Garbage in, Garbage out? Validity of Coded Diagnoses from GP Claims Records
Garbage in, Garbage out? Validity of Coded Diagnoses from GP Claims Records
复制标题
DOI：
10.1055/s-0029-1214399
复制
发表时间：
2009-12-01
期刊：
影响因子：
1.1
通讯作者：
Brennecke, R.
中科院分区：
文献类型：
--
作者：
Erler, A.;Beyer, M.;Brennecke, R.
背景：索赔记录中ICD-10编码的诊断经常被用作研究以及质量管理和薪酬方面的风险调整的发病率指标。这种应用的一个要求是诊断的高效性。方法：在10家全科医生诊所随机抽取250名患者进行回顾性横断面研究，根据患者的病历，检验2003年就诊的健康问题是否与同一时间段内基于索赔的诊断相匹配。结果：尽管每个患者基于索赔的诊断的平均值很高，但30%的病例在研究期间内治疗的健康问题被漏报，主要与全科医生实践中经常遇到的非严重诊断有关，慢性疾病不需要药物治疗，并且诊断证明有必要进行筛查测试。在19%的病例中观察到了在研究期间未治疗的疾病的过度报告，最常见的情况是永久性慢性病。在11%的案例中，基于索赔的诊断的ICD-10代码与病历中的诊断不匹配(“错误代码”)。对于全科医生实践中最常见的六种诊断(高血压、糖尿病、高脂蛋白血症、心血管疾病、背痛和急性呼吸道感染)，71%-93%的正确率高于完整性(56%-86%)。结论：来自全科医生索赔记录的ICD-10编码诊断的有效性受到质疑，它们作为发病率指标的有效性受到质疑。
Context: ICD-10-coded diagnoses from claims records are frequently used as morbidity indicators for research as well as for risk adjustment purposes in quality management and remuneration. A requirement for this application is the high validity of the diagnoses. In GP practices in particular, it is questionable whether claims-based diagnoses realistically reflect the health problems of patients treated over a one year period.Methods: In a retrospective cross-sectional study of a random sample of 250 patients from 10 GP practices we examined whether, on the basis of the patients' medical records, health problems treated in the year 2003 matched claims-based diagnoses within the same time period.Results: In spite of a high mean of 6.1 claims-based diagnoses per patient, health problems treated within the study period were under-reported in 30% of the cases, mainly relating to non-severe diagnoses frequently encountered in GP practice, chronic conditions not requiring medication, and diagnoses justifying a screening test. An over-reporting for diseases not treated within the study period was observed in 19% of the cases, most often in the case of permanent chronic conditions. In 11% of cases the ICD-10 codes of claims-based diagnoses and the diagnoses in the medical records did not match ("erroneous codes"). For six of the diagnoses most common in GP practice (hypertension, diabetes, hyperlipoproteinemia, cardiovascular disease, back pain, and acute respiratory tract infections) correctness at 71-93% was higher than completeness (56-86%).Conclusion: The low validity of ICD-10-coded diagnoses from GP claims records calls their usefulness as morbidity indicators into question.