NHS Digital issued new guidance on sepsis coding in April 2017 which was further modified in April 2018. During these timeframes some centres reported increased sepsis associated mortality, whilst others reported reduced mortality, in some cases coincident with specific quality improvement programmes. We hypothesised that changes in reported mortality could not be separated from changes in coding practice.
Hospital Episode Statistics from the Admitted Patient Care dataset for NHS hospitals in England, from April 2016 to March 2020 were analysed. Admissions of adults with sepsis: an International Classification of Diseases 10 (ICD-10) code associated with the Agency for Healthcare Research and Quality Clinical Classifications Software class \'Septicaemia (except in labour)\', were assessed. Patient comorbidities were defined by other ICD-10 codes recorded within the admission episode.
1,081,565 hospital episodes with a coded diagnosis of sepsis were studied. After April 2017 there was a significant increase in admission episodes with sepsis coded as the primary reason for admission. There were significant changes in the case-mix of patients with a primary diagnosis of sepsis after April 2017. An analysis of case-mix, hospital and year treated as random effects, defined a small reduction in sepsis associated mortality across England following the first change in coding guidance. No centre specific improvement in outcome could be separated from these random-effects.
Changes in sepsis coding practice altered case-mix and case selection, in ways that varied between centres. This was associated with changes in centre-specific sepsis associated mortality, over time. According to the direction of change these may be interpreted either as requiring local investigation for cause or as supporting coincident changes in clinical practice. A whole system analysis showed that centre specific changes in mortality cannot be separated from system-wide changes. Caution is therefore required when interpreting sepsis outcomes in England, particularly when using single centre studies to inform or support guidance or policy.

Our objective was to improve the accuracy of bacteria and resistance coding in a hospital case mix database. Data sources consisted of 50,074 files on bacteriological susceptibility tests transmitted with the HPRIM protocol from laboratory management system to electronic health record of the University hospital of Saint Etienne in July 2017. An algorithm was implemented to detect susceptibility tests containing information corresponding to codes whose addition in the case mix database was susceptible to increase the severity level of a diagnosis related group. Among 132 hospital stays fulfilling the conditions, 27 were lacking bacteria and/or resistance codes, and the tariff was increased for 9 stays, with earnings of €54,612. Analyzing Antimicrobial susceptibility tests helps to improve clinical coding and optimize the financial gain.

OBJECTIVE: To present the associated risk factors, prevention measures, and assessment and management of pseudoverrucous lesions specific to a surgically created ileal conduit, as well as three clinical scenarios illustrating this condition.
BACKGROUND: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.
OBJECTIVE: After participating in this educational activity, the participant will:1. Define pseudoverrucous lesions.2. Identify the risk factors for stoma complications such as pseudoverrucous lesions.3. Select the appropriate routine care procedures to teach patients following stoma creation to help prevent pseudoverrucous lesions.4. Choose the recommended treatment options for patients who develop pseudoverrucous lesions.
Pseudoverrucous lesions are a late peristomal complication that occurs most commonly in people with urinary stomas. Impairment of the peristomal skin can result in pouching system leaks that can translate into odor, embarrassment, and diminished quality of life. Prevention is key to maintaining smooth, dry skin and intact psyche. Treatment revolves around outpatient postoperative follow-up, refitting the pouching system to eliminate moisture impacting the peristomal area, modification of pouching system wear time, acidification of the urine, and intensive education. This review includes three case scenarios to support early, intermediate, and late-stage intervention guidelines. Some interventions were successful; one case remains unresolved.

The cost and comorbidity of obesity in hospitalized inpatients, is less known. A retrospective study of patients presenting to a large district hospital in Western Sydney (April 2016-February 2017) using clinical, pathological as well as diagnostic coding data for obesity as per ICD-10. Of 43 212 consecutive hospital presentations, 390 had an obesity-coded diagnosis (Ob, 0.90%), of which 244 were gender and age-matched to a non-obesity coded cohort (NOb). Weight and BMI were higher in the Ob vs NOb group (126 ± 37 vs 82 ± 25 kg; BMI 46 ± 12 vs 29 ± 8 kg/m2 , P < .001) with a medical record documentation rate of 62% for obesity among Ob. The Ob cohort had 2-5× higher rates of cardiopulmonary and metabolic complications (P < .001), greater pharmacologic burden, length of stay (LOS, 225 vs 89 hours, P < .001) and stay in intensive care but no differences in the prevalence of mental disorders. Compared with BMI <35 kg/m2 , inpatients with BMI >35 kg/m2 were 5× more likely to require intensive care (OR 5.08 [1.43-27.3, 95% CI], P = .0047). The initiation of obesity-specific interventions by clinical teams was very low. People with obesity who are admitted to hospital carry significant cost and complications, yet obesity is seldom recognized as a clinical entity or contributor.

UNASSIGNED: AR-DRG system for classification hospital episodes was implemented in Serbia to improve efficiency and transparency in the health system.
UNASSIGNED: L3H3, IQR, and 10th-95th percentile methods were used to identify outlier episodes in the classification. Classification efficiency and within-group homogeneity were measured by an adjusted reduction in variance (R2) and a coefficient of variation (CV).
UNASSIGNED: There were 246,131 hospital episodes with a total 1,651,913 bed days from 14 hospitals. All episodes were classified into 652 groups of which 441 had CV lower than 100%. \"Medical groups\" accounted for 51% of groups and for 72% of episodes. Chemotherapy and vaginal delivery were the highest volume groups, with 5% and 4% of total episodes. Major diagnostic category 6 (MDC 6, Diseases of the digestive system) was the highest volume MDC, accounting for 11% of episodes. \"Day-cases\" and \"prolonged hospitalisation\" accounted for 21% and 3% of episodes, respectively. The average length of stay varied from 5.6 to 8.2 days. Adjusted R2 was 0.3 for untrimmed data. Trimming by L3H3, IQR, and 10th-95th percentile method improved the value of adjusted R2 to 0.61, 0.49, and 0.51, identifying 24%, 7%, and 7% of total cases as outliers, respectively. Mental diseases (MDC 19) remained the lowest adjusted R2 in untrimmed and trimmed datasets.
UNASSIGNED: A long length of stay and a small percentage of \"day-cases\" characterized hospital activity in Vojvodina. Trimming methods significantly improved DRG efficiency. Future studies should consider cost data.
UNASSIGNED: Klasifikacijski sistem hospitalizacij AR-DRG je bil v Srbiji vpeljan za izboljšanje učinkovitosti in preglednosti zdravstvenega sistema.
UNASSIGNED: Za prepoznavanje odstopanj v klasifikaciji so bile uporabljene metode L3H3, IQR, in 10.-95. percentila. Učinkovitost klasifikacije in homogenosti znotraj skupine primerljivih primerov diagnoz sta bili izmerjeni s prilagojenim zmanjšanjem neskladij (R2) in koeficientom razlik (CV).
UNASSIGNED: Zabeleženih je bilo 246.131 hospitalizacij s skupnim številom 1.651.913 preležanih dni v 14 bolnišnicah. Vse hospitalizacije so bile razvrščene v 652 skupin, od tega jih je imelo 441 vrednost CV nižjo od 100 %. »Kliničnih skupin« je bilo 51 % od vseh skupin in 72 % od vseh hospitalizacij. Kemoterapija in vaginalni porod sta po obsegu največji skupini s 5 % in 4 % vseh hospitalizacij. Skupina primerljivih primerov diagnoz 6 (MDC 6, bolezni prebavnega sistema) je največja, in sicer zavzema 11 % vseh hospitalizacij. »Dnevne obravnave« obsegajo 22 % in »podaljšane hospitalizacije« 3 % hospitalizacij. Povprečno trajanje hospitalizacije se giblje med 5,6 in 8,2 dni. Prilagojeni R2 se obravnava za 0,3 neprirezanih podatkov. Aplikacija metod L3H3, IQR, in 10.-95. percentila je izboljšala vrednost prilagojenega R2 na 0,61, 0,49 in 0,51, esktremne vrednosti so se pojavljale v 24 %, 7 % in 7 % vseh primerov. Duševne bolezni (MDC 19) imajo najnižji prilagojen R2 v neprirezanih in prirezanih podatkovnih setih.
UNASSIGNED: Bolnišnično dejavnost v Vojvodini označuje dolgotrajna hospitalizacija in nizek delež dnevnih obravnav. Metode prirezovanja so opazno izboljšale učinkovitost DRG. Prihodnje raziskave naj vključijo še stroškovni vidik.

Procedure codes in the Danish National Patient Registry are used for administrative purposes and are a potentially valuable resource for epidemiologic research. To our knowledge, the validity of antineoplastic procedure codes has only been evaluated in one study.
We randomly extracted a sample of 420 patients in the Southern Region of Denmark with a diagnosis of colorectal cancer and an oncology contact during 2016-2018. Using the medical record as gold standard, we computed the positive predictive value (PPV) and sensitivity of antineoplastic procedure codes recorded in the Danish National Patient Registry.
We identified 2,243 codes for antineoplastic treatments in the registry and 2,299 in the medical records. We confirmed that 213 of 214 patients with registered therapies in the Danish National Patient Registry received therapy, corresponding to a PPV of \"any registration\" of 1.00 (95% confidence interval [CI] = 0.97, 1.00). Considering single registrations, the overall PPV was 0.95 (95% CI = 0.94, 0.95), and the overall sensitivity was 0.90 (95% CI = 0.89, 0.91). Number of recorded treatments and treatments administered were strongly correlated. Considering the most frequent single antineoplastic regimens, PPV ranged from 0.90 (95% CI = 0.87, 0.92) for capecitabine to 0.98 (95% CI = 0.95, 1.00) for cetuximab, whereas sensitivity ranged from 0.81 (95% CI = 0.75, 0.87) for 5-fluorouracil and irinotecan (FOLFIRI) regimen to 0.97 (95% CI = 0.94, 0.99) for bevacizumab. Analysis per hospital showed the highest validity of registrations at the University Hospital.
The validity of antineoplastic procedure codes in the Danish National Patient Registry is generally high and thus usable for epidemiologic research.

Case study.
To present a framework for developing an International Classification of Functioning, Disability and Health (ICF)-based documentation system in spinal cord injury (SCI)-specific rehabilitation.
Data collection took place at Maharaj Hospital, Thailand. The preparatory studies and analysis were performed at Swiss Paraplegic Research, Switzerland.
Data collected from interviews and health records of four SCI cases across the continuum of care (acute, post-acute, early and late long term) were linked to ICF categories using established ICF linking rules. The resulting categories were compared with selected ICF sets (ICF Generic-30, ICF core sets for SCI and multiple sclerosis) to determine the extent of coverage. Furthermore, the context of applicable services was described systematically.
Less than half of the ICF categories in the defined ICF sets were covered by clinical assessment tools. Low correspondence was found predominantly in acute and late long-term phase. Least well covered were categories of activities and participations and environmental factors. The correspondence of categories increased when considering the additional ICF categories identified from patient interviews. The description of rehabilitation services provided in each case classified according to the dimensions of service provider, funding, and service delivery.
There is a need to promote the systematic and standardized assessment of functioning among health professionals working in the field of SCI in developing countries. This study describes basic steps toward developing a standardized ICF-based system for assessing and reporting functioning outcomes in SCI rehabilitation and across the continuum of care.

Process mining can provide greater insight into medical treatment processes and organizational processes in healthcare. To enhance comparability between processes, the quality of the labelled-data is essential. A literature review of the clinical case studies by Rojas et al. in 2016 identified several common aspects for comparison, which include methodologies, algorithms or techniques, medical fields, and healthcare specialty. However, clinical aspects are not reported in a uniform way and do not follow a standard clinical coding scheme. Further, technical aspects such as details of the event log data are not always described. In this paper, we identified 38 clinically-relevant case studies of process mining in healthcare published from 2016 to 2018 that described the tools, algorithms and techniques utilized, and details on the event log data. We then correlated the clinical aspects of patient encounter environment, clinical specialty and medical diagnoses using the standard clinical coding schemes SNOMED CT and ICD-10. The potential outcomes of adopting a standard approach for describing event log data and classifying medical terminology using standard clinical coding schemes are further discussed. A checklist template for the reporting of case studies is provided in the Appendix A to the article.

To demonstrate how data-driven variability methods can be used to identify changes in disease recording in two English electronic health records databases between 2001 and 2015.
Repeated cross-sectional analysis that applied data-driven temporal variability methods to assess month-by-month changes in routinely collected medical data. A measure of difference between months was calculated based on joint distributions of age, gender, socioeconomic status and recorded cardiovascular diseases. Distances between months were used to identify temporal trends in data recording.
400 English primary care practices from the Clinical Practice Research Datalink (CPRD GOLD) and 451 hospital providers from the Hospital Episode Statistics (HES).
The proportion of patients (CPRD GOLD) and hospital admissions (HES) with a recorded cardiovascular disease (CPRD GOLD: coronary heart disease, heart failure, peripheral arterial disease, stroke; HES: International Classification of Disease codes I20-I69/G45).
Both databases showed gradual changes in cardiovascular disease recording between 2001 and 2008. The recorded prevalence of included cardiovascular diseases in CPRD GOLD increased by 47%-62%, which partially reversed after 2008. For hospital records in HES, there was a relative decrease in angina pectoris (-34.4%) and unspecified stroke (-42.3%) over the same time period, with a concomitant increase in chronic coronary heart disease (+14.3%). Multiple abrupt changes in the use of myocardial infarction codes in hospital were found in March/April 2010, 2012 and 2014, possibly linked to updates of clinical coding guidelines.
Identified temporal variability could be related to potentially non-medical causes such as updated coding guidelines. These artificial changes may introduce temporal correlation among diagnoses inferred from routine data, violating the assumptions of frequently used statistical methods. Temporal variability measures provide an objective and robust technique to identify, and subsequently account for, those changes in electronic health records studies without any prior knowledge of the data collection process.

Pathology reports are important clinical documents for the diagnosis, treatment, and follow-up of often severe diseases. They are subject to a series of formal and substantive requirements that are anchored in several jurisdictions, which also apply to the digital form of these records. Only a few of the currently used digital document formats meet these requirements and are at the same time interoperable, regardless of the computer platforms used. Practically, they are only partially used in pathology laboratories, practice management, and hospital information systems. The consistent use of these standard formats for pathological findings reports provided a clear digital added value for both pathologists and clinicians as well as their patients.