Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data
Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data
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DOI：
10.1097/01.mlr.0000182534.19832.83
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发表时间：
2005-11-01
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, HD;Sundararajan, V;Ghali, WA
目的：实施《疾病和有关健康问题国际统计分类》第10次修订版（ICD-10）编码系统对使用行政数据提出了挑战。认识到这一点，我们进行了一个多步骤的过程来开发ICD-10编码算法，以定义管理数据中的Charlson和Elixhauser合并症，并评估所得算法的性能。方法：ICD-10编码算法是通过“翻译”构成Deyo的ICD-9-CM代码而开发的。（对于Charlson合并症）和Elixhauser编码算法以及医生对所选ICD- 10编码的表面有效性的评估。精心开发ICD-10算法的过程还产生了针对Charlson和Elixhauser合并症的修改和增强的ICD-9-CM编码算法。然后，我们使用来自加拿大某卫生区的ICD-9-CM和ICD-10管理医院出院数据中18岁及以上住院患者的数据，评估原始ICD-9-CM算法、增强型ICD-9-CM算法和新ICD-10编码算法实现的合并症频率和死亡率预测。在ICD-9-CM数据中的56，585例患者和ICD-10数据中的58，805例患者中，17种Charlson合并症和30种Elixhauser合并症的频率在不同算法中保持大致相似。新的ICD-10和增强的ICD 9-CM编码算法在预测住院死亡率方面与原始Deyo和Elixhauser ICD-9-CM编码算法相匹配或优于原始Deyo和Elixhauser ICD-9-CM编码算法。Deyo ICD 9-CM编码算法的C统计量为0.842，ICD-10编码算法为0.860，增强型ICD-9-CM编码算法为0.859，原始Elixhauser ICD-9-CM编码算法为0.868，ICD-10编码算法为0.870，增强型ICD-9-CM编码算法为0.878。这些新开发的ICD-10和ICD-9-CM合并症编码算法在管理数据中产生了类似的合并症患病率估计值，并且可能优于现有的ICD-9-CM编码算法。
Objectives: Implementation of the International Statistical Classification of Disease and Related Health Problems, 10th Revision (ICD-10) coding system presents challenges for using administrative data. Recognizing this, we conducted a multistep process to develop ICD-10 coding algorithms to define Charlson and Elixhauser comorbidities in administrative data and assess the performance of the resulting algorithms.Methods: ICD-10 coding algorithms were developed by "translation" of the ICD-9-CM codes constituting Deyo's (for Charlson comorbidities) and Elixhauser's coding algorithms and by physicians' assessment of the face-validity of selected ICD- 10, codes. The process of carefully developing ICD-10 algorithms also produced modified and enhanced ICD-9-CM coding algorithms for the Charlson and Elixhauser comorbidities. We then used data on in-patients aged 18 years and older in ICD-9-CM and ICD-10 administrative hospital discharge data from a Canadian health region to assess the comorbidity frequencies and mortality prediction achieved by the original ICD-9-CM algorithms, the enhanced ICD-9-CM algorithms, and the new ICD-10 coding algorithms.Results: Among 56,585 patients in the ICD-9-CM data and 58,805 patients in the ICD-10 data, frequencies of the 17 Charlson comorbidities and the 30 Elixhauser comorbidities remained generally similar across algorithms. The new ICD-10 and enhanced ICD9-CM coding algorithms either matched or outperformed the original Deyo and Elixhauser ICD-9-CM coding algorithms in predicting in-hospital mortality. The C-statistic was 0.842 for Deyo's ICD9-CM coding algorithm, 0.860 for the ICD-10 coding algorithm, and 0.859 for the enhanced ICD-9-CM coding algorithm, 0.868 for the original Elixhauser ICD-9-CM coding algorithm, 0.870 for the ICD-10 coding algorithm and 0.878 for the enhanced ICD-9-CM coding algorithm.Conclusions: These newly developed ICD-10 and ICD-9-CM comorbidity coding algorithms produce similar estimates of comorbidity prevalence in administrative data, and may outperform existing ICD-9-CM coding algorithms.