Can additional information be obtained from claims data to support surgical site infection diagnosis codes?
Can additional information be obtained from claims data to support surgical site infection diagnosis codes?
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能否从索赔数据中获得更多信息来支持手术部位感染诊断代码？
DOI：
10.1086/677830
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发表时间：
2014
影响因子：
4.5
通讯作者：
Olsen,MargaretA
中科院分区：
文献类型：
--
作者：
Warren,DavidK;Nickel,KatelinB;Wallace,AnnaE;Mines,Daniel;Fraser,VictoriaJ;Olsen,MargaretA
目的国际疾病分类第九版临床修改 (ICD-9-CM) 诊断代码越来越多地用于识别医疗保健相关感染，但通常没有足够的证据证明所用代码的有效性。在没有病历验证的情况下，我们试图通过检查是否存在临床预期的 SSI 治疗来确认索赔算法，以识别手术部位感染 (SSI)。方法我们使用 65 岁以下的私人保险公司索赔数据进行了一项回顾性队列研究，这些数据来自 2004 年 1 月至 2010 年 12 月进行前十字韧带 (ACL) 重建的 ICD-9-CM 程序或当前程序术语 (CPT-4) 代码。 ACL重建后90天内通过ICD-9-CM诊断代码进行识别。 SSI 代码 14 天内的抗生素使用、手术治疗和微生物培养声明被用作支持 SSI 诊断的证据。 结果 在 40,702 例手术中，401 例 (1.0%) 并发 SSI，其中 172 例 (0.4%) 被明确诊断为化脓性关节炎。大多数 SSI 与住院 (232/401 [58%]) 和/或治疗外科手术 (250/401 [62%]) 相关。与时间相关的抗生素、手术治疗程序和培养物分别占 84% (338/401)、61% (246/401) 和 59% (238/401)。只有 5.7% (23/401) 编码为 SSI 的手术在 SSI 索赔后 14 天内没有使用抗生素、手术治疗或培养。结论 在我们的索赔算法确定的 SSI 患者中，超过 94% 的患者接受了临床预期的感染治疗，包括抗生素、手术治疗和培养，表明该算法具有非常好的阳性预测价值。该方法可能有助于回顾性 SSI 监测以及跨设施和提供者的 SSI 率比较。
ObjectiveInternational Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes are increasingly used to identify healthcare-associated infections, often with insufficient evidence demonstrating validity of the codes used. Absent medical record verification, we sought to confirm a claims algorithm to identify surgical site infections (SSIs) by examining the presence of clinically expected SSI treatment.MethodsWe performed a retrospective cohort study, using private insurer claims data from persons less than 65 years old with ICD-9-CM procedure or Current Procedure Terminology (CPT-4) codes for anterior cruciate ligament (ACL) reconstruction from January 2004 through December 2010. SSIs occurring within 90 days after ACL reconstruction were identified by ICD-9-CM diagnosis codes. Antibiotic utilization, surgical treatment, and microbiology culture claims within 14 days of SSI codes were used as evidence to support the SSI diagnosis.ResultsOf 40,702 procedures, 401 (1.0%) were complicated by SSI, 172 (0.4%) of which were specifically identified as septic arthritis. Most SSIs were associated with an inpatient admission (232/401 [58%]), and/or surgical procedure(s) for treatment (250/401 [62%]). Temporally associated antibiotics, surgical treatment procedures, and cultures were present for 84% (338/401), 61% (246/401), and 59% (238/401), respectively. Only 5.7% (23/401) of procedures coded for SSI after the procedure had no antibiotics, surgical treatments, or cultures within 14 days of the SSI claims.ConclusionsMore than 94% of patients identified by our claims algorithm as having an SSI received clinically expected treatment for infection, including antibiotics, surgical treatment, and culture, suggesting that this algorithm has very good positive predictive value. This method may facilitate retrospective SSI surveillance and comparison of SSI rates across facilities and providers.