在一个独特的双重编码数据库中评估ICD-9-CM和ICD-10管理数据记录临床病症的有效性。
Assessing validity of ICD-9-CM and ICD-10 administrative data in recording clinical conditions in a unique dually coded database.
作者信息
Quan Hude, Li Bing, Saunders L Duncan, Parsons Gerry A, Nilsson Carolyn I, Alibhai Arif, Ghali William A
机构信息
Department of Community Health Sciences and Centre for Health and Policy Studies, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB T2N4N1, Canada.
出版信息
Health Serv Res. 2008 Aug;43(4):1424-41. doi: 10.1111/j.1475-6773.2007.00822.x.
OBJECTIVE
The goal of this study was to assess the validity of the International Classification of Disease, 10th Version (ICD-10) administrative hospital discharge data and to determine whether there were improvements in the validity of coding for clinical conditions compared with ICD-9 Clinical Modification (ICD-9-CM) data.
METHODS
We reviewed 4,008 randomly selected charts for patients admitted from January 1 to June 30, 2003 at four teaching hospitals in Alberta, Canada to determine the presence or absence of 32 clinical conditions and to assess the agreement between ICD-10 data and chart data. We then re-coded the same charts using ICD-9-CM and determined the agreement between the ICD-9-CM data and chart data for recording those same conditions. The accuracy of ICD-10 data relative to chart data was compared with the accuracy of ICD-9-CM data relative to chart data.
RESULTS
Sensitivity values ranged from 9.3 to 83.1 percent for ICD-9-CM and from 12.7 to 80.8 percent for ICD-10 data. Positive predictive values ranged from 23.1 to 100 percent for ICD-9-CM and from 32.0 to 100 percent for ICD-10 data. Specificity and negative predictive values were consistently high for both ICD-9-CM and ICD-10 databases. Of the 32 conditions assessed, ICD-10 data had significantly higher sensitivity for one condition and lower sensitivity for seven conditions relative to ICD-9-CM data. The two databases had similar sensitivity values for the remaining 24 conditions.
CONCLUSIONS
The validity of ICD-9-CM and ICD-10 administrative data in recording clinical conditions was generally similar though validity differed between coding versions for some conditions. The implementation of ICD-10 coding has not significantly improved the quality of administrative data relative to ICD-9-CM. Future assessments like this one are needed because the validity of ICD-10 data may get better as coders gain experience with the new coding system.
目的
本研究的目的是评估《国际疾病分类》第10版（ICD - 10）医院行政出院数据的有效性，并确定与《国际疾病分类》第9版临床修订本（ICD - 9 - CM）数据相比，临床疾病编码的有效性是否有所提高。
方法
我们回顾了2003年1月1日至6月30日期间在加拿大艾伯塔省四家教学医院随机抽取的4008份患者病历，以确定32种临床疾病的有无，并评估ICD - 10数据与病历数据之间的一致性。然后我们使用ICD - 9 - CM对相同的病历重新编码，并确定ICD - 9 - CM数据与病历数据在记录这些相同疾病方面的一致性。将ICD - 10数据相对于病历数据的准确性与ICD - 9 - CM数据相对于病历数据的准确性进行比较。
结果
ICD - 9 - CM的灵敏度值范围为9.3%至83.1%，ICD - 10数据的灵敏度值范围为12.7%至80.8%。ICD - 9 - CM的阳性预测值范围为23.1%至100%，ICD - 10数据的阳性预测值范围为32.0%至100%。ICD - 9 - CM和ICD - 10数据库的特异性和阴性预测值一直都很高。在评估的32种疾病中，相对于ICD - 9 - CM数据，ICD - 10数据对一种疾病的灵敏度显著更高，对七种疾病的灵敏度更低。对于其余24种疾病，两个数据库的灵敏度值相似。
结论
ICD - 9 - CM和ICD - 10行政数据在记录临床疾病方面的有效性总体相似，尽管某些疾病的编码版本之间有效性存在差异。相对于ICD - 9 - CM，ICD - 10编码的实施并未显著提高行政数据的质量。由于随着编码人员对新编码系统获得经验，ICD - 10数据的有效性可能会提高，因此需要进行像这样的未来评估。
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