undergoing CHS, APR-DRG coding has systematic misclassifications, which may result in inaccurate reporting of CHS case volumes and mortality.

DOI10.1016/j.athoracsur.2013.08.012
Alternate JournalAnn. Thorac. Surg.
PubMed ID24200398
PubMed Central IDPMC4624088
Grant List5T32HD060550-02 / HD / NICHD NIH HHS / United States
T32 HD060550 / HD / NICHD NIH HHS / United States