Quality indicators and healthcare
A first step to the evaluation of healthcare quality
Ana Cristina Barbosa Pereira, mimed08010@med.up.pt
Ana Rita de Sousa Vieira de Oliveira, mimed08281@med.up.pt
Ana Teresa Leite Fernandes Carapenha, mimed08015@med.up.pt
André de Jesus Magalhães Vinha, mimed08262@med.up.pt
Catarina Castro Vieira, mimed08053@med.up.pt
Eduardo Manuel Pinto Ferreira Silva Freitas, mimed08029@med.up.pt
João Manuel Dias Ferreira Rebelo, mimed08109@med.up.pt
Mariana Almeida Leite Gomes de Oliveira, mimed08158@med.up.pt
Nuno Filipe da Silva Ribeiro, mimed08180@med.up.pt
Susete Marli Fonseca da Cruz, mimed08223@med.up.pt
Victoriano Penhor José da Costa, mimed08285@med.up.pt
José Alberto Silva Freitas, PhD, alberto@med.up.pt
Class 10
ABSTRACT
The quality of health services is considered a serious public health problem, since they
influence a great part of the population. We can improve the quality of healthcare if we study the
evolution some indicators’ values (such as mortality, postponed surgeries or childbirth of caesarian
operation). AIM: This paper aims to calculate the indicators’ values according to the proposed
variables. METHODS: This is a retrospective and observational study that will focus on data since
1990 until 2007 in a Portuguese central hospital. These data will be treated with SPSS. To reach the
initial aim, a syntax file (which contains a set of commands that is used to analyze the entire
database and select the appropriate cases for each indicator) is needed. RESULTS: In a first stage,
data from 2000 to 2005 was analysed. Within these years, 3.6% of the patients died, having achieved
the highest and lowest values in 2000 and 2002, respectively. Men had a higher rate of mortality, so
as the +64 years-old group. The 0-14 age group had the lowest rate of mortality. The length of stay
decreased from 2000 until 2003, and then increased from that year until 2005. These values resulted
in a general mean of 7,98 days of internment. Outpatients represent 8,4% of total patients, having
their percentage increased till 2005. CONCLUSION: Many conclusions can be drawn from
1
mathematical and statistical results, since they do not carry any subjectivity which could justify some
situations out of what would be considered “normal” for a particular hospital. Also, these indicators,
by themselves, do not totally represent the performance of the hospital due to its complex
organization in many services. Taking these facts into consideration, our study becomes only the
initial step to the analysis of hospital healthcare.
KEY-WORDS:
Quality
of
Healthcare,
Quality
Indicators,
Patients,
Performance
Measurements, DRGs.
2
INTRODUCTION: BACKGROUND AND JUSTIFICATION
Quality is a concept widely used in our days when we want to evaluate a certain aspect.
However, it is considerably difficult to find an universal definition that can be used and understood by
everyone due to its subjectivity. As in all areas of interest, the quality in health is also a
multidimensional concept and it includes not only the notion of clinical quality but also social,
economical, ethical and physical aspects
[1].Taking
this into account, it is easy to understand that the
global quality of a health system is the average of the values assigned to each of the dimensions
mentioned above.
In spite of the subjectivity of the concept “quality”, it is extremely necessary to establish terms
of comparison in order to analyze the performance of health systems and its evolution, and thus
improve the conditions of health services. Besides, we must not forget the constant search for
healthcare by a more and more aged population, and also by more informed and demanding people
[2].
After all, patient satisfaction is important as it may reflect the quality of the health care. However,
“patient satisfaction or dissatisfaction is a complicated phenomenon that is linked to patients'
expectations, health status, and personal characteristics, as well as health system characteristics”
[3].
Therefore, governments are increasingly introducing performance management systems to
improve the quality and outcomes of healthcare.
[4]
Even though it is not an easy task, as it is
impossible to find the perfect evaluation system, it must be accomplished with responsibility in order
to develop the best methods. “Given the importance of healthcare, it seems inconceivable that we do
not have excellent ways of evaluating how well we are doing”. [5]
To do so, many surveys were made to discover which quality aspects of a hospital
performance must be analyzed, not only to improve the quality of hospital care but also to find out
patients and doctors’ opinion about the relevance of the quality indicators that are included in hospital
reports [6].
One of the used case mix classification systems are Diagnosis Related Groups (DRGs) and,
more specifically, indicators [7].
DRGs are “A system for classifying patient care by relating common characteristics such as
diagnosis, treatment, and age to an expected consumption of hospital resources and length of stay.
Its purpose is to provide a framework for specifying case mix and to reduce hospital costs and
reimbursements and it forms the cornerstone of the prospective payment system.” [8]
Every hospital keeps a permanent database about their patients to classify them in DRGs, and
that information is sent periodically to Administração Central do Sistema de Saúde (ACSS). It’s at
ACSS that data is processed for cost calculation in order to make more accurate budgets
[9].
3
Indicators can be defined as measurement units that allow monitoring and evaluation of key
variables of an organization through comparison with its corresponding internal and external
referential. So, indicators are empirical instruments that allow us to show the theorical dimension of a
key variable. Specifically, healthcare indicators are measurements that reflect relevant information
about different attributes, health dimensions and factors that influence health system performance
[10].
With the information given by these instruments, governments can know how much money was spent
and where it was used (normally prices per DRGs), as well as understand where it is needed
[11].
Then, there are some indicators that can provide us useful information about the performance
of a hospital, such as mortality, length of stay, postponed surgeries, outpatient department episodes,
outpatient surgery, childbirth of cesarean operation, principal diagnosis, and finally surgical
proceedings (and complications). All of these will be used as sources of data in our study.
We can see, by the examples of foreign countries, that the information given by these
indicators is very useful, as well as the performance measurements. For instance, Australia has
introduced a National Quality and Performance System (NQPS) with the purpose of establishing a
higher performance, promote best practice, support under performance and sharpen the focus of
healthcare institutions
[4].
To accomplish those goals, about 52 indicators (National Performance
Indicators-NPI) are analyzed. These indicators are concerned with governance, prevention and early
intervention access, integration and chronic diseases management.
In the USA, a study was done to evaluate if the 7 operations chosen as quality indicators by
the Agency for Healthcare Research and Quality were performed frequently enough to identify
hospitals with increased mortality rates [12].
To do that, a large number of data from different hospitals and from different gaps of time was
used to turn possible the representation of all hospitals in the country.
Analysing the results of this study, we easily understand that for only one operation, the
majority of hospitals exceed the minimum caseload and for the remainder just a small number of
hospitals met the minimum caseload required.
So, using this indicator, we are assuming that one hospital with great results in this 7 surgeries
is an excellent hospital but that might not be exactly true, because this hospital could have this
results simply because his activity is very low in this kind of operations. This way, patients are falsely
reassured that they are choosing a safe hospital basing their choice in this indicator.
The main conclusion of this study was that the policy makers should consider sample size in
selecting the best quality measure for specific procedures, particularly when data is used for public
reporting [13]. Otherwise, they run the risk of mislabelling hospitals and misinforming patients.
4
With the importance given by the Australian and American authorities, we can confirm the
importance of having regular analyses to improve management policies
[14].
We can also use these
examples to avoid measurement errors.
In our study in the near future, we will have access to specific information about a central
hospital through a number of quality indicators. The aim of this project is to analyze these indicators
(the ones referred above) and obtain information that may be useful in the future to study the
evolution of the hospital healthcare.
RESEARCH QUESTION AND AIMS
The main question in this study is related to how the indicators evolved through the years in
the chosen central hospital. According to this, our general purpose is the calculation of the indicators’
values concerning the proposed variables. Some specific aims can be also be referred, such as the
examination of the quality of healthcare by analysing the evolution of mortality, postponed surgeries,
surgical procedures, among others; the definition of an hospital’s activity and production by using the
data related with indicators as, for instance, length of stay, outpatient episodes, outpatient surgery
and childbirth of caesarean operation; and finally the use of main diagnosis to study the quality of the
available data.
PARTICIPANTS AND METHODS
This study is observational and retrospective, as it is based on pre-existing data and will focus
on episodes from a Portuguese central hospital that occurred between 1990 and 2007.
In this research we will calculate and analyze the indicators in agreement with the variable
proposals.
Indicators can be subdivided in various categories, including mortality, length of stay,
postponed surgeries, outpatient department episodes, outpatient surgery, childbirth of cesarean
operation, main diagnosis and complications related to surgical procedures.
Mortality is an indicator with dubious quality (death as a result does not necessarily mean
problems in the provided healthcare). However, it has important advantages: the concept of death is
objective and does not allow subjective interpretations and big differences are not expected in
registration of obits in hospitals. [15]
Length of stay is an indicator that can be easily interpreted. For each DRG are established
minimum and maximum limits of internment, that allow the identification of irregular situations.
The number of postponed surgeries is an indicator which consists in a retrospective evaluation
of cancellations of scheduled elective and urgent operations, considering the reason for the
5
adjournment. The reasons are normally related with the lack of medical clearance and patient
preparation, the lack or failure of instruments or patient cancellation.
Outpatient department episodes are inserted in the area of activity and production. In fact, its
main purpose is to calculate the number of outpatient department episodes to estimate the evolution
of the hospital’s performance. Important sources of data to estimate this indicator are DRGs.
[16]
Outpatient surgery compares the number of outpatient surgeries with the number of
programmed surgeries. Typically, in this type of surgeries, the recovery phase is transferred to the
home environment. For this reason, the clinical practice has little opportunity to observe the patient's
post-operative course. If we relate these numbers with the satisfaction of the patient, the comparison
between each method of operation is very important to obtain information about reasonable
measures for improvement. When a reliable method is reached, it is applied as a repetitive process in
the provision of highly predictable and reproducible surgical services, as benefit to the evolution of
healthcare quality. [17]
Childbirth of cesarean operation is expressed by the relation between childbirth of cesarean
surgery and the total number of childbirths. This indicator does not provide information about the
reason for undergoing caesarean section, and includes cesarean sections that were performed
without a clinical indication as well as those that were medically indicated. Various studies were
made in order to conclude which is the most advantageous kind of labor: vaginal breech delivery or
caesarean section. Still, we can admit that “offering a trial of vaginal breech delivery to wellcounseled strictly selected patients remains an appropriate option”. [18]
Main diagnosis is a variable that can decisively affect the course of the illness. It depends on
the formation and experience of the doctor, the availability of technological resources and it also
depends on the time of permanence in the hospital.
[19]
Evaluating the quality and the results of the
diagnosis and converting that data into numbers, we can relate this indicator with others, such as the
time of internment or mortality. It is calculated in percentage or simply numbers, and it expresses the
quality of the data.
Complications related to surgical procedures are powerful indicators. Although some of them
cannot be avoided, a high number of complications after surgery could be associated with bad clinical
practice or deficient health care quality in hospitals.
These indicators are calculated by applying the SPSS which stands for Statistical Package for
the Social Sciences, a program for Windows. “The SPSS technology has made difficult analytical
tasks easier through advances in usability and data access”.
[20]
To calculate the indicators, a syntax
file is needed. The syntax file contains a set of commands that is used to analyze the entire database
and select the appropriate cases for each indicator.
6
The next step consists in the analysis of the calculated indicators. In the case of mortality, we
will compare the mortality for each DRG with the average mortality in order to find out the most
incongruent values. The ten DRGs with the highest and the lowest percentage of mortality will be
carefully examined since they carry more interesting information. We will also calculate mortality by
year, gender, age group and diagnostic and surgical procedures.
Concerning the indicator length of stay, we will calculate the overall statistics of summary
(mean, median and mode) and by each DRG (single, medical and surgery), including and excluding
obstetric DRG. [21]
In postponed surgeries, we will use the code "surgeries postponed due to postponement" to
analyze this indicator in an overall perspective and by each DRG (single, medical and surgery),
including and excluding obstetric DRG.
To evaluate the outpatient episodes, we will create a variable that indicates whether it is an
outpatient episode or not and use medical and surgical outpatient DRGs. In outpatient surgery we will
analyze its relative weight in relation to surgery scheduled.
To investigate the childbirth of cesarean we will calculate its relative weight in relation to the
total numbers of childbirth in order to find out if the percentage of cesarean births have increased or
decreased through the years.
To study the indicator main diagnosis, we will calculate the codes corresponding to
nonspecific, unacceptable and questionable diagnosis.
We will analyze the codes referring to complications related to surgical procedures (bleeding,
dehiscence, postoperative infections) and check its frequency.
To sum up, the use of the referred SPSS will allow us to reach our initial aim, create more
information and, at the same time, more questions, for further studies.
EXPECTED RESULTS
The project that we will realize consists in the analysis of diverse indicators in order to
conclude about the importance of them in the management and quality of a central hospital. Besides
that, our study will also focus on the evolution of those same indicators during the past 17 years,
which means since 1990 to 2007. Among those indicators there are mortality, length of stay,
postponed surgeries, outpatient episodes, outpatient surgery, childbirth of cesarean operation, main
diagnosis and complications related to surgical procedures.
It is simple to understand that this analysis requires a very careful approach, and due to that
fact, the aim of our study in a first phase is to prepare further stages, by starting to introduce and
analyze a very small percentage of the data referring to the indicators previously mentioned. Given
7
that data, we can try to predict how the indicators will evolve though the years using the data
concerning the full percentage of episodes occurred in that seventeen-year gap, which will be studied
in the near future. Then, we can establish comparisons between our predictions and the actual
results. However, the sample that we will have access to subsequently may be a different one, and if
that occurs, fewer similarities will be found.
Disparities in the values of the indicators throughout the years are expected as hospital quality
systems have undoubtedly been improved mainly due to the advances of medicine, which is a
science in a constant development and with repercussions in the quality of life of populations.
It is not easy to draw conclusions concerning the quality of a hospital from the analysis of the
indicators, not only due to the fact that we will contact with few of them but also because many
interpretations can be made from the mathematical and statistical results, since they do not carry any
subjectivity which could justify some situations out of what would be considered “normal” for a
particular hospital.
For instance, one would consider that the lower the length of stay the better health care, which
is correct in most cases. However, a length of stay that is too short could result in complications and
readmissions, since the patient did not fully recovered till he was discharged. The comparisons
concerning diagnosis are even more specific. Patients that need an urgent and complex surgery
could be transferred from a district hospital to a central one because of the probability of needing ICU
(Intensive Care Unit) after the operation, changing the indicators of the central hospital, which cannot
be interpreted as worse health care. Concerning now childbirth of cesarean operation, does a lower
number of cesareans mean a better health care? Not necessarily, because a hospital or maternity
which do not have the necessary resources (professionals and equipment) will present less
cesareans and send some patients to central hospitals. Studies demonstrate that the number of
cesareans has increased through the years in many countries all over the world in a significant way,
but there is not a consensus about the limits of delivery rates, which are still debated frequently
because of the risks that cesareans still carry. [22-23]
Having in mind these examples, comparisons with reference centers’ indicators will be
required, such as the indicators of AHRQ (Agency for Healthcare Research and Quality).
The results will be obtained after a statistical analysis, realized with the help of SPSS program
for Windows, which will assist all the mathematical calculations. By allowing the data treatment
related to all the proposed indicators, it will be an indispensible tool for the accomplishment of our
objectives.
In this first stage, we have analyzed a small sample of the data, concerning information from
2000 to 2005. Within these years, 3.6% of the patients died, having achieved the highest and lowest
8
values in 2000 and 2002, respectively. We have also compared the mortality between genders,
having concluded that males had a higher rate than females over these years, and divided the
population by age groups in order to try to find disparities between them
. The 64 group achieved
[24]
the highest rate, as expected, and the 0-14 age group the lowest.
Besides that, the length of stay was also examined. It decreased from 2000 until 2003, and
then increased from that year until 2005. These values resulted in a general mean of 7,98 days of
internment.
Regarding outpatients, they represent 8,4% of total patients, having their percentage
increased till 2005.
In the sample accessed at this stage, there weren’t any cases of postponed surgeries;
therefore we cannot make assignments about this indicator.
Similar results would be expected in the full sample of the data, since these values represent a
small percentage of it. However, it is imperative to state that this data is not definitive and we cannot
consider it as entirely representative of the hospital’s situation.
We believe that quality systems should be encouraged in every health institution, because
they allow not only the population to increase their knowledge about some of the hospital services
and conditions, but also the doctors and the rest of the hospital staff to have a general idea of the
hospital’s situation that otherwise would not be accessed. With that information taken into account,
everyone can make more informed and consequently more responsible decisions when making
choices.
Although we will only study a small quantity of indicators that, by themselves, do not totally
represent the performance of the hospital due to its complex organization in many services, we
consider it an interesting way of improving our knowledge about healthcare quality systems and
understanding the relevance of indicators and DRGs in the very complex quality evaluation that, in
spite of being far to be considered perfect, it is more and more complete as time goes by.
REFERENCES
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[3]
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[11] Ribeiro,
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Nuno. Administração pública. TOC. 2000/08
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[15]
Ravaud P, Giraudeau B, Roux PM, Durieux P. Are mortality indicators acceptable indicators for
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Merrill D. Management of outcomes in the ambulatory surgery center: the role of standard work
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[18]
D H Moore, G F Sawaya, L M Hopkins, M S Noah, R K Laros T Esakoff,; Outcomes associated
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Uriel, Zanon. Qualidade da assistência médico-hospitalar: conceito e avaliação de indicadores.
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11
Annexes
1. Graphics
Graphic 1 - Mortality by gender. Note: The data is related to a total of 2593 female episodes and 2434 male episodes.
Graphic 2 - Evolution of Mortality between 2000 and 2005
Graphic 3 - Relationship between outpatient and normal episodes.
12
2. Syntax (SPSS)
* Selection of hospital 24.
FILTER OFF.
USE ALL.
SELECT IF (HOSP_IDr = 24).
EXECUTE.
*Atribute labels to Drg.
Value labels drg
1 'craniotomy age >17 w cc'
2 'craniotomy age >17 w/o cc'
6 'carpal tunnel release'
7 'periph & cranial nerve & other nerv syst proc w cc'
8 'periph & cranial nerve & other nerv syst proc w/o cc'
9 'spinal disorders & injuries'
10 'nervous system neoplasms w cc'
11 'nervous system neoplasms w/o cc'
12 'degenerative nervous system disorders'
13 'multiple sclerosis & cerebellar ataxia'
14 'stroke w infarct'
15 'nonspecific cva & precerebral occlusion w/o infarct'
16 'nonspecific cerebrovascular disorders w cc'
17 'nonspecific cerebrovascular disorders w/o cc'
18 'cranial & peripheral nerve disorders w cc'
19 'cranial & peripheral nerve disorders w/o cc'
20 'nervous system infection except viral meningitis'
21 'viral meningitis'
22 'hypertensive encephalopathy'
23 'nontraumatic stupor & coma'
24 'seizure & headache age >17 w cc'
25 'seizure & headache age >17 w/o cc'
34 'other disorders of nervous system w cc'
35 'other disorders of nervous system w/o cc'
36 'retinal procedures'
37 'orbital procedures'
38 'primary iris procedures'
39 'lens procedures with or without vitrectomy'
40 'extraocular procedures except orbit age >17'
41 'extraocular procedures except orbit age <18'
42 'intraocular procedures except retina, iris & lens'
43 'hyphema'
44 'acute major eye infections'
45 'neurological eye disorders'
13
46 'other disorders of the eye age >17 w cc'
47 'other disorders of the eye age >17 w/o cc'
48 'other disorders of the eye age <18'
49 'major head & neck procedures except for malignancy'
50 'sialoadenectomy'
51 'salivary gland procedures except sialoadenectomy'
52 'cleft lip & palate repair'
53 'sinus & mastoid procedures age >17'
54 'sinus & mastoid procedures age <18'
55 'miscellaneous ear, nose, mouth & throat procedures'
56 'rhinoplasty'
57 't&a proc,except tonsillectomy &/or adenoidect only,age >17'
58 't&a proc,except tonsillectomy &/or adenoidect only,age <18'
59 'tonsillectomy &/or adenoidectomy only, age >17'
60 'tonsillectomy &/or adenoidectomy only, age <18'
61 'myringotomy w tube insertion age >17'
62 'myringotomy w tube insertion age <18'
63 'other ear, nose, mouth & throat o.r. procedures'
64 'ear, nose, mouth & throat malignancy'
65 'dysequilibrium'
66 'epistaxis'
67 'epiglottitis'
68 'otitis media & uri age >17 w cc'
69 'otitis media & uri age >17 w/o cc'
70 'otitis media & uri age <18'
71 'laryngotracheitis'
72 'nasal trauma & deformity'
73 'other ear, nose, mouth & throat diagnoses age >17'
74 'other ear, nose, mouth & throat diagnoses age <18'
75 'major chest procedures'
76 'other resp system o.r. procedures w cc'
77 'other resp system o.r. procedures w/o cc'
78 'pulmonary embolism'
79 'respiratory infections & inflammations age >17 w cc'
80 'respiratory infections & inflammations age >17 w/o cc'
82 'respiratory neoplasms'
83 'major chest trauma w cc'
84 'major chest trauma w/o cc'
85 'pleural effusion w cc'
86 'pleural effusion w/o cc'
87 'pulmonary edema & respiratory failure'
88 'chronic obstructive pulmonary disease'
89 'simple pneumonia & pleurisy age >17 w cc'
90 'simple pneumonia & pleurisy age >17 w/o cc'
14
92 'interstitial lung disease w cc'
93 'interstitial lung disease w/o cc'
94 'pneumothorax w cc'
95 'pneumothorax w/o cc'
96 'bronchitis & asthma age >17 w cc'
97 'bronchitis & asthma age >17 w/o cc'
99 'respiratory signs & symptoms w cc'
100 'respiratory signs & symptoms w/o cc'
101 'other respiratory system diagnoses w cc'
102 'other respiratory system diagnoses w/o cc'
103 'heart transplant'
104 'cardiac valve & other major cardiothoracic proc w cardiac cath'
105 'cardiac valve & other major cardiothoracic proc w/o cardiac cath'
106 'coronary bypass w ptca'
107 'coronary bypass w/o ptca w cardiac cath'
108 'other cardiothoracic proc w/o pdx congenital anomaly'
109 'coronary bypass w/o ptca w./o cardiac cath'
110 'major cardiovascular procedures w cc'
111 'major cardiovascular procedures w/o cc'
112 'percutaneous cardiovascular proc w/o ami,heart failure or shock'
113 'amputation for circ system disord except upper limb & toe'
114 'upper limb & toe amputation for circ system disorders'
115 'prm card pacem impl w ami/hf/shock or aicd lead or gnrtr proc'
116 'other permanent cardiac pacemaker implant'
117 'cardiac pacemaker revision except device replacement'
118 'cardiac pacemaker device replacement'
119 'vein ligation & stripping'
120 'other circulatory system o.r. procedures'
121 'circulatory disorders w ami & major comp, discharged alive'
122 'circulatory disorders w ami w/o major comp, discharged alive'
123 'circulatory disorders w ami, expired'
124 'circulatory disord except ami, w card cath & complex diag'
125 'circulatory disord except ami, w card cath w/o complex diag'
126 'acute & subacute endocarditis'
127 'heart failure & shock'
128 'deep vein thrombophlebitis'
129 'cardiac arrest, unexplained'
130 'peripheral vascular disorders w cc'
131 'peripheral vascular disorders w/o cc'
132 'atherosclerosis w cc'
133 'atherosclerosis w/o cc'
134 'hypertension'
135 'cardiac congenital & valvular disorders age >17 w cc'
136 'cardiac congenital & valvular disorders age >17 w/o cc'
15
137 'cardiac congenital & valvular disorders age <18'
138 'cardiac arrhythmia & conduction disorders w cc'
139 'cardiac arrhythmia & conduction disorders w/o cc'
140 'angina pectoris'
141 'syncope & collapse w cc'
142 'syncope & collapse w/o cc'
143 'chest pain'
144 'other circulatory system diagnoses w cc'
145 'other circulatory system diagnoses w/o cc'
146 'rectal resection w cc'
147 'rectal resection w/o cc'
148 'major small & large bowel procedures w cc'
149 'major small & large bowel procedures w/o cc'
150 'peritoneal adhesiolysis w cc'
151 'peritoneal adhesiolysis w/o cc'
152 'minor small & large bowel procedures w cc'
153 'minor small & large bowel procedures w/o cc'
154 'stomach, esophageal & duodenal procedures age >17 w cc'
155 'stomach, esophageal & duodenal procedures age >17 w/o cc'
156 'stomach, esophageal & duodenal procedures age <18'
157 'anal & stomal procedures w cc'
158 'anal & stomal procedures w/o cc'
159 'hernia procedures except inguinal & femoral age >17 w cc'
160 'hernia procedures except inguinal & femoral age >17 w/o cc'
161 'inguinal & femoral hernia procedures age >17 w cc'
162 'inguinal & femoral hernia procedures age >17 w/o cc'
163 'hernia procedures age <18'
164 'appendectomy w complicated principal diag w cc'
165 'appendectomy w complicated principal diag w/o cc'
166 'appendectomy w/o complicated principal diag w cc'
167 'appendectomy w/o complicated principal diag w/o cc'
168 'mouth procedures w cc'
169 'mouth procedures w/o cc'
170 'other digestive system o.r. procedures w cc'
171 'other digestive system o.r. procedures w/o cc'
172 'digestive malignancy w cc'
173 'digestive malignancy w/o cc'
174 'g.i. hemorrhage w cc'
175 'g.i. hemorrhage w/o cc'
176 'complicated peptic ulcer'
177 'uncomplicated peptic ulcer w cc'
178 'uncomplicated peptic ulcer w/o cc'
179 'inflammatory bowel disease'
180 'g.i. obstruction w cc'
16
181 'g.i. obstruction w/o cc'
182 'esophagitis, gastroent & misc digest disord age >17 w cc'
183 'esophagitis, gastroent & misc digest disord age >17 w/o cc'
185 'dental & oral dis except extractions & restorations, age >17'
186 'dental & oral dis except extractions & restorations, age <18'
187 'dental extractions & restorations'
188 'other digestive system diagnoses age >17 w cc'
189 'other digestive system diagnoses age >17 w/o cc'
191 'pancreas, liver & shunt procedures w cc'
192 'pancreas, liver & shunt procedures w/o cc'
193 'biliary tract proc except only cholecyst w or w/o c.d.e. w cc'
194 'biliary tract proc except only cholecyst w or w/o c.d.e. w/o cc'
195 'cholecystectomy w c.d.e. w cc'
196 'cholecystectomy w c.d.e. w/o cc'
197 'cholecystectomy w/o c.d.e. w cc'
198 'cholecystectomy w/o c.d.e. w/o cc'
199 'hepatobiliary diagnostic procedure for malignancy'
200 'hepatobiliary diagnostic procedure for non-malignancy'
201 'other hepatobiliary or pancreas o.r. procedures'
202 'cirrhosis & alcoholic hepatitis'
203 'malignancy of hepatobiliary system or pancreas'
204 'disorders of pancreas except malignancy'
205 'disorders of liver except malig,cirr,alc hepa w cc'
206 'disorders of liver except malig,cirr,alc hepa w/o cc'
207 'disorders of the biliary tract w cc'
208 'disorders of the biliary tract w/o cc'
209 'maj joint & limb reattach proc of low ext, exc hip, exc for comp'
210 'hip & femur procedures except major joint age >17 w cc'
211 'hip & femur procedures except major joint age >17 w/o cc'
212 'hip & femur procedures except major joint age <18'
213 'amputation for musculoskelet system & conn tissue disorders'
216 'biopsies of musculoskeletal system & connective tissue'
217 'wnd debrid & skin grft exc opn wnd,for ms & conn tis dis,exc hand'
218 'lower extrem & humer proc exc hip,foot,femur age >17 w cc'
219 'lower extrem & humer proc exc hip,foot,femur age >17 w/o cc'
220 'lower extrem & humer proc exc hip,foot,femur age <18'
221 'knee procedures w cc'
222 'knee procedures w/o cc'
223 'major shoulder/elbow proc, or oth upper extremity proc w cc'
224 'shoulder,elbow or forearm proc,exc major joint proc, w/o cc'
225 'foot procedures'
226 'soft tissue procedures w cc'
227 'soft tissue procedures w/o cc'
228 'major thumb or joint proc,or oth hand or wrist proc w cc'
17
229 'hand or wrist proc, except major joint proc, w/o cc'
230 'local excision & removal of int fix devices of hip & femur'
232 'arthroscopy'
233 'other musculoskelet sys & conn tiss o.r. proc w cc'
234 'other musculoskelet sys & conn tiss o.r. proc w/o cc'
235 'fractures of femur'
236 'fractures of hip & pelvis'
237 'sprains, strains, & dislocations of hip, pelvis & thigh'
238 'osteomyelitis'
239 'pathological fractures & muscskelet & conn tiss malignancy'
240 'connective tissue disorders w cc'
241 'connective tissue disorders w/o cc'
242 'septic arthritis'
243 'medical back problems'
244 'bone diseases & specific arthropathies w cc'
245 'bone diseases & specific arthropathies w/o cc'
246 'non-specific arthropathies'
247 'signs & symptoms of musculoskeletal system & conn tissue'
248 'tendonitis, myositis & bursitis'
249 'malfunction,reaction or complication of orthopedic device or proc'
250 'fx, sprn,strn & disl of forearm, hand, foot age >17 w cc'
251 'fx, sprn,strn & disl of forearm, hand, foot age >17 w/o cc'
252 'fx, sprn,strn & disl of forearm, hand, foot age <18'
253 'fx, sprn,strn & disl of uparm,lowleg ex foot age >17 w cc'
254 'fx, sprn,strn & disl of uparm,lowleg ex foot age >17 w/o cc'
255 'fx, sprn,strn & disl of uparm,lowleg ex foot age <18'
256 'other musculoskeletal system & connective tissue diagnoses'
257 'total mastectomy for malignancy w cc'
258 'total mastectomy for malignancy w/o cc'
259 'subtotal mastectomy for malignancy w cc'
260 'subtotal mastectomy for malignancy w/o cc'
261 'breast proc for non-malignancy except biopsy & local excision'
262 'breast biopsy & local excision for non-malignancy'
263 'skin graft &/or debrid for skn ulcer,cellulitis w cc'
264 'skin graft &/or debrid for skn ulcer,cellulitis w/o cc'
265 'skin graft &/or debrid exc for skin ulcer, cellulitis w cc'
266 'skin graft &/or debrid exc for skin ulcer, cellulitis w/o cc'
267 'perianal & pilonidal procedures'
268 'skin, subcutaneous tissue & breast plastic procedures'
269 'other skin, subcut tiss & breast proc w cc'
270 'other skin, subcut tiss & breast proc w/o cc'
271 'skin ulcers'
272 'major skin disorders w cc'
273 'major skin disorders w/o cc'
18
274 'malignant breast disorders w cc'
275 'malignant breast disorders w/o cc'
276 'non-maligant breast disorders'
277 'cellulitis age >17 w cc'
278 'cellulitis age >17 w/o cc'
279 'cellulitis age <18'
280 'trauma to the skin, subcut tiss & breast age >17 w cc'
281 'trauma to the skin, subcut tiss & breast age >17 w/o cc'
282 'trauma to the skin, subcut tiss & breast age <18'
283 'minor skin disorders w cc'
284 'minor skin disorders w/o cc'
285 'amputat of low limb for endocrine,nutrit,& metabol disorders'
286 'adrenal & pituitary procedures'
287 'skin graft & wound debrid for endoc,nutrit & metab disorders'
288 'o.r. procedures for obesity'
289 'parathyroid procedures'
290 'thyroid procedures'
291 'thyroglossal procedures'
292 'other endocrine, nutrit & metab o.r. proc w cc'
293 'other endocrine, nutrit & metab o.r. proc w/o cc'
294 'diabetes age >35'
295 'diabetes age <36'
296 'nutritional & misc metabolic disorders age >17 w cc'
297 'nutritional & misc metabolic disorders age >17 w/o cc'
298 'nutritional & misc metabolic disorders age <18'
299 'inborn errors of metabolism'
300 'endocrine disorders w cc'
301 'endocrine disorders w/o cc'
302 'kidney transplant'
303 'kidney,ureter & maj bladder proc for neoplasm'
304 'kidney,ureter & maj bladder proc for non-neoplasm w cc'
305 'kidney,ureter & maj bladder proc for non-neoplasm w/o cc'
306 'prostatectomy w cc'
307 'prostatectomy w/o cc'
308 'minor bladder procedures w cc'
309 'minor bladder procedures w/o cc'
310 'transurethral procedures w cc'
311 'transurethral procedures w/o cc'
312 'urethral procedures age >17 w cc'
313 'urethral procedures age >17 w/o cc'
314 'urethral procedures age <18'
315 'other kidney & urinary tract o.r. procedures'
316 'renal failure'
317 'admit for renal dialysis'
19
318 'kidney & urinary tract neoplasms w cc'
319 'kidney & urinary tract neoplasms w/o cc'
320 'kidney & urinary tract infections age >17 w cc'
321 'kidney & urinary tract infections age >17 w/o cc'
322 'kidney & urinary tract infections age <18'
323 'urinary stones w cc, &/or esw lithotripsy'
324 'urinary stones w/o cc'
325 'kidney & urinary tract signs & symptoms age >17 w cc'
326 'kidney & urinary tract signs & symptoms age >17 w/o cc'
327 'kidney & urinary tract signs & symptoms age <18'
328 'urethral stricture age >17 w cc'
329 'urethral stricture age >17 w/o cc'
330 'urethral stricture age <18'
331 'other kidney & urinary tract diagnoses age >17 w cc'
332 'other kidney & urinary tract diagnoses age >17 w/o cc'
333 'other kidney & urinary tract diagnoses age <18'
334 'major male pelvic procedures w cc'
335 'major male pelvic procedures w/o cc'
336 'transurethral prostatectomy w cc'
337 'transurethral prostatectomy w/o cc'
338 'testes procedures, for malignancy'
339 'testes procedures, non-malignancy age >17'
340 'testes procedures, non-malignancy age <18'
341 'penis procedures'
342 'circumcision age >17'
343 'circumcision age <18'
344 'other male reproductive syst o.r. proc for malignancy'
345 'other male reproductive syst o.r. proc except for malignancy'
346 'malignancy, male reproductive system, w cc'
347 'malignancy, male reproductive system, w/o cc'
348 'benign prostatic hypertrophy w cc'
349 'benign prostatic hypertrophy w/o cc'
350 'inflammation of the male reproductive system'
351 'sterilization, male'
352 'other male reproductive system diagnoses'
353 'pelvic evisceration,radical hysterect & radical vulvectomy'
354 'uterine,adnexa proc for non-ovarian/adnexal malignancy w cc'
355 'uterine,adnexa proc for non-ovarian/adnexal malignancy w/o cc'
356 'female reproductive system reconstructive procedures'
357 'uterine & adnexa proc for ovarian or adnexal malignancy'
358 'uterine & adnexa proc for ca in situ & non-malignancy w cc'
359 'uterine & adnexa proc for ca in situ & non-malignancy w/o cc'
360 'vagina, cervix & vulva procedures'
361 'laparoscopy & incisional tubal interruption'
20
362 'endoscopic tubal interruption'
363 'd&c, conization & radio-implant, for malignancy'
364 'd&c, conization except for malignancy'
365 'other female reproductive system o.r. procedures'
366 'malignancy, female reproductive system, w cc'
367 'malignancy, female reproductive system, w/o cc'
368 'infections, female reproductive system'
369 'menstrual & other female reproductive system disorders'
370 'cesarean section w cc'
371 'cesarean section w/o cc'
372 'vaginal delivery w complicating diagnoses'
373 'vaginal delivery w/o complicating diagnoses'
374 'vaginal delivery w sterilization &/or d&c'
375 'vaginal delivery w o.r. proc except steril &/or d&c'
376 'postpartum & post abortion diagnoses w/o o.r. procedure'
377 'postpartum & post abortion diagnoses w o.r. procedure'
378 'ectopic pregnancy'
379 'threatened abortion'
380 'abortion w/o d&c'
381 'abortion w d&c, aspiration curettage or hysterotomy'
382 'false labor'
383 'other antepartum diagnoses w medical complications'
384 'other antepartum diagnoses w/o medical complications'
392 'splenectomy age >17'
393 'splenectomy age <18'
394 'other o.r. procedures of blood and blood forming organs'
395 'red blood cell disorders age >17'
397 'coagulation disorders'
398 'reticuloendothelial & immunity disorders w cc'
399 'reticuloendothelial & immunity disorders w/o cc'
401 'lymphoma & non-acute leukemia w other o.r. proc w cc'
402 'lymphoma & non-acute leukemia w other o.r. proc w/o cc'
403 'lymphoma & non-acute leukemia w cc'
404 'lymphoma & non-acute leukemia w/o cc'
406 'myeloprolif disord or poor diff neopl w maj o.r.proc w cc'
407 'myeloprolif disord or poor diff neopl w maj o.r.proc w/o cc'
408 'myeloprolif disord or poorly diff neopl w other o.r.proc'
409 'radiotherapy'
410 'chemotherapy'
413 'other myeloprolif dis or poor diff neopl diag w cc'
414 'other myeloprolif dis or poor diff neopl diag w/o cc'
415 'o.r. procedure for infectious & parasitic diseases'
416 'septicemia age >17'
417 'septicemia age <18'
21
418 'postoperative & post-traumatic infections'
419 'fever of unknown origin age >17 w cc'
420 'fever of unknown origin age >17 w/o cc'
421 'viral illness age >17'
422 'viral illness & fever of unknown origin age <18'
423 'other infectious & parasitic diseases diagnoses'
424 'o.r. procedure w principal diagnoses of mental illness'
425 'acute adjustment reaction & psychosocial dysfunction'
426 'depressive neuroses'
427 'neuroses except depressive'
428 'disorders of personality & impulse control'
429 'organic disturbances & mental retardation'
430 'psychoses'
431 'childhood mental disorders'
432 'other mental disorder diagnoses'
439 'skin grafts for injuries'
440 'wound debridements for injuries except open wounds'
441 'hand procedures for injuries'
442 'other o.r. procedures for injuries w cc'
443 'other o.r. procedures for injuries w/o cc'
444 'injuries to unspecified or multiple sites age >17 w cc'
445 'injuries to unspecified or multiple sites age >17 w/o cc'
446 'injuries to unspecified or multiple sites age <18'
447 'allergic reactions age >17'
448 'allergic reactions age <18'
449 'poisoning & toxic effects of drugs age >17 w cc'
450 'poisoning & toxic effects of drugs age >17 w/o cc'
451 'poisoning & toxic effects of drugs age <18'
452 'complications of treatment w cc'
453 'complications of treatment w/o cc'
454 'other injury, poisoning & toxic effect diagnosis w cc'
455 'other injury, poisoning & toxic effect diagnosis w/o cc'
461 'o.r. proc w diagnoses of other contact w health services'
462 'rehabilitation'
463 'signs & symptoms w cc'
464 'signs & symptoms w/o cc'
465 'aftercare w history of malignancy as secondary diagnosis'
466 'aftercare w/o history of malignancy as secondary diagnosis'
467 'other factors influencing health status'
468 'extensive o.r. procedure unrelated to principal diagnosis'
469 'principal diagnosis invalid as discharge diagnosis'
470 'ungroupable'
471 'bilateral or multiple major joint procs of lower extremity'
475 'respiratory system diagnosis with ventilator support'
22
476 'prostatic o.r. procedure unrelated to principal diagnosis'
477 'non-extensive o.r. procedure unrelated to principal diagnosis'
478 'other vascular procedures w cc'
479 'other vascular procedures w/o cc'
480 'liver transplant'
482 'tracheostomy for face,mouth & neck diagnoses'
483 'ecmo or trach w mech vent 96+ hrs or trach w pdx except face/mouth/neck dx'
491 'major joint & limb reattachment procedures of upper extremity'
493 'laparoscopic cholecystectomy w/o c.d.e w cc'
494 'laparoscopic cholecystectomy w/o c.d.e w/o cc'
530 'craniotomy w major cc'
531 'nervous system procedures except craniotomy w major cc'
532 'tia, precerebral occlusions, seizure & headache w major cc'
533 'other nervous system disord except tia, seizure & headache w major cc'
534 'eye procedures w major cc'
535 'eye disorders w major cc'
536 'ent & mouth procedures except major head & neck w major cc'
538 'major chest procedures w major cc'
539 'respiratory procedures except major chest w major cc'
540 'respiratory infections & inflammations w major cc'
541 'respiratory disord except infections, bronchitis, asthma w major cc'
542 'bronchitis & asthma w major cc'
543 'circ disorders except ami, endocarditis, chf & arrhythmia w major cc'
544 'chf & cardiac arrhythmia w major cc'
545 'cardiac valve procedure w major cc'
546 'coronary bypass w major cc'
547 'other cardiothoracic procedures w major cc'
548 'oth cardiac pacemaker implant/revision or aicd proc w major cc'
549 'major cardiovascular procedures w major cc'
550 'other vascular procedures w major cc'
551 'esophagitis, gastroenteritis & uncomplicated ulcers w major cc'
552 'digest syst disord except esoph,gastroent & uncompl ulcers w major cc'
553 'digest syst proc exc hernia & major stomach or bowel proc w major cc'
554 'hernia procedures w major cc'
555 'pancreas,liver & oth bil tract proc except liver transplnt w major cc'
556 'cholecystectomy and other hepatobiliary procedures w major cc'
557 'hepatobiliary and pancreas disorders w major cc'
558 'major musculoskelet procs except bilat or mult major joint w major cc'
559 'non-major musculoskeletal procedures w major cc'
560 'musculoskel disord exc osteo, septic arth & conn tissue dis w major cc'
561 'osteomyelitis, septic arthritis & conn tissue disorder w major cc'
562 'major skin & breast disorders w major cc'
563 'other skin disorders w major cc'
564 'skin & breast procedures w major cc'
23
565 'endocrine, nutrit & metab proc except lower limb amputat w major cc'
566 'endocrine, nutrit & metab disord exc eating disorder or cf w major cc'
567 'kidney & urinary tract procedures except kidney transplant w major cc'
568 'renal failure w major cc'
569 'kidney & urinary tract disorders except renal failure w major cc'
570 'male reproductive disorders w major cc'
571 'male reproductive procedures w major cc'
572 'female reproductive disorders w major cc'
573 'non-radical female reproductive procedures w major cc'
574 'blood, blood forming organs & immunological disorders w major cc'
575 'blood, blood forming organs & immunological procedures w major cc'
576 'acute leukemia w major cc'
577 'myeloprolif disorders & poorly differentiated neoplasms w major cc'
578 'lymphoma & non-acute leukemia w major cc'
579 'procedures for lymphoma, leukemia, myeloprolif disorders w major cc'
580 'systemic infections & parasitic disord except septicemia w major cc'
581 'systemic infections & parasitic disorder procedures w major cc'
582 'injuries except multiple trauma w major cc'
583 'procedures for injuries except multiple trauma w major cc'
584 'septicemia w major cc'
585 'major stomach,esophageal,duodenal,small & large bowel proc w major cc'
586 'ent & mouth disorders age >17 w major cc'
587 'ent & mouth disorders age <18 w major cc'
602 'neonate, birthwt <750g, discharged alive'
603 'neonate, birthwt <750g, died'
604 'neonate, birthwt 750-999g, discharged alive'
605 'neonate, birthwt 750-999g, died'
606 'neonate, birthwt 1000-1499g, w signif or proc, discharged alive'
607 'neonate, birthwt 1000-1499g, w/o signif or proc, discharged alive'
608 'neonate, birthwt 1000-1499g, died'
609 'neonate, birthwt 1500-1999g, w signif or proc, w mult major prob'
610 'neonate, birthwt 1500-1999g, w signif or proc, w/o mult major prob'
611 'neonate, birthwt 1500-1999g, w/o signif or proc, w mult major prob'
612 'neonate, birthwt 1500-1999g, w/o signif or proc, w major prob'
613 'neonate, birthwt 1500-1999g, w/o signif or proc, w minor prob'
614 'neonate, birthwt 1500-1999g, w/o signif or proc, w other prob'
615 'neonate, birthwt 2000-2499g, w signif or proc, w mult major prob'
616 'neonate, birthwt 2000-2499g, w signif or proc, w/o mult major prob'
617 'neonate, birthwt 2000-2499g, w/o signif or proc, w mult major prob'
618 'neonate, birthwt 2000-2499g, w/o signif or proc, w major prob'
619 'neonate, birthwt 2000-2499g, w/o signif or proc, w minor prob'
620 'neonate, bwt 2000-2499g, w/o signif or proc, w norm newborn diag'
621 'neonate, birthwt 2000-2499g, w/o signif or proc, w other prob'
622 'neonate, birthwt >2499g, w signif or proc, w mult major prob'
24
623 'neonate, birthwt >2499g, w signif or proc, w/o mult major prob'
624 'neonate, birthwt >2499g, w minor abdom procedure'
626 'neonate, birthwt >2499g, w/o signif or proc, w mult major prob'
627 'neonate, birthwt >2499g, w/o signif or proc, w major prob'
628 'neonate, birthwt >2499g, w/o signif or proc, w minor prob'
629 'neonate, bwt >2499g, w/o signif or proc, w normal newborn diag'
630 'neonate, birthwt >2499g, w/o signif or proc, w other prob'
631 'bpd and oth chronic respiratory diseases arising in perinatal period'
633 'multiple, other and unspecified congenital anomalies, w cc'
634 'multiple, other and unspecified congenital anomalies, w/o cc'
635 'neonatal aftercare for weight gain'
636 'infant aftercare for weight gain, age >28 days <1 year'
637 'neonate, died w/in one day of birth, born here'
638 'neonate, died w/in one day of birth, not born here'
639 'neonate, transferred <5 days old, born here'
640 'neonate, transferred <5 days old, not born here'
641 'neonate, birthweight >2499g, w ecmo'
650 'high risk cesarean section w cc'
651 'high risk cesarean section w/o cc'
652 'high risk vaginal delivery w sterilization and/or d&c'
700 'tracheostomy for hiv infection'
701 'hiv w o.r procedure & ventilator or nutritional support'
702 'hiv w o.r procedure w multiple major related infections'
703 'hiv w o.r procedure w major related diagnosis'
704 'hiv w o.r procedure w/o major related diagnosis'
705 'hiv w multiple major related infections w tb'
706 'hiv w multiple major related infections w/o tb'
707 'hiv w ventilator or nutritional support'
708 'hiv w major related diagnosis, discharged ama'
709 'hiv w major related diag w mult major or signif diag w tb'
710 'hiv w major related diag w mult major or signif diag w/o tb'
711 'hiv w major related diag w/o mult major or signif diag w tb'
712 'hiv w major related diag w/o mult major or signif diag w/o tb'
713 'hiv w significant related diagnosis, discharged ama'
714 'hiv w significant related diagnosis'
715 'hiv w other related diagnosis'
716 'hiv w/o other related diagnosis'
730 'craniotomy for multiple significant trauma'
731 'spine, hip, femur or limb proc for multiple significant trauma'
732 'other o.r. procedure for multiple significant trauma'
733 'head, chest and lower limb diagnoses of multiple significant trauma'
734 'other diagnoses of multiple significant trauma'
737 'venticular shunt revision'
738 'craniotomy age <18 w cc'
25
739 'craniotomy age <18 w/o cc'
740 'cystic fibrosis'
743 'opioid abuse or dependence, left against medical advice'
744 'opioid abuse or dependence w cc'
745 'opioid abuse or dependence w/o cc'
746 'cocaine or other drug abuse or dependence, left against medical advice'
747 'cocaine or other drug abuse or dependence w cc'
748 'cocaine or other drug abuse or dependence w/o cc'
749 'alcohol abuse or dependence, left against medical advice'
750 'alcohol abuse or dependence, w cc'
751 'alcohol abuse or dependence, w/o cc'
752 'lead poisoning'
753 'compulsive nutrition disorder rehabilitation'
754 'tertiary aftercare, age =>1 year'
755 'spinal fusion w cc'
756 'spinal fusion w/o cc'
757 'back & neck procedures except spinal fusion w cc'
758 'back & neck procedures except spinal fusion w/o cc'
759 'multiple channel cochlear implants'
760 'hemophilia factors viii and ix'
761 'traumatic stupor & coma, coma >1 hr'
762 'concussion, intracranial injury w coma <1 hr or no coma age <18'
763 'traumatic stupor & coma, coma <1 hr age <18'
764 'concussion, intracranial injury w coma <1 hr or no coma age >17 w cc'
765 'concussion, intracranial injury w coma <1 hr or no coma age >17 w/o cc'
766 'traumatic stupor & coma, coma <1 hr age >17 w cc'
767 'traumatic stupor & coma, coma <1 hr age >17 w/o cc'
768 'seizure & headache age <18 w cc'
769 'seizure & headache age <18 w/o cc'
770 'respiratory infections & inflammations age <18 w cc'
771 'respiratory infections & inflammations age <18 w/o cc'
772 'simple pneumonia & pleurisy age <18 w cc'
773 'simple pneumonia & pleurisy age <18 w/o cc'
774 'bronchitis & asthma age <18 w cc'
775 'bronchitis & asthma age <18 w/o cc'
776 'esophagitis, gastroent & misc digest disord age <18 w cc'
777 'esophagitis, gastroent & misc digest disord age <18 w/o cc'
778 'other digestive system diagnoses age <18 w cc'
779 'other digestive system diagnoses age <18 w/o cc'
780 'acute leukemia w/o major o.r. procedure age <18 w cc'
781 'acute leukemia w/o major o.r. procedure age <18 w/o cc'
782 'acute leukemia w/o major o.r. procedure age >17 w cc'
783 'acute leukemia w/o major o.r. procedure age >17 w/o cc'
784 'acquired hemolytic anemia or sickle cell crisis age <18'
26
785 'other red blood cell disorders age <18'
786 'major head & neck procedures for malignancy'
787 'laparoscopic cholecystectomy w c.d.e'
789 'maj joint & limb reattach proc of low ext, exc hip, for comp'
790 'wound debrid & skin grft for open wnd,ms & conn tiss dis,exc hand'
791 'wound debridements for open wound injuries'
792 'craniotomy for multiple sig trauma with non-traumatic major cc'
793 'proc for mul sig trauma exc craniotomy w non-traumatic major cc'
794 'diag for multiple significant trauma with non-traumatic major cc'
795 'lung transplant'
796 'lower extremity revascularization w cc'
797 'lower extremity revascularization w/o cc'
798 'tuberculosis w operating room procedure'
799 'tuberculosis, left against medical advice'
800 'tuberculosis w cc'
801 'tuberculosis w/o cc'
802 'pneumocystosis'
803 'allogeneic bone marrow transplant'
804 'autologous bone marrow transplant'
805 'simultaneous kidney/pancreas transplant'
806 'combined anterior/posterior spinal fusion w cc'
807 'combined anterior/posterior spinal fusion w/o cc'
808 'percutaneous cardiovascular proc w ami,heart failure or shock'
809 'other cardiothoracic proc w pdx congenital anomaly'
810 'intracranial hemorrhage'
811 'heart assist system implant'
812 'malfunction, reaction & comp of cardiac or vasc device or proc'
813 'nonbacterial gastroenteritis & abdominal pain age >17 w cc'
814 'nonbacterial gastroenteritis & abdominal pain age >17 w/o cc'
815 'nonbacterial gastroenteritis & abdominal pain age <18 w cc'
816 'nonbacterial gastroenteritis & abdominal pain age <18 w/o cc'
817 'hip replacement for complications'
818 'hip replacement except for complications'
819 'create, revise or remove renal access device'
820 'malfunctions, reactions & comp of gu device/graft/transplant'
821 'extensive 3rd degree burns w skin graft'
822 'extensive 3rd degree burns w/o skin graft'
823 'full thickness burn w skin graft or inhal inj w cc or sig trauma'
824 'full thickness burn w skin grft or inhal inj w/o cc or sig trauma'
825 'full thickness burn w/o skin grft or inhal inj w cc or sig trauma'
826 'full thickness burn w/o skin grft or inh inj w/o cc or sig trauma'
827 'non-extensive burns w inhal inj,cc or significant trauma'
828 'non-extensive burns w/o inhal inj, cc or significant trauma'
829 'pancreas transplant'
27
832 'transient ischemia'
833 'intracranial vascular procedures w pdx hemorrhage'
836 'spinal procedures w cc'
837 'spinal procedures w/o cc'
838 'extracranial procedures w cc'
839 'extracranial procedures w/o cc'
849 'cardiac defib implant w cardiac cath w ami/hf/shock'
850 'cardiac defib implant w cardiac cath w/o ami/hf/shock'
851 'cardiac defibrillator w/o cardiac catheter'
852 'percutaneous cardiovascular procedure w non-drug eluting stent w/o ami'
853 'percutaneous cardiovascular procedure w drug-eluting stent w ami'
854 'percutaneous cardiovascular procedure w drug-eluting stent w/o ami'
864 'cervical spinal fusion w cc'
865 'cervical spinal fusion w/o cc'
866 'local excision & removal of int fix devices except hip & femur w cc'
867 'local excision & removal of int fix devices except hip & femur w/o cc'
874 'lymphoma & leukemia w major o.r. procedure w cc'
875 'lymphoma & leukemia w major o.r. procedure w/o cc'
876 'chemo w acute leukemia as sdx or w use of high dose chemo agent'.
*Definition which Drg are medical or surgical.
RECODE DRG
(1=2) (2=2) (6=2) (7=2) (8=2) (36=2) (37=2) (38=2) (39=2) (40=2) (41=2) (42=2) (49=2) (50=2)
(51=2) (52=2) (53=2) (54=2) (55=2) (56=2) (57=2) (58=2) (59=2) (60=2) (61=2) (62=2) (63=2)
(75=2) (76=2) (77=2) (103=2) (104=2) (105=2) (106=2) (107=2) (108=2) (109=2) (110=2) (111=2)
(112=2) (113=2) (114=2) (115=2) (116=2) (117=2) (118=2) (119=2) (120=2) (146=2) (147=2)
(148=2) (149=2) (150=2) (151=2) (152=2) (153=2) (154=2) (155=2) (156=2) (157=2) (158=2)
(159=2) (160=2) (161=2) (162=2) (163=2) (164=2) (165=2) (166=2) (167=2) (168=2) (169=2)
(170=2) (171=2) (191=2) (192=2) (193=2) (194=2) (195=2) (196=2) (197=2) (198=2) (199=2)
(200=2) (201=2) (209=2) (210=2) (211=2) (212=2) (213=2) (216=2) (217=2) (218=2) (219=2)
(220=2) (221=2) (222=2) (223=2) (224=2) (225=2) (226=2) (227=2) (228=2) (229=2) (230=2)
(232=2) (233=2) (234=2) (257=2) (258=2) (259=2) (260=2) (261=2) (262=2) (263=2) (264=2)
(265=2) (266=2) (267=2) (268=2) (269=2) (270=2) (285=2) (286=2) (287=2) (288=2) (289=2)
(290=2) (291=2) (292=2) (293=2) (302=2) (303=2) (304=2) (305=2) (306=2) (307=2) (308=2)
(309=2) (310=2) (311=2) (312=2) (313=2) (314=2) (315=2) (334=2) (335=2) (336=2) (337=2)
(338=2) (339=2) (340=2) (341=2) (342=2) (343=2) (344=2) (345=2) (353=2) (354=2) (355=2)
(356=2) (357=2) (358=2) (359=2) (360=2) (361=2) (362=2) (363=2) (364=2) (365=2) (370=2)
(371=2) (374=2) (375=2) (377=2) (381=2) (392=2) (393=2) (394=2) (401=2) (402=2) (406=2)
(407=2) (408=2) (415=2) (424=2) (439=2) (440=2) (441=2) (442=2) (443=2) (461=2) (468=2)
(471=2) (476=2) (477=2) (478=2) (479=2) (480=2) (482=2) (483=2) (491=2) (493=2) (494=2)
(530=2) (531=2) (534=2) (536=2) (538=2) (539=2) (545=2) (546=2) (547=2) (548=2) (549=2)
(550=2) (553=2) (554=2) (555=2) (556=2) (558=2) (559=2) (564=2) (565=2) (567=2) (571=2)
(573=2) (575=2) (579=2) (581=2) (583=2) (585=2) (606=2) (609=2) (610=2) (615=2) (616=2)
(622=2) (623=2) (624=2) (641=2) (650=2) (651=2) (652=2) (700=2) (701=2) (702=2) (703=2)
28
(704=2) (730=2) (731=2) (732=2) (737=2) (738=2) (739=2) (755=2) (756=2) (757=2) (758=2)
(759=2) (786=2) (787=2) (789=2) (790=2) (791=2) (792=2) (793=2) (795=2) (796=2) (797=2)
(798=2) (803=2) (804=2) (805=2) (806=2) (807=2) (808=2) (809=2) (811=2) (817=2) (818=2)
(819=2) (821=2) (823=2) (824=2) (829=2) (833=2) (836=2) (837=2) (838=2) (839=2) (849=2)
(850=2) (851=2) (852=2) (853=2) (854=2) (864=2) (865=2) (866=2) (867=2) (874=2) (875=2)
(9=1) (10=1) (11=1) (12=1) (13=1) (14=1) (15=1) (16=1) (17=1) (18=1) (19=1) (20=1) (21=1)
(22=1) (23=1) (24=1) (25=1) (34=1) (35=1) (43=1) (44=1) (45=1) (46=1) (47=1) (48=1) (64=1)
(65=1) (66=1) (67=1) (68=1) (69=1) (70=1) (71=1) (72=1) (73=1) (74=1) (78=1) (79=1) (80=1)
(82=1) (83=1) (84=1) (85=1) (86=1) (87=1) (88=1) (89=1) (90=1) (92=1) (93=1) (94=1) (95=1)
(96=1) (97=1) (99=1) (100=1) (101=1) (102=1) (121=1) (122=1) (123=1) (124=1) (125=1) (126=1)
(127=1) (128=1) (129=1) (130=1) (131=1) (132=1) (133=1) (134=1) (135=1) (136=1) (137=1)
(138=1) (139=1) (140=1) (141=1) (142=1) (143=1) (144=1) (145=1) (172=1) (173=1) (174=1)
(175=1) (176=1) (177=1) (178=1) (179=1) (180=1) (181=1) (182=1) (183=1) (185=1) (186=1)
(187=1) (188=1) (189=1) (202=1) (203=1) (204=1) (205=1) (206=1) (207=1) (208=1) (235=1)
(236=1) (237=1) (238=1) (239=1) (240=1) (241=1) (242=1) (243=1) (244=1) (245=1) (246=1)
(247=1) (248=1) (249=1) (250=1) (251=1) (252=1) (253=1) (254=1) (255=1) (256=1) (271=1)
(272=1) (273=1) (274=1) (275=1) (276=1) (277=1) (278=1) (279=1) (280=1) (281=1) (282=1)
(283=1) (284=1) (294=1) (295=1) (296=1) (297=1) (298=1) (299=1) (300=1) (301=1) (316=1)
(317=1) (318=1) (319=1) (320=1) (321=1) (322=1) (323=1) (324=1) (325=1) (326=1) (327=1)
(328=1) (329=1) (330=1) (331=1) (332=1) (333=1) (346=1) (347=1) (348=1) (349=1) (350=1)
(351=1) (352=1) (366=1) (367=1) (368=1) (369=1) (372=1) (373=1) (376=1) (378=1) (379=1)
(380=1) (382=1) (383=1) (384=1) (395=1) (397=1) (398=1) (399=1) (403=1) (404=1) (409=1)
(410=1) (413=1) (414=1) (416=1) (417=1) (418=1) (419=1) (420=1) (421=1) (422=1) (423=1)
(425=1) (426=1) (427=1) (428=1) (429=1) (430=1) (431=1) (432=1) (444=1) (445=1) (446=1)
(447=1) (448=1) (449=1) (450=1) (451=1) (452=1) (453=1) (454=1) (455=1) (462=1) (463=1)
(464=1) (465=1) (466=1) (467=1) (475=1) (532=1) (533=1) (535=1) (540=1) (541=1) (542=1)
(543=1) (544=1) (551=1) (552=1) (557=1) (560=1) (561=1) (562=1) (563=1) (566=1) (568=1)
(569=1) (570=1) (572=1) (574=1) (576=1) (577=1) (578=1) (580=1) (582=1) (584=1) (586=1)
(587=1) (602=1) (603=1) (604=1) (605=1) (607=1) (608=1) (611=1) (612=1) (613=1) (614=1)
(617=1) (618=1) (619=1) (620=1) (621=1) (626=1) (627=1) (628=1) (629=1) (630=1) (631=1)
(633=1) (634=1) (635=1) (636=1) (637=1) (638=1) (639=1) (640=1) (705=1) (706=1) (707=1)
(708=1) (709=1) (710=1) (711=1) (712=1) (713=1) (714=1) (715=1) (716=1) (733=1) (734=1)
(740=1) (743=1) (744=1) (745=1) (746=1) (747=1) (748=1) (749=1) (750=1) (751=1) (752=1)
(753=1) (754=1) (760=1) (761=1) (762=1) (763=1) (764=1) (765=1) (766=1) (767=1) (768=1)
(769=1) (770=1) (771=1) (772=1) (773=1) (774=1) (775=1) (776=1) (777=1) (778=1) (779=1)
(780=1) (781=1) (782=1) (783=1) (784=1) (785=1) (794=1) (799=1) (800=1) (801=1) (802=1)
(810=1) (812=1) (813=1) (814=1) (815=1) (816=1) (820=1) (822=1) (825=1) (826=1) (827=1)
(828=1) (832=1) (876=1) (469=3) (470=3)
INTO drg_mp.
EXECUTE.
Value labels drg_mp 1 'M' 2 'P' 3 'other'.
freq drg_mp.
29
*Definition of the variable Mortality.
COMPUTE Mortality=DSP = 20.
EXECUTE.
Value labels Mortality 0 'live' 1 'deceased'.
*Determination of global mortality.
FREQUENCIES VARIABLES=Mortality
/FORMAT=DFREQ
/ORDER=ANALYSIS.
*Mortality by gender.
Value labels Gender 1 'male' 2 'female' .
CROSSTABS
/TABLES=Gender BY Mortality
/FORMAT=DVALUE TABLES
/CELLS=COUNT ROW COLUMN TOTAL
/COUNT ROUND CELL.
*Definition of the variable Year of episode.
COMPUTE Year=XDATE.YEAR(SAIDLAST).
EXECUTE.
*Mortality by year.
CROSSTABS
/TABLES=Mortality BY Year
/FORMAT=AVALUE TABLES
/CELLS=COUNT ROW COLUMN TOTAL
/COUNT ROUND CELL.
*Definition of Age Groups.
RECODE AGE (Lowest thru 14=1) (15 thru 24=2) (25 thru 64=3) (65 thru Highest=4)
(ELSE=SYSMIS) INTO
Faixa_etaria.
VARIABLE LABELS Age_Group ' Age Group '.
EXECUTE.
Value labels Age_Group 1 '0-14' 2 '15-20' 3 '25-64' 4 ' +64'.
CROSSTABS
/TABLES=Mortality BY Age_Group
/FORMAT=AVALUE TABLES
/CELLS=COUNT ROW COLUMN TOTAL
/COUNT ROUND CELL.
30
*Crosstab linking gender, year and mortality.
CROSSTABS
/TABLES=Gender BY Year BY Mortality
/FORMAT=AVALUE TABLES
/CELLS=COUNT TOTAL
/COUNT ROUND CELL.
*Crosstab linking gender, age group and mortality.
CROSSTABS
/TABLES=Gender BY Age_Group BY Mortality
/FORMAT=AVALUE TABLES
/CELLS=COUNT TOTAL
/COUNT ROUND CELL
*Definition of DRG's obstetrical.
COMPUTE DRGs_obstetrical=MDC=14.
EXECUTE.
Value labels DRGs_obstetrical 1 'obstetric' 0 'not obstetric' .
*Summary statistics of length of stay.
EXAMINE VARIABLES=TOTDIAS
/PLOT NONE
/PERCENTILES(5,10,25,50,75,90,95) HAVERAGE
/STATISTICS DESCRIPTIVES
/CINTERVAL 95
/MISSING LISTWISE
/NOTOTAL.
*Length of stay by year.
MEANS TABLES=TOTDIAS BY Year
/CELLS MEAN COUNT STDDEV.
* Definition of the variable postponed surgeries.
COMPUTE Postponed_ surgeries =DDX1='v64.3' | DDX2='v64.3' | DDX3='v64.3' | DX4='v64.3' |
DDX5='v64.3' | DDX6='v64.3' | DDX7='v64.3' | DDX8='v64.3' | DDX9='v64.3' | DX10='v64.3' |
DDX11='v64.3' | DDX12='v64.3' | DDX13='v64.3'| DDX14='v64.3'| DDX15='v64.3' |
DDX16='v64.3' | DDX17='v64.3' | DDX18='v64.3' | DDX19='v64.3' | DDX20='v64.3'.
EXECUTE.
* Outpatient episode?.
COMPUTE amb = DSP ~= 20 & TOTDIAS = 0 & ADM_TIP ~= "2" & LTRIM(SRG1) ~= "".
EXECUTE.
31
Value labels amb 0 'no' 1 'amb'.
freq amb.
exe.
*Outpatient episode by medical DRG’s.
CROSSTABS
/TABLES=drg_mp BY amb
/FORMAT=AVALUE TABLES
/CELLS=COUNT
/COUNT ROUND CELL.
CROSSTABS
/TABLES=drg_mp DRG BY amb
/FORMAT=AVALUE TABLES
/CELLS=COUNT
/COUNT ROUND CELL.
*Outpatients episodes by year.
CROSSTABS
/TABLES=amb BY Year
/FORMAT=AVALUE TABLES
/CELLS=COUNT ROW COLUMN TOTAL
/COUNT ROUND CELL.
32