English summary: ACCURACY OF DIAGNOSIS OF MYOCARDIAL INFARCTION IN HUCHMEILAHTI HOSPITAL

Background

The new definitions of myocardial infarction and the inconvenient diagnosis-related grouping (DRG) require more focus on the accuracy of diagnosis of myocardial infarction. The aim of this study was to examine on the basis of discharge registries how accurately the ST-elevation (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) diagnosis coding was carried out in HUCH Meilahti Hospital and to detect deficiencies in secondary discharge diagnoses which affect DRG grouping. At the same time the in-hospital management of acute myocardial infarction was analysed.

Methods

The diagnoses used in discharge reports and hospital registries were compared in parallel by using patient records and the redefined guidelines of myocardial infaction and acute coronary syndrome. The total number of patients was 394, of whom 188 had ST-elevation myocardial infarction.

Results

The main finding was serious deficiency in coding the secondary diagnoses in the discharge registries. Some of the secondary diagnoses, such as congestive heart failure, are complications of myocardial infarction and thus alter the DRG-billing. The complicating secondary diagnoses were missing in the majority of cases. Diagnoses in the discharge case reports were coded slightly better. Hospital transfers excluded, the average hospitalisation time for STEMI patients was 5.8 days and for NSTEMI patients 8.1 days. The 30-day mortality rates were 6.9% and 6.3%, respectively.

Conclusions

Deficient coding of discharge diagnoses for hospital registries leads to billing that does not correspond to actual costs. It also reduces the credibility and usability of national health registers. Examination of the patient characteristics and outcomes revealed that NSTEMI patients were older but that outcomes were just as severe as in STEMI patients.

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