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Morgan E, Arnold M, Rutherford MJ, Bardot A, Ferlay J, De P, Engholm G, Jackson C, Little A, Saint-Jacques N, Walsh P, Woods RR, O'Connell DL, Bray F, Parkin DM, Soerjomataram I. The impact of reclassifying cancers of unspecified histology on international differences in survival for small cell and non-small cell lung cancer (ICBP SurvMark-2 project). Int J Cancer 2021; 149:1013-1020. [PMID: 33932300 DOI: 10.1002/ijc.33620] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/07/2022]
Abstract
Survival from lung cancer remains low, yet is the most common cancer diagnosed worldwide. With survival contrasting between the main histological groupings, small-cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC), it is important to assess the extent that geographical differences could be from varying proportions of cancers with unspecified histology across countries. Lung cancer cases diagnosed 2010-2014, followed until 31 December 2015 were provided by cancer registries from seven countries for the ICBP SURVMARK-2 project. Multiple imputation was used to reassign cases with unspecified histology into SCLC, NSCLC and other. One-year and three-year age-standardised net survival were estimated by histology, sex, age group and country. In all, 404 617 lung cancer cases were included, of which 47 533 (11.7%) and 262 040 (64.8%) were SCLC and NSCLC. The proportion of unspecified cases varied, from 11.2% (Denmark) to 29.0% (The United Kingdom). After imputation with unspecified histology, survival variations remained: 1-year SCLC survival ranged from 28.0% (New Zealand) to 35.6% (Australia) NSCLC survival from 39.4% (The United Kingdom) to 49.5% (Australia). The largest survival change after imputation was for 1-year NSCLC (4.9 percentage point decrease). Similar variations were observed for 3-year survival. The oldest age group had lowest survival and largest decline after imputation. International variations in SCLC and NSCLC survival are only partially attributable to differences in the distribution of unspecified histology. While it is important that registries and clinicians aim to improve completeness in classifying cancers, it is likely that other factors play a larger role, including underlying risk factors, stage, comorbidity and care management which warrants investigation.
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Affiliation(s)
- Eileen Morgan
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Melina Arnold
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Mark J Rutherford
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Aude Bardot
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Jacques Ferlay
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Prithwish De
- Analytics and Informatics, Cancer Care Ontario, Toronto, Ontario, Canada
| | | | | | - Alana Little
- Cancer Institute NSW, Alexandria, New South Wales, Australia
| | - Nathalie Saint-Jacques
- Nova Scotia Health Authority Cancer Care Program, Registry & Analytics, Halifax, Nova Scotia, Canada
| | - Paul Walsh
- National Cancer Registry Ireland, Cork Airport Business Park, Cork, Ireland
| | | | - Dianne L O'Connell
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - D Max Parkin
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Scott JW, Staudenmayer K, Sangji N, Fan Z, Hemmila M, Utter G. Evaluating the association between American Association for the Surgery of Trauma emergency general surgery anatomic severity grades and clinical outcomes using national claims data. J Trauma Acute Care Surg 2021; 90:296-304. [PMID: 33214490 DOI: 10.1097/ta.0000000000003030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Emergency general surgery (EGS) encompasses a heterogeneous population of acutely ill patients, and standardized methods for determining disease severity are essential for comparative effectiveness research and quality improvement initiatives. The American Association for the Surgery of Trauma (AAST) has developed a grading system for the anatomic severity of 16 EGS conditions; however, little is known regarding how well these AAST EGS grades can be approximated by diagnosis codes in administrative databases. METHODS We identified adults admitted for 16 common EGS conditions in the 2012 to 2017q3 National Inpatient Sample. Disease severity strata were assigned using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes based on AAST EGS anatomic severity grades. We evaluated whether assigned EGS severity (multiple strata or dichotomized into less versus more complex) were associated with in-hospital mortality, complications, length of stay, discharge disposition, and costs. Analyses were adjusted for age, sex, comorbidities, hospital traits, geography, and year. RESULTS We identified 10,886,822 EGS admissions. The number of anatomic severity strata derived from ICD-9/10-CM codes varied by EGS condition and by year. Four conditions mapped to four strata across all years. Two conditions mapped to four strata with ICD-9-CM codes but only two or three strata with ICD-10-CM codes. Others mapped to three or fewer strata. When dichotomized into less versus more complex disease, patients with more complex disease had worse outcomes across all 16 conditions. The addition of multiple strata beyond a binary measure of complex disease, however, showed inconsistent results. CONCLUSION Classification of common EGS conditions according to anatomic severity is feasible with International Classification of Diseases codes. No condition mapped to five distinct severity grades, and the relationship between increasing grade and outcomes was not consistent across conditions. However, a standardized measure of severity, even if just dichotomized into less versus more complex, can inform ongoing efforts aimed at optimizing outcomes for EGS patients across the nation. LEVEL OF EVIDENCE Prognostic, level III.
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Affiliation(s)
- John W Scott
- From the Department of Surgery (J.W.S., N.S., M.H.), and Center for Health Outcomes and Policy (J.W.S., N.S., Z.F., M.H.), University of Michigan, Ann Arbor, Michigan; Department of Surgery (K.S.), Stanford University, Stanford; and Outcomes Research Group (G.U.), University of California Davis, Sacramento, California
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Mølstrøm IM, Henriksen MG, Nordgaard J. Differential-diagnostic confusion and non-specificity of affective symptoms and anxiety: An empirical study of first-admission patients. Psychiatry Res 2020; 291:113302. [PMID: 32763555 DOI: 10.1016/j.psychres.2020.113302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 07/05/2020] [Accepted: 07/12/2020] [Indexed: 11/18/2022]
Abstract
In everyday clinical work, psychiatrists encounter patients who present with symptoms spanning several diagnostic categories, e.g., showing signs of a psychosis, depression, and anxiety. This raises the critical question of which symptoms hold precedence over other and, by extension, which diagnosis is the right diagnosis. ICD-10 and DSM-5 do not provide unambiguous answers to this question and therefore psychiatry remains exposed to diagnostic disagreement with consequences for treatment and research. We explored symptom distribution in a sample of 98 first-admission psychiatric patients. We extracted and categorized singular symptoms into symptom domains: anxiety, mania, delusions, hallucinations, first-rank symptoms, and negative symptoms. Most symptoms were seen in most disorders. We found symptoms of depression and anxiety in almost all patients. Thus, just counting symptoms do not seem to be a valid way to make diagnoses. We elaborately discuss these issues in the context of the differential-diagnosis between schizophrenia and depression. Finally, we suggest that a combination of a criteria- and Gestalt-based approach to diagnosing mental disorders may contribute to counteract some of the current differential-diagnostic confusion.
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Affiliation(s)
| | - Mads Gram Henriksen
- Mental Health Center Amager, Denmark; Center for Subjectivity Research, Department of Communication, University of Copenhagen, Denmark; Mental Health Center Glostrup, Denmark
| | - Julie Nordgaard
- Mental Health Center Amager, Denmark; Faculty of Health and Medical Science, University of Copenhagen, Denmark.
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Carter K, Tannous C, Walmsley S, Rome K, Turner DE. Linking the effect of psoriatic arthritis-related foot involvement to the Leeds Foot Impact Scale using the International Classification for Functioning, Disability and Health: a study to assess content validity. J Foot Ankle Res 2020; 13:52. [PMID: 32831126 PMCID: PMC7445917 DOI: 10.1186/s13047-020-00420-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/17/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Previous research to describe the impact of foot involvement in psoriatic arthritis has used the Leeds Foot Impact Scale in Rheumatoid Arthritis (LFIS-RA) in the current absence of any psoriatic arthritis foot-specific tools. However, the LFIS-RA is a rheumatoid arthritis disease-specific outcome measure and its content validity for evaluating the experiences of people with psoriatic arthritis-related foot involvement is unknown. The study objective was to determine the content validity of the LFIS-RA for assessing people with psoriatic arthritis, using the International Classification of Functioning, Disability and Health (ICF) as the frame of reference. METHOD Concepts within each item of the LFIS-RA were linked to the best-matched ICF categories using established linking rules, which enable a systematic and standardised linking process. All concepts were independently linked to the ICF by 2 investigators with different professional backgrounds, which included occupational therapy and podiatry. The list of ICF categories derived from previous research that pertained to the foot in psoriatic arthritis was then compared with the ICF categories linked to the LFIS-RA. The comparison was undertaken in order to determine the extent to which concepts important and relevant to people with psoriatic arthritis-related foot involvement were addressed. RESULTS Thirty-five distinct ICF categories were linked to the LFIS-RA, which related to body functions (44%), activities and participation (35%), environmental factors (16%) and body structure (5%). In comparison with the ICF categories derived from concepts of the foot in psoriatic arthritis previously defined, the LFIS-RA provided coverage of key constructs including pain, functioning, daily activities, footwear restrictions and psychological impact. Other concepts of importance in psoriatic arthritis such as skin and toenail involvement, self-management and paid employment were not addressed in the LFIS-RA. CONCLUSION Content validity of the LFIS-RA to determine the impact of foot functional impairments and disability in people with psoriatic arthritis was not supported by the results of this study. Future work should consider the development of a psoriatic arthritis foot-specific patient reported outcome measure, using the LFIS-RA as an important foundation.
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Affiliation(s)
- Kate Carter
- Podiatry department, School of Health Science, Campbelltown Campus, Western Sydney University, Sydney, Australia.
| | - Caterina Tannous
- Occupational therapy department. School of Health Science, Campbelltown Campus, Western Sydney University, Sydney, Australia
| | - Steven Walmsley
- Podiatry department, School of Health Science, Campbelltown Campus, Western Sydney University, Sydney, Australia
| | - Keith Rome
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Science, AUT University, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand
| | - Deborah E Turner
- Podiatry department, School of Clinical Sciences, Kelvin Grove Campus, Queensland University of Technology, Brisbane, Queensland, Australia
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Tiganov AS, Savenko YS. The necessity of developing a two-stage qualification in ICD-11. Psychiatriki 2020; 31:172-176. [PMID: 32840221 DOI: 10.22365/jpsych.2020.312.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In the International Classification of Diseases, 10th Revision (ICD-10) two opposing principles are combined and mixed: atheoreticity that is necessary for the natural classification and commitment to nosology. Implementation of these principles requires a two-stage qualification. The first stage should be narrative detailed syndromological qualifications with identification of psychotic level of disorders. As for the second stage, the qualification should be nosological, based on complete clinical analysis, which is far from being possible to realize at once. ICD-10, specifically brought to nosological certainty, may remain the natural foundation for nosological qualification. Implementation of the syndromic qualification at the first stage will allow to consider nosological features of each syndrome at the second stage and to expand the list of criteria in different clusters. Such a suggestion opens the prospect for subsequent revisions of the ICD and allows to direct our efforts and those of practitioners to the unified channel, where the statistical goals would not be implemented at the expense of the research ones.
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Affiliation(s)
- A S Tiganov
- The Mental Health Research Center of the Russian Academy of Sciences
| | - Yu S Savenko
- Independent Psychiatric Association of Russia, Russia
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Abstract
Background The International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) Injury Severity Score (ICISS) is a risk adjustment model when injuries are recorded using ICD-9-CM coding. The trauma mortality prediction model (TMPM-ICD9) provides better calibration and discrimination compared with ICISS and injury severity score (ISS). Though TMPM-ICD9 is statistically rigorous, it is not precise enough mathematically and has the tendency to overestimate injury severity. The purpose of this study is to develop a new ICD-10-CM injury model which estimates injury severities for every injury in the ICD-10-CM lexicon by a combination of rigorous statistical probit models and mathematical properties and improves the prediction accuracy. Methods We developed an injury mortality prediction (IMP-ICDX) using data of 794,098 patients admitted to 738 hospitals in the National Trauma Data Bank from 2015 to 2016. Empiric measures of severity for each of the trauma ICD-10-CM codes were estimated using a weighted median death probability (WMDP) measurement and then used as the basis for IMP-ICDX. ISS (version 2005) and the single worst injury (SWI) model were re-estimated. The performance of each of these models was compared by using the area under the receiver operating characteristic (AUC), the Hosmer-Lemeshow (HL) statistic, and the Akaike information criterion statistic. Results IMP-ICDX exhibits significantly better discrimination (AUCIMP-ICDX, 0.893, and 95% confidence interval (CI), 0.887 to 0.898; AUCISS, 0.853, and 95% CI, 0.846 to 0.860; and AUCSWI, 0.886, and 95% CI, 0.881 to 0.892) and calibration (HLIMP-ICDX, 68, and 95% CI, 36 to 98; HLISS, 252, and 95% CI, 191 to 310; and HLSWI, 92, and 95% CI, 53 to 128) compared with ISS and SWI. All models were improved after the extension of age, gender, and injury mechanism, but the augmented IMP-ICDX still dominated ISS and SWI by every performance. Conclusions The IMP-ICDX has a better discrimination and calibration compared to ISS. Therefore, we believe that IMP-ICDX could be a new viable trauma research assessment method.
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Affiliation(s)
- Muding Wang
- Department of Emergency Medicine, Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Gongshu District, Hangzhou, 310015 Zhejiang People’s Republic of China
| | - Wusi Qiu
- Department of Neurosurgery, Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015 Zhejiang People’s Republic of China
| | - Yunji Zeng
- Department of Orthopedic, Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015 Zhejiang People’s Republic of China
| | - Wenhui Fan
- Department of Emergency Medicine, Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Gongshu District, Hangzhou, 310015 Zhejiang People’s Republic of China
| | - Xiao Lian
- Department of Orthopedic, Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015 Zhejiang People’s Republic of China
| | - Yi Shen
- Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Hangzhou, 310058 Zhejiang People’s Republic of China
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Arnold LE, Roy A, Taylor E, Hechtman L, Sibley M, Swanson JM, Mitchell JT, Molina BSG, Rohde LA. Predictive utility of childhood diagnosis of ICD-10 hyperkinetic disorder: adult outcomes in the MTA and effect of comorbidity. Eur Child Adolesc Psychiatry 2019; 28:557-570. [PMID: 30232561 DOI: 10.1007/s00787-018-1222-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/03/2018] [Indexed: 01/20/2023]
Abstract
Diagnostic guidelines differ between DSM attention-deficit/hyperactivity disorder (ADHD) and ICD hyperkinetic disorder (HKD). Only 145 of 579 children age 7-9 in the Multimodal Treatment Study of ADHD (the MTA) with combined-type DSM-IV ADHD met criteria for ICD-10 HKD, because major internalizing comorbidities and more stringent symptom count/pervasiveness requirements excluded most. The 145 HKD had significantly better 14-month medication response than the rest. We explored whether HKD had greater adult symptom persistence and/or impairment than other ADHD. Multi-informant assessments were done for 16 years. We used the 12/14/16-year assessments, in young adulthood. The post-attrition 109 with baseline HKD had no greater adult persistence of ADHD symptoms/impairment than 367 without HKD, but had more cumulative stimulant use, more job losses, lower emotional lability, and fewer car crashes. However, those excluded for internalizing comorbidity but otherwise meeting HKD criteria had significantly more persistence. Only 6 of the 109 (5.5%) with baseline HKD met ICD-10 criteria for HKD in adulthood, compared to 25 of 367 (6.8%) without a childhood HKD diagnosis. Despite greater initial symptom severity, HKD had no worse 16-year young adult outcome than others, except for job losses, balanced by less emotional lability and fewer crashes. Comorbid internalizing disorder seems to have worse prognosis than initial severity/pervasiveness of ADHD symptoms.
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Affiliation(s)
- L Eugene Arnold
- Department of Psychiatry and Behavioral Health, Ohio State University, 395E McCampbell Hall, 1581 Dodd Dr, Columbus, OH, 43210, USA.
| | - Arunima Roy
- Division of Molecular Psychiatry, University Hospital Würzburg, Würzburg, Germany
| | - Eric Taylor
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Lily Hechtman
- McGill University, Montreal Children's Hospital, Montreal, Canada
| | - Margaret Sibley
- Department of Psychiatry and Behavioral Health, Florida International University, Miami, USA
| | - James M Swanson
- Department of Pediatrics, University of California Irvine, Irvine, USA
| | - John T Mitchell
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, USA
| | - Brooke S G Molina
- Departments of Psychiatry, Psychology, and Pediatrics, University of Pittsburgh, Pittsburgh, USA
| | - Luis A Rohde
- Division of Child and Adolescent Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul and National Institute of Developmental Psychiatry for Children and Adolescents, Porto Alegre, Brazil
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Jathanna PNR, Vijeta R, Jathanna VR. Trend of intestinal infectious diseases recorded at a tertiary care hospital in India: an ICD-10 analysis. BMJ Health Care Inform 2019; 26:0. [PMID: 31039122 PMCID: PMC7062317 DOI: 10.1136/bmjhci-2019-000021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 03/05/2019] [Accepted: 03/13/2019] [Indexed: 11/05/2022] Open
Abstract
The World Health Organization identifies the leading cause of morbidity and mortality in developing countries as infectious and communicable diseases. Health records coded uniformly using ICD-10 can form an accurate database and conclusions drawn from this are extremely important for understanding the public health situation.The aim of this study is to analyse the trend of intestinal infectious diseases recorded at a tertiary care hospital in India.A retrospective disease index study was conducted on data comprising 5317 cases from 2012 to 2016 for intestinal infectious diseases, analysed with ICD-10.Of these, 5.5% were from the age group 0-5 years; 57.66% were male; and 85% deaths in this cohort (62/73) were due to diarrhoea and gastroenteritis of presumed infectious origin.The findings of this study highlight an urgent need for health education among the population regarding infectious intestinal diseases and to redesign health promotion and preventive strategies for addressing these problems.
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Affiliation(s)
- P N Roopalekha Jathanna
- Department of Health Information Management, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Ramya Vijeta
- Department of Orthodontics and Dentofacial Orthopaedics, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Vinod R Jathanna
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Mangalore, India
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Hooker EA, Mallow PJ, Oglesby MM. Characteristics and Trends of Emergency Department Visits in the United States (2010-2014). J Emerg Med 2019; 56:344-351. [PMID: 30704822 DOI: 10.1016/j.jemermed.2018.12.025] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/05/2018] [Accepted: 12/10/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is important that policy makers, health administrators, and emergency physicians have up-to-date statistics on the most common diagnoses of patients seen in the emergency department (ED). OBJECTIVES We sought to describe the changes that occurred in ED visits from 2010 through 2014 and to describe the frequency of different ED diagnoses. METHODS This is a retrospective analysis of ED visit data from the National Emergency Department Sample from 2010 through 2014. Visits were stratified by age, sex, insurance status, disposition, diagnosis, and diagnostic category. We calculated the total annual ED visits and the ED visit rates by diagnoses and diagnostic categories. RESULTS Between 2010 and 2014, the number of U.S. ED visits increased from 128.9 million to 137.8 million. The rate of ED Visits per 1000 persons increased from 416.92 (95% confidence interval [CI] 399.47-434.37) in 2010 to 432.51 (95% CI 411.51-453.61) in 2014 (p = 0.0136). ED visits grew twice as quickly (1.7%) as the overall population (0.7%). The most common reason for an ED visit was abdominal pain (11.75% [95% CI 11.61-11.89]). This was followed by mental health problems (4.45% [95% CI 4.19-4.72]). CONCLUSION The number of ED visits in the United States continues to increase faster than the rate of population growth. Abdominal problems and mental health issues, including substance abuse, were the most common reasons for an ED visit in 2014.
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Affiliation(s)
- Edmond A Hooker
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio; Department of Health Service Administration, Xavier University, Cincinnati, Ohio
| | - Peter J Mallow
- Department of Health Service Administration, Xavier University, Cincinnati, Ohio
| | - Michelle M Oglesby
- Department of Health Service Administration, Xavier University, Cincinnati, Ohio
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Maalouf FI, Cooper WO, Stratton SM, Dudley JA, Ko J, Banerji A, Patrick SW. Positive Predictive Value of Administrative Data for Neonatal Abstinence Syndrome. Pediatrics 2019; 143:e20174183. [PMID: 30514781 PMCID: PMC6317565 DOI: 10.1542/peds.2017-4183] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Neonatal abstinence syndrome (NAS) is a postnatal withdrawal syndrome experienced by some infants with opioid exposure. Hospital administrative data are commonly used for research and surveillance but have not been validated for NAS. Our objectives for this study were to validate the diagnostic codes for NAS and to develop an algorithm to optimize identification. METHODS Tennessee Medicaid claims from 2009 to 2011 (primary sample) and 2016 (secondary sample; post-International Classification of Diseases, 10th Revision, Clinical Modification [ICD-10-CM]) were obtained. Cases of NAS were identified by using International Classification of Diseases, Ninth Revision, Clinical Modification code (2009-2011) 779.5 and ICD-10-CM code (2016) P96.1. Medical record review cases were then conducted by 2 physicians using a standardized algorithm, and positive predictive value (PPV) was calculated. Algorithms were developed for optimizing the identification of NAS in administrative data. RESULTS In our primary sample of 112 029 mother-infant dyads, 950 potential NAS cases were identified from Medicaid claims data and reviewed. Among reviewed records, 863 were confirmed as having NAS (including 628 [66.1%] cases identified as NAS requiring pharmacotherapy, 224 [23.5%] as NAS not requiring pharmacotherapy, and 11 [1.2%] as iatrogenic NAS), and 87 (9.2%) did not meet clinical criteria for NAS. The PPV of the International Classification of Diseases, Ninth Revision, Clinical Modification code for NAS in clinically confirmed NAS was 91% (95% confidence interval: 88.8%-92.5%). Similarly, the PPV for the ICD-10-CM code in the secondary sample was 98.2% (95% confidence interval: 95.4%-99.2%). Algorithms using elements from the Medicaid claims and from length of stay improved PPV. CONCLUSIONS In a large population-based cohort of Medicaid participants, hospital administrative data had a high PPV in identifying cases of clinically diagnosed NAS.
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Affiliation(s)
- Faouzi I Maalouf
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - William O Cooper
- Departments of Pediatrics and
- Health Policy, Vanderbilt University, Nashville, Tennessee
- Vanderbilt Center for Child Health Policy, Nashville, Tennessee
| | | | | | - Jean Ko
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service Commissioned Corps, Rockville, Maryland; and
| | - Anamika Banerji
- Division of Neonatology, Loma Linda University, Loma Linda, California
| | - Stephen W Patrick
- Departments of Pediatrics and
- Health Policy, Vanderbilt University, Nashville, Tennessee
- Vanderbilt Center for Child Health Policy, Nashville, Tennessee
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Abstract
ICD-11 (International Classification of Diseases, 11th Revision) is the next major revision of the ICD by the World Health Organization (WHO). ICD-11 differs dramatically from historical versions, as it is based on an underlying semantic network of terms and meaning, called the Foundation. To function as a mutually exclusive and exhaustive statistical classification, ICD-11 creates derivative linearizations from the network that is a monohierarchy with residual categories such as Not Elsewhere Classified. ICD-11 also introduces the widespread post-coordination of terms, which allows for highly expressive representation of detailed patient descriptions. Phenotyping features are included in many subchapters or the signs and symptoms chapter. Composite phenotype descriptions of specific presentations or syndromes can be represented though post-coordination. Rare diseases are well represented in the Foundation, though not all appear in the relatively shallow linearization hierarchies.
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Affiliation(s)
- Christopher G Chute
- Johns Hopkins University, 2024 E. Monument, Suite 1-200, Baltimore, MD, 21287, USA.
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13
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Bucci P. [The draft of the ICD-11 chapter on mental and behavioral disorders: an update for clinicians]. Riv Psichiatr 2017; 52:95-100. [PMID: 28692070 DOI: 10.1708/2722.27760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The ICD-11 chapter on mental and behavioral disorders is currently under development. A simplified version of the diagnostic guidelines for schizophrenia and other primary psychotic disorders, mood disorders, anxiety disorders, disorders specifically associated with stress, and feeding and eating disorders has been made available for use in the field studies. For all the other sections of the classification, a brief general definition and sometimes a description of some of the included disorders can be found on the ICD-11 beta platform. In the present article, we provide some information on the content of the various sections of the classification on the basis of the available documents, with the warning that some of the aspects may still be subject to revision.
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Affiliation(s)
- Paola Bucci
- Centro Collaboratore dell'Organizzazione Mondiale della Sanità per la Ricerca e la Formazione nel Campo della Salute Mentale, Dipartimento di Psichiatria, Università di Napoli SUN, Napoli
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Rugg D. FY 2017 Updates to ICD-10-CM. J AHIMA 2016; 87:64-67. [PMID: 29437320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Ward MN. FY 2017 Updates to ICD-10-PCS. J AHIMA 2016; 87:60-63. [PMID: 29437319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Bowman S. A Look Back on the ICD-10 Transition: CRISIS AVERTED OR IMAGINARY? J AHIMA 2016; 87:24-31. [PMID: 29425006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Clack C. FY 2016 CPT Updates. J AHIMA 2016; 87:48-49. [PMID: 26939382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Manchikanti L, Hammer M, Boswell MV, Kaye AD, Hirsch JA. A Seamless Navigation to ICD-10-CM for Interventional Pain Physicians: Is a Rude Awakening Avoidable? Pain Physician 2016; 19:E1-E14. [PMID: 26752478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Since October 1, 2015, the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) was integrated into U.S. medical practices. This monumental transition seemingly occurred rather unceremoniously, despite significant opposition and reservations having been expressed by the provider community. In prior publications, we have described various survival strategies for interventional pain physicians. The regulators and beneficiaries of system-CMS, consultants, and health information technology industry are congratulating themselves for a job well done. Nonetheless, this transition comes at an immeasurable financial and psychological drain on providers. However, a rude awakening may be making its way with expiration of initial concessions from government and private payers.This manuscript provides a template for interventional pain management professionals with multiple steps for seamless navigation, including descriptions of the most commonly used codes, navigation through ICD-10-CM manual, steps for correct coding, and finally, detailed coding descriptions for various interventional techniques.
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Affiliation(s)
- Laxmaiah Manchikanti
- Pain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY
| | | | - Mark V Boswell
- Department of Anesthesiology and Perioperative Medicine, University of Louisville
| | | | - Joshua A Hirsch
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Bélteczki Z. [The nosological evolution of bipolar affective disorder]. Psychiatr Hung 2016; 31:119-135. [PMID: 27244868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The nosological improvement of the bipolar disorder (manic-depression) follow the written history of psychiatry. The symptoms of manic and depressive episodes and mixed states were described in the ancient times. In my summary I accompany the taxonomic improvement, the changing of diagnostic categories and the work of the most important researchers from the beginning to these days.
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Affiliation(s)
- Zsuzsanna Bélteczki
- Szabolcs-Szatmar-Bereg Megyei Korhazak es Egyetemi Oktatokorhaz Santha Kalman Szakkorhaz I. sz. Pszichiatriai Osztaly, Nagykallo, Hungary, E-mail:
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Bert JM, Beach WR, McIntyre LF, Sachdev R. Getting Ready for ICD-10 and Meaningful Use Stage 2. Instr Course Lect 2016; 65:609-622. [PMID: 27049227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
For the past 24 years, most developed countries have used the International Classification of Diseases, Tenth Revision (ICD-10) to report physician services. In the United States, physicians have continued to use the American Medical Association Current Procedural Terminology, Fourth Edition and the Healthcare Common Procedure Coding System. The ICD-10-Clinical Modification (CM) has approximately 4.9 times more codes than the International Classification of Diseases, Ninth Revision. ICD-10-CM allows for more specific descriptors of a procedure and is broken down by category, etiology, anatomic site, severity, and extension. ICD-10-CM is scheduled to be implemented by Medicare and commercial payers on October 1, 2015. In addition to ICD-10 implementation, physicians have to meet the requirements of the Meaningful Use Electronic Health Record Incentive Program. The Meaningful Use program is designed to promote the use of certified electronic health technology by providing eligible professionals with incentive payments if they meet the defined core and menu objectives of each stage of the program. All core measures must be met; however, providers can choose to meet a preset number of menu measures. Meaningful Use Stage 1 required eligible professionals to meet core and menu objectives that focused on data capture and sharing. Meaningful Use Stage 2 requires eligible professionals to meet core and menu objects that focus on advanced clinical processes for a full year in 2015. Stage 3 has been delayed until 2017, and core and menu measures that will focus on improving outcomes have not yet been defined. It is important for orthopaedic surgeons to understand the history of and techniques for the use of ICD-10-CM in clinical practice. Orthopaedic surgeons also should understand the requirements for Meaningful Use Stages 1 and 2, including the core objectives that must be met to achieve satisfactory attestation.
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Affiliation(s)
- Jack M Bert
- Physician, Minnesota Bone and Joint Specialists, Adjunct Clinical Professor, University of Minnesota School of Medicine, Woodbury, Minnesota
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Terry AR, Jordan JT, Schwamm L, Plotkin SR. Increased Risk of Cerebrovascular Disease Among Patients With Neurofibromatosis Type 1: Population-Based Approach. Stroke 2015; 47:60-5. [PMID: 26645253 DOI: 10.1161/strokeaha.115.011406] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/04/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Although neurofibromatosis type 1 (NF1) may be associated with an incompletely understood vasculopathy, relative odds of stroke in this population is not known. METHODS Using the 1998 to 2009 US Nationwide Inpatient Sample, we performed a case-control study matching cases of NF1 to controls without such a diagnosis. We then compared the odds of stroke between the 2 groups. We used multivariable logistic regression to adjust for known or suspected confounders. RESULTS NF1 was associated with younger mean age at the time of stroke (41 versus 48) and a lower prevalence of stroke risk factors among adult patients. Pediatric patients with NF1, however, were more likely to have hypertension. Patients with NF1 were significantly more likely to be diagnosed with any stroke (odds ratio, 1.2; P<0.0001) than the general population. The odds of intracerebral hemorrhage were greatest among hemorrhagic stroke types analyzed (odds ratio, 1.9; P<0.0001). In the pediatric NF1 population, the odds of intracerebral hemorrhage were more dramatically elevated (odds ratio, 8.1; P<0.0001). The odds of ischemic stroke were also increased with NF1 in the pediatric (odds ratio, 3.4; P<0.0001) but not in the adult population. CONCLUSIONS When compared with the general population, the odds of any type of stroke are significantly increased for patients with NF1, both adult and pediatric. This risk is most notable for hemorrhagic strokes although it is also increased for ischemic strokes in children. Physicians should be aware of the increased risk of stroke in this population, and consider stroke as a potential cause of new neurological symptoms.
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Affiliation(s)
- Anna R Terry
- From the Department of Neurosurgery, Duke University Medical Center/Duke Raleigh Hospital, Raleigh, NC (A.R.T.); and Department of Neurology, Massachusetts General Hospital, Boston (J.T.J., L.S., S.R.P.).
| | - Justin T Jordan
- From the Department of Neurosurgery, Duke University Medical Center/Duke Raleigh Hospital, Raleigh, NC (A.R.T.); and Department of Neurology, Massachusetts General Hospital, Boston (J.T.J., L.S., S.R.P.)
| | - Lee Schwamm
- From the Department of Neurosurgery, Duke University Medical Center/Duke Raleigh Hospital, Raleigh, NC (A.R.T.); and Department of Neurology, Massachusetts General Hospital, Boston (J.T.J., L.S., S.R.P.)
| | - Scott R Plotkin
- From the Department of Neurosurgery, Duke University Medical Center/Duke Raleigh Hospital, Raleigh, NC (A.R.T.); and Department of Neurology, Massachusetts General Hospital, Boston (J.T.J., L.S., S.R.P.)
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Pontious JM. The Games We Play ... So now it's ICD 10. J Okla State Med Assoc 2015; 108:383-384. [PMID: 26638416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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23
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Adler KG. ICD-10: Our Newest Documentation Dilemma. Fam Pract Manag 2015; 22:7. [PMID: 26554559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Butler M. Life After ICD-10. J AHIMA 2015; 86:22-27. [PMID: 26489223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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25
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ICD-10 Implementation: Making the Best of Transition. Mich Med 2015; 114:10-4. [PMID: 26521416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Grönvik L, Grönvik L. [The Swedish National Board of Health and Welfare agrees with the need for reproducible diagnosis coding]. Lakartidningen 2015; 112:DEPZ. [PMID: 25781600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Andersson RE. [Confusing diagnosis coding prevents historical and international comparisons. Diagnosing should be unambiguous and consistent]. Lakartidningen 2015; 112:DDWH. [PMID: 25781590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Roland E Andersson
- Länssjukhuset Ryhov - Länssjukhuset Ryhov, 551 85 Jönköping, Sweden Länssjukhuset Ryhov - Länssjukhuset Ryhov, 551 85 Jönköping, Sweden
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Manchikanti L, Falco FJE, Helm Ii S, Hirsch JA. First, do no harm by adopting evidence-based policy initiatives: the overselling of ICD-10 by congress with high expectations. Pain Physician 2015; 18:E107-E113. [PMID: 25794209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
While it appears to be beneficial to apply a detailed disease classification system, the costs, cash flow disruptions, and increased investments with physician time incorporated into learning these processes, patient care might unfortunately suffer. This is essentially an unfunded mandate with much of the burden of transitioning to ICD-10 falling on health care providers,especially small independent practices. This will impact interventional pain management practices substantially.Further, as we have shown in previous manuscripts,the so-called advantages of multiple codes with specificity and granularity does not translate into reality where some specificity is actually lost for various codes. As Grimsley and O'Shea (1) have described in clinical practices, doctors do not treat codes, but they treat patients according to the individual clinical condition.A doctor will be losing valuable time and also will not be able to obtain meaningful information due to burdensome regulations of meaningful use, PQRS,value-based reimbursement, electronic prescribing,and now a major impact with change to ICD-10. Thus,very little benefit will be seen by practitioners, which cannot be said for the health care information industry.With overwhelming regulatory atmosphere created by numerous federal regulations and those including under the Affordable Care Act (15), there is no evidence that ICD-10 is needed, there is no evidence that it will be effective, and, finally, there is preponderance of evidence of adverse consequences. Thus, Congress should be cautious in imposing further regulations on already strained independent practices with ongoing regulations and imposing yet another unfunded mandate on the medical profession.
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Affiliation(s)
- Laxmaiah Manchikanti
- Pain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY; Mid Atlantic Spine & Pain Physicians, Newark, DE, and Temple University Hospital, Philadelphia, PA
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Tennant RM. HIT update: What to watch for in 2015. MGMA Connex 2015; 15:19-21. [PMID: 26647513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Lamb AJ. ICD-10 codes: more specificity with more characters. Cutis 2014; 94:171-172. [PMID: 25372250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Abstract
BACKGROUND AND PURPOSE Characterizing International Classification of Disease 9th Revision, Clinical Modification (ICD-9-CM) code validity is essential given widespread use of hospital discharge databases in research. Using the Atherosclerosis Risk in Communities (ARIC) Study, we estimated the accuracy of ICD-9-CM stroke codes. METHODS Hospitalizations with ICD-9-CM codes 430 to 438 or stroke keywords in the discharge summary were abstracted for ARIC cohort members (1987-2010). A computer algorithm and physician reviewer classified definite and probable ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Using ARIC classification as a gold standard, we calculated the positive predictive value (PPV) and sensitivity of ICD-9-CM codes grouped according to the American Heart Association/American Stroke Association (AHA/ASA) 2013 categories and an alternative code grouping for comparison. RESULTS Thirty-three percent of 4260 hospitalizations were validated as strokes (1251 ischemic, 120 intracerebral hemorrhage, 46 subarachnoid hemorrhage). The AHA/ASA code groups had PPV 76% and 68% sensitivity compared with PPV 72% and 83% sensitivity for the alternative code groups. The PPV of the AHA/ASA code group for ischemic stroke was slightly higher among blacks, individuals <65 years, and at teaching hospitals. Sensitivity was higher among older individuals and increased over time. The PPV of the AHA/ASA code group for intracerebral hemorrhage was higher among blacks, women, and younger individuals. PPV and sensitivity varied across study sites. CONCLUSIONS A new AHA/ASA discharge code grouping to identify stroke had similar PPV and lower sensitivity compared with an alternative code grouping. Accuracy varied by patient characteristics and study sites.
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Affiliation(s)
- Sydney A Jones
- From the Department of Epidemiology (S.A.J., W.D.R.) and Department of Biostatistics (L.W.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); and Epidemiology and Biostatistics Division, the University of Arizona College of Public Health, Tucson (E.S.)
| | - Rebecca F Gottesman
- From the Department of Epidemiology (S.A.J., W.D.R.) and Department of Biostatistics (L.W.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); and Epidemiology and Biostatistics Division, the University of Arizona College of Public Health, Tucson (E.S.)
| | - Eyal Shahar
- From the Department of Epidemiology (S.A.J., W.D.R.) and Department of Biostatistics (L.W.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); and Epidemiology and Biostatistics Division, the University of Arizona College of Public Health, Tucson (E.S.)
| | - Lisa Wruck
- From the Department of Epidemiology (S.A.J., W.D.R.) and Department of Biostatistics (L.W.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); and Epidemiology and Biostatistics Division, the University of Arizona College of Public Health, Tucson (E.S.)
| | - Wayne D Rosamond
- From the Department of Epidemiology (S.A.J., W.D.R.) and Department of Biostatistics (L.W.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); and Epidemiology and Biostatistics Division, the University of Arizona College of Public Health, Tucson (E.S.)
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Collins R. Billing for ICD-10: be prepared. Nephrol News Issues 2014; 28:27-28. [PMID: 25306847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Gomella LG. Prostate cancer and prostatocystitis: equal in the eyes of ICD-10. Can J Urol 2014; 21:7330-7331. [PMID: 25171273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Penn CL. Highlights from House of Delegates meeting & word from the AMA. J Ark Med Soc 2014; 111:16-17. [PMID: 25137823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Leading by example. Healthc Financ Manage 2014; 68:68-73. [PMID: 24968628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Koller D, Schön G, Schäfer I, Glaeske G, van den Bussche H, Hansen H. Multimorbidity and long-term care dependency--a five-year follow-up. BMC Geriatr 2014; 14:70. [PMID: 24884813 PMCID: PMC4046081 DOI: 10.1186/1471-2318-14-70] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 05/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Not only single, but also multiple, chronic conditions are becoming the normal situation rather than the exception in the older generation. While many studies show a correlation between multimorbidity and various health outcomes, the long-term effect on care dependency remains unclear. The objective of this study is to follow up a cohort of older adults for 5 years to estimate the impact of multimorbidity on long-term care dependency. METHODS This study is based on claims data from a German health insurance company. We included 115,203 people (mean age: 71.5 years, 41.4% females). To identify chronic diseases and multimorbidity, we used a defined list of 46 chronic conditions based on ICD-10 codes. Multimorbidity was defined as three or more chronic conditions from this list. The main outcome was "time until long-term care dependency". The follow-up started on January 1st, 2005 and lasted for 5 years until December 31st, 2009. To evaluate differences between those with multimorbidity and those without, we calculated Kaplan-Meier curves and then modeled four distinct Cox proportional hazard regressions including multimorbidity, age and sex, the single chronic conditions, and disease clusters. RESULTS Mean follow-up was 4.5 years. People with multimorbidity had a higher risk of becoming care dependent (HR: 1.85, CI 1.78-1.92). The conditions with the highest risks for long-term care dependency are Parkinson's disease (HR: 6.40 vs. 2.68) and dementia (HR: 5.70 vs. 2.27). Patients with the multimorbidity pattern "Neuropsychiatric disorders" have a 79% higher risk of care dependency. CONCLUSIONS The results should form the basis for future health policy decisions on the treatment of patients with multiple chronic diseases and also show the need to introduce new ways of providing long-term care to this population. A health policy focus on chronic care management as well as the development of guidelines for multimorbidity is crucial to secure health services delivery for the older population.
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Affiliation(s)
- Daniela Koller
- Centre for Social Policy Research, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany
| | - Gerhard Schön
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20246 Hamburg, Germany
| | - Ingmar Schäfer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20246 Hamburg, Germany
| | - Gerd Glaeske
- Centre for Social Policy Research, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany
| | - Hendrik van den Bussche
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20246 Hamburg, Germany
| | - Heike Hansen
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20246 Hamburg, Germany
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Barta A. Coding ICD-10-PCS medical and surgical-related sections. Understanding obstetrics, placement, and administration. J AHIMA 2014; 85:62-66. [PMID: 24834560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Heil FJ, Tappe U. [Enhancements and new features -- correct coding]. Z Gastroenterol 2014; 52:394-395. [PMID: 25006635 DOI: 10.1055/s-0033-1362445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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DeJohn P. Decisions, decisions: should you outsource coding to comply with ICD-10? OR Manager 2014; 30:28-30. [PMID: 24716249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Grantham D. Technology disruption: 'it's not always this crazy'. Behav Healthc 2014; 34:44-45. [PMID: 24864552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Conn J. Health IT survey. Double trouble. Mod Healthc 2014; 44:18-20. [PMID: 24730150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Conn J. Tardy EHR upgrades loom as one of many Stage 2 challenges. Mod Healthc 2014; 44:22. [PMID: 24730151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Smoller BM. Keep the lights on for me. Md Med 2014; 14:7. [PMID: 24683706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Nicoletti B. 10 steps to preparing your office for ICD-10--now. Fam Pract Manag 2014; 21:9-13. [PMID: 24444617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Green D. New ICD-10 coding: documentation to provide better care, support more accurate billing. Am Nurse 2014; 46:4. [PMID: 24568083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Denesecia Green
- Office of E-Health Standards and Services, Centers for Medicare and Medicaid Services, USA
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Nakane H. [Trend in ICD-11 primary health care version--possibility of introducing new psychiatric diagnosis categories]. Seishin Shinkeigaku Zasshi 2014; 116:61-69. [PMID: 24640553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Revision of ICD-11 will be submitted for approval at the general assembly in 2015. The influence of the ICD revision will be marked in the field of psychiatry. The trend in developing ICD-11-PHC is promoting cooperation with primary carers. The goals of the revision of ICD-11-PHC are as follows: 1) To produce a classification system that corresponds more closely to common mental disorders encountered in general medical practice; 2) The "co-morbidity" we want practitioners to recognize is that between physical and psychological disorders; 3) To allow dimensions of severity of some common disorders to be recognized, rather than case/non-case distinctions. The ICD-11-PHC draft consists of 28 categories and detailed clinical descriptions. The number of categories has increased in the ICD-11-PHC draft in comparison with ICD-10-PHC. Anxiety disorders such as neurasthenia, and phobic disorders and panic disorder have been deleted. On the other hand, new diagnostic categories such as autistic spectrum disorder, PTSD, and personality disorder have been introduced. Furthermore, name changes such as anxious depression, bodily stress syndrome, health anxiety, and persistent psychotic disorders have been suggested. We should be aware of such new diagnostic concepts. In addition, it is thought that it is necessary for us to deepen our understanding of ICD-11, which will be important in the future.
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Talebian S. Transitioning to ICD-10. Urol Nurs 2014; 34:29-37. [PMID: 24716378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Kealey B, Howie A. ICD-10 is coming an update on medical diagnosis and inpatient procedure coding. Minn Med 2013; 96:48-50. [PMID: 24428020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In October 2014, the United States will switch from using the ICD-9 coding system to ICD-10. This change will allow for greater specificity in describing medical conditions and the addition of new codes as medical knowledge and technology evolve. The change will be a big one for hospitals and clinics. This article describes what physicians need to know about the new system and what the organizations they work for need to consider when preparing for the change.
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Conn J. Expensive. Confusing. Time consuming. Looming shift to more complex ICD-10 coding system has hospitals and physicians scrambling. Mod Healthc 2013; 43:22-24. [PMID: 24371940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Goozner M. A make-or-break year for health IT. With ICD-10 looming in 2014, CIOs face tough decisions in deploying resources. Mod Healthc 2013; 43:22. [PMID: 24340705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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