日本国际疾病分类第十版（ICD-10）编码对急性心肌梗死的阳性预测价值：一项单中心验证研究
Positive predictive value of ICD-10 codes for acute myocardial infarction in Japan: a validation study at a single center.
作者信息
Ando Takashi, Ooba Nobuhiro, Mochizuki Mayumi, Koide Daisuke, Kimura Koichi, Lee Seitetz L, Setoguchi Soko, Kubota Kiyoshi
机构信息
Division of Evaluation and Analysis of Drug Information, Keio University Faculty of Pharmacy, Tokyo, Japan.
Department of Clinical Pharmacy, Nihon University School of Pharmacy, Chiba, Japan.
出版信息
BMC Health Serv Res. 2018 Nov 26;18(1):895. doi: 10.1186/s12913-018-3727-0.
BACKGROUND
In Japan, several large healthcare databases have become available for research since the early 2000's. However, validation studies to examine the accuracy of these databases remain scarce. We conducted a validation study in order to estimate the positive predictive value (PPV) of local or ICD-10 codes for acute myocardial infarction (AMI) in Japanese claims. In particular, we examined whether the PPV differs between claims in the Diagnosis Procedure Combination case mix scheme (DPC claims) and in non-DPC claims.
METHODS
We selected a random sample of 200 patients from all patients hospitalized at a large tertiary-care university hospital between January 1, 2009 and December 31, 2011 who had an inpatient claim assigned a local or ICD-10 code for AMI. We used a standardized data abstraction form to collect the relevant information from an electronic medical records system. Abstracted information was then categorized by a single cardiologist as being either definite or not having AMI.
RESULTS
In a random sample of 200 patients, the average age was 67.7 years and the proportion of males was 78.0%. The PPV of the local or ICD-10 code for AMI was 82.5% in this sample of 200 patients. Further, of 178 patients who had an ICD-10 code for AMI based on any of the 7 types of condition codes in the DPC claims, the PPV was 89.3%, whereas of the 161 patients who had an ICD-10 code for AMI based on any of 3 major types of condition codes in the DPC claims, the PPV was 93.8%.
CONCLUSION
The PPV of the local or ICD-10 code for AMI was high for inpatient claims in Japan. The PPV was even higher for the ICD-10 code for AMI for those patients who received AMI care through the DPC case mix scheme. The current study was conducted in a single center, suggesting that a multi-center study involving different types of hospitals is needed in the future. The accuracy of condition codes for DPC claims in Japan may also be worth examining for conditions other than AMI such as stroke.
背景
自21世纪初以来，日本有几个大型医疗保健数据库可供研究使用。然而，检验这些数据库准确性的验证研究仍然很少。我们进行了一项验证研究，以估计日本索赔中急性心肌梗死（AMI）的本地或ICD - 10编码的阳性预测值（PPV）。特别是，我们研究了在诊断程序组合病例组合方案（DPC索赔）和非DPC索赔中PPV是否存在差异。
方法
我们从2009年1月1日至2011年12月31日期间在一家大型三级大学医院住院的所有患者中随机抽取了200名患者样本，这些患者的住院索赔被分配了AMI的本地或ICD - 10编码。我们使用标准化的数据提取表从电子病历系统中收集相关信息。然后由一名心脏病专家将提取的信息分类为确诊AMI或未患AMI。
结果
在200名患者的随机样本中，平均年龄为67.7岁，男性比例为78.0%。在这个200名患者的样本中，AMI的本地或ICD - 10编码的PPV为82.5%。此外，在178名基于DPC索赔中的7种条件编码中的任何一种而有AMI的ICD - 10编码的患者中，PPV为89.3%，而在161名基于DPC索赔中的3种主要条件编码中的任何一种而有AMI的ICD - 10编码的患者中，PPV为93.8%。
结论
在日本，住院索赔中AMI的本地或ICD - 10编码的PPV较高。对于那些通过DPC病例组合方案接受AMI治疗的患者，AMI的ICD - 10编码的PPV甚至更高。本研究是在单一中心进行的，这表明未来需要进行涉及不同类型医院的多中心研究。日本DPC索赔条件编码对于AMI以外的其他疾病（如中风）的准确性也可能值得研究。
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