Accuracy of ICD-9-CM Codes by Hospital Characteristics and Stroke Severity: Paul Coverdell National Acute Stroke Program.
Accuracy of ICD-9-CM Codes by Hospital Characteristics and Stroke Severity: Paul Coverdell National Acute Stroke Program.
复制标题
DOI：
10.1161/jaha.115.003056
复制
发表时间：
2016-05-31
影响因子：
5.4
通讯作者：
George MG
中科院分区：
文献类型：
--
作者：
Chang TE;Lichtman JH;Goldstein LB;George MG
流行病学和卫生服务研究经常使用国际疾病分类第九版临床修订本（ICD - 9 - CM）编码在管理数据库中识别患有临床疾病的患者。我们确定了在按医院特征和卒中严重程度分层的情况下，卒中患者的临床诊断与ICD - 9 - CM编码之间是否存在系统性差异。
我们使用了2013年参与保罗·科弗代尔国家急性卒中项目的医院出院患者的记录。在这个富含卒中患者的队列中，我们比较了主治医师的临床诊断与主要的ICD - 9 - CM编码之间的一致性，并确定了不一致性是否因医院特征（是否有卒中单元、卒中团队、医院病床数量以及医院位置）而有所不同。对于入院时有记录的美国国立卫生研究院卒中量表评分的患者，我们评估了诊断一致性是否因卒中严重程度而不同。一致性通常较高（>89%）；医生诊断与ICD - 9 - CM编码之间的差异主要归因于缺血性卒中和短暂性脑缺血发作（TIA）以及蛛网膜下腔出血和脑内出血之间的不一致。在设有卒中单元、卒中团队且病床数>200张的大都市医院的患者中，一致性更高（所有P<0.001）。对于病床数≤200张且没有卒中单元或团队的农村医院，一致性最低（60.3%）。与更严重的缺血性卒中（96.4%）相比，较轻的缺血性卒中（94.9%）的一致性也较低（P<0.001）。
我们根据医院特征和卒中严重程度确定了在卒中/TIA编码方面的不一致性，特别是对于较轻的缺血性卒中。ICD - 9 - CM编码实践中的这种系统性差异可能会影响流行病学研究中卒中病例的识别，并可能对医院层面的质量指标产生影响。
Epidemiological and health services research often use International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) codes to identify patients with clinical conditions in administrative databases. We determined whether there are systematic variations between stroke patient clinical diagnoses and ICD‐9‐CM codes, stratified by hospital characteristics and stroke severity. We used the records of patients discharged from hospitals participating in the Paul Coverdell National Acute Stroke Program in 2013. Within this stroke‐enriched cohort, we compared agreement between the attending physician's clinical diagnosis and principal ICD‐9‐CM code and determined whether disagreements varied by hospital characteristics (presence of a stroke unit, stroke team, number of hospital beds, and hospital location). For patients with a documented National Institutes of Health Stroke Scale score at admission, we assessed whether diagnostic agreement varied by stroke severity. Agreement was generally high (>89%); differences between the physician diagnosis and ICD‐9‐CM codes were primarily attributed to discordance between ischemic stroke and transient ischemic attack (TIA), and subarachnoid and intracerebral hemorrhage. Agreement was higher for patients in metropolitan hospitals with stroke units, stroke teams, and >200 beds (all P<0.001). Agreement was lowest (60.3%) for rural hospitals with ≤200 beds and without stroke units or teams. Agreement was also lower for milder (94.9%) versus more‐severe (96.4%) ischemic strokes (P<0.001). We identified disagreements in stroke/TIA coding by hospital characteristics and stroke severity, particularly for milder ischemic strokes. Such systematic variations in ICD‐9‐CM coding practices can affect stroke case identification in epidemiological studies and may have implications for hospital‐level quality metrics.