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Evaluation of the PresentonAdmission Indicator among Hospitalized FeeforService Medicare Patients with a Pressure Ulcer Diagnosis: Coding Patterns and Impact on HospitalAcquired Pressure Ulcer R

Objectives: To evaluate national presentonadmission (POA) reporting for hospitalacquired pressure ulcers (HAPUs) and examine the impact of quality measure exclusion criteria on HAPU rates.

Data Sources/Study Setting: Medicare inpatient, outpatient, and nursing facility data as well as independent provider claims (2010–2011).

Study Design: Retrospective crosssectional study.

Data Collection/Extraction Methods: We evaluated acute inpatient hospital admissions among Medicare feeforservice (FFS) beneficiaries in 2011. Admissions were categorized as follows: (1) no pressure ulcer diagnosis, (2) new pressure ulcer diagnosis, and (3) previously documented pressure ulcer diagnosis. HAPU rates were calculated by varying patient exclusion criteria.

Principal Findings: Among admissions with a pressure ulcer diagnosis, we observed a large discrepancy in the proportion of admissions with a HAPU based on hospitalreported POA data (5.2 percent) and the proportion with a new pressure ulcer diagnosis based on patient history in billing claims (49.7 percent). Applying quality measure exclusion criteria resulted in removal of 91.2 percent of admissions with a pressure injury diagnosis from HAPU rate calculations.

Conclusions: As payers and health care organizations expand the use of quality measures, it is important to consider how the measures are implemented, coding revisions to improve measure validity, and the impact of patient exclusion criteria on provider performance evaluation.

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