使用 ICD-10-CM 代码检测非法药物使用：与回顾性自我报告的比较。

Using ICD-10-CM codes to detect illicit substance use: A comparison with retrospective self-report.

机构信息

San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, California, 94102, USA; University of California, Berkeley, 2121 Berkeley Way, 5th Floor, Berkeley, California, 94702, USA.

San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, California, 94102, USA; University of California, San Francisco, 500 Parnassus Avenue, San Francisco, California, 94143, USA.

出版信息

Drug Alcohol Depend. 2021 Apr 1;221:108537. doi: 10.1016/j.drugalcdep.2021.108537. Epub 2021 Jan 20.

DOI:10.1016/j.drugalcdep.2021.108537

PMID:33621806

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11008535/

Abstract

BACKGROUND

Understanding whether International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) codes can be used to accurately detect substance use can inform their use in future surveillance and research efforts.

METHODS

Using 2015-2018 data from a retrospective cohort study of 602 safety-net patients prescribed opioids for chronic non-cancer pain, we calculated the sensitivity and specificity of using ICD-10-CM codes to detect illicit substance use compared to retrospective self-report by substance (methamphetamine, cocaine, opioids [heroin or non-prescribed opioid analgesics]), self-reported use frequency, and type of healthcare encounter.

RESULTS

Sensitivity of ICD-10-CM codes for detecting self-reported substance use was highest for methamphetamine (49.5 % [95 % confidence interval: 39.6-59.5 %]), followed by cocaine (44.4 % [35.8-53.2 %]) and opioids (36.3 % [28.8-44.2 %]); higher for participants who reported more frequent methamphetamine (intermittent use: 27.7 % [14.6-42.6 %]; ≥weekly use: 67.2 % [53.7-79.0 %]) and opioid use (intermittent use: 21.4 % [13.2-31.7 %]; ≥weekly use: 52.6 % [40.8-64.2 %]); highest for outpatient visits (methamphetamine: 43.8 % [34.1-53.8 %]; cocaine: 36.8 % [28.6-45.6 %]; opioids: 33.1 % [25.9-41.0 %]) and lowest for emergency department visits (methamphetamine: 8.6 % [4.0-15.6 %]; cocaine: 5.3 % [2.1-10.5 %]; opioids: 6.3 % [3.0-11.2 %]). Specificity was highest for methamphetamine (96.4 % [94.3-97.8 %]), followed by cocaine (94.0 % [91.5-96.0 %]) and opioids (85.0 % [81.3-88.2 %]).

CONCLUSIONS

ICD-10-CM codes had high specificity and low sensitivity for detecting self-reported substance use but were substantially more sensitive in detecting frequent use. ICD-10-CM codes to detect substance use, particularly those from emergency department visits, should be used with caution, but may be useful as a lower-bound population measure of substance use or for capturing frequent use among certain patient populations.

摘要

背景

了解国际疾病分类第 10 次修订版临床修订本（ICD-10-CM）代码是否可用于准确检测物质使用情况，可以为今后的监测和研究工作提供参考。

方法

我们使用了 2015 年至 2018 年期间一项回顾性队列研究中的数据，该研究纳入了 602 名因慢性非癌症疼痛而开处阿片类药物的患者，我们计算了使用 ICD-10-CM 代码检测物质使用情况的灵敏度和特异性，将其与物质（冰毒、可卡因、阿片类药物[海洛因或非处方阿片类镇痛药]）的回顾性自我报告、自我报告的使用频率以及医疗保健类型进行比较。

结果

ICD-10-CM 代码检测自我报告物质使用的灵敏度，冰毒最高（49.5%[95%置信区间：39.6%-59.5%]），其次是可卡因（44.4%[35.8%-53.2%]）和阿片类药物（36.3%[28.8%-44.2%]）；在报告使用冰毒更频繁的参与者中（间歇性使用：27.7%[14.6%-42.6%]；每周≥1 次：67.2%[53.7%-79.0%]）和阿片类药物（间歇性使用：21.4%[13.2%-31.7%]；每周≥1 次：52.6%[40.8%-64.2%]）中，灵敏度更高；在门诊就诊中最高（冰毒：43.8%[34.1%-53.8%]；可卡因：36.8%[28.6%-45.6%]；阿片类药物：33.1%[25.9%-41.0%]），在急诊就诊中最低（冰毒：8.6%[4.0%-15.6%]；可卡因：5.3%[2.1%-10.5%]；阿片类药物：6.3%[3.0%-11.2%]）。特异性方面，冰毒最高（96.4%[94.3%-97.8%]），其次是可卡因（94.0%[91.5%-96.0%]）和阿片类药物（85.0%[81.3%-88.2%]）。