1. Update from the Quality and Safety TAG
William Ghali
Harold Pincus

2. Safety and Quality An ICD-11 ‘use case’
Overlaps with the mortality, morbidity, and case mix use cases
A horizontal theme that applies across chapters
Numerous existing safety/quality indicators
HSMR
PSI
Other measures (e.g, Charlson, Elixhauser)

3. The need for a Q&S TAG
The world has changed, with quality measurement becoming central for health system accountability and improvement
ICD-10 is limited in capturing Q&S information
ICD-11 creates unique opportunities for capturing Q&S data with greater reliability, validity and efficiency
Areas of attention:
Chapters 19/20 (injury and external causes)
Horizontal content review across chapters
Coding rules
Volume 2 of ICD-11
Applicability of ICD-10 indicators in ICD-11

4. Quality and Safety

5. TAG Work Plan
Co-chaired by William Ghali, U Calgary and Harold Pincus, Columbia University, NY
Membership from N. America, Europe, and Australia
Funding from CPSI, CIHI, and AHRQ
In-kind support from UofC & Columbia
Work catalyzed by a number of face-to-face meetings (8 so far)

6. Coding rules
Main condition
Diagnosis timing
Clustering

7. Coding rules
Main condition
Diagnosis timing
Clustering

8. Coding rules
Main condition
Diagnosis timing
Clustering

9. Canadian Hospital Discharge Data
Diagnosis type indicator:
Type M: Most responsible diagnosis
Type 1: Important diagnoses present at admission
Type 2: Arising some time after admission
Type 3: Secondary diagnoses, present at admission

10. Coding rules
Main condition
Diagnosis timing
Clustering

11. Clustering of diagnoses
Essential to the Q&S use case
Mechanisms already exist in ICD-10
But needs to be ubiquitous
Endorsed by RSG
Suffix/prefix codes?
Other approaches?

12. Revision of Chapters 19/20 Healthcare-related injury
New information (logic) model
Clustering mechanism essential
Revisions now reflected in ICD-beta

13. Revision of Chapters 19/20 Four sources of harm: For each:
Medications & substances
Procedures
Devices
Other aspects of care
For each:
Cause of harm (Ch 20)
Mode/mechanism (Ch 20)
Actual harm (Ch 1-19)

14. A clinical example
A patient presents with an intracranial hemorrhage arising while on warfarin anticoagulation. INR found to be 7.0 and careful history reveals patient to have accidentally taken double doses over several days.

15. A clinical example
A patient presents with an intracranial hemorrhage arising while on warfarin anticoagulation. INR found to be 7.0 and careful history reveals patient to have accidentally taken double doses over several days.
Clustered Coding?

16. A clinical example
A patient presents with an intracranial hemorrhage arising while on warfarin anticoagulation. INR found to be 7.0 and careful history reveals patient to have accidentally taken double doses over several days.
Clustered Coding?
Code for the cause of harm (warfarin)
Code for mode/mechanism (overdose of substance)
Code for actual harm (intracranial hemorrhage)

17. A clinical example
A patient presents with an intracranial hemorrhage arising while on warfarin anticoagulation. INR found to be 7.0 and careful history reveals patient to have accidentally taken double doses over several days.
Clustered Coding?
Code for the cause of harm (warfarin)
Code for mode/mechanism (overdose of substance)
Code for actual harm (intracranial hemorrhage)
Concepts linked through clustering mechanism

18. Field trials

19. Stakeholder survey

20. Clinical Episode Coding Trial

22. Code – Recode Trial

23. Quality and Safety TAG An exciting mandate
Real potential for ICD enhancement
Academic publications

27. Quality and Safety TAG An exciting mandate
Real potential for ICD enhancement
Academic publications
Knowledge exchange
Dialogue/interaction with RSG and all other TAGs crucial…

28. Questions or comments?