Huo Jinhai, Yang Ming, Tina Shih Ya-Chen
Department of Health Services Research, Management and Policy, The University of Florida, Gainesville, FL, USA.
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Value Health. 2018 Mar;21(3):334-340. doi: 10.1016/j.jval.2017.09.002. Epub 2017 Oct 18.
The "meaningful use of certified electronic health record" policy requires eligible professionals to record smoking status for more than 50% of all individuals aged 13 years or older in 2011 to 2012.
To explore whether the coding to document smoking behavior has increased over time and to assess the accuracy of smoking-related diagnosis and procedure codes in identifying previous and current smokers.
We conducted an observational study with 5,423,880 enrollees from the year 2009 to 2014 in the Truven Health Analytics database. Temporal trends of smoking coding, sensitivity, specificity, positive predictive value, and negative predictive value were measured.
The rate of coding of smoking behavior improved significantly by the end of the study period. The proportion of patients in the claims data recorded as current smokers increased 2.3-fold and the proportion of patients recorded as previous smokers increased 4-fold during the 6-year period. The sensitivity of each International Classification of Diseases, Ninth Revision, Clinical Modification code was generally less than 10%. The diagnosis code of tobacco use disorder (305.1X) was the most sensitive code (9.3%) for identifying smokers. The specificities of these codes and the Current Procedural Terminology codes were all more than 98%.
A large improvement in the coding of current and previous smoking behavior has occurred since the inception of the meaningful use policy. Nevertheless, the use of diagnosis and procedure codes to identify smoking behavior in administrative data is still unreliable. This suggests that quality improvements toward medical coding on smoking behavior are needed to enhance the capability of claims data for smoking-related outcomes research.
“认证电子健康记录的有意义使用”政策要求符合条件的专业人员在2011年至2012年期间为超过50%的13岁及以上个体记录吸烟状况。
探讨记录吸烟行为的编码随时间推移是否有所增加，并评估吸烟相关诊断和程序编码在识别既往和当前吸烟者方面的准确性。
我们对2009年至2014年期间来自Truven Health Analytics数据库的5423880名参保者进行了一项观察性研究。测量了吸烟编码、敏感性、特异性、阳性预测值和阴性预测值的时间趋势。
到研究期结束时，吸烟行为的编码率显著提高。在6年期间，索赔数据中记录为当前吸烟者的患者比例增加了2.3倍，记录为既往吸烟者的患者比例增加了4倍。每个《国际疾病分类（第九版）临床修订本》编码的敏感性普遍低于10%。烟草使用障碍的诊断编码（305.1X）是识别吸烟者最敏感的编码（9.3%）。这些编码以及《现行程序术语》编码的特异性均超过98%。
自有意义使用政策实施以来，当前和既往吸烟行为的编码有了很大改进。然而，在行政数据中使用诊断和程序编码来识别吸烟行为仍然不可靠。这表明需要改进吸烟行为的医学编码质量，以提高索赔数据用于吸烟相关结局研究的能力。
