The impact of changes in coding on mortality reports using the example of sepsis.
The impact of changes in coding on mortality reports using the example of sepsis.
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DOI：
10.1186/s12911-022-01947-x
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发表时间：
2022-08-01
影响因子：
3.5
通讯作者：
中科院分区：
文献类型：
--
作者：
NHS Digital于2017年4月发布了关于脓毒症编码的新指南，并于2018年4月进行了进一步修改。在这些时间范围内，一些中心报告败血症相关死亡率增加，而其他中心报告死亡率降低，在某些情况下与特定的质量改进计划相一致。我们假设报告死亡率的变化不能与编码实践的变化分开。分析了2016年4月至2020年3月英国NHS医院入院患者护理数据集的医院事件统计数据。患有脓毒症的成人的入院：评估了与医疗保健研究和质量临床分类软件分类“败血症”（分娩时除外）相关的国际疾病分类10（ICD-10）代码。患者合并症由入院事件中记录的其他ICD-10代码定义。研究了1，081，565例编码诊断为脓毒症的医院事件。2017年4月后，以脓毒症编码为主要入院原因的入院事件显著增加。2017年4月后，初步诊断为脓毒症的患者的病例组合发生了显著变化。对病例组合、医院和年份作为随机效应进行分析，在编码指南首次变更后，定义了英格兰脓毒症相关死亡率的小幅降低。这些随机效应无法分离出中心特异性结局改善。脓毒症编码实践的变化改变了病例组合和病例选择，不同中心之间的方式不同。这与中心特异性脓毒症相关死亡率随时间的变化相关。根据变更方向，这些变更可能被解释为需要当地调查原因或支持临床实践中的同步变更。对整个系统的分析表明，各中心死亡率的变化不能与全系统的变化分开。因此，在解释英国脓毒症结局时需要谨慎，特别是在使用单中心研究来告知或支持指南或政策时。在线版本包含补充材料，可通过10.1186/s12911-022-01947-x获得。
NHS Digital issued new guidance on sepsis coding in April 2017 which was further modified in April 2018. During these timeframes some centres reported increased sepsis associated mortality, whilst others reported reduced mortality, in some cases coincident with specific quality improvement programmes. We hypothesised that changes in reported mortality could not be separated from changes in coding practice. Hospital Episode Statistics from the Admitted Patient Care dataset for NHS hospitals in England, from April 2016 to March 2020 were analysed. Admissions of adults with sepsis: an International Classification of Diseases 10 (ICD-10) code associated with the Agency for Healthcare Research and Quality Clinical Classifications Software class ‘Septicaemia (except in labour)’, were assessed. Patient comorbidities were defined by other ICD-10 codes recorded within the admission episode. 1,081,565 hospital episodes with a coded diagnosis of sepsis were studied. After April 2017 there was a significant increase in admission episodes with sepsis coded as the primary reason for admission. There were significant changes in the case-mix of patients with a primary diagnosis of sepsis after April 2017. An analysis of case-mix, hospital and year treated as random effects, defined a small reduction in sepsis associated mortality across England following the first change in coding guidance. No centre specific improvement in outcome could be separated from these random-effects. Changes in sepsis coding practice altered case-mix and case selection, in ways that varied between centres. This was associated with changes in centre-specific sepsis associated mortality, over time. According to the direction of change these may be interpreted either as requiring local investigation for cause or as supporting coincident changes in clinical practice. A whole system analysis showed that centre specific changes in mortality cannot be separated from system-wide changes. Caution is therefore required when interpreting sepsis outcomes in England, particularly when using single centre studies to inform or support guidance or policy. The online version contains supplementary material available at 10.1186/s12911-022-01947-x.
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