Verana Health, San Francisco, California, USA.
Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, California, USA.
J Am Med Inform Assoc. 2023 May 19;30(6):1199-1204. doi: 10.1093/jamia/ocad037.
Observational studies of diabetic retinopathy (DR) using electronic health record data often determine disease severity using International Classification of Disease (ICD) codes. We investigated the mechanism of missingness for DR severity based on ICD coding using the American Academy of Ophthalmology IRIS® Registry. We included all patient encounters in the registry with a DR ICD-9 or ICD-10 code between January 1, 2014 and June 30, 2021. Demographic, clinical, and practice-level characteristics were compared between encounters with specified and unspecified disease severity. Practices were divided into quartiles based on the proportion of clinical encounters with unspecified DR severity. Encounters with unspecified disease severity were associated with significantly older patient age, better visual acuity, and lower utilization of ophthalmic procedures. Higher volume practices and retina specialist practices had lower proportions of clinical encounters with unspecified disease severity. Results strongly suggest that DR disease severity related to ICD coding is missing not at random.
使用电子健康记录数据进行的糖尿病视网膜病变 (DR) 观察性研究通常使用国际疾病分类 (ICD) 代码来确定疾病的严重程度。我们使用美国眼科学会 IRIS®登记处，基于 ICD 编码研究了 DR 严重程度缺失的机制。我们纳入了 2014 年 1 月 1 日至 2021 年 6 月 30 日期间登记处中所有带有 DR ICD-9 或 ICD-10 代码的患者就诊。在指定和未指定疾病严重程度的就诊之间，比较了人口统计学、临床和实践水平的特征。根据未指定 DR 严重程度的临床就诊比例，将实践分为四组。未指定疾病严重程度的就诊与患者年龄明显较大、视力较好和眼科手术利用率较低有关。高容量实践和视网膜专家实践的未指定疾病严重程度的临床就诊比例较低。结果强烈表明，与 ICD 编码相关的 DR 疾病严重程度的缺失不是随机的。
