2015年10月,美国从国际疾病分类过渡了医疗保健诊断代码,第九次修订,临床修改(ICD-9-CM),第十次修订(ICD-10-CM)。与酒精相关的停留趋势分析可能仅从分类系统的变化中显示出不连续性。这项研究检查了ICD-10-CM编码系统对涉及酒精相关诊断的住院时间估计的影响。
此分析使用了来自17个州的医疗保健研究机构和优质医疗保健成本和利用项目州住院数据库的2014年至2017年行政数据。2014年第二季度至2015年第三季度的ICD-9-CM季度数据与2015年第四季度至2017年第一季度的ICD-10-CM数据相连。对酒精相关住院的季度计数进行总体检查,然后按6个诊断亚组进行检查:戒断,滥用,依赖,酒精诱发的精神障碍(AIMD),非精神病酒精引起的疾病,和中毒或毒性作用。在每一组中,我们计算了ICD-9-CM和ICD-10-CM编码周期之间的平均停留次数的差异。
平均而言,ICD-10-CM转换前后6个季度内涉及任何酒精相关诊断的住院次数稳定.然而,酒精滥用的停留时间发生了实质性的变化,AIMD,和中毒或毒性作用。例如,ICD-10-CM期间涉及AIMD的平均季度住院次数比ICD-9-CM期间高170.7%.这种增加很大程度上是由1个ICD-10-CM代码驱动的,酒精使用,未指明与未指明的酒精引起的疾病。
对涉及酒精相关诊断的住院患者进行趋势分析的研究人员应该考虑ICD-10-CM代码系统和编码指南的持续修改可能如何影响他们的工作。在ICD-10-CM过渡期间进行趋势分析的明智方法是将诊断代码汇总为更广泛的代码,具有临床意义的组-包括包含所有与酒精相关的停留的单个全局组-然后选择诊断组,以最大程度地减少2个编码系统之间的不连续性,同时提供有关这一重要人群健康指标的有用信息.
In October 2015, the United States transitioned healthcare diagnosis codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), to the Tenth Revision (ICD-10-CM). Trend analyses of alcohol-related stays could show discontinuities solely from the change in classification systems. This study examined the impact of the ICD-10-CM coding system on estimates of hospital stays involving alcohol-related diagnoses.
This analysis used 2014 to 2017 administrative data from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Inpatient Databases for 17 states. Quarterly ICD-9-CM data from second quarter 2014 through third quarter 2015 were concatenated with ICD-10-CM data from fourth quarter 2015 through first quarter 2017. Quarterly counts of alcohol-related stays were examined overall and then by 6 diagnostic subgroups: withdrawal, abuse, dependence, alcohol-induced mental disorders (AIMD), nonpsychiatric alcohol-induced disease, and intoxication or toxic effects. Within each group, we calculated the difference in the average number of stays between ICD-9-CM and ICD-10-CM coding periods.
On average, the number of stays involving any alcohol-related diagnosis in the 6 quarters before and after the ICD-10-CM transition was stable. However, substantial shifts in stays occurred for alcohol abuse, AIMD, and intoxication or toxic effects. For example, the average quarterly number of stays involving AIMD was 170.7% higher in the ICD-10-CM period than in the ICD-9-CM period. This increase was driven in large part by 1 ICD-10-CM code, Alcohol use, unspecified with unspecified alcohol-induced disorder.
Researchers conducting trend analyses of inpatient stays involving alcohol-related diagnoses should consider how ongoing modifications in the ICD-10-CM code system and coding guidelines might affect their work. An advisable approach for trend analyses across the ICD-10-CM transition is to aggregate diagnosis codes into broader, clinically meaningful groups-including a single global group that encompasses all alcohol-related stays-and then to select diagnostic groupings that minimize discontinuities between the 2 coding systems while providing useful information on this important indicator of population health.