国际疾病分类第10版（ICD - 10）编码是否适用于基层医疗中哮喘和慢性阻塞性肺疾病（COPD）的绩效评估？一项横断面观察性研究的结果
Are ICD-10 codes appropriate for performance assessment in asthma and COPD in general practice? Results of a cross sectional observational study.
作者信息
Schneider Antonius, Gantner Lutz, Maag Inko, Borst Mathias M, Wensing Michel, Szecsenyi Joachim
机构信息
Department of General Practice and Health Services Research, Bergheimer Strasse 147, D-69115 Heidelberg, Germany.
出版信息
BMC Health Serv Res. 2005 Feb 1;5(1):11. doi: 10.1186/1472-6963-5-11.
BACKGROUND
The increasing prevalence and impact of obstructive lung diseases and new insights, reflected in clinical guidelines, have led to concerns about the diagnosis and therapy of asthma and COPD in primary care. In Germany diagnoses written in medical records are used for reimbursement, which may influence physicians' documentation behaviour. For that reason it is unclear to what respect ICD-10 codes reflect the real problems of the patients in general practice. The aim of this study was to assess the appropriateness of the recorded diagnoses and to determine what diagnostic information is used to guide medical treatment.
METHODS
All patients with lower airway symptoms (n = 857) who had attended six general practices between January and June 2003 were included into this cross sectional observational study. Patients were selected from the computerised medical record systems, focusing on ICD-10-codes concerning lower airway diseases (J20-J22, J40-J47, J98 and R05). The performed diagnostic procedures and actual medication for each identified patient were extracted manually. Then we examined the associations between recorded diagnoses, diagnostic procedures and prescribed treatment for asthma and COPD in general practice.
RESULTS
Spirometry was used in 30% of the patients with a recorded diagnosis of asthma and in 58% of the patients with a recorded diagnosis of COPD. Logistic regression analysis showed an improved use of spirometry when inhaled corticosteroids were prescribed for asthma (OR = 5.2; CI 2.9-9.2) or COPD (OR = 4.7; CI 2.0-10.6). Spirometry was also used more often when sympathomimetics were prescribed (asthma: OR = 2.3; CI 1.2-4.2; COPD: OR = 4.1; CI 1.8-9.4).
CONCLUSIONS
This study revealed that spirometry was used more often when corticosteroids or sympathomimetics were prescribed. The findings suggest that treatment was based on diagnostic test results rather than on recorded diagnoses. The documented ICD-10 codes may not always reflect the real status of the patients. Thus medical care for asthma and COPD in general practice may be better than initially found on the basis of recorded diagnoses, although further improvement of practice patterns in asthma and COPD is still necessary.
背景
阻塞性肺疾病的患病率和影响日益增加，临床指南中也体现了新的见解，这引发了对基层医疗中哮喘和慢性阻塞性肺疾病（COPD）诊断和治疗的关注。在德国，病历中的诊断用于报销，这可能会影响医生的记录行为。因此，目前尚不清楚国际疾病分类第十版（ICD - 10）编码在多大程度上反映了全科医疗中患者的实际问题。本研究的目的是评估所记录诊断的合理性，并确定用于指导医疗治疗的诊断信息。
方法
纳入2003年1月至6月期间在六家全科诊所就诊的所有有下呼吸道症状的患者（n = 857），进行这项横断面观察性研究。从计算机化病历系统中选取患者，重点关注与下呼吸道疾病相关的ICD - 10编码（J20 - J22、J40 - J47、J98和R05）。手动提取每个确诊患者所进行的诊断程序和实际用药情况。然后我们研究了全科医疗中记录的哮喘和COPD诊断、诊断程序与处方治疗之间的关联。
结果
在记录诊断为哮喘的患者中，30%使用了肺功能测定；在记录诊断为COPD的患者中，58%使用了肺功能测定。逻辑回归分析显示，当为哮喘（比值比[OR] = 5.2；可信区间[CI] 2.9 - 9.2）或COPD（OR = 4.7；CI 2.0 - 10.6）开具吸入性糖皮质激素时，肺功能测定的使用有所改善。当开具拟交感神经药时，肺功能测定的使用也更频繁（哮喘：OR = 2.3；CI 1.2 - 4.2；COPD：OR = 4.1；CI 1.8 - 9.4）。
结论
本研究表明，当开具糖皮质激素或拟交感神经药时，肺功能测定的使用更频繁。研究结果表明，治疗是基于诊断测试结果而非记录的诊断。所记录的ICD - 10编码可能并不总是反映患者的实际状况。因此，全科医疗中哮喘和COPD的医疗护理可能比最初根据记录诊断发现的情况要好，尽管哮喘和COPD的医疗模式仍有必要进一步改进。
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