Challenges and remediation for Patient Safety Indicators in the transition to ICD-10-CM

Reporting of hospital adverse events relies on Patient Safety Indicators (PSIs) using International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes. The US transition to ICD-10-CM in 2015 could result in erroneous comparisons of PSIs. Using the General Equivalent Mappings (GEMs), we compared the accuracy of ICD-9-CM coded PSIs against recommended ICD-10-CM codes from the Centers for Medicaid/Medicare Services (CMS). We further predict their impact in a cohort of 38 644 patients (1 446 581 visits and 399 hospitals). We compared the predicted results to the published PSI related ICD-10-CM diagnosis codes. We provide the first report of substantial hospital safety reporting errors with five direct comparisons from the 23 types of PSIs (transfusion and anesthesia related PSIs). One PSI was excluded from the comparison between code sets due to reorganization, while 15 additional PSIs were inaccurate to a lesser degree due to the complexity of the coding translation. The ICD-10-CM translations proposed by CMS pose impending risks for (1) comparing safety incidents, (2) inflating the number of PSIs, and (3) increasing the variability of calculations attributable to the abundance of coding system translations. Ethical organizations addressing ‘data-, process-, and system-focused’ improvements could be penalized using the new ICD-10-CM Agency for Healthcare Research and Quality PSIs because of apparent increases in PSIs bearing the same PSI identifier and label, yet calculated differently. Here we investigate which PSIs would reliably transition between ICD-9-CM and ICD-10-CM, and those at risk of under-reporting and over-reporting adverse events while the frequency of these adverse events remain unchanged.     

The views and attitudes of general practitioners and smokers toward provision of smoking cessation advice: a qualitative study.

Objectives: To identify common themes between general practitioners (GP's) and patients on smoking cessation in primary care in order to inform the development of acceptable guidelines, thus maximising the chance that recommendations will be received positively and implemented. Design: Qualitative study using focus groups and individual interviews with GPs and patients. Setting: North East Scotland. Subjects: 10 general practitioners and 20 patients (10 smokers and 10 patients who described themselves as ex-smokers). Results: Both general practitioners and patients agreed that the GP has a key role in providing a range of advice and support for smoking cessation. Both parties expressed views at variance with current guidelines but agreed that, for support and advice to be successful, it needs to comply with four of the five main themes identified; that it should be practical, pertinent to the consultation, personalised to the smoker's clinical need, and should emphasise the positive health gains from quitting. Conclusion: The considerable concordance between the perceptions of GPs and their patients about smoking cessation care suggests potential for a more positive partnership in working towards reduction of smoking in the UK.     

Cellular immune reactions in the lung

The lung constantly interacts with the environment through thousands of liters of air that are inhaled daily. This continually transports toxic chemicals and particles or pathogenic microorganisms deep into the respiratory system, posing a challenge to physicochemical barriers and the local immune system. Thus, complex structures and mechanisms have evolved to recognize and fend off environmental dangers while at the same time allowing efficient gas exchange. Here we review our current knowledge regarding cellular mechanisms of the immune system in context with the highly specialized anatomical features of the airways and especially the alveolar compartment. The focus is on fungal and viral infections, merging anatomical aspects well known to pulmonologists with fundamental immunological concepts. We discuss the specialized morphological constraints of immune cells compressed under a continuous layer of the surfactant lining within alveoli as well as the importance of functional polarization of respiratory tract epithelia. Furthermore, we summarize the different types of innate and adaptive immune cells and their relative contribution to lung homeostasis with respect to localization. Finally, we provide a list of currently unresolved questions with high relevance for the field that might serve as food for thought regarding future research directions.