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Eastwood CA, Southern DA, Khair S, Doktorchik C, Cullen D, Ghali WA, Quan H. Field testing a new ICD coding system: methods and early experiences with ICD-11 Beta Version 2018. BMC Res Notes 2022; 15:343. [DOI: 10.1186/s13104-022-06238-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Objective
A beta version (2018) of International Classification of Diseases, 11th Revision for MMS (ICD-11), needed testing. Field-testing involves real-world application of the new codes to examine usability. We describe creating a dataset and characterizing the usability of ICD-11 code set by coders. We compare ICD-11 against ICD-10-CA (Canadian modification) and a reference standard dataset of diagnoses. Real-world usability encompasses code selection and time to code a complete inpatient chart using ICD-11 compared with ICD-10-CA.
Methods and results
A random sample of inpatient records previously coded using ICD-10-CA was selected from hospitals in Calgary, Alberta (N = 2896). Nurses examined these charts for conditions and healthcare-related harms. Clinical coders re-coded the same charts using ICD-11 codes. Inter-rater reliability (IRR) and coding time improved with ICD-11 coding experience (23.6 to 9.9 min average per chart). Code structure comparisons and challenges encountered are described. Overall, 86.3% of main condition codes matched. Coder comments regarding duplicate codes, missing codes, code finding issues enabled improvements to the ICD-11 Browser, Coding Tool, and Reference Guide. Training is essential for solid IRR with 17,000 diagnostic categories in the new ICD-11. As countries transition to ICD-11, our coding experiences and methods can inform users for implementation or field testing.
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Khair S, Dort JC, Quan ML, Cheung WY, Sauro KM, Nakoneshny SC, Popowich BL, Liu P, Wu G, Xu Y. Validated algorithms for identifying timing of second event of oropharyngeal squamous cell carcinoma using real-world data. Head Neck 2022; 44:1909-1917. [PMID: 35653151 DOI: 10.1002/hed.27109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/29/2022] [Accepted: 05/18/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Understanding occurrence and timing of second events (recurrence and second primary cancer) is essential for cancer specific survival analysis. However, this information is not readily available in administrative data. METHODS Alberta Cancer Registry, physician claims, and other administrative data were used. Timing of second event was estimated based on our developed algorithm. For validation, the difference, in days between the algorithm estimated and the chart-reviewed timing of second event. Further, the result of Cox-regression modeling cancer-free survival was compared to chart review data. RESULTS Majority (74.3%) of the patients had a difference between the chart-reviewed and algorithm-estimated timing of second event falling within the 0-60 days window. Kaplan-Meier curves generated from the estimated data and chart review data were comparable with a 5-year second-event-free survival rate of 75.4% versus 72.5%. CONCLUSION The algorithm provided an estimated timing of second event similar to that of the chart review.
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Affiliation(s)
- Shahreen Khair
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joseph C Dort
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Surgery, Cumming School of Medicine, University of Calgary, North Tower, Foothills Medical Centre, Calgary, Alberta, Canada
| | - May Lynn Quan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Surgery, Cumming School of Medicine, University of Calgary, North Tower, Foothills Medical Centre, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker, Cancer Centre, Calgary, Alberta, Canada
| | - Winson Y Cheung
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Surgery, Cumming School of Medicine, University of Calgary, North Tower, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Khara M Sauro
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Surgery, Cumming School of Medicine, University of Calgary, North Tower, Foothills Medical Centre, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker, Cancer Centre, Calgary, Alberta, Canada
| | - Steven C Nakoneshny
- The Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - Brittany Lynn Popowich
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Teaching Research and Wellness (TRW), Calgary, Alberta, Canada
| | - Ping Liu
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Guosong Wu
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Teaching Research and Wellness (TRW), Calgary, Alberta, Canada
| | - Yuan Xu
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Surgery, Cumming School of Medicine, University of Calgary, North Tower, Foothills Medical Centre, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker, Cancer Centre, Calgary, Alberta, Canada.,Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Teaching Research and Wellness (TRW), Calgary, Alberta, Canada
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Khair S, Eastwood CA, Lu M, Jackson J. Supervised consumption site enables cost savings by avoiding emergency services: a cost analysis study. Harm Reduct J 2022; 19:32. [PMID: 35346223 PMCID: PMC8959556 DOI: 10.1186/s12954-022-00609-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background and aims
We report on a cost analysis study, using population level data to determine the emergency service costs avoided from emergency overdose management at supervised consumption services (SCS).
Design
We completed a cost analysis from a payer’s perspective. In this setting, there is a single-payer model of service delivery.
Setting
In Calgary, Canada, ‘Safeworks Harm Reduction Program’ was established in late 2017 and offers 24/7 access to SCS. The facility is a nurse-led service, available for client drop-in. We conducted a cost analysis for the entire duration of the program from November 2017 to January 2020, a period of 2 years and 3 months.
Methods
We assessed costs using the following factors from government health databases: monthly operational costs of providing services for drug consumption, cost of providing ambulance pre-hospital care for clients with overdoses who could not be revived at the facility, cost of initial treatment in an emergency department, and benefit of costs averted from overdoses that were successfully managed at the SCS.
Results
The proportion of clients who have overdosed at the SCS has decreased steadily for the duration of the program. The number of overdoses that can be managed on site at the SCS has trended upward, currently 98%. Each overdose that is managed at the SCS produces approximately $1600 CAD in cost savings, with a savings of over $2.3 million for the lifetime of the program.
Conclusion
Overdose management at an SCS creates cost savings by offsetting costs required for managing overdoses using emergency department and pre-hospital ambulance services.
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Eastwood CA, Southern DA, Doktorchik C, Khair S, Cullen D, Boxill A, Maciszewski M, Varela LO, Ghali W, Moskal L, Quan H. Training and experience of coding with the World Health Organization's International Classification of Diseases, Eleventh Revision. HEALTH INF MANAG J 2021; 52:92-100. [PMID: 34555947 PMCID: PMC10170554 DOI: 10.1177/18333583211038633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The new International Classification of Diseases, Eleventh Revision for Mortality and Morbidity Statistics (ICD-11) was developed and released by the World Health Organization (WHO) in June 2018. Because ICD-11 incorporates new codes and features, training materials for coding with ICD-11 are urgently needed prior to its implementation. OBJECTIVE This study outlines the development of ICD-11 training materials, training processes and experiences of clinical coders while learning to code using ICD-11. METHOD Six certified clinical coders were recruited to code inpatient charts using ICD-11. Training materials were developed with input from experts from the Canadian Institute for Health Information and the WHO, and the clinical coders were trained to use the new classification. Monthly team meetings were conducted to enable discussions on coding issues and to select the correct ICD-11 codes. The training experience was evaluated using qualitative interviews, a questionnaire and a coding quiz. RESULTS total of 3011 charts were coded using ICD-11. In general, clinical coders provided positive feedback regarding the training program. The average score for the coding quiz (multiple choice, True/False) was 84%, suggesting that the training program was effective. Feedback from the coders enabled the ICD-11 code content, electronic tooling and terminologies to be updated. CONCLUSION This study provides a detailed account of the processes involved with training clinical coders to use ICD-11. Important findings from the interviews were reported at the annual WHO conferences, and these findings helped improve the ICD-11 browser and reference guide.
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Affiliation(s)
| | | | | | | | - Denise Cullen
- 6321Canadian Institute for Health and Information, Canada
| | - Alicia Boxill
- 6321Canadian Institute for Health and Information, Canada
| | | | | | | | - Lori Moskal
- 6321Canadian Institute for Health and Information, Canada
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Perelman I, Khair S, Dermer E, Tinmouth A, Saidenberg E, Fergusson D. The epidemiology of multicomponent blood transfusion: a systematic review. Transfus Med 2019; 29:80-94. [PMID: 30859667 DOI: 10.1111/tme.12584] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 01/16/2019] [Accepted: 01/31/2019] [Indexed: 01/28/2023]
Abstract
We performed a systematic review to describe the prevalence of multicomponent blood transfusion and, as a secondary objective, to determine patient characteristics and outcomes associated with multicomponent transfusion. There is a lack of literature on the epidemiology of multicomponent transfusion as most studies concentrate on a single blood product and its utilisation. Patient care and blood management can be optimised by better understanding the patients who receive multicomponent transfusions. The databases Medline, EMBASE and the Cochrane Library of Systematic Reviews were searched. Observational cohort and cross-sectional studies of hospital patients reporting on multicomponent transfusion prevalence or on patient characteristics and outcomes associated with multicomponent transfusion were included. A descriptive synthesis of studies was performed. A total of 37 eligible studies were included. It was found that multicomponent transfusion prevalence varied greatly by patient population and by the combination of blood products given in the multicomponent transfusion. Multicomponent-transfused patients included burn, cardiac surgery, liver surgery and transplant, cancer, infectious diseases, trauma and intensive care unit patients. Five studies found associations between multicomponent transfusion and adverse health outcomes; however, these findings are likely confounded by indication. The overall quality of evidence was low given a fair-to-poor individual study quality, inconsistent multicomponent transfusion prevalence estimates and confounding by indication. Further research is needed to better understand the epidemiology of multicomponent transfusion, including studies on multicomponent transfusion in haematological cancer patients and studies looking for patient characteristics that can better predict multicomponent transfusion need.
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Affiliation(s)
- I Perelman
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - S Khair
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - E Dermer
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - A Tinmouth
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Ottawa Hospital, Ottawa, Ontario, Canada
| | - E Saidenberg
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Ottawa Hospital, Ottawa, Ontario, Canada
| | - D Fergusson
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Khair S, Lu M, Quan H, Doktorchik C, Eastwood C. The Economic Impacts of ICD-9 to ICD-10 Health Indicator Coding System Transition in the Calgary Region. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.1021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
IntroductionCoded data serves a critical part in the process of identifying the resource allocation required for each department in a hospital and for research purposes. This paper attempts a cost-benefit analysis of the transition from ICD-9 health indicator coding system to ICD-10 coding system and quantify the economic impacts.
Objectives and ApproachThe hypothesis adopted by this paper is that the transition from ICD-9 to ICD-10 has been beneficial for the health system due better disease management, resulting in cost savings and facilitation of high quality health research. Analyzing the inflation-adjusted costs compared with the benefits accrued from implementing the new coding system would enable informed decision making for the stakeholders at government and other levels of health provision.
The methodology involves constructing ‘benefit scenarios’ via analysis of existing literature and interviewing coding managers; costs are evaluated using data collected on re-training coders and productivity losses during the transition phase.
ResultsAn example of a benefit scenario would take the form of cost savings associated with correctly identifying people with diabetes (due to coded charts), hence resulting in a decline in blood sugar (HbA1c) levels via better disease management. This in turn may cause reductions in other high blood-sugar related diseases and thus increase efficiency for government funding in the health care sector. Improved data quality in ICD-10 is expected to have resulted in gains from specificity due to increased sensitivity of data classification and grouping. Actual cost of re-training of coders and ICD-10 software provider fees are expected to be higher than the costs anticipated before ICD-10 implementation. Productivity losses in the transition phase are expected to have declined as coders became more adept at coding.
Conclusion/ImplicationsAn economic evaluation proves to be a vital part of eliciting whether the transition to the newer method of coding, ICD-10, has been beneficial to the end users of the data. It is important to understand the efficiency of resource allocation to healthcare and the financial implications such investments entail.
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