Does date stamping ICD-9-CM codes increase the value of clinical information in administrative data?
Does date stamping ICD-9-CM codes increase the value of clinical information in administrative data?
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DOI：
10.1111/j.1475-6773.2005.00419.x
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发表时间：
2006-02-01
影响因子：
3.4
通讯作者：
Mukamel, DB
中科院分区：
文献类型：
--
作者：
Glance, LG;Dick, AW;Mukamel, DB
上下文在将国际疾病分类（ICD-9-CM）编码映射到诊断类别时，共同标准措施旨在排除并发症。使用数据字段，表明是否每个次要诊断是目前在入院时，可能会导致更准确地识别预先存在的条件。通过Dartmouth-Manitoba改编的Charlson指数和Elixhauser共分类算法，检查ICD-9-CM编码在诊断类别中的错误分类率。分析了2000年因七种主要内科和外科疾病之一而入院的加州州住院患者数据库（CA SID）中的178，838例患者。CA SID包括每个ICD-9-CM代码的入院时存在状况（CPAA）修饰符。研究设计。使用达特茅斯/Charlson指数和Elixhauser合并症指标将ICD-9-CM编码映射到每个研究人群患者的诊断类别中。我们计算了每种映射算法的错误分类率，使用来自CPAA的信息作为“金标准”。“主要发现。达特茅斯/查尔森指数低估了偏瘫/截瘫的患病率70%，脑血管疾病70%，心肌梗死65%，充血性心力衰竭（CHF）45%，消化性溃疡34%。Elixhauser算法将43%的凝血功能障碍、25%的液体和电解质紊乱、18%的心律失常、18%的心律失常和9%的CHF病例的并发症错误分类为既存疾病。在管理数据中添加CPAA修饰符将显著增强达特茅斯/Charlson指数和Elixhauser算法将ICD-9-CM代码准确映射到诊断类别的能力。
Context. Comorbidity measures are designed to exclude complications when they map International Classification of Diseases (ICD-9-CM) codes to diagnostic categories. The use of data fields that indicates whether each secondary diagnosis was present at the time of hospital admission may lead to the more accurate identification of preexisting conditions.Objective. To examine the rate of misclassification of ICD-9-CM codes into diagnostic categories by the Dartmouth-Manitoba adaptation of the Charlson index and by the Elixhauser comorbidity algorithm.Data Source. Analysis of 178,838 patients in the California State Inpatient Database (CA SID) admitted in 2000 for one of seven major medical and surgical conditions. The CA SID includes a condition present at admission (CPAA) modifier for each ICD-9-CM code.Study Design. The Dartmouth/Charlson index and the Elixhauser comorbidity measure were used to map the ICD-9-CM codes into diagnostic categories for patients in each study population. We calculated the misclassification rate for each mapping algorithm, using information from the CPAA as the "gold standard."Principal Findings. The Dartmouth/Charlson index underestimated the prevalence of hemiplegia/paraplegia by 70 percent, cerebrovascular disease by 70 percent, myocardial infarction by 65 percent, congestive heart failure (CHF) by 45 percent, and peptic ulcer disease by 34 percent. The Elixhauser algorithm misclassified complications as preexisting conditions for 43 percent of the coagulopathies, 25 percent of the fluid and electrolyte disorders, 18 percent of the cardiac arrhythmias, 18 percent of the cardiac arrhythmias, and 9 percent of the cases of CHF.Conclusion. Adding the CPAA modifier to administrative data would significantly enhance the ability of the Dartmouth/Charlson index and of the Elixhauser algorithm to map ICD-9-CM codes to diagnostic categories accurately.