T1MI 观察到的住院和结局在 MI 亚型编码引入前后。
Hospitalizations and Outcomes of T1MI Observed Before and After the Introduction of MI Subtype Codes.
机构信息
Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
出版信息
J Am Coll Cardiol. 2021 Sep 21;78(12):1242-1253. doi: 10.1016/j.jacc.2021.07.034.
BACKGROUND
International Classification of Disease (ICD)-10 coding of type 1 myocardial infarction (MI) is used for reimbursement, value-based programs, and clinical research.
OBJECTIVES
This study sought to determine whether the introduction of ICD-10 codes for type 2 and types 3-5 MI was associated with changes in hospitalizations for ICD-10 codes now attributed to type 1 MI.
METHODS
Using the Nationwide Readmissions Database, we identified patients with ICD-10 codes now attributed to type 1 MI between January 2016 and December 2018. Patients were stratified according to the timing of their event in relation to the introduction of the type 2 and types 3-5 MI codes on October 1, 2017.
RESULTS
There were 2,680,323 hospitalizations for ICD-10 codes now attributed to type 1 MI; after adjustment for seasonality, there was a 13.7% decline in hospitalizations after the introduction of the new subtype codes. Patients with ICD-10 codes now attributed to type 1 MI after the coding change were less likely to be female, had lower prevalence of several cardiovascular and noncardiovascular comorbidities, and had higher rates of coronary angiography and revascularization. After introduction of the new codes, there was a positive deflection in the slope of risk-adjusted in-hospital mortality (0.007%; P <0.001) and a negative deflection in risk-adjusted 30-day readmission (-0.002%; P = 0.05) for patients with ICD-10 codes now attributed to type 1 MI.
CONCLUSIONS
The introduction of ICD-10 codes for type 2 and types 3-5 MI was associated with a decrease in hospitalizations for ICD-10 codes now attributed to type 1 MI and changes in the observed characteristics and treatment patterns of these patients.
背景
国际疾病分类（ICD）第 10 版对 1 型心肌梗死（MI）的编码用于报销、基于价值的项目和临床研究。
目的
本研究旨在确定 2 型和 3-5 型 MI 的 ICD-10 编码的引入是否与归因于 1 型 MI 的 ICD-10 编码的住院人数变化相关。
方法
使用全国再入院数据库，我们确定了 2016 年 1 月至 2018 年 12 月期间归因于 1 型 MI 的 ICD-10 编码的患者。根据事件发生的时间与 2017 年 10 月 1 日引入 2 型和 3-5 型 MI 编码的关系，对患者进行分层。
结果
有 2680323 例归因于 1 型 MI 的 ICD-10 编码的住院治疗；在季节性调整后，新亚组编码引入后住院人数下降了 13.7%。编码变更后归因于 1 型 MI 的患者中，女性比例较低，几种心血管和非心血管合并症的患病率较低，冠状动脉造影和血运重建的比例较高。新代码引入后，归因于 1 型 MI 的患者的风险调整住院死亡率（0.007%；P<0.001）斜率呈正偏移，风险调整 30 天再入院率（-0.002%；P=0.05）呈负偏移。
结论
2 型和 3-5 型 MI 的 ICD-10 编码的引入与归因于 1 型 MI 的 ICD-10 编码的住院人数减少以及这些患者的观察特征和治疗模式的变化相关。
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