Slotina Ekaterina, Ditscheid Bianka, Meissner Franziska, Marschall Ursula, Wedding Ulrich, Freytag Antje
Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany.
Barmer Institute for Health Systems Research, Berlin, Wuppertal, Germany.
SAGE Open Med. 2024 Aug 13;12:20503121241269599. doi: 10.1177/20503121241269599. eCollection 2024.
ICD-10-based approaches often provide the basis for retrospective estimation of potential palliative care need. Applying the ICD-10-based Murtagh et al. classification from 2014 (Murtagh classification), developed using mortality data, to administrative claims data leads to inconsistencies in estimating palliative care need. The aim of the study was to refine the classification for palliative care need estimation in deceased individuals with cancer and non-cancer diagnosis.
A retrospective population-based study comparing Murtagh classification to a new ICD-10-based classification (revised by expert opinion) was conducted using outpatient and inpatient claims data, including billing codes for palliative care. Palliative care need was estimated for diagnoses groups and was contrasted with palliative care utilization rates in the last year of life. Our dataset included records of 417,405 individuals who deceased in 2016-2019.
Out of individuals deceased in 2019 ( = 117,436), 81.4% had at least one diagnosis from the new classification, while 97.0% had at least one diagnosis from the Murtagh classification. Classification revision thus identified fewer individuals as potentially in need of palliative care. Among individuals with cancer, 70.7% (vs. 55.7% via Murtagh classification) received palliative care. In non-cancer subgroups, the utilization rate was considerably lower, with a maximum of 36.7% (vs. 33.7% via Murtagh classification) in 2019. Similar results were observed for the other years.
Compared to the ICD10-based Murtagh classification, the revised ICD-10-based classification enables more realistic estimations if the cause of death is unavailable and reveals higher rates of palliative care coverage and differences especially in cancer versus non-cancer diseases. German Clinical Trials Register (DRKS00024133).
基于国际疾病分类第十版（ICD - 10）的方法通常为回顾性估计潜在姑息治疗需求提供依据。将2014年基于ICD - 10的莫塔格等人的分类法（莫塔格分类法，利用死亡率数据制定）应用于行政索赔数据会导致在估计姑息治疗需求时出现不一致情况。本研究的目的是完善针对患有癌症和非癌症诊断的已故个体的姑息治疗需求估计分类法。
使用门诊和住院索赔数据（包括姑息治疗计费代码）进行了一项基于人群的回顾性研究，将莫塔格分类法与一种新的基于ICD - 10的分类法（经专家意见修订）进行比较。对诊断组的姑息治疗需求进行了估计，并与生命最后一年的姑息治疗利用率进行了对比。我们的数据集包括2016 - 2019年死亡的417,405人的记录。
在2019年死亡的个体（n = 117,436）中，81.4%至少有一项来自新分类法的诊断，而97.0%至少有一项来自莫塔格分类法的诊断。因此，分类法修订后确定可能需要姑息治疗的个体较少。在患有癌症的个体中，70.7%（相比通过莫塔格分类法的55.7%）接受了姑息治疗。在非癌症亚组中，利用率要低得多，2019年最高为36.7%（相比通过莫塔格分类法的33.7%）。其他年份也观察到了类似结果。
与基于ICD - 10的莫塔格分类法相比，如果死亡原因未知，修订后的基于ICD - 10的分类法能够进行更现实的估计，并揭示出更高的姑息治疗覆盖率以及尤其是癌症与非癌症疾病之间的差异。德国临床试验注册中心（DRKS00024133）。
