Impact of adverse drug reactions on the coding of a hospital stay in quebec: Exploratory descriptive study by simulation

Abstract

The discharge summary sheet’s coding allows calculation of the severity index (SI), mortality index (MI), and resource intensity weight (RIW). These indicators help to describe the burden of care for individual cases and could potentially influence patient-based funding. This study was undertaken to simulate the impact of different adverse drug reactions (ADRs) on the hospital length of stay, thus allowing calculation of the effect of ADRs on the SI, MI, and RIW. This exploratory descriptive study was based on computer simulations. We created, by simulation, seven patient profiles of various complexities representative of our patients. Fifteen types of combination of drug and ADR manifestation comprising 15 ADR caused by eight different drug classes were identified based on the most frequently coded ADR in fiscal years 2016–2017 and 2017–2018. Those 15 combinations were applied to the patient profile to simulate the impact on the SI, MI, and RIW in eight scenarios. From these data, we measured the impact of the ADRs on these indicators. A total of 1,571 simulations were run. In general, the addition of a couple of drug and ADR manifestation contributed to increases in all three of the indicators. More specifically, the SI and RIW both increased in 30.7% (n = 482), whereas the MI increased in 14.6% (n = 229). For a same scenario, the impact on the three indicators could vary depending on the patient profile to which it was applied. This study has presented simulation data on the impact of the coding of ADRs on the hospital stay of a patient in Quebec.