The Sensitivity of Adverse Event Cost Estimates to Diagnostic Coding Error
Article first published online: 27 OCT 2011
© Health Research and Educational Trust
Health Services Research
Volume 47, Issue 3pt1, pages 984–1007, June 2012
How to Cite
Wardle, G., Wodchis, W. P., Laporte, A., Anderson, G. M. and Ross Baker, G. (2012), The Sensitivity of Adverse Event Cost Estimates to Diagnostic Coding Error. Health Services Research, 47: 984–1007. doi: 10.1111/j.1475-6773.2011.01340.x
- Issue published online: 8 MAY 2012
- Article first published online: 27 OCT 2011
- Canadian Institute for Health Research. Grant Number: 84310
- Medical errors;
- patient safety;
- hospital costs;
- propensity matching
To examine the impact of diagnostic coding error on estimates of hospital costs attributable to adverse events.
Original and reabstracted medical records of 9,670 complex medical and surgical admissions at 11 hospital corporations in Ontario from 2002 to 2004. Patient specific costs, not including physician payments, were retrieved from the Ontario Case Costing Initiative database.
Adverse events were identified among the original and reabstracted records using ICD10-CA (Canadian adaptation of ICD10) codes flagged as postadmission complications. Propensity score matching and multivariate regression analysis were used to estimate the cost of the adverse events and to determine the sensitivity of cost estimates to diagnostic coding error.
Estimates of the cost of the adverse events ranged from $16,008 (metabolic derangement) to $30,176 (upper gastrointestinal bleeding). Coding errors caused the total cost attributable to the adverse events to be underestimated by 16 percent. The impact of coding error on adverse event cost estimates was highly variable at the organizational level.
Estimates of adverse event costs are highly sensitive to coding error. Adverse event costs may be significantly underestimated if the likelihood of error is ignored.