Prevalence and nature of adverse medical device events in hospitalized children

Our objective was to describe the prevalence and nature of adverse medical device events (AMDEs) in tertiary care children's hospitals. In our retrospective cohort study of patients at 44 children's hospitals in the Pediatric Health Information System (PHIS), we included all inpatient stays with an AMDE-related diagnosis from January 1, 2004 to December 31, 2011. We identified AMDEs by diagnoses that specified a device in their definition. We included events present on admission as well as those complicating hospital stays. We described the characteristics of these admissions and patients, and stratified analysis by device category and presence of a complex chronic condition. Of 4,115,755 admissions in the PHIS database during the study period, 136,465 (3.3%) had at least 1 AMDE. Vascular access and nervous system devices together represented 44.4% of pediatric AMDE admissions. The majority (75.5%) of AMDE admissions were of children with complex chronic conditions. The most common age group was patients aged 2 years or less at the time of their first AMDE-related admission. AMDEs occur commonly in a population cared for in tertiary children's hospitals. Research to more specifically delineate AMDEs and their predictors are next steps to understand and improve device safety in children.

[Trends in primary health version of ICD-11]

The WHO recognizes the importance of a psychiatric diagnostic system in primary care. Regarding the revision of ICD-11 primary health care (ICD-11-PHC), a working group is organized and acts positively. The WG makes the draft of ICD-11-PHC. Some new and interesting disease names, such as ANXIOUS DEPRESSION and BODILY STRESS SYNDROME (BSS), are incorporated in ICD-11-PHC. Revision to ICD-11 continues, and an international Field Trial of ICD-11-PHC by the WHO is planned. Participation in the Field Trial of Japanese researchers is expected. We psychiatrists should closely follow trends in interesting new knowledge in ICD-11-PHC.

[Toward a revision of ICD: current discussion on stress-related disorders]

Under the ICD-10 Classification of Mental and Behavioral Disorders, reaction to severe stress and adjustment disorders (F43) is unique in that the disorders are defined by a stressor which caused the disorder, along with the specific psychiatric symptoms. Acute stress reactions (F43.0), post-traumatic stress disorder (PTSD) (F43.1), adjustment disorder (F43.2), and other reactions to severe stress are grouped into this category. Major conceptual change in F43 is discussed and will be proposed upon the next revision of the ICD. The proposal will include the removal of acute stress reactions from F43 to normalize such reactions, including PTSD and complex PTSD under traumatic stress disorder, introducing prolonged grief disorder, and a redefining of adjustment disorder. Further discussion and field testing of this proposed definition will follow before the release of ICD-11. There are claims that the disorder concept, typical clinical features, and its way of formulation are based on Western views and, consequently, operational classification is difficult to use in Asian cultures and societies. There are multiple avenues to provide feedback during the process of the revision; thus, more input from Japanese psychiatrists is awaited.

Examining the use of ICD-9 diagnosis codes for primary immune deficiency diseases in New York State

PURPOSE

To use International Classification of Disease Codes (ICD-9) codes to investigate primary immune deficiency (PID) in New York State.

METHODS

We investigated the diagnosis of Primary Immune Deficiency (PID) in New York State (NYS) using the Statewide Planning and Research Cooperative System (SPARCS) database, a comprehensive data reporting system that collects ICD-9 codes for each patient hospitalized in NYS.

RESULTS

From 2000-2004 there were 13,539,358 hospitalizations for 4,777,295 patients; of these, 2,361 patients (0.05 %) were diagnosed with one or more of the ICD-9 codes for PID. Antibody defects were the most common diagnoses made. The PID population had significantly more Caucasians, and fewer African American or Hispanic subjects compared to the general population. Subjects with PID codes were younger, had longer hospitalizations, were less likely to have Medicare and more likely to have Medicaid or Blue Cross insurance. Most hospitalizations were due to respiratory and infectious diseases. Most patients resided in the most populous counties, Kings, New York and Queens, but the distribution of home zip codes was not proportional to county populations.

CONCLUSIONS

These data provide useful information on incidence and complications of selected PID diagnoses in one large state.

Increased registration of hypertension and cancer diagnoses after the introduction of a new reimbursement system

OBJECTIVE

To investigate the impact on ICD coding behaviour of a new case-mix reimbursement system based on coded patient diagnoses. The main hypothesis was that after the introduction of the new system the coding of chronic diseases like hypertension and cancer would increase and the variance in propensity for coding would decrease on both physician and health care centre (HCC) levels.

DESIGN

Cross-sectional multilevel logistic regression analyses were performed in periods covering the time before and after the introduction of the new reimbursement system.

SETTING

Skaraborg primary care, Sweden.

SUBJECTS

All patients (n = 76 546 to 79 826) 50 years of age and older visiting 468 to 627 physicians at the 22 public HCCs in five consecutive time periods of one year each.

MAIN OUTCOME MEASURES

Registered codes for hypertension and cancer diseases in Skaraborg primary care database (SPCD).

RESULTS

After the introduction of the new reimbursement system the adjusted prevalence of hypertension and cancer in SPCD increased from 17.4% to 32.2% and from 0.79% to 2.32%, respectively, probably partly due to an increased diagnosis coding of indirect patient contacts. The total variance in the propensity for coding declined simultaneously at the physician level for both diagnosis groups.

CONCLUSIONS

Changes in the healthcare reimbursement system may directly influence the contents of a research database that retrieves data from clinical practice. This should be taken into account when using such a database for research purposes, and the data should be validated for each diagnosis.

The DRG shift: a new twist for ICD-10 preparation

Analysis of your specific business is a key component of ICD-10 implementation. An understanding of your organization's current reimbursement trends will go a long way to assessing and preparing for the impact of ICD-10 in your environment. If you cannot be prepared for each detailed scenario, remember that much of the analysis and resolution requires familiar coding, DRG analysis, and claims processing best practices. Now, they simply have the new twist of researching new codes and some new concepts. The news of a delay in the implementation compliance date, along with the release of grouper Version 29, should encourage your educational and business analysis efforts. This is a great opportunity to maintain open communication with the Centers for Medicare & Medicaid Services, Department of Health and Human Services, and Centers for Disease Control. This is also a key time to report any unusual or discrepant findings in order to provide input to the final rule.

Preparing for ICD-10-CM/PCS: one payer's experience with general equivalence mappings (GEMs)

The International Classification of Diseases, Tenth Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) has been mandated as the new code set to be used for medical coding in the United States beginning on October 1, 2013, replacing the use of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). To assist in the transition from ICD-9-CM to ICD-10-CM/PCS, the National Center for Health Statistics developed bidirectional general equivalent mappings (GEMs) between the old and new code sets. This article looks at how the GEMs have been leveraged by Health Care Service Corporation (HCSC) to achieve the goal of transition to ICD-10-CM/PCS. The analysis examines the questions asked and lessons learned in the practical application of the GEMs for the translation of business rules and processes in order to promote a deeper understanding of the data issues involved in the transition from ICD-9-CM to ICD-10-CM/PCS from a payer's perspective.

Lessons learned from an ICD-10-CM clinical documentation pilot study

On October 1, 2013, the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) will be mandated for use in the United States in place of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). This new classification system will used throughout the nation's healthcare system for recording diagnoses or the reasons for treatment or care. A pilot study was conducted to determine whether current levels of inpatient clinical documentation provide the detail necessary to fully utilize the ICD-10-CM classification system for heart disease, pneumonia, and diabetes cases. The design of this pilot study was cross-sectional. Four hundred ninety-one de-identified records from two sources were coded using ICD-10-CM guidelines and codebooks. The findings of this study indicate that healthcare organizations need to assess clinical documentation and identify gaps. In addition, coder proficiency should be assessed prior to ICD-10-CM implementation to determine the need for further education and training in the biomedical sciences, along with training in the new classification system.

ICD-10 coding for congenital anomalies: a Canadian experience

The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10 CM) will be implemented on October 1, 2013 in the United States by institutions such as hospitals and insurance companies, and by surveillance programs and registries. The Alberta Congenital Anomalies Surveillance System (ACASS) experienced a transition in 2000, changing from the British Paediatric Association version of ICD-9 (ICD-9 BPA) to the Royal College of Paediatrics and Child Health adaptation of ICD-10 (ICD-10 RCPCH). Although the United States will use ICD-10 CM, the experiences discussed are applicable to birth defects programs in the United States. ACASS is funded by the Alberta Ministry of Health known as Alberta Health and Wellness (AHW) and is primarily a passive system covering approximately 50,000 annual births in the province of Alberta. Hospitals in Alberta changed from ICD-9 to an enhanced version of ICD-10 developed by the Canadian Institute for Health Information (ICD-10 CA) in 2002. Both ICD-10 RCPCH and ICD-10 CA are comparable; however, ICD-10 RCPCH offers a more detailed breakdown of some congenital anomaly categories. Although the implementation date for ICD-10 CA was to be in 2002, Alberta hospitals were aware in 1999 that the change would occur. This 3-year period allowed for preparation by ACASS prior to the required implementation.