Diagnostic value and reliability of the present-on-admission indicator in different diagnosis groups: pilot study at a Swiss tertiary care center.

Triep, Karen; Beck, Thomas A.; Donzé, Jacques; Endrich, Olga (2019). Diagnostic value and reliability of the present-on-admission indicator in different diagnosis groups: pilot study at a Swiss tertiary care center. BMC health services research, 19(1), p. 23. BioMed Central 10.1186/s12913-018-3858-3

Triep, BMC Health Serv Res 2019.pdf - Published Version
Available under License Creative Commons: Attribution (CC-BY).

Download (854kB) | Preview


With few exceptions the International Statistical Classification of Diseases (ICD) codes for diagnoses and official coding guidelines do not distinguish pre-existing conditions from complications or comorbidities which occur during hospitalization. However, information on diagnosis timing is relevant with regard to the case's severity, resource consumption and quality of care. In this study we analyzed the diagnostic value and reliability of the present-on-admission (POA) indicator using routinely collected health data.


We included all inpatient cases of the department of medicine during 2016 with a diagnosis of deep vein thrombosis, decubitus ulcer or delirium. Swiss coding guidelines of 2016 and the definitions of the Swiss medical statistics of hospitals were analyzed to evaluate the potential to encode information on diagnosis timing. The diagnoses were revised by applying the information present-on-admission by a coding specialist and by a medical expert, serving as Gold Standard. The diagnostic value and reliability were evaluated.


The inter-rater reliability for POA of all diagnoses was 0.7133 (Cohen's kappa), but differed between diagnosis groups (0.558-0.7164). The rate of POA positive of the total applied by the coding specialist versus the expert was similar, but differed between diagnoses. In group "thrombosis" SEN was 0.95, SPE 0.75, PPV 0.97 and NPV 0.60, in group "decubitus ulcer" SEN 0.89, SPE 0.82, PPV 0.89 and NPV 0.82, in group "delirium" SEN 0.91, SPE 0.65, PPV 0.71 and NPV 0.88 For all diagnoses SEN 0.92, SPE 0.73, PPV 0.87, NPV 0.82, summing up the cases of all diagnosis groups.


Coding the POA indicator identified diagnoses which were pre-existent with insufficient reliability on individual patient's level. The overall fair to sufficient diagnostic quality is appropriate for screening and benchmarking performance on population level. As the medical statistics of hospitals carries no variable on pre-existing conditions, the novel approach to apply the POA indicator to diagnoses gives more information on quality of hospital care and complexity of cases. By preparing documentation for POA reporting diagnostic quality must be increased before implementation for risk-assessment or reimbursement on the individual patient's level.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

UniBE Contributor:

Beck, Thomas A. and Donzé, Jacques


600 Technology > 610 Medicine & health




BioMed Central




Tobias Tritschler

Date Deposited:

05 Feb 2019 12:24

Last Modified:

07 Sep 2021 17:17

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Complications and comorbidities Diagnostic value Present on admission Quality indicator Quality of inpatient care Routinely collected health data





Actions (login required)

Edit item Edit item
Provide Feedback