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At least 199 records · Page 11Linked to original sources
PubMed2006

ICD-10-CA/CCI coding algorithms for defining clinical variables to assess outcome after aortic and mitral valve replacement surgery.

Implementation of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada (ICD-10-CA) and the Canadian Classification of Interventions (CCI) coding system presents challenges for using Canadian administrative data. Thus, a multi-step process was conducted to develop ICD-10-CA/CCI coding algorithms to define nine comorbidities and three procedures. These clinical variables have been used in ICD-9-CM data for risk adjustment in assessment of outcomes after aortic and mitral valve replacement surgery. Among patients included in the ICD-9-CM data during 1999 and 2001 and in the ICD-10-CA/CCI data during 2002 and 2003 in a Canadian Health Region, frequencies of the nine comorbidities and the three procedures remained generally similar across databases. The newly developed ICD-10-CA/CCI and previous ICD-9-CM coding algorithms are comparable in detecting these clinical variables. However, performance of ICD-10-CA/CCI coding algorithms in risk adjustment should be evaluated in a larger database.

Algorithms↗
PubMed1997

[Codes and names of clinical laboratory tests and shared interlaboratory databases].

Physicians need to combine and compare laboratory data for one patient results from many laboratories and hospital officers and policy makers also need to merge them form the view point of public health. As there are many different codes used by different sources for the same test, it is impossible to transmit results using electronic massage standards. This problem would not exist if all laboratories used the same universal set of test identifiers. Public use sets of codes and names of clinical laboratory tests are available. We have to select and use them properly. We proposed a project to have a systematizing guideline for laboratory systems not for rationalization of laboratory works but for sharing database to assess appropriate laboratory use.

Clinical Laboratory Information Systems↗
PubMedDate not supplied

Clinical terms project: a coding system for clinicians.

Advances in information management and technology are necessary for improved communication, research and resource management in the health service. The medical profession must be closely involved in the development of a computer-based communications network if it is to be clinically useful and acceptable. The Read codes have been developed by clinicians and form the basis of an entire clinical information system.

England↗
PubMed2004

Evaluation of angiotensin-converting enzyme inhibitor use in patients with type 2 diabetes in a state managed care plan.

OBJECTIVE: To compare angiotensin-converting enzyme (ACE) inhibitor use in patients with type 2 diabetes at 1 year and 3 years after guidelines were published. STUDY DESIGN: Retrospective database review. PATIENTS AND METHODS: The drug utilization review database of a state managed care plan was accessed to retrieve 2 random samples of 500 patients each. These patients had an International Classification of Diseases, Ninth Revision, Clinical Modification code for diabetes mellitus (250) and a National Drug Code for an oral hypoglycemic agent in both 1998 and 2000. Specific clinical modification codes, prescription claims, and diagnostic codes were obtained from patient profiles. Use of ACE inhibitors in 1998 and 2000 then was evaluated by using Pearson's chi-square test. RESULTS: The proportion of patients with diabetes and hypertension who were taking an ACE inhibitor increased by 10 percentage points over the 2 years; however, ACE inhibitors were only used in 46% of those patients in 2000. A few of the patients receiving an ACE inhibitor had a contraindication to use of the agent. Microalbuminuria screening and glycosylated hemoglobin screening were found to have been conducted in only 4.6% and 54.6%, respectively, of the 496 patients in 2000. CONCLUSIONS: The results of this study indicate that although ACE inhibitor use improved, fewer than 50% of patients received appropriate therapy. Awareness of and adherence to the recommendations in the guidelines need to be improved. Larger studies may be beneficial to determine more clearly the extent of this problem.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1998

Medicare coding and reimbursement for clinical laboratory services.

Medicare will continue to increase its efforts to cut spending through aggressive review of claims and the use of new fraud and abuse regulations. Providers must be especially careful to provide correct procedure codes that define precisely what services have been provided and accurate diagnosis codes that link those procedures or tests to an appropriate diagnosis. Medicare reimbursement rules for clinical laboratory procedures are explained, including the proper use of procedure and diagnosis codes. Coding and payment for new automated test panels are discussed, as well as the economic consequences of using smaller panels. Medicare coverage requirements, including medical necessity, are described, as well as the proper use of advance beneficiary notices and the Medicare appeals process.

Abstracting and Indexing↗
PubMedDate not supplied

[Comparison between peak expiratory flow rate and daily report of the symptoms in asthmatic children (author's transl)].

In a group of 140 asthmatic children (6-15 years old) followed up for six months, the authors compared : (1) the daily transcription of asthmatic symptoms, of their intensity and of the use of antibiotics or corticosteroids ; (2) the peak expiratory flow rate measured daily at nine a.m. ; (3) the clinical history, coded every fifth day. A clinical score was computed by multiple linear correlation between (1) and (3), with a correlation coefficient of 0.84 (p less than 0.001), showing that the propounded quantification of symptoms and treatments was very good for estimating the clinical history. The coefficient of simple linear correlation between peak expiratory flow rate and score (r = --0.41) and between peak expiratory flow rate and clinical history (r = --0.65) was statistically significant ; however a further computation by stepwise multiple linear correlation showed that the peak expiratory flow rate was essentially correlated to the intensity of the symptoms, and to a lesser degree to the presence of breathlessness and prescription of corticosteroids. The correlation coefficient was -- 0.55 (p less than 0.01). Thus the peak expiratory flow rate does not very well account for the clinical state of asthmatics ; useful for the fast but superficial monitoring of patients, it cannot replace the daily transcription of symptoms and treatments : both methods are complementary.

Adolescent↗
PubMed2003

Randomised crossover trial comparing the performance of Clinical Terms Version 3 and Read Codes 5 byte set coding schemes in general practice.

OBJECTIVE: To determine whether Clinical Terms Version 3 provides greater accuracy and consistency in coding electronic patient records than the Read Codes 5 byte set. DESIGN: Randomised crossover trial. Clinicians coded patient records using both schemes after being randomised in pairs to use one scheme before the other. SETTING: 10 general practices in urban, suburban, and rural environments in Norfolk. PARTICIPANTS: 10 general practitioners. SOURCE OF DATA: Concepts were collected from records of 100 patient encounters. MAIN OUTCOME MEASURES: Percentage of coded choices ranked as being exact representations of the original terms; percentage of cases where coding choice of paired general practitioners was identical; length of time taken to find a code. RESULTS: A total of 995 unique concepts were collected. Exact matches were more common with Clinical Terms (70% (95% confidence interval 67% to 73%)) than with Read Codes (50% (47% to 53%)) (P < 0.001), and this difference was significant for each of the 10 participants individually. The pooled proportion with exact and identical matches by paired participants was greater for Clinical Terms (0.58 (0.55 to 0.61)) than Read Codes (0.36 (0.33 to 0.39)) (P < 0.001). The time taken to code with Clinical Terms (30 seconds per term) was not significantly longer than that for Read Codes. CONCLUSIONS: Clinical Terms Version 3 performed significantly better than Read Codes 5 byte set in capturing the meaning of concepts. These findings suggest that improved coding accuracy in primary care electronic patient records can be achieved with the use of such a clinical terminology.

Adult↗
PubMed2001

The legal status of clinical and ethics policies, codes, and guidelines in medical practice and research.

This article examines the legal status of "soft law" in the fields of medicine and medical research. Many areas of clinical practice and research involve complex and rapidly changing issues for which the law provides no guidance. Instead, guidance for physicians and researchers comes from what has often been called "soft law"--non-legislative, non-regulatory sources, such as ethics policy statements, codes, and guidelines from professional or quasi-governmental bodies. This article traces the evolution of these "soft law" instruments: how they are created, how they are adopted within the professional community, and how they become accepted by the courts. It studies the relationship between soft law instruments and the courts. It includes an examination of the approaches to judicial analysis used by the courts in theory and in practice. The authors then examine the jurisprudence to see how courts will adopt professional norms as the legal standard of care in some circumstances and not others. They consider the legal concerns and ethical issues surrounding the weight attached to professional practices and norms in law. The authors demonstrate how practices and policies that guide professional conduct may ultimately bear weight as norms recognizable and enforceable within the legal sphere.

Bioethical Issues↗
PubMed1999

An index of clinical oral disorder in elders (CODE).

Attempts to construct an index of oral health or disorder suitable for older adults have been limited in clinical scope or based on the judgement of very few individuals. Consequently, we present here a multidimensional index of Clinical Oral Disorder in Elders (CODE) based on a breadth of clinical measures relevant to elders. The data for the index are derived from a clinical examination of jaw function, dentures, mucosa, teeth, and periodontium. Weighting or ranking for each disorder within the context of an elderly person was established as mild, moderate or severe by experienced dental clinicians and dental hygienists. Subsequently, the index was constructed by transforming the weights into a numerical value for each clinical measure. Individual scores can relate to the heaviest weight identified during the examination or to the sum of the weights assigned throughout the examination, and the average score during a series of examinations will reflect the clinical status of a particular population. Clinical applications in elderly residential-care populations indicate that the index can be constructed efficiently and with reasonable reliability. We suggest, therefore, that the CODE index is suitable for descriptive and comparative research by providing a clinical format for measuring oral disorder in disabled elders, and, when combined with a psychosocial index, it should be very comprehensive indicator of oral dysfunction in older adults.

Aged↗
PubMed1998

Compositional concept representation using SNOMED: towards further convergence of clinical terminologies.

This paper describes several approaches to the expression and coding of clinical concepts as composites of elementary entities, and describes an approach based on SNOMED RT that may permit further convergence of clinical terminology efforts. We explain the shortcomings of previous approaches to compositional concept representation, as well as the reasons for SNOMED's current approach, which adopts a foundation based in description logics (DLs). The DL model has many advantages: it establishes a formal semantics for SNOMED assertions and suggests a syntax; it provides a basis for understanding expressiveness and computational complexity, through correspondence with known results from DLs; and it helps to clarify the relationships among existing concept representation methods in SNOMED, NHS Clinical Terms (formerly the Read Codes), and GALEN, making a path to convergence more clear.

Models, Theoretical↗
PubMed2003

Clinical evaluation of chirp-coded excitation in medical ultrasound.

Despite the enormous development in medical ultrasound (US) imaging over the last decades, penetration depth with satisfying image quality is often a problem in clinical practice. Coded excitation, used for years in radar techniques to increase signal-to-noise ratio (SNR), has recently been introduced in medical US scanning. In the present study, coded excitation using frequency-modulated US signals is implemented and evaluated in vivo.A total of nine male volunteers were scanned in three different abdominal locations, using both conventional pulsed and coded excitation. A modified scanner (B-K Medical model 3535) with transmitter and receiver boards developed in our group and a mechanical 4 MHz transducer were used. The system acquired coded and conventional US image frames interleaved, yielding identical acquisitions with the two techniques. Cine-loop sequences were evaluated by three experienced sonographers estimating penetration depth and scoring image quality of both conventional and coded imaging. The results showed a significant (p < 0.001) increase in penetration depth around 2 cm. Image quality was significantly (p < 0.001) better using codes at full usable depth and slightly, but also significantly (p < 0.05), better above depths, where the effect of coded excitation was noticeable to the sonographers. We conclude that the higher SNR offered by coded excitation gives improved image quality and provides increased penetration in medical US imaging. This increased SNR can, alternatively, be used to allow imaging at higher frequencies and thereby increase spatial resolution without any loss of penetration.

Abdomen↗
PubMed2004

Written clinic procedures enhance delivery of HIV "prevention with positives" counseling in primary health care settings.

BACKGROUND: The Institute of Medicine recommends prevention counseling in primary health care settings to help HIV-infected individuals reduce the risk of transmitting HIV to others ("prevention with positives"). In this study, we assessed receipt of HIV prevention counseling by patients seen in clinics funded by the Ryan White CARE Act, a major source of support for HIV primary care. METHODS: Six hundred fourteen HIV-infected patients completed an exit survey immediately after an HIV primary care visit at 16 clinics in 9 states. Patient characteristics and frequency of receipt of HIV prevention counseling were measured. Clinic approaches to HIV prevention were coded as clinics with written procedures, clinics where individual providers initiated counseling because of a personal sense of responsibility, and clinics with no procedures. RESULTS: HIV-infected patients in clinics with written procedures were significantly more likely to report receiving HIV prevention counseling in the last 6 months than were patients in clinics with no procedures (odds ratio [OR] = 3.17, 95% confidence interval [CI]:1.24-8.06; P < 0.02). In clinics where individual providers initiated counseling and in clinics with no procedures, patient characteristics such as race, gender, and sexual orientation were associated with receipt of prevention counseling. These differences were not observed in clinics with written procedures, however. CONCLUSION: Written procedures provide an important guide for clinic staff and increase the likelihood that patients receive prevention with positives counseling irrespective of patient characteristics.

Adolescent↗
PubMed1996

The epidemiology, clinical characteristics, and natural history of older nursing home residents with a diagnosis of Parkinson's disease.

OBJECTIVE: To determine the epidemiology, clinical characteristics and natural history of nursing home residents with a diagnosis of Parkinson's disease (PD). DESIGN: A cohort study with 18-month follow-up utilizing resident assessments from the National HealthCorp 1991-1992 dataset. SETTING: Seventy-one National HealthCorp nursing homes. PARTICIPANTS: A total of 5020 nursing home residents older than age 55 were studied. Residents with primary and secondary diagnoses of PD were identified from the population using the International Classification of Diseases, Ninth Revision, Clinical Modification code 332.0. MEASUREMENTS: Baseline demographic and clinical characteristics were compared for residents with and those without Parkinson's disease. Outcome measures over the course of 18 months included death and functional status. RESULTS: The prevalence of a diagnosis of PD was 6.8%. Significant factors associated independently with PD included: younger age (79 +/- 7 vs 81 +/- 9 years; P < .001), male sex (32% vs 23%; P < .001), severe dependence in activities of daily living (OR = 1.26; 95% CI 1.08-1.46), impared body control (OR = 1.38; 95% CI 1.03-1.68), symptoms of depression (OR = 1.29; 95% CI 1.02-1.64), and the number of daily medications (OR = 1.23; 95% CI 1.08-1.44). Residents with a diagnosis of PD had a faster rate of functional decline over 18 months (P < .001) but did not have a higher mortality rate than residents without PD. CONCLUSIONS: Parkinson's disease is a relatively common diagnosis among nursing home residents and is associated with increased functional disability. There are several potentially modifiable conditions associated with PD that may offer an opportunity to design specific interventions and health services to improve the quality of life and slow functional decline in this frail population.

Activities of Daily Living↗
PubMed2005

Reducing amputation rates in patients with diabetes at a military medical center: the limb preservation service model.

OBJECTIVE: To describe and evaluate the Limb Preservation Service (LPS), a multidisciplinary, state-of-the-art, foot care clinic for patients with diabetes at Madigan Army Medical Center (MAMC). Evaluation criteria include the overall incidence of lower-extremity amputation (LEA) and the distribution of the anatomic level of amputation between 1999 and 2003. RESEARCH DESIGN AND METHODS: This is a retrospective study of the incidence and types of LEAs performed in patients with diabetes at MAMC. Patients with diagnosed diabetes and LEA procedures were identified by ICD-9-Clinical Modification (CM) codes. Hospital and clinic characteristics that are integral to the success of the program are described. RESULTS: The number of patients at MAMC with diagnosed diabetes increased 48% from 1999 to 2003; however, the number of LEAs decreased 82% from 33 in 1999 to 9 in 2003. Amputations of the foot, ankle, and toe comprise 71% of amputations among patients with diabetes. CONCLUSIONS: The results of this study provide evidence of the value of a focused multidisciplinary foot care program for patients with diabetes. Associations between the creation of the LPS and LEA rates are discussed.

Amputation, Surgical↗