Denham Alina, Mullaney Teraisa, Hill Elaine L, Veazie Peter J
Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
Health Serv Insights. 2019 Jul 11;12:1178632919861338. doi: 10.1177/1178632919861338. eCollection 2019.
Based on calculations using all-listed diagnoses, the Agency for Healthcare Research and Quality (AHRQ) reports increasing national trends in opioid-related hospitalizations. It is unclear whether the reported increases are attributable to increases in available diagnosis fields. We leveraged increases in available diagnosis fields, ie, diagnosis recordability, in 2 states to examine their effects on opioid-related hospitalizations, graphically and with nonlinear least squares. Hospitalization data from Texas (1999-2011, N = 36 593 049) and New York (2005-2015Q3, N = 27 582 208) were aggregated to quarter-year in each state. Opioid-related hospitalizations were identified using the same International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Diagnosis Codes as AHRQ. In Texas, the increase in diagnosis recordability resulted in a 29.9% discrete shift in the number of recorded opioid diagnoses and a 3-fold increase in the slope. In New York, a smaller discrete shift (3.1%) and a 3-fold increase in the slope were identified, although a more pronounced change in the trend occurred 5 years earlier (slope change from flat to increasing). Increases in recordability lead to a broader definition of opioid-related hospitalizations, if all-listed diagnoses are used; we found that more hospitalizations are identified using the postchange definition than with the prechange definition (9.7% more in Texas and 4.9% more in New York after 4 years). We conclude that reported increases in opioid-related hospitalizations are partially attributable to increases in diagnosis recordability. Cross-state and temporal comparisons of opioid-related hospitalization rates based on all-listed diagnoses can misrepresent the true relative extent of opioid-related hospital use and therefore of the opioid epidemic.
基于对所有列出诊断的计算，医疗保健研究与质量局（AHRQ）报告称全国与阿片类药物相关的住院人数呈上升趋势。目前尚不清楚报告的增长是否归因于可用诊断字段的增加。我们利用两个州可用诊断字段的增加，即诊断可记录性的增加，以图形方式和非线性最小二乘法来研究它们对与阿片类药物相关的住院人数的影响。汇总了得克萨斯州（1999 - 2011年，N = 36593049）和纽约州（2005 - 2015年第三季度，N = 27582208）的住院数据，按各州的季度年份进行统计。使用与AHRQ相同的《国际疾病分类，第九版，临床修订本》（ICD - 9 - CM）诊断代码来确定与阿片类药物相关的住院病例。在得克萨斯州，诊断可记录性的增加导致记录的阿片类药物诊断数量出现29.9%的离散变化，斜率增加了3倍。在纽约州，虽然斜率变化更为明显的情况提前5年就已出现（斜率从平缓变为上升），但发现离散变化较小（3.1%）且斜率增加了3倍。如果使用所有列出的诊断，可记录性的增加会导致对与阿片类药物相关的住院病例定义更宽泛；我们发现，使用变化后的定义比变化前的定义识别出更多的住院病例（4年后，得克萨斯州多9.7%，纽约州多4.9%）。我们得出结论，报告的与阿片类药物相关的住院人数增加部分归因于诊断可记录性的提高。基于所有列出诊断的与阿片类药物相关的住院率的跨州和跨时间比较可能会误报阿片类药物相关住院使用的真实相对程度，进而误报阿片类药物流行的真实程度。
