International variation in the definition of 'main condition' in ICD-coded health data

H. Quan, L. Moskal, A. J. Forster, S. Brien, R. Walker, Patrick S Romano, V. Sundararajan, B. Burnand, G. Henriksson, O. Steinum, S. Droesler, H. A. Pincus, W. A. Ghali

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Hospital-based medical records are abstracted to create International Classification of Disease (ICD) coded discharge health data in many countries. The 'main condition' is not defined in a consistent manner internationally. Some countries employ a 'reason for admission' rule as the basis for the main condition, while other countries employ a 'resource use' rule. A few countries have recently transitioned from one of these approaches to the other. The definition of 'main condition' in such ICD data matters when it is used to define a disease cohort to assign diagnosis-related groups and to perform risk adjustment. We propose a method of harmonizing the international definition to enable researchers and international organizations using ICD-coded health data to aggregate or compare hospital care and outcomes across countries in a consistent manner. Inter-observer reliability of alternative harmonization approaches should be evaluated before finalizing the definition and adopting it worldwide.

Original languageEnglish (US)
Pages (from-to)511-515
Number of pages5
JournalInternational Journal for Quality in Health Care
Issue number5
StatePublished - Oct 1 2014


  • benchmarking
  • international classification of disease
  • measurement of quality
  • standards

ASJC Scopus subject areas

  • Medicine(all)


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