Kennell and Associates, Inc., Falls Church, VA 22042, USA.
Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, USA.
Mil Med. 2024 Nov 21;189(Supplement_4):78-86. doi: 10.1093/milmed/usad462.
The U.S. Military Health System (MHS) transitioned to the ICD-10-CM coding scheme in October 2015 and began the phased rollout of a new electronic health record system, MHS GENESIS, in October 2017. Both changes have the potential to affect the observed prevalence and health care utilization associated with musculoskeletal injuries (MSKIs) in service members. The purpose of this article was to (1) determine the effect of the ICD-10-CM transition on the observed prevalence of select MSKI conditions and (2) describe MSKI-related health care utilization in four MTFs during the adoption of MHS GENESIS.
We calculated monthly prevalence rates for six diagnostic groupings of MSKIs routinely seen in the MHS between October 2011 and February 2020. To determine if the transition to ICD-10-CM influenced prevalence rates, we performed an interrupted time series analysis, using the ICD-10-CM transition date (October 1, 2015) as the interruption point. To assess trends in direct and private sector care encounters during the MHS GENESIS transition, we calculated monthly MSKI-related encounters at four MTFs from November 1, 2015 through September 30, 2021.
Three diagnoses had a significant (P < .05) change in the slope, or rate of change, for their monthly prevalence after the introduction of ICD-10-CM (patellofemoral pain syndrome, -0.18; stress fractures, 0.12; subacromial pain, 0.03). These diagnoses also had a significant level change or immediate change in monthly prevalence following the ICD-10-CM transition (patellofemoral pain syndrome, 24.2; stress fractures, 0.16; subacromial pain, 0.36). Three of the four sites adopting MHS GENESIS showed reduced 3-month averages (range: -7.1-13.0%) of MSKI-related encounters following the electronic health record transition. For two of the four MTFs, we observed an increased reliance on private sector immediately leading up to and following the change to MHS GENESIS.
The observed differences in monthly prevalence for certain MSKIs could be because of the changes in the amount and/or specificity of available codes in ICD-10-CM. Within the six selected diagnostic groupings of MSKIs, we found that patellofemoral pain syndrome, stress fractures, and subacromial pain syndrome demonstrated the greatest changes in prevalence during the ICD-10-CM transition. Those involved in MSKI surveillance should exercise caution when evaluating MSKI prevalence that spans the ICD-10-CM transition. Changes in health care utilization patterns in two of the four MTFs during their adoption of MHS GENESIS suggest that MSKI care may have transferred from direct to private sector care during this period. Future research will be required to validate this finding and determine the impacts on clinical outcomes and military readiness.
美国军事卫生系统 (MHS) 于 2015 年 10 月过渡到 ICD-10-CM 编码方案，并于 2017 年 10 月开始分阶段推出新的电子健康记录系统 MHS GENESIS。这两个变化都有可能影响到军人中肌肉骨骼损伤 (MSKI) 的观察到的流行率和医疗保健利用情况。本文的目的是：(1) 确定 ICD-10-CM 过渡对选定 MSKI 状况的观察到的流行率的影响；(2) 在 MHS GENESIS 采用期间描述四个 MTF 中与 MSKI 相关的医疗保健利用情况。
我们计算了 2011 年 10 月至 2020 年 2 月期间 MHS 中常规出现的六种 MSKI 诊断组别的每月患病率。为了确定 ICD-10-CM 过渡是否影响患病率，我们使用 ICD-10-CM 过渡日期（2015 年 10 月 1 日）作为中断点进行了中断时间序列分析。为了评估在 MHS GENESIS 过渡期间直接和私营部门医疗保健就诊的趋势，我们从 2015 年 11 月 1 日至 2021 年 9 月 30 日在四个 MTF 计算了与 MSKI 相关的每月就诊次数。
三种诊断在引入 ICD-10-CM 后，其每月患病率的斜率（或变化率）有显著变化（P < .05）（髌股疼痛综合征，-0.18；应力性骨折，0.12；肩峰下疼痛，0.03）。这些诊断在 ICD-10-CM 过渡后也有显著的水平变化或每月患病率的即时变化（髌股疼痛综合征，24.2；应力性骨折，0.16；肩峰下疼痛，0.36）。在采用 MHS GENESIS 的四个站点中的三个站点中，在电子健康记录过渡后，与 MSKI 相关的就诊的 3 个月平均值（范围：-7.1%至 13.0%）有所减少。对于四个 MTF 中的两个，我们观察到在过渡到 MHS GENESIS 前后，对私营部门的依赖立即增加。
某些 MSKI 的每月患病率的观察到的差异可能是由于 ICD-10-CM 中可用代码的数量和/或特异性的变化所致。在六个选定的 MSKI 诊断分组中，我们发现髌股疼痛综合征、应力性骨折和肩峰下疼痛综合征在 ICD-10-CM 过渡期间患病率变化最大。在评估跨越 ICD-10-CM 过渡的 MSKI 患病率时，参与 MSKI 监测的人员应谨慎行事。在四个 MTF 中的两个 MTF 中，在采用 MHS GENESIS 期间，医疗保健利用模式发生了变化，这表明在此期间，MSKI 护理可能已从直接护理转移到私营部门护理。未来的研究将需要验证这一发现，并确定对临床结果和军事准备的影响。
