School of Medicine, Meharry Medical College, Nashville, Tennessee.
Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee.
JAMA Dermatol. 2021 Sep 1;157(9):1089-1094. doi: 10.1001/jamadermatol.2021.2856.
Patients can develop multiple skin cancers, and their medical data can be spread over multiple health care systems. This fragmented care, combined with the lack of skin cancer registries, has limited our ability both to provide accurate estimates of incidence and to study the pathogenesis of multiple skin cancers.
To assess whether standard diagnostic and procedural codes present in the electronic health records at a single health care system are a valid proxy for estimating the number of overall skin cancers.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of patients seen at a single-center tertiary care hospital (ie, Vanderbilt University Medical Center) between July 1, 2008, and June 30, 2018. All patients with at least 1 electronic health record-based diagnostic or procedural code for any skin cancer and at least 1 pathology report of a skin cancer.
The number of International Classification of Disease (ICD) or Current Procedural Terminology (CPT) codes relating to skin cancer.
Pearson correlation coefficient and R2 were calculated for the total number of ICD or CPT codes for skin cancer and histologically verified skin cancers.
In this cohort study of 35 901 patients, the mean (SD) age was 70.4 (14.4) years, 20 404 (56.8%) were men, and 31 623 (88.1%) were White individuals. Of these patients, 6307 had at least 1 ICD or CPT code or pathology report for a skin cancer, of whom 5688 patients had both a CPT code related to skin malignancy and a histologically verified skin cancer. There was a strong linear correlation between the number of CPT codes and pathology records (r = 0.87). There was a poor correlation between the number of ICD codes and pathology records (r = 0.22).
This cohort study found that the use of ICD codes was a poor proxy measure for the number of skin cancers per patient. In contrast, CPT codes accounted for more than 75% of the variability in the number of skin cancers (R2 = 0.76) and were a better proxy measure for the total number of skin cancers per patient.
患者可能会患上多种皮肤癌，而他们的医疗数据可能分散在多个医疗系统中。这种分散的护理方式，再加上缺乏皮肤癌登记处，限制了我们提供准确发病率估计和研究多种皮肤癌发病机制的能力。
评估单一医疗保健系统中的电子健康记录中的标准诊断和程序代码是否可作为估计总体皮肤癌数量的有效替代指标。
设计、地点和参与者：这是一项对 2008 年 7 月 1 日至 2018 年 6 月 30 日期间在单中心三级保健医院（即范德比尔特大学医学中心）就诊的患者进行的回顾性队列研究。所有患者至少有 1 份基于电子健康记录的任何皮肤癌诊断或程序代码记录，并且至少有 1 份皮肤癌病理报告。
与皮肤癌相关的国际疾病分类（ICD）或当前程序术语（CPT）代码数量。
计算了 ICD 或 CPT 皮肤癌代码总数与组织学验证的皮肤癌之间的 Pearson 相关系数和 R2。
在这项队列研究中，共纳入了 35901 名患者，平均（SD）年龄为 70.4（14.4）岁，20404 名（56.8%）为男性，31623 名（88.1%）为白人。在这些患者中，有 6307 名患者至少有 1 份 ICD 或 CPT 代码或皮肤癌病理报告，其中 5688 名患者既有与皮肤恶性肿瘤相关的 CPT 代码，又有组织学验证的皮肤癌。CPT 代码数量与病理记录之间存在很强的线性相关性（r=0.87）。ICD 代码数量与病理记录之间的相关性较差（r=0.22）。
这项队列研究发现，ICD 代码的使用是衡量每位患者皮肤癌数量的一个较差的替代指标。相比之下，CPT 代码占皮肤癌数量的可变性的 75%以上（R2=0.76），并且是衡量每位患者皮肤癌总数的更好替代指标。
