Nicklas Jacinda M, Zera Chloe A, Lui Janet, Seely Ellen W
Division of General Internal Medicine, University of Colorado School of Medicine, 12348 E. Montview Blvd, C263, Aurora, CO, 80045, USA.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
BMC Pregnancy Childbirth. 2017 Jan 6;17(1):11. doi: 10.1186/s12884-016-1191-6.
Hospital discharge codes are often used to determine the incidence of gestational diabetes mellitus (GDM) at state and national levels. Previous studies demonstrate substantial variability in the accuracy of GDM reporting, and rarely report how the GDM was diagnosed. Our aim was to identify deliveries coded as gestational diabetes, and then to determine how the diagnosis was assigned and whether the diagnosis followed established guidelines.
We identified which deliveries were coded at discharge as complicated by GDM at the Brigham and Women's Hospital in Boston, MA for the year 2010. We reviewed medical records to determine whether the codes were appropriately assigned.
Of 7883 deliveries, coding for GDM was assigned with 98% accuracy. We identified 362 cases assigned GDM delivery codes, of which 210 (58%) had oral glucose tolerance test (OGTT) results available meeting established criteria. We determined that 126 cases (34%) received a GDM delivery code due to a clinician diagnosis documented in the medical record, without an OGTT result meeting established guidelines for GDM diagnosis. We identified only 15 cases (4%) that were coding errors.
Thirty four percent of women assigned GDM delivery codes at discharge had a medical record diagnosis of GDM but did not meet OGTT criteria for GDM by established guidelines. Although many of these patients may have met guidelines if guideline-based testing had been conducted, our findings suggest that clinician diagnosis outside of published guidelines may be common. There are many ramifications of this approach to diagnosis, including affecting population-level statistics of GDM prevalence and the potential impact on some women who may be diagnosed with GDM erroneously.
医院出院编码常用于确定州和国家层面的妊娠期糖尿病（GDM）发病率。以往研究表明，GDM报告的准确性存在很大差异，且很少报告GDM的诊断方式。我们的目的是识别被编码为妊娠期糖尿病的分娩病例，然后确定诊断是如何确定的，以及该诊断是否遵循既定指南。
我们确定了2010年马萨诸塞州波士顿市布里格姆妇女医院哪些分娩病例在出院时被编码为患有GDM。我们查阅病历以确定编码是否正确。
在7883例分娩病例中，GDM编码的准确率为98%。我们识别出362例被赋予GDM分娩编码的病例，其中210例（58%）有符合既定标准的口服葡萄糖耐量试验（OGTT）结果。我们确定，126例（34%）因病历中有临床医生诊断而被赋予GDM分娩编码，但没有OGTT结果符合GDM诊断的既定指南。我们仅识别出15例（4%）编码错误的病例。
34%在出院时被赋予GDM分娩编码女性的病历中有GDM诊断，但不符合既定指南的GDM的OGTT标准。尽管如果进行基于指南的检测，这些患者中的许多人可能符合指南，但我们的研究结果表明，超出已发表指南的临床医生诊断可能很常见。这种诊断方法有许多影响，包括影响GDM患病率的人群水平统计数据以及对一些可能被错误诊断为GDM的女性的潜在影响。
