Trends in Severe Maternal Morbidity in the US Across the Transition to ICD-10-CM/PCS From 2012-2019.
Trends in Severe Maternal Morbidity in the US Across the Transition to ICD-10-CM/PCS From 2012-2019.
复制标题
从2012年至2019年，美国向ICD-10-CM/PC的过渡到美国的严重孕产妇发病率的趋势。
DOI：
10.1001/jamanetworkopen.2022.22966
复制
发表时间：
2022-07-01
影响因子：
13.8
通讯作者：
Main, Elliott K.
中科院分区：
文献类型：
--
作者：
Hirai, Ashley H.;Owens, Pamela L.;Reid, Lawrence D.;Vladutiu, Catherine J.;Main, Elliott K.
从2012年到2019年，在向国际疾病分类第十版临床修改/程序编码系统（ICD-10-CM/PCS）编码过渡的过程中，美国重度孕产妇发病率（SMM）的总体和SMM指标和状态发生了怎样的变化？在这项包括2012年至2019年590万例分娩住院的重复横断面分析中，SMM（不包括输血）的全国估计发生率从每10000例分娩住院69.5例增加到79.7例，这与ICD-10-CM/PCS过渡无关。然而，随着时间推移的变化因指标和国家而异，有些数据可能无法在不同编码系统之间进行比较。总体SMM率在2012年至2019年期间有所增加，但指标和州之间存在显著差异。这项横断面研究分析了2012年至2019年过渡到国际疾病分类第十版、临床修改和程序编码系统后美国医院严重孕产妇发病率的趋势。严重孕产妇发病率（SMM）的监测是至关重要的监测孕产妇健康和评价临床质量的改善工作。评估2012年至2019年国家和州SMM率的趋势，以及2015年10月过渡到国际疾病分类第10次修订版、临床修改和程序编码系统（ICD-10-CM/PCS）的潜在中断。这项重复的横断面分析检查了2012年至2019年医疗保健成本和利用项目的国家住院病人样本和国家住院病人数据库中的分娩住院情况，这是一个社区非康复医院出院记录的所有付款人汇编。使用分段线性二项回归模型评价趋势，该模型允许ICD-10-CM/PCS过渡期间的不连续性。分析于二零二一年四月至二零二二年三月期间完成。时间、ICD-10-CM/PCS编码系统和状态。总体和按指标分列的每10 000次分娩住院的SMM率（不包括输血）从2012年到2019年，全国样本中有5 964 315例分娩住院，加权分娩总数为2980万例，平均（SD）产妇年龄为28.6（5.9）岁。SMM发生率从2012年的69.5/10000增加到2019年的79.7/10000（率差[RD]，10.2; 95%CI，5.8至14.6），在ICD-10-CM/PCS过渡期间没有显著变化（RD，-3.2; 95%CI，-6.9至0.6）。在20个SMM指标中，10个指标的比率显著增加，3个显著降低;其中5个变化与ICD-10-CM/PCS转换相关。急性肾衰竭的增加幅度最大，从每10000例分娩住院6.4例增加到15.3例（RD，8.9; 95%CI，7.5 - 10.3），与ICD转换无关（RD，-0.1; 95%CI，-1.2至1.1）。弥散性血管内凝血的降幅最大，从31.3/10000降至21.2/10000（RD，10.2; 95%CI，−12.8至−7.5），ICD转换相关的显著下降（RD，−7.9; 95%CI，−10.2至−5.6）。从2012年到2019年，1个州的SMM率显着下降，21个州显着增加，与ICD过渡的关联各不相同。在这项横断面研究中，2012年至2019年，美国总体SMM发生率增加，这与ICD-10-CM/PCS转换无关。然而，某些指标和状态的数据在不同编码系统之间可能不具有可比性;需要努力了解SMM的增加和状态变化。
How did US rates of severe maternal morbidity (SMM), overall and by SMM indicator and state, change from 2012 to 2019 across the transition to International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) coding? In this repeated cross-sectional analysis including 5.9 million delivery hospitalizations from 2012 to 2019, the national estimated rate of SMM (excluding blood transfusions) increased from 69.5 to 79.7 per 10 000 delivery hospitalizations, which was not associated with the ICD-10-CM/PCS transition. However, changes over time varied by indicator and state and some data may not be comparable across coding systems. Overall SMM rates increased between 2012 and 2019, with noted variation by indicator and state. This cross-sectional study analyzes trends in rates of severe maternal morbidity in US hospitals following the transition to the International Classification of Diseases, Tenth Revision, Clinical Modification and Procedure Coding System between 2012 and 2019. Surveillance of severe maternal morbidity (SMM) is critical for monitoring maternal health and evaluating clinical quality improvement efforts. To evaluate national and state trends in SMM rates from 2012 to 2019 and potential disruptions associated with the transition to International Classification of Diseases, 10th Revision, Clinical Modification and Procedure Coding System (ICD-10-CM/PCS) in October 2015. This repeated cross-sectional analysis examined delivery hospitalizations from 2012 through 2019 in the Healthcare Cost and Utilization Project’s National Inpatient Sample and State Inpatient Databases, an all-payer compendium of hospital discharge records from community, nonrehabilitation hospitals. Trends were evaluated using segmented linear binomial regression models that allowed for discontinuities across the ICD-10-CM/PCS transition. Analyses were completed from April 2021 through March 2022. Time, ICD-10-CM/PCS coding system, and state. SMM rates, excluding blood transfusion, per 10 000 delivery hospitalizations, overall and by indicator. From 2012 to 2019, there were 5 964 315 delivery hospitalizations in the national sample representing a weighted total of 29.8 million deliveries with a mean (SD) maternal age of 28.6 (5.9) years. SMM rates increased from 69.5 per 10 000 in 2012 to 79.7 per 10 000 in 2019 (rate difference [RD], 10.2; 95% CI, 5.8 to 14.6) without a significant change across the ICD-10-CM/PCS transition (RD, −3.2; 95% CI, −6.9 to 0.6). Of 20 SMM indicators, rates for 10 indicators significantly increased while 3 significantly decreased; 5 of these changes were associated with ICD-10-CM/PCS transition. Acute kidney failure had the largest increase, from 6.4 to 15.3 per 10 000 delivery hospitalizations (RD, 8.9; 95% CI, 7.5 to 10.3) with no change associated with ICD transition (RD, −0.1; 95% CI, −1.2 to 1.1). Disseminated intravascular coagulation had the largest decrease from 31.3 to 21.2 per 10 000 (RD, 10.2; 95% CI, −12.8 to −7.5), with a significant drop associated with ICD transition (RD, −7.9; 95% CI, −10.2 to −5.6). State SMM rates significantly decreased for 1 state and significantly increased for 21 states from 2012 to 2019 and associations with ICD transition varied. In this cross-sectional study, overall US SMM rates increased from 2012 to 2019, which was not associated with the ICD-10-CM/PCS transition. However, data for certain indicators and states may not be comparable across coding systems; efforts are needed to understand SMM increases and state variation.
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DOI：
10.1097/00001648-199001000-00010
发表时间：
1990-01-01
期刊：
Epidemiology (Cambridge, Mass.)
影响因子：
--
作者：
Rothman, K J
通讯作者：
Rothman, K J
影响因子：
9.8
作者：
Metcalfe, Amy;Sheikh, Manal;Hetherington, Erin
通讯作者：
Hetherington, Erin
评估美国妇女在分娩后与严重孕产妇发病率相关的因素。
影响因子：
13.8
作者：
Chen J;Cox S;Kuklina EV;Ferre C;Barfield W;Li R
通讯作者：
Li R
影响因子：
2
作者：
Chen, Han-Yang;Chauhan, Suneet P.;Blackwell, Sean C.
通讯作者：
Blackwell, Sean C.
影响因子：
120.7
作者：
Metz, Torri D.;Clifton, Rebecca G.;Macones, George A.
通讯作者：
Macones, George A.