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Paraphrase Researchers have validated PSI 11 under ICD-9-CM specifications in academic centers and the Veteran’s Health Administration using chart review as the criterion standard and found the positive predictive value (PPV) was 67-83%.15,17, 18, 19, 20 Subsequently, the AHRQ took advantage of present-on-admission (POA) flags starting in 2008 to exclude preoperative respiratory failure and revised the diagnosis code criteria in 2011 to better focus PSI 11 on cases following trauma or surgery. Contemporaneously, hospitals began verifying PSI-flagged events through clinical documentation improvement programs, which involve concurrent communication between physicians, clinical documentation specialists, and coders.21, 22, 23, 24 Our primary objective was to study the effect of the new ICD-9-CM diagnosis codes and the POA flag—in the context of clinical documentation improvement programs—on the ability of PSI 11 to accurately identify PRF. Our secondary objective was to analyze records that triggered PSI 11 but that did not represent PRF to understand how PSI 11 might be further refined.

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