Identifying patients with opioid use disorder using International Classification of Diseases (ICD) codes: Challenges and opportunities.
Identifying patients with opioid use disorder using International Classification of Diseases (ICD) codes: Challenges and opportunities.
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使用国际疾病分类 (ICD) 代码识别阿片类药物使用障碍患者：挑战和机遇。
DOI：
10.1111/add.16338
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Baldwin,Laura-Mae
中科院分区：
文献类型：
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作者：
Osterhage,KatieP;Hser,Yih-Ing;Mooney,LarissaJ;Sherman,Seth;Saxon,AndrewJ;Ledgerwood,Maja;Holtzer,CalebC;Gehring,MargaretA;Clingan,SarahE;Curtis,MeganE;Baldwin,Laura-Mae
背景和目的国际疾病分类(ICD)诊断代码经常用于研究识别阿片类药物使用障碍(OUD)患者，但其准确性尚未得到充分评估。这项研究描述了从电子健康记录(EHR)数据提取中对阿片类药物使用、依赖和滥用的ICD-10诊断代码的应用，使用来自诊所的OUD患者登记和临床医生/工作人员EHR条目的数据。设计横断面观察性研究。设置在华盛顿和爱达荷州的四家农村初级保健诊所。参与者307名患者。测量本研究使用来自每个诊所的三个数据来源：(1)从EHR提取的有限数据集，(2)基于临床的OUD患者登记和(3)EHR的临床医生/工作人员接口(例如，进展记录，问题列表)。数据来源一包括关于阿片类药物使用、依赖和滥用的六个常用ICD-10编码的记录：F11.10(阿片滥用，无并发症)、F11.20(阿片依赖，无复杂)、F11.21(阿片依赖，缓解中)、F11.23(阿片依赖戒断)、F11.90(阿片使用，未指明、未指明的阿片诱发障碍)和F11.99(阿片使用，未指明阿片诱发的障碍)。护理协调员使用两个和三个数据源对数据源一中确定的每个患者进行分类：(1)确诊的OUD，(2)可能有OUD但没有确认的OUD诊断，(3)没有OUD证据的慢性疼痛，(4)没有OUD或慢性疼痛的证据。结果F11.10，F11.21和F11.99最常应用于具有OUD临床诊断的患者(分别为，89%和79%)。F11.20、F11.23和F11.90被应用于诊断为OUD和慢性疼痛混合但没有OUD的患者。结论ICD诊断码缺乏统一应用，难以利用EHR的诊断码数据识别阿片类药物使用障碍的研究人群。
Background and AimsInternational Classification of Diseases (ICD) diagnosis codes are often used in research to identify patients with opioid use disorder (OUD), but their accuracy for this purpose is not fully evaluated. This study describes application of ICD‐10 diagnosis codes for opioid use, dependence and abuse from an electronic health record (EHR) data extraction using data from the clinics' OUD patient registries and clinician/staff EHR entries.DesignCross‐sectional observational study.SettingFour rural primary care clinics in Washington and Idaho, USA.Participants307 patients.MeasurementsThis study used three data sources from each clinic: (1) a limited dataset extracted from the EHR, (2) a clinic‐based registry of patients with OUD and (3) the clinician/staff interface of the EHR (e.g. progress notes, problem list). Data source one included records with six commonly applied ICD‐10 codes for opioid use, dependence and abuse: F11.10 (opioid abuse, uncomplicated), F11.20 (opioid dependence, uncomplicated), F11.21 (opioid dependence, in remission), F11.23 (opioid dependence with withdrawal), F11.90 (opioid use, unspecified, uncomplicated) and F11.99 (opioid use, unspecified with unspecified opioid‐induced disorder). Care coordinators used data sources two and three to categorize each patient identified in data source one: (1) confirmed OUD diagnosis, (2) may have OUD but no confirmed OUD diagnosis, (3) chronic pain with no evidence of OUD and (4) no evidence for OUD or chronic pain.FindingsF11.10, F11.21 and F11.99 were applied most frequently to patients who had clinical diagnoses of OUD (64%, 89% and 79%, respectively). F11.20, F11.23 and F11.90 were applied to patients who had a diagnostic mix of OUD and chronic pain without OUD. The four clinics applied codes inconsistently.ConclusionsLack of uniform application of ICD diagnosis codes make it challenging to use diagnosis code data from EHR to identify a research population of persons with opioid use disorder.