Metcalfe Amy, Sheikh Manal, Hetherington Erin
Department of Obstetrics and Gynecology, University of Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Alberta, Canada.
Department of Community Health Sciences, University of Calgary, Alberta, Canada.
Am J Obstet Gynecol. 2021 Oct;225(4):422.e1-422.e11. doi: 10.1016/j.ajog.2021.03.036. Epub 2021 Apr 16.
Surveillance of maternal mortality and severe maternal morbidity is important to identify temporal trends, evaluate the impact of clinical practice changes or interventions, and monitor quality of care. A common source for severe maternal morbidity surveillance is hospital discharge data. On October 1, 2015, all hospitals in the United States transitioned from the International Classification of Diseases, Ninth Revision, Clinical Modification to the International Classification of Diseases, Tenth Revision, Clinical Modification coding for diagnoses and procedures.
This study aimed to evaluate the impact of the transition from the International Classification of Diseases, Ninth Revision, Clinical Modification to the International Classification of Diseases, Tenth Revision, Clinical Modification coding systems on the incidence of severe maternal morbidity in the United States in hospital discharge data.
Using data from the National Inpatient Sample, obstetrical deliveries between January 1, 2012, and December 31, 2017, were identified using a validated case definition. Severe maternal morbidity was defined using the International Classification of Diseases, Ninth Revision, Clinical Modification (January 1, 2012, to September 30, 2015) and the International Classification of Diseases, Tenth Revision, Clinical Modification (October 1, 2015, to December 31, 2017) codes provided by the Centers for Disease Control and Prevention. An interrupted time series and segmented regression analysis was used to assess the impact of the transition from the International Classification of Diseases, Ninth Revision, Clinical Modification to the International Classification of Diseases, Tenth Revision, Clinical Modification coding on the incidence of severe maternal morbidity per 1000 obstetrical deliveries.
From 22,751,941 deliveries, the incidence of severe maternal morbidity in the International Classification of Diseases, Ninth Revision, Clinical Modification coding era was 19.04 per 1000 obstetrical deliveries and decreased to 17.39 per 1000 obstetrical deliveries in the International Classification of Diseases, Tenth Revision, Clinical Modification coding era (P<.001). The transition to International Classification of Diseases, Tenth Revision, Clinical Modification coding led to an immediate decrease in the incidence of severe maternal morbidity (-2.26 cases of 1000 obstetrical deliveries) (P<.001). When blood products transfusion was removed from the case definition, the magnitude of the decrease in the incidence of SMM was much smaller (-0.60 cases/1000 obstetric deliveries), but still significant (P<.001).
After the transition to the International Classification of Diseases, Tenth Revision, Clinical Modification coding for health diagnoses and procedures in the United States, there was an abrupt statistically significant and clinically meaningful decrease in the incidence of severe maternal morbidity in hospital discharge data. Changes in the underlying health of the obstetrical population are unlikely to explain the sudden change in severe maternal morbidity. Although much work has been done to validate the International Classification of Diseases, Ninth Revision, Clinical Modification codes for severe maternal morbidity, it is critical that validation studies be undertaken to validate the International Classification of Diseases, Tenth Revision, Clinical Modification codes for severe maternal morbidity to permit ongoing surveillance, quality improvement, and research activities that rely on hospital discharge data.
监测孕产妇死亡率和严重孕产妇发病率对于确定时间趋势、评估临床实践变化或干预措施的影响以及监测医疗质量至关重要。严重孕产妇发病率监测的一个常见数据来源是医院出院数据。2015年10月1日，美国所有医院在诊断和手术编码方面从《疾病和有关健康问题的国际统计分类》第九版临床修订本（ICD-9-CM）过渡到了《疾病和有关健康问题的国际统计分类》第十版临床修订本（ICD-10-CM）。
本研究旨在评估从ICD-9-CM编码系统过渡到ICD-10-CM编码系统对美国医院出院数据中严重孕产妇发病率的影响。
利用来自全国住院患者样本的数据，通过经过验证的病例定义确定2012年1月1日至2017年12月31日期间的产科分娩情况。严重孕产妇发病率根据疾病控制和预防中心提供的ICD-9-CM（2012年1月1日至2015年9月30日）和ICD-10-CM（2015年10月1日至2017年12月31日）编码来定义。采用中断时间序列和分段回归分析来评估从ICD-9-CM编码过渡到ICD-10-CM编码对每千例产科分娩中严重孕产妇发病率的影响。
在22751941例分娩中，ICD-9-CM编码时代严重孕产妇发病率为每千例产科分娩19.04例，在ICD-10-CM编码时代降至每千例产科分娩17.39例（P<0.001）。向ICD-10-CM编码的过渡导致严重孕产妇发病率立即下降（每千例产科分娩减少2.26例）（P<0.001）。当从病例定义中去除血液制品输血时，严重孕产妇发病率下降的幅度要小得多（每千例产科分娩减少0.60例），但仍具有统计学意义（P<0.001）。
在美国过渡到使用ICD-10-CM进行健康诊断和手术编码后，医院出院数据中严重孕产妇发病率出现了统计学上显著且具有临床意义的突然下降。产科人群潜在健康状况的变化不太可能解释严重孕产妇发病率的突然变化。尽管已经做了大量工作来验证ICD-9-CM用于严重孕产妇发病率的编码，但至关重要的是要开展验证研究，以验证ICD-10-CM用于严重孕产妇发病率的编码,以便进行持续监测、质量改进以及依赖医院出院数据的研究活动。
