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Bias due to re-used databases: Coding in hospital for extremely vulnerable patients

Author

Listed:
  • Carine Milcent

    (PSE - Paris School of Economics - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement)

Abstract

Electronic health records (EHRs) are intended to reduce healthcare costs and improve the quality of care. Nevertheless, usability issues common to EHRs have been identified. In this paper, we investigate these usability issues for social vulnerability codes. Using the acute care EHR and the rehabilitation care EHR databases, hospital stays of 800'000 patients are studied. This article highlights the differences in coding processes between public and private institutions observed when there are different incentives to code. Furthermore, it shows that the differences in coding are not random but depend on the coding strategy. This article emphasises that the reuse of data leads to biases in interpretation. Using the example of social vulnerability alerts policymakers to the need to consider these differences in coding processes when decisions are based on EHR information. Otherwise, this process of coding differences in social vulnerability may exacerbate social inequalities rather than reduce them.

Suggested Citation

  • Carine Milcent, 2023. "Bias due to re-used databases: Coding in hospital for extremely vulnerable patients," Working Papers hal-03960584, HAL.
    • Handle: RePEc:hal:wpaper:hal-03960584
    Note: View the original document on HAL open archive server: https://hal.science/hal-03960584v1
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    References listed on IDEAS

    as
    1. Carine Milcent, 2021. "From downcoding to upcoding: DRG based payment in hospitals," International Journal of Health Economics and Management, Springer, vol. 21(1), pages 1-26, March.
    2. Leemore S. Dafny, 2005. "How Do Hospitals Respond to Price Changes?," American Economic Review, American Economic Association, vol. 95(5), pages 1525-1547, December.
    3. Carine Milcent, 2021. "Rehabilitation Care: Performance and Ownership," PSE Working Papers halshs-03010949, HAL.
    4. Kjartan Sarheim Anthun & Johan Håkon Bjørngaard & Jon Magnussen, 2017. "Economic incentives and diagnostic coding in a public health care system," International Journal of Health Economics and Management, Springer, vol. 17(1), pages 83-101, March.
    5. Fisher, E.S. & Whaley, F.S. & Krushat, W.M. & Malenka, D.J. & Fleming, C. & Baron, J.A. & Hsia, D.C., 1992. "The accuracy of Medicare's hospital claims data: Progress has been made, but problems remain," American Journal of Public Health, American Public Health Association, vol. 82(2), pages 243-248.
    6. Silverman, Elaine & Skinner, Jonathan, 2004. "Medicare upcoding and hospital ownership," Journal of Health Economics, Elsevier, vol. 23(2), pages 369-389, March.
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    More about this item

    Keywords

    Database; Hospitals; quality; efficiency; ownership; social vulnerability; inequity;
    All these keywords.

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