Chami Jason, Nicholson Calum, Strange Geoff, Baker David, Cordina Rachael, Celermajer David S
Sydney Medical School, University of Sydney, Camperdown, NSW, 2006, Australia.
Heart Research Institute, 7 Eliza St, Newtown, NSW, 2042, Australia.
Int J Cardiol Congenit Heart Dis. 2022 Jan 4;7:100320. doi: 10.1016/j.ijcchd.2022.100320. eCollection 2022 Mar.
Hospital discharge codes are relied upon for research, accounting/invoicing and health systems planning. Congenital heart disease (CHD), however, is uniquely difficult for non-cardiologists to code due to the rarity, variety and complexity of lesions. It is therefore important that the accuracy of hospital discharge codes is regularly checked to ensure that the prevalence and burden of CHD is being correctly estimated and recorded.
We identified all inpatient admissions of adults with CHD to Royal Prince Alfred Hospital in Sydney, Australia from January 2018 to March 2021 (257 admissions, 106 unique patients). The associated discharge coding summaries were extracted and compared to the codes in the separately collected and audited Adult CHD database. Only a quarter of discharge coding summaries contained any diagnosis of CHD, and just one-tenth accurately recorded all appropriate CHD diagnoses. Patients with simple lesions were most likely to have a coded diagnosis of CHD, while those with moderate and complex lesions were much less likely. Moreover, patients admitted under a cardiovascular specialty were twice as likely to have a coded diagnosis of CHD, compared with those admitted under non-cardiovascular specialties (p = 0.006). Overall, less than half of patients had any hospital-coded diagnosis of CHD in any admission over the three-year study period.
Hospital discharge coding dramatically underreports CHD, especially for patients with moderate and severe CHD lesions and for admissions under non-cardiovascular specialties. This suggests that discharge coding-based estimates of the burden of CHD on hospitals and health systems may be substantially underestimated.
医院出院编码用于研究、会计/计费和卫生系统规划。然而，由于先天性心脏病（CHD）病变的罕见性、多样性和复杂性，非心脏病专家对其进行编码特别困难。因此，定期检查医院出院编码的准确性很重要，以确保正确估计和记录CHD的患病率和负担。
我们确定了2018年1月至2021年3月期间澳大利亚悉尼皇家阿尔弗雷德王子医院所有成年CHD患者的住院情况（257例住院，106例不同患者）。提取相关的出院编码摘要，并与单独收集和审核的成人CHD数据库中的编码进行比较。只有四分之一的出院编码摘要包含任何CHD诊断，只有十分之一准确记录了所有适当的CHD诊断。病变简单的患者最有可能有CHD的编码诊断，而病变中度和复杂的患者则可能性小得多。此外，与非心血管专科收治的患者相比，心血管专科收治的患者有CHD编码诊断的可能性是其两倍（p = 0.006）。总体而言，在三年研究期间，不到一半的患者在任何一次住院中有任何医院编码的CHD诊断。
医院出院编码严重低估了CHD，特别是对于患有中度和重度CHD病变的患者以及非心血管专科收治的患者。这表明基于出院编码对CHD给医院和卫生系统造成的负担的估计可能被大幅低估。
