Biomedical subjects

Andrew G Wilson

Publications and source records attributed to Andrew G Wilson.

2 recordsLinked to original sources

PubMed2002

Reliability of assigning correct current procedural terminology-4 E/M codes.

STUDY OBJECTIVES: We determine the degree of interagency and intra-agency agreement on Current Procedural Terminology-4 (CPT-4) coding levels for emergency department medical records. We hypothesized that the level of agreement among coding agencies would be poor, but the distribution of codes would be similar and not significantly different. METHODS: We performed a prospective observational study consisting of 3 separate randomized, blinded trials: 2 interagency comparisons and 1 intra-agency comparison. The setting was 2 suburban academic EDs. In the 2 interagency audits, 4 coding agencies were used. In the intra-agency comparison, we used 5 individual coders from within our own internal agency. The main outcome measures were the level of agreement not due to chance estimated with the multiple-rater weighted kappa statistic and the Kendall tau-b. We measured the distribution of codes by agency or by individual coders with the chi(2) test. RESULTS: Our sample for the 2 interagency audits consisted of 194 and 195 records, respectively. We observed poor agreement in the level of coding assigned to individual charts among the 4 coding agencies, with kappa values of 0.28 (95% confidence interval [CI] 0.275 to 0.285) and 0.287 (95% CI 0.283 to 0.291). Our intra-agency comparison consisted of 100 records. The agreement in the intra-agency review was significantly better but still fair (kappa=0.436; 95% CI 0.428 to 0.444). The distribution of CPT-4 codes was significantly different for all 3 comparisons (P <.001). CONCLUSION: For our patient population, group of physicians, and methods of documentation, we identified poor-to-fair agreement in coding of emergency charts between coding agencies. Only fair agreement was measured in the intra-agency sample. The distribution of assigned CPT-4 codes was significantly different in each comparison. These findings have important financial and legal implications regarding the reliability of coding methods.

Centers for Medicare and Medicaid Services, U.S.↗

PubMedDate not supplied

A pilot study of home treatment of deep vein thrombosis with subcutaneous once-daily enoxaparin plus warfarin.

OBJECTIVE: To evaluate patient satisfaction, effectiveness, and safety of at-home treatment of acute deep vein thrombosis (DVT) with subcutaneous enoxaparin dosed at 1.5 mg/kg once daily plus oral warfarin. METHODS: Patients with acute DVT and no more than 1 previous episode of DVT received enoxaparin plus oral warfarin until their international normalized ratio (INR) was >2 on 2 consecutive days. Patients were recruited between November 2000 and June 2003, and a home-care nurse visited the patient daily to administer the enoxaparin and to perform a fingerstick INR test. Patients received warfarin at doses adjusted to maintain an INR in the range of 2 to 3. Efficacy and safety were assessed daily by a home-care nurse and then by telephone interview conducted by a pharmacist at 14, 30, and 90 days during follow-up. Patient satisfaction with treatment was assessed by a verbal questionnaire. RESULTS: There were 52 patients enrolled. The mean duration of enoxaparin home treatment was 4.5 days, and the mean INR on discontinuation of enoxaparin was 2.73. Most patients (84.6%) had INRs within the desired therapeutic range (INR value 2-3); no patient had a subtherapeutic INR. There were no symptoms of recurrent venous thromboembolism reported. Major bleeding occurred 7 days after discontinuation of enoxaparin in one patient with impending surgery for removal of a uterine tumor. There were 2 cases of minor bleeding. The patient satisfaction questionnaire revealed that patients considered home treatment to be acceptable. The average cost savings was $2,925 per patient compared with typical inpatient treatment with unfractionated heparin. CONCLUSION: The results of this pilot study suggest that home treatment with initial once-daily enoxaparin in conjunction with long-term oral warfarin is a safe and effective alternative to inpatient therapy with once-daily enoxaparin or unfractionated heparin for select patients with acute DVT. Cost savings are derived from the substitution of inpatient care with home care.

Adult↗