The Present on Admission (POA) indicator is a data element on the hospital administrative record that is associated with each diagnosis field and indicates whether the condition was present at hospital admission (a comorbidity) or whether it arose during the hospitalization stay (a complication). Inclusion of the indicator can assist in identifying quality of care issues as well as providing a more accurate picture for risk-adjustment. In the 1990s, states began adding POA indicators to their hospital discharge data. POA collection became required by United States law on October 1, 2007 on certain types of Medicare inpatient claims (hospitalizations covered by Inpatient Prospective Payments System). Many states have begun to collect POA on all-payer data from all hospitals in their state regardless of the payer.

AHRQ funded four Healthcare Cost and Utilization Project (HCUP) Partner Pilot and Planning Projects to study the collection of the POA indicator, as well as explore the value of adding laboratory values to hospital administrative data. The POA Toolkit draws heavily from these HCUP Partner projects and includes materials to help others with POA indicator collection.

The Present on Admission (POA) Indicator Toolkit contains items assembled during the course of the AHRQ Pilot and Planning contracts or identified by other Partners; tools already in use in other States that are made available to AHRQ for posting; and materials to address additional needs identified by Partners, such as POA and Hospital-Acquired Conditions (HACs) benchmarks created from HCUP data.

This toolkit aims to provide a comprehensive set of materials needed for all-payer POA indicator collection and analysis, ranging from materials for educating data organizations and stakeholders and building the business case for POA collection, to surveys to gauge hospital readiness and resources.

Additional information on the background and development of the POA toolkit can be found in the following HCUP Methods Series Reports:

• The Case for the POA Indicator: Update 2011 (PDF file, 418 KB)
• The Case for the Present-on-Admission (POA) Indicator (PDF file, 246 KB)

Toolkit Editor’s Note: Although information and links within this Toolkit were current during the course of the project and are periodically updated, content may occasionally change.

POA Indicator Toolkit Sections

• Background: Presentations and publications related to the Pilot and Planning projects and illustrating the significance of collecting the POA indicator.



• Training Tools: Media to train healthcare staff and physicians on medical record documentation needed for accurate POA coding.



• Data Standards and Transmission Tools: Technical materials for collecting POA information.



• Feedback and Reporting Tools: Ideas for informing hospitals and stakeholders about the quality of their reporting and assisting them in analyzing results for hospital-specific quality improvement.