[Use of a pharmaceutical decision support system in the valuation of hospital stays: Evaluation through 3 examples in collaboration with the department of medical information].

Abstract

Pharmacy decision support systems (PDSS) help clinical pharmacists to prevent and detect adverse drug events. The coding of hospital stays by the department of medical information (DMI) requires expertise, as it determines hospital revenues and the epidemiological data transmitted via the French national hospital database. The aim was to study the interest and feasibility of using a PDSS, in collaboration with the DMI, to help with the coding of hospital stays. Over 5 months, three rules were implemented in the PDSS to detect gout, Parkinson's disease and oro-pharyngeal candidiasis. The PDSS alerts were analyzed by a pharmacy resident and then forwarded to the DMI, who analyzed the stays to see whether or not the coding for the disease corresponding to the alert was present. The absence of coding was evaluated and tracked, along with the resulting change in severity and valuation. Three hundred and ninety-nine alerts from the PDSS were analyzed and sent to the DMI, representing 211 stays and 309 uniform hospital standardized discharge abstract (UHSDA) in the fields of medicine, surgery and obstetrics. Two hundred and eight (67.3%) UHSDA did not have the coding corresponding to the alert. For the majority of these UHSDAs, apart from diagnostic precision, there was no impact on the valuation of stays. For 4 UHSDAs, the addition of the diagnosis code led to an increase in the value of the stay and the severity of the homogeneous patient groups. The total revaluation corresponding to this modification was €5416. The use of PDSS has helped in the precision of diagnosis coding and the valuation of stays. This result must be weighed against the time invested in analyzing alerts and associated coding. An improvement in disease detection and data processing is needed to be feasible in practice, given the more than 227,600 RSS performed per year at our facility.