Rezaeiahari Mandana, Brown Clare C, Ali Mir M
Department of Health Policy and Management, University of Arkansas for Medical Sciences, Arkansas, USA.
Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Arkansas, USA.
Womens Health Rep (New Rochelle). 2022 May 2;3(1):458-464. doi: 10.1089/whr.2021.0092. eCollection 2022.
Severe maternal morbidity (SMM) is considered as a near miss for maternal death, therefore it is crucial to identify and prevent SMM. Medical insurance claims can be used to identify SMM. There was a national transition from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) to International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) in October 2015.
This study investigates the impact of transition from ICD-9-CM to ICD-10-CM on the rates of SMM in the state of Arkansas using birth certificates linked with insurance claims data in the Arkansas All-Payer Claims Database (APCD).
Birth certificates between January 1, 2013, and December 31, 2017, were linked to insurance claims data from the APCD. SMM was defined using the algorithm provided by the Centers for Disease Control and Prevention, using ICD-9 codes for births before October 1, 2015, and ICD-10-CM codes for births on or after October 1, 2015.
The incidence of SMM increased after transition to the ICD-10-CM system in Arkansas. The relatively higher rate of SMM in ICD-10-CM versus ICD-9-CM was greater in magnitude on the delivery day and throughout the 42-day postpartum period (odds ratio [OR]: 1.30; 95% confidence interval [CI]: 1.20-1.42) compared with the rate on the day of delivery (OR: 1.20; 95% CI: 1.06-1.36). When excluding blood transfusions, the higher rate of SMM during the ICD-10 era was even greater both in the delivery day and 42-day postpartum period (OR: 1.66; 95% CI: 1.49-1.85) and on the day of delivery (OR: 1.58; 95% CI: 1.31-1.90).
严重孕产妇发病（SMM）被视为孕产妇死亡的濒死情况，因此识别和预防SMM至关重要。医疗保险理赔数据可用于识别SMM。2015年10月，美国进行了从《国际疾病分类》第九版临床修订本（ICD-9-CM）到《国际疾病分类》第十版临床修订本/手术编码系统（ICD-10-CM/PCS）的全国性转换。
本研究利用与阿肯色州全支付者理赔数据库（APCD）中的保险理赔数据相关联的出生证明，调查从ICD-9-CM转换到ICD-10-CM对阿肯色州SMM发生率的影响。
将2013年1月1日至2017年12月31日期间的出生证明与APCD的保险理赔数据相关联。使用疾病控制和预防中心提供的算法定义SMM，2015年10月1日前出生的使用ICD-9编码，2015年10月1日及以后出生的使用ICD-10-CM编码。
阿肯色州转换到ICD-10-CM系统后，SMM的发生率有所上升。与分娩当天相比，ICD-10-CM中SMM的发生率相对高于ICD-9-CM，在分娩日和产后42天期间幅度更大（优势比[OR]：1.30；95%置信区间[CI]：1.20 - 1.42）（分娩日OR：1.20；95% CI：1.06 - 1.36）。排除输血情况后，ICD-10时代分娩日和产后42天期间SMM的较高发生率更高（OR：1.66；95% CI：1.49 - 1.85），分娩当天也是如此（OR：1.58；95% CI：1.31 - 1.90）。
