Inscore Matthew C, Gonzales Katherine R, Rennix Christopher P, Jones Bruce H
Army Public Health Center, 5158 Black Hawk Rd, Aberdeen, MD, 21010, USA.
Navy and Marine Corps Public Health Center, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA, 23708, USA.
Inj Epidemiol. 2018 Aug 20;5(1):32. doi: 10.1186/s40621-018-0162-y.
Acute injuries are a burden on the Military Health System and degrade service members' ability to train and deploy. Long-term injuries contribute to early attrition and increase disability costs. To properly quantify acute injuries and evaluate injury prevention programs, injuries must be accurately coded and documented. This analysis describes how the transition from International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to the Tenth Revision (ICD-10-CM) impacted acute injury surveillance among active duty (AD) service members. Twelve months of ICD-9-CM and ICD-10-CM coded ambulatory injury encounter records for Army, Navy, Air Force, and Marine Corps AD service members were analyzed to evaluate the effect of ICD-10-CM implementation on acute injury coding. Acute injuries coded with ICD-9-CM and categorized with the Barell matrix were compared to ICD-10-CM coded injuries classified by the proposed Injury Diagnosis Matrix (IDM). Both matrices categorize injuries by the nature of injury and into three levels of specificity for body region, although column and row headings are not identical.
Acute injury distribution between the two matrices was generally similar in the broader body region categories but diverged substantially at the most granular cell level. The proportion of Level 1 Spine and back Body Region diagnoses was higher in the Barell than in the IDM (6.8% and 2.3%, respectively). Unspecified Level 3 Lower extremity injuries were markedly lower in the IDM compared to the Barell (0.1% and 12.1%, respectively).
This is the first large scale analysis evaluating the impacts of ICD-10-CM implementation on acute injury surveillance using ambulatory encounter data. Some injury diagnoses appeared to have shifted to a different chapter of the codebook. Also, it's likely that the more detailed diagnostic descriptions and episode of care codes in ICD-10-CM discouraged re-coding of initial acute injury diagnoses. The proposed IDM did not result in a major disruption of acute injury surveillance. However, many acute injury diagnosis codes cannot be aligned between ICD versions. Overall, the increased specificity of ICD-10-CM and use of the IDM may lead to more precise acute injury surveillance and tailored prevention programs, which may result in less chronic injury, reduced morbidity, and lower health-care costs.
急性损伤给军事卫生系统带来负担，并降低军人的训练和部署能力。长期损伤会导致早期人员流失，并增加残疾成本。为了准确量化急性损伤并评估损伤预防计划，必须对损伤进行准确编码和记录。本分析描述了从《国际疾病分类》第九版临床修订本（ICD-9-CM）向第十版（ICD-10-CM）的转变如何影响现役（AD）军人的急性损伤监测。对陆军、海军、空军和海军陆战队现役军人的12个月ICD-9-CM和ICD-10-CM编码的门诊损伤就诊记录进行了分析，以评估ICD-10-CM实施对急性损伤编码的影响。将用ICD-9-CM编码并用巴雷尔矩阵分类的急性损伤与按拟议的损伤诊断矩阵（IDM）分类的ICD-10-CM编码损伤进行比较。两个矩阵都根据损伤性质对损伤进行分类，并对身体部位分为三个特异性级别，尽管列标题和行标题并不相同。
在更广泛的身体部位类别中，两个矩阵之间的急性损伤分布总体相似，但在最细粒度的单元格级别上有很大差异。巴雷尔矩阵中一级脊柱和背部身体部位诊断的比例高于IDM（分别为6.8%和2.3%）。与巴雷尔矩阵相比，IDM中未指定的三级下肢损伤明显更低（分别为0.1%和12.1%）。
这是首次使用门诊就诊数据对ICD-10-CM实施对急性损伤监测的影响进行的大规模分析。一些损伤诊断似乎已转移到编码手册的不同章节。此外，ICD-10-CM中更详细的诊断描述和护理事件编码可能阻碍了对初始急性损伤诊断的重新编码。拟议的IDM并未导致急性损伤监测的重大中断。然而，许多急性损伤诊断代码在ICD版本之间无法对齐。总体而言，ICD-10-CM更高的特异性和IDM的使用可能会导致更精确的急性损伤监测和量身定制的预防计划，这可能会减少慢性损伤、降低发病率并降低医疗成本。
