The Accuracy of Present‐on‐Admission Reporting in Administrative Data

OBJECTIVE: To test the accuracy of reporting present-on-admission (POA) and to assess whether POA reporting accuracy differs by hospital characteristics. DATA SOURCES: We performed an audit of POA reporting of secondary diagnoses in 1,059 medical records from 48 California hospitals. STUDY DESIGN: We used patient discharge data (PDD) to select records with secondary diagnoses that are powerful predictors of mortality and could potentially represent comorbidities or complications among patients who either had a primary procedure of a percutaneous transluminal coronary angioplasty or a primary diagnosis of acute myocardial infarction, community-acquired pneumonia, or congestive heart failure. We modeled the relationship between secondary diagnoses POA reporting accuracy (over-reporting and under-reporting) and hospital characteristics. DATA COLLECTION: We created a gold standard from blind reabstraction of the medical records and compared the accuracy of the PDD against the gold standard. PRINCIPAL FINDINGS: The PDD and gold standard agreed on POA reporting in 74.3 percent of records, with 13.7 percent over-reporting and 11.9 percent under-reporting. For-profit hospitals tended to overcode secondary diagnoses as present on admission (odds ratios OR 1.96; 95 percent confidence interval CI 1.11, 3.44), whereas teaching hospitals tended to undercode secondary diagnoses as present on admission (OR 2.61; 95 percent CI 1.36, 5.03). CONCLUSIONS: POA reporting of secondary diagnoses is moderately accurate but varies by hospitals. Steps should be taken to improve POA reporting accuracy before using POA in hospital assessments tied to payments.