Facilitating Cross-National Comparisons of Indicators for Patient ...

DELSA/ELSA/WD/HTP(2008)1Table 2: Examples of Country VersionsICD-10WHO(2006)ICD-10-CA(Canada, 2006)ICD-10-AM(Australia, 2006)ICD-10-GM(Germany, 2006), a 5 thdigit has to be used tospecify the location (10subgroups)L89.0Decubitus ulcer limited toerythema only [redness]without skin breakdown(Stage 1)Decubitus [pressure]ulcer, stage IL89.1Decubitus ulcer limited tobreakdown of skin (Stage 2)Decubitus [pressure]ulcer, stage IIDecubitus ulcer Stage 1L89DecubitusulcerL89.2L89.3Decubitus ulcer with fat layerexposed (Stage 3)Decubitus ulcer with depthinvolving muscle (Stage 4)Decubitus [pressure]ulcer, stage IIIDecubitus [pressure]ulcer, stage IVDecubitus ulcer Stage 2Decubitus ulcer Stage 3L89.4Decubitus ulcer with depthinvolving bone (Stage 5)Decubitus ulcer Stage 4L89.5Decubitus ulcer with jointspace involvement (Stage 5)L89.8Decubitus ulcer with necrosisinvolving muscle or bone(Stage X)L89.9Decubitus ulcer withoutmention of severityDecubitus [pressure]ulcer, unspecifiedDecubitus ulcer,unspecified18. There are several criteria which are not consistent between countries that may influence thecalculated rates of the indicators. These are:• Coding rules− Definition of principal diagnosis− Definition of secondary diagnosis• Use of diagnosis type indicators (e.g. marking of secondary diagnosis as “present at admission”)• Use of DRG for hospital reimbursement• Certain administrative case information− Admission type (elective, from long-term care, transferred from acute care)− Admission weight of neonates.19. A questionnaire was distributed with this manual to collect more information on the codingspecifications within each country participating in the initial experimental calculations of the indicators(Annex 3). Participating countries were asked to fill out the questionnaire and return it to the OECDSecretariat. The information on country specific coding specifications strongly facilitated the interpretationof the results by the OECD Secretariat.11