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An Analysis of 2003 NEISS Evaluation Data

An Analysis of 2003 NEISS Evaluation Data. Tom Schroeder, EPDS 8/2004. NEISS Quality Control. Internal CPSC Every case is reviewed for additional coding and to find discrepancies in coding Weekly computer programs identify additional cases with discrepancies

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An Analysis of 2003 NEISS Evaluation Data

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  1. An Analysis of 2003 NEISS Evaluation Data Tom Schroeder, EPDS 8/2004

  2. NEISS Quality Control • Internal CPSC • Every case is reviewed for additional coding and to find discrepancies in coding • Weekly computer programs identify additional cases with discrepancies • Teams review cases on a regular basis • Ad-hoc identification of additional discrepancies

  3. NEISS Quality Control • Error Message Sent • Message sent to hospital (in-window) or reviewed by analyst (out-of-window) • ~50,000 messages sent in 2003 • Case is changed or • Message is rejected and reason provided

  4. NEISS Quality Control • On-site record evaluations • On-site evaluations done twice a year • ER log and 100 plus records reviewed • Laptop application identifies discrepancies in reporting and coding • Reconciliation should be done on-site

  5. Results: Missed Cases • ~ 17,000 records reviewed in 2003 evaluations • ~ 4,500 records determined to be reportable • ~ 11% of reportable cases were missed • 11% CPSC • 9% Work • 13 % Other Trauma

  6. Results: Missed Cases • Why are 11% of cases being missed? • ~ 70% are clearly reportable • Basketball injuries • Motor vehicle accidents • Assaults • ~30 are less obvious/debatable • Unclear reporting rules? • Not quickly identified in ER log or on ER chart? • Illnesses – product-related, work • Adverse Drug effects

  7. Results: Incorrect Coding • Age 98% • Body Part 94% • Diagnosis 95% • Disposition 98% • Fire Department 99% • Location 92% • Product 94% 96% • Sex 98% • Race 95% • Intent 99% • Work-related 98% • OVERALL ~1/3 of all cases had a discrepancy in the coding of at least one variable.

  8. Results: Incorrect Coding • 22% of discrepancies found during evaluation were easily detected by reading NEISS record • These errors should be detected during routine QC • Ex. Motor vehicle accident with Product = 1903 • Why are these errors occurring? • Lack of understanding, experience? • Diagnosis of a rash (68, 74, 71)? • Receiving conflicting or incomplete information from training, error messages, and evaluators? • Typing mistakes/sloppiness • Body part = 82 versus 92

  9. Results: Incorrect Coding • 78% of discrepancies found during evaluation were only detected when additional information was abstracted from ER chart • Ex. Piece of metal in NEISS record (Product = 7878) versus Piece of metal on swing in ER chart (Product = 3246) • ~20% of all NEISS cases have additional or different information in the ER chart that could change or enhance the NEISS record

  10. Results: Incorrect Coding • Why is the coding important to us? • Who is interested in the case/jurisdiction • 7878 versus CPSC product code • 23% of all cases are coded as 7878 • Over 10% of cases coded as 7878 by NEISS coder were found to have a different product code by evaluator • Work • Intent • Injury Cost Model

  11. Results: Incorrect Coding • Who is interested in the case/jurisdiction • 2nd Screens • NIOSH work invoked by OCC variable • NCIPC firearm invoked by product codes • CPSC children’s poisoning invoked by age and diagnosis • NCIPC ADE invoked by product codes • NCIPC self-inflicted violence invoked by INTENT • NCIPC traumatic brain injury invoked by body part (75), diagnosis, and word searches

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