Khanna Raman R, Kim Sharon B, Jenkins Ian, El-Kareh Robert, Afsarmanesh Nasim, Amin Alpesh, Sand Heather, Auerbach Andrew, Chia Catherine Y, Maynard Gregory, Romano Patrick S, White Richard H
*Department of Medicine, Division of Hospital Medicine, UCSF, San Francisco †Department of Medicine, Division of Hospital Medicine, UCSD, San Diego ‡Department of Medicine, UCLA, Los Angeles §Division of General Internal Medicine, Department of Medicine ∥Department of Medicine, UCI, Irvine ¶Department of Medicine #Division of General Internal Medicine, Department of Medicine, UCD, Davis, CA.
Med Care. 2015 Apr;53(4):e31-6. doi: 10.1097/MLR.0b013e318286e34f.
Hospital-acquired venous thromboembolic (HA-VTE) events are an important, preventable cause of morbidity and death, but accurately identifying HA-VTE events requires labor-intensive chart review. Administrative diagnosis codes and their associated "present-on-admission" (POA) indicator might allow automated identification of HA-VTE events, but only if VTE codes are accurately flagged "not present-on-admission" (POA=N). New codes were introduced in 2009 to improve accuracy.
We identified all medical patients with at least 1 VTE "other" discharge diagnosis code from 5 academic medical centers over a 24-month period. We then sampled, within each center, patients with VTE codes flagged POA=N or POA=U (insufficient documentation) and POA=Y or POA=W (timing clinically uncertain) and abstracted each chart to clarify VTE timing. All events that were not clearly POA were classified as HA-VTE. We then calculated predictive values of the POA=N/U flags for HA-VTE and the POA=Y/W flags for non-HA-VTE.
Among 2070 cases with at least 1 "other" VTE code, we found 339 codes flagged POA=N/U and 1941 flagged POA=Y/W. Among 275 POA=N/U abstracted codes, 75.6% (95% CI, 70.1%-80.6%) were HA-VTE; among 291 POA=Y/W abstracted events, 73.5% (95% CI, 68.0%-78.5%) were non-HA-VTE. Extrapolating from this sample, we estimated that 59% of actual HA-VTE codes were incorrectly flagged POA=Y/W. POA indicator predictive values did not improve after new codes were introduced in 2009.
The predictive value of VTE events flagged POA=N/U for HA-VTE was 75%. However, sole reliance on this flag may substantially underestimate the incidence of HA-VTE.
医院获得性静脉血栓栓塞（HA-VTE）事件是发病和死亡的一个重要且可预防的原因，但准确识别HA-VTE事件需要耗费大量人力的病历审查。行政诊断编码及其相关的“入院时存在”（POA）指标可能有助于自动识别HA-VTE事件，但前提是VTE编码被准确标记为“入院时不存在”（POA = N）。2009年引入了新编码以提高准确性。
我们识别了5个学术医疗中心在24个月期间内所有至少有1个VTE“其他”出院诊断编码的内科患者。然后，在每个中心内，我们抽取了VTE编码被标记为POA = N或POA = U（记录不足）以及POA = Y或POA = W（时间在临床上不确定）的患者，并提取每份病历以明确VTE的发生时间。所有未明确为POA的事件都被归类为HA-VTE。然后，我们计算了POA = N/U标记对HA-VTE的预测值以及POA = Y/W标记对非HA-VTE的预测值。
在2070例至少有1个“其他”VTE编码的病例中，我们发现339个编码被标记为POA = N/U，1941个被标记为POA = Y/W。在275个被提取的POA = N/U编码中，75.6%（95%CI，70.1% - 80.6%）为HA-VTE；在291个被提取的POA = Y/W事件中，73.5%（95%CI，68.0% - 78.5%）为非HA-VTE。根据这个样本推断，我们估计实际HA-VTE编码中有59%被错误地标记为POA = Y/W。2009年引入新编码后，POA指标的预测值并未改善。
被标记为POA = N/U的VTE事件对HA-VTE的预测值为75%。然而，仅依赖这个标记可能会大幅低估HA-VTE的发生率。
