Validity of procedure codes in International Classification of Diseases, 9th revision, clinical modification administrative data
Validity of procedure codes in International Classification of Diseases, 9th revision, clinical modification administrative data
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DOI：
10.1097/01.mlr.0000132391.59713.0d
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发表时间：
2004-08-01
期刊：
影响因子：
3
通讯作者：
Ghali, WA
中科院分区：
文献类型：
--
作者：
Quan, H;Parsons, GA;Ghali, WA
背景：行政出院数据被广泛用于评估接受某些手术的患者的护理质量。然而，人们对程序数据管理编码的有效性知之甚少。我们进行了详细的图表审查，以评估行政数据中程序信息的准确性和完整性。 方法：我们从加拿大阿尔伯塔省卡尔加里的3家急性成人医院的行政出院数据中随机抽取1996年4月1日至1997年3月31日期间的1200名住院患者。管理数据中的每个分离记录最多包含 10 个过程编码字段。审查相应的医疗图表以记录是否存在手术。然后，当图表数据（标准）中存在程序时，我们确定了量化行政数据中程序编码准确性的敏感性。结果：在所研究的 35 个程序中，2 个数据库之间的一致性差异很大。灵敏度范围为 0% 至 94%。在所研究的 6 个主要手术中，编码的有效性总体良好，其中 5 个手术的编码敏感性为 69% 及以上，只有 1 个手术（腹膜粘连松解术）的敏感性较低，为 41%。相比之下，许多小手术的敏感性较低。在研究的 29 个小型程序中，有 15 个程序的敏感性低于 50%，有 10 个程序的敏感性在 50% 至 79% 之间，有 4 个程序的敏感性在 80% 及以上。结论：行政出院数据中程序信息的有效性似乎与程序类型有关。通常在手术室中执行的主要程序都经过相当良好的编码。与此同时，在病房或放射科常规进行的小手术通常编码不足。
Background: Administrative hospital discharge data are widely used to assess quality of care in patients undergoing certain procedures. However, little is known about the validity of administrative coding of procedure data. We conducted a detailed chart review to evaluate the accuracy and completeness of information on procedures in administrative data.Methods: We randomly selected 1200 hospital separations in the period April 1, 1996, to March 31, 1997, from administrative discharge data of 3 acute adult hospitals in Calgary, Alberta, Canada. Each separation record in administrative data contains up to 10 procedure coding fields. The corresponding medical charts were reviewed for recording presence or absence of procedures. We then determined sensitivity to quantify the accuracy of coding presence of procedures in administrative data when these are present in the chart data (criterion standard).Results: The agreement between the 2 databases varied greatly across 35 procedures studied. The sensitivity ranged from 0% to 94%. Of 6 major procedures studied, validity of coding was generally good, with 5 procedures having coding sensitivity of 69% and over and only 1 (lysis of peritoneal adhesion) with a low sensitivity of 41%. In contrast, many minor procedures had low sensitivities. Of 29 minor procedures studied, sensitivity was lower than 50% for 15 procedures, between 50% and 79% for 10, and 80% and over for 4.Conclusion: Validity of information on procedures in administrative discharge data appears to be related to type of procedures. Major procedures that are usually performed in operating rooms are reasonably well-coded. Meanwhile, minor procedures that are routinely performed on wards or in radiology departments are generally undercoded.