From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA (T.E.C., X.T., M.G.G., S.M.C.K., X.Y., J.L.W.).
IHRC, Inc, Atlanta, GA (T.E.C., X.Y.).
Stroke. 2019 Aug;50(8):1959-1967. doi: 10.1161/STROKEAHA.118.024092. Epub 2019 Jun 18.
Background and Purpose- International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification (ICD-9-CM and ICD-10-CM) codes are often used for disease surveillance. We examined changes in concordance between ICD-CM codes and clinical diagnoses before and after the transition to ICD-10-CM in the United States (October 1, 2015), and determined if there were systematic variations in concordance by patient and hospital characteristics. Methods- We included Paul Coverdell National Acute Stroke Program patient discharges from 2014 to 2017. Concordance between ICD-CM codes and the clinical diagnosis documented by the physician (assumed as accurate) was calculated for each diagnosis category: ischemic stroke, transient ischemic attack, subarachnoid hemorrhage, and intracerebral hemorrhage. Results- In total, 314 857 patient records were included in the analysis (n=280 hospitals), 55.9% of which were obtained after the transition to ICD-10-CM. While concordance was generally high, a small, and temporary decline occurred from the last calendar quarter of ICD-9-CM (average unadjusted concordance =92.8%) to the first quarter of ICD-10-CM use (91.0%). Concordance differed by diagnosis category and was generally highest for ischemic stroke. In the analysis of ICD-10-CM records, disagreements often occurred between ischemic stroke and transient ischemic attack records and between subarachnoid and intracerebral hemorrhage records. Compared with the smallest hospitals (≤200 beds), larger hospitals had significantly higher odds of concordance (ischemic stroke adjusted odds ratio for ≥400 beds, 1.7; 95% CI, 1.5-1.9). Conclusions- This study identified a small and transient decline in concordance between ICD-CM codes and stroke clinical diagnoses during the coding transition, indicating no substantial impact on the overall identification of stroke patients. Researchers and policymakers should remain aware of potential changes in ICD-CM code accuracy over time, which may affect disease surveillance. Systematic variations in the accuracy of codes by hospital and patient characteristics have implications for quality-of-care studies and hospital comparative assessments.
背景与目的-国际疾病分类第 9 修订版临床修订本（ICD-9-CM）和第 10 修订本（ICD-10-CM）代码常用于疾病监测。我们研究了美国从 2015 年 10 月 1 日开始向 ICD-10-CM 过渡前后，ICD-CM 代码与临床诊断之间的一致性变化，并确定了患者和医院特征是否存在系统的一致性差异。方法-我们纳入了 2014 年至 2017 年期间保罗·科弗代尔国家急性中风项目患者的出院记录。每个诊断类别（缺血性中风、短暂性脑缺血发作、蛛网膜下腔出血和脑出血）的 ICD-CM 代码与医生记录的临床诊断（假设准确）之间的一致性进行了计算。结果-共有 314857 份患者记录被纳入分析（n=280 家医院），其中 55.9%是在过渡到 ICD-10-CM 之后获得的。尽管一致性总体较高，但从 ICD-9-CM 的最后一个日历季度（平均未经调整的一致性=92.8%）到 ICD-10-CM 使用的第一个季度，一致性出现了一个小的、暂时的下降（91.0%）。一致性因诊断类别而异，缺血性中风的一致性通常最高。在 ICD-10-CM 记录的分析中，缺血性中风和短暂性脑缺血发作记录以及蛛网膜下腔出血和脑出血记录之间经常存在不一致。与最小的医院（≤200 张床位）相比，较大的医院具有更高的一致性优势（缺血性中风的床位调整优势比≥400 张床位，1.7；95%置信区间，1.5-1.9）。结论-本研究发现，在编码转换期间，ICD-CM 代码与中风临床诊断之间的一致性出现了一个小的、暂时的下降，这表明对整体识别中风患者没有实质性影响。研究人员和政策制定者应始终意识到 ICD-CM 代码准确性随时间的潜在变化，这可能会影响疾病监测。代码准确性按医院和患者特征的系统差异对医疗质量研究和医院比较评估具有重要意义。
