Interrupted time series design to evaluate the effect of the ICD-9-CM to ICD-10-CM coding transition on injury hospitalization trends.
Interrupted time series design to evaluate the effect of the ICD-9-CM to ICD-10-CM coding transition on injury hospitalization trends.
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DOI：
10.1186/s40621-018-0165-8
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发表时间：
2018-10-01
影响因子：
2.2
通讯作者：
Bunn TL
中科院分区：
文献类型：
--
作者：
Slavova S;Costich JF;Luu H;Fields J;Gabella BA;Tarima S;Bunn TL
2015 年 10 月 1 日在美国实施的国际疾病分类第十次修订版临床修改 (ICD-10-CM) 是一项重大政策变化，有可能影响既定的伤害发病率趋势。本研究使用来自单一州的数据来证明：1）使用统计方法来估计这种编码转换对伤害住院趋势的影响，以及2）在ICD-9-CM和ICD-10-CM之间的结构和概念差异的背景下解释伤害趋势的显着变化，新的ICD-10-CM特定编码指南，以及提出的基于ICD-10-CM的按意图和机制报告伤害的框架。使用分段回归分析对中断时间序列月度数据进行统计建模，以评估 2012 年 1 月至 2017 年 12 月期间向 ICD-10-CM 的过渡对肯塔基州住院的外因伤害完整性（主要伤害诊断补充有外因伤害代码的记录的百分比）以及按意图或机制划分的伤害住院趋势的影响。分段回归分析显示，过渡月份期间，外因伤害的完整性显着下降，但在 2015 年 11 月恢复到过渡前的水平。因意外 (3.34%) 和未确定意图 (− 3.39%) 导致的受伤住院率发生了显着的立即变化。由于中毒、窒息、撞击/撞击、其他交通、未具体说明的机制以及其他未在其他地方分类的具体机制，导致受伤住院率水平立即发生显着变化。过渡后坡度发生显着变化（没有立即水平变化），从而确定了攻击、枪支、割伤/刺穿和机动车辆交通伤害率。观察到的趋势变化反映了 ICD-10-CM 编码的结构和概念特征（例如，中毒和窒息现在仅通过诊断代码捕获）、新的编码指南（例如，如果未知或未指定，则要求将伤害意图编码为“意外”），以及 CDC 提出的按伤害意图和机制进行的外因伤害代码分组。研究人员可以使用管理计费数据集复制这种方法来评估伤害或其他 ICD-10-CM 编码状况的趋势。 CDC 使用 ICD-10-CM 伤害外部原因代码呈现伤害数据的拟议框架，按意图和机制提供了从基于 ICD-9-CM 的伤害住院趋势矩阵的逻辑过渡。我们的研究结果旨在提高人们的认识，即必须了解 ICD-10-CM 编码系统的变化，以确保准确解释伤害趋势。本文的在线版本 (10.1186/s40621-018-0165-8) 包含补充材料，可供授权用户使用。
Implementation of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) in the U.S. on October 1, 2015 was a significant policy change with the potential to affect established injury morbidity trends. This study used data from a single state to demonstrate 1) the use of a statistical method to estimate the effect of this coding transition on injury hospitalization trends, and 2) interpretation of significant changes in injury trends in the context of the structural and conceptual differences between ICD-9-CM and ICD-10-CM, the new ICD-10-CM-specific coding guidelines, and proposed ICD-10-CM-based framework for reporting of injuries by intent and mechanism. Segmented regression analysis was used for statistical modeling of interrupted time series monthly data to evaluate the effect of the transition to ICD-10-CM on Kentucky hospitalizations’ external-cause-of-injury completeness (percentage of records with principal injury diagnoses supplemented with external-cause-of-injury codes), as well as injury hospitalization trends by intent or mechanism, January 2012–December 2017. The segmented regression analysis showed an immediate significant drop in external-cause-of-injury completeness during the transition month, but returned to its pre-transition levels in November 2015. There was a significant immediate change in the percentage of injury hospitalizations coded for unintentional (3.34%) and undetermined intent (− 3.39%). There were immediate significant changes in the level of injury hospitalization rates due to poisoning, suffocation, struck by/against, other transportation, unspecified mechanism, and other specified not elsewhere classifiable mechanism. Significant change in slope after the transition (without immediate level change) was identified for assault, firearm, cut/pierce, and motor vehicle traffic injury rates. The observed trend changes reflected structural and conceptual features of ICD-10-CM coding (e.g., poisoning and suffocations are now captured via diagnosis codes only), new coding guidelines (e.g., requiring coding of injury intent as “accidental” if it is unknown or unspecified), and CDC proposed external-cause-of-injury code groupings by injury intent and mechanism. Researchers can replicate this methodology assessing trends in injuries or other ICD-10-CM-coded conditions using administrative billing data sets. The CDC ‘s Proposed Framework for Presenting Injury Data Using ICD-10-CM External Cause of Injury Codes provided a logical transition from the ICD-9-CM-based matrix on injury hospitalization trends by intent and mechanism. Our findings are intended to raise awareness that changes in the ICD-10-CM coding system must be understood to assure accurate interpretation of injury trends. The online version of this article (10.1186/s40621-018-0165-8) contains supplementary material, which is available to authorized users.