McCarron Kelly K, Reinhard Matthew J, Bloeser Katharine J, Mahan Clare M, Kang Han K
War Related Illness and Injury Study Center, Veterans Affairs Medical Center, Washington, DC, USA.
J Trauma Stress. 2014 Oct;27(5):626-9. doi: 10.1002/jts.21961.
To guide budgetary and policy-level decisions, the U.S. Department of Veterans Affairs (VA) produces quarterly reports that count the number of Iraq and Afghanistan veterans with International Classification of Diseases, 9(th) Revision, Clinical Modification (ICD-9-CM) codes for posttraumatic stress disorder (PTSD; 309.81) in their electronic medical record administrative data. We explored the accuracy of VA administrative data (i.e., diagnostic codes used for billing purposes), by comparing it to chart review evidence of PTSD (i.e., medical progress notes and all other clinical documentation contained in the entire VA medical record). We reviewed VA electronic medical records for a nationwide sample of 1,000 Iraq and Afghanistan veterans with at least one ICD-9-CM code for PTSD in their VA administrative data. Among veterans sampled, 99.9% had 2 or more ICD-9-CM codes for PTSD. Reviewing all VA electronic medical record notes for these 1,000 veterans for the full course of their VA health care history revealed that PTSD was diagnosed by a mental health provider for 89.6%, refuted for 5.6%, and PTSD was never evaluated by a mental health provider for 4.8%. VA treatment notes for the 12 months preceding chart review showed that 661 veterans sampled received a VA PTSD diagnosis during that 12-month timeframe, and of these 555 were diagnosed by a mental health provider (83.9%). Thus, the presence of an ICD-9-CM code for PTSD approximated diagnoses by VA mental health providers across time points (89.6% for entire treatment history and 83.9% for 12 months prior to chart review). Administrative data offer large-scale means to track diagnoses and treatment utilization; however, their limitations are many, including the inability to detect false-negatives.
为指导预算和政策层面的决策，美国退伍军人事务部（VA）编制季度报告，统计伊拉克和阿富汗战争退伍军人电子病历管理数据中患有创伤后应激障碍（PTSD；国际疾病分类第9版临床修订本[ICD - 9 - CM]编码为309.81）的人数。我们通过将VA管理数据（即用于计费目的的诊断编码）与PTSD的病历审查证据（即整个VA病历中包含的医疗进展记录和所有其他临床文档）进行比较，探究了VA管理数据的准确性。我们对全国范围内1000名伊拉克和阿富汗战争退伍军人的VA电子病历进行了审查，这些退伍军人的VA管理数据中至少有一个PTSD的ICD - 9 - CM编码。在抽样的退伍军人中，99.9%有2个或更多PTSD的ICD - 9 - CM编码。审查这1000名退伍军人整个VA医疗保健历史过程中的所有VA电子病历记录发现，心理健康提供者诊断为PTSD的占89.6%，排除诊断的占5.6%，心理健康提供者从未评估过PTSD的占4.8%。病历审查前12个月的VA治疗记录显示，抽样的661名退伍军人在此12个月期间接受了VA的PTSD诊断，其中555名由心理健康提供者诊断（83.9%）。因此，PTSD的ICD - 9 - CM编码在不同时间点与VA心理健康提供者的诊断结果相近（整个治疗历史为89.6%，病历审查前12个月为83.9%）。管理数据提供了大规模跟踪诊断和治疗利用情况的手段；然而，其局限性也很多，包括无法检测出假阴性。
