Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Geriatric Research Education and Clinical Centers, James J Peters VA Medical Center, Bronx, New York, USA.
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
J Pain Symptom Manage. 2019 Jun;57(6):1137-1142. doi: 10.1016/j.jpainsymman.2019.03.006. Epub 2019 Mar 12.
Identifying the seriously ill population is integral to improving the value of health care. Efforts to identify this population using existing data are anchored to a list of severe medical conditions (SMCs) using diagnostic codes. Published approaches have used International Classification of Diseases, Ninth Revision (ICD-9) codes, which has since been replaced by ICD-10.
We translated SMCs from ICD-9 to ICD-10 using a refined code list. We aimed to test the hypothesis that people identified by ICD-9 or ICD-10 codes would have similar Medicare costs, health care utilization, and mortality.
Using data from the National Health and Aging Trends Study linked to Medicare claims, we compared samples from periods using ICD-9 (2014) and ICD-10 (2016). We included participants with six-month fee-for-service Medicare data before their interview date who had an SMC identified within that period. We compared the groups' demographic, functional, and medical characteristics and followed up them for six months to compare outcomes.
Among subjects in the 2016 (ICD-10) sample, 19.9% were hospitalized, 24.6% used the emergency department, 7.2% died, and average Medicare spending totaled $9902.04 over six months of follow-up. We observed no significant differences between the 2014 and 2016 samples (P > 0.05); both samples represent 18% of Medicare fee-for-service beneficiaries.
Identifying the seriously ill population using currently available data requires using ICD-10 to define SMCs. Routine measurement of function, quality of life, and caregiver strain will further enhance the identification process and efficiently target palliative care services and appropriate quality measures.
确定重症患者人群对于提高医疗保健的价值至关重要。使用现有数据来确定这一人群的努力是基于一系列严重的医疗条件（SMCs）的诊断代码。已发表的方法使用了国际疾病分类，第九修订版（ICD-9）代码，该代码已被国际疾病分类，第十版（ICD-10）取代。
我们使用经过改进的代码列表将 SMC 从 ICD-9 转换为 ICD-10。我们旨在检验以下假设：使用 ICD-9 或 ICD-10 代码确定的人群的医疗保险费用、医疗保健利用和死亡率相似。
使用国家健康老龄化趋势研究的数据与医疗保险索赔相关联，我们比较了使用 ICD-9（2014 年）和 ICD-10（2016 年）的两个时期的样本。我们纳入了在访谈日期之前有六个月的按服务收费的医疗保险数据且在此期间有 SMC 被识别的参与者。我们比较了两组人群的人口统计学、功能和医学特征，并对他们进行了六个月的随访，以比较结果。
在 2016 年（ICD-10）样本中的受试者中，19.9%住院，24.6%使用急诊室，7.2%死亡，平均医疗保险支出在六个月的随访期间为 9902.04 美元。我们没有观察到 2014 年和 2016 年样本之间存在显著差异（P>0.05）；两个样本都代表了 18%的按服务收费的医疗保险受益人群。
使用现有数据确定重症患者人群需要使用 ICD-10 来定义 SMC。常规测量功能、生活质量和护理人员负担将进一步增强识别过程，并有效地针对姑息治疗服务和适当的质量措施进行定位。
