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At least 253 records · Page 14Linked to original sources
PubMed1987

A new electrocardiographic classification for post-myocardial infarction clinical trials.

A new electrocardiographic code was developed for clinical trials involving patients with acute myocardial infarction (AMI). In the Multicenter Post-Infarction Program (MPIP), the electrocardiogram, classified by the Minnesota code, was not useful as a clinical predictor and played almost no role in subsequent analysis. To test its value the new code was applied to the electrocardiograms of 653 of the 866 patients in the MPIP data base who had sustained a first AMI. The MPIP code identifies AMI by region and severity. The 4 regions are anterior, lateral, inferior and posterior, defined by traditional criteria. Severity codes include Q-wave and non-Q-wave AMI, ST depression and no ischemic changes. The interpretation for each of 4 regions results in a 4-digit location severity code that is amenable to sorting and analysis. Fourteen separate and mutually exclusive groups were identified. Mortality gradients were found within the inferior AMI groups, but not within the anterior AMI groups. Mean ejection fraction was 50% for patients with isolated anterior infarction and decreased progressively (p less than 0.0003) as the extent of lateral wall involvement increased. For isolated inferior AMI, mean ejection fraction was 53%; lateral or posterior involvement did not significantly change this. The MPIP code is easy to apply, correlates acceptably well with clinically relevant variables of left ventricular function and permits the electrocardiogram to be used as a clinical predictor in large clinical trials.

Clinical Trials as Topic↗
PubMed2006

Automating the assignment of diagnosis codes to patient encounters using example-based and machine learning techniques.

OBJECTIVE: Human classification of diagnoses is a labor intensive process that consumes significant resources. Most medical practices use specially trained medical coders to categorize diagnoses for billing and research purposes. METHODS: We have developed an automated coding system designed to assign codes to clinical diagnoses. The system uses the notion of certainty to recommend subsequent processing. Codes with the highest certainty are generated by matching the diagnostic text to frequent examples in a database of 22 million manually coded entries. These code assignments are not subject to subsequent manual review. Codes at a lower certainty level are assigned by matching to previously infrequently coded examples. The least certain codes are generated by a naïve Bayes classifier. The latter two types of codes are subsequently manually reviewed. MEASUREMENTS: Standard information retrieval accuracy measurements of precision, recall and f-measure were used. Micro- and macro-averaged results were computed. RESULTS At least 48% of all EMR problem list entries at the Mayo Clinic can be automatically classified with macro-averaged 98.0% precision, 98.3% recall and an f-score of 98.2%. An additional 34% of the entries are classified with macro-averaged 90.1% precision, 95.6% recall and 93.1% f-score. The remaining 18% of the entries are classified with macro-averaged 58.5%. CONCLUSION: Over two thirds of all diagnoses are coded automatically with high accuracy. The system has been successfully implemented at the Mayo Clinic, which resulted in a reduction of staff engaged in manual coding from thirty-four coders to seven verifiers.

Abstracting and Indexing↗
PubMed1998

Accuracy of ICD-9-CM coding for the identification of patients with acute ischemic stroke: effect of modifier codes.

BACKGROUND AND PURPOSE: Discharge ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) codes have been used to identify patients with acute stroke for epidemiological, quality of care, and cost studies. The aim of this study was to determine if the accuracy of the primary ICD-9-CM codes for ischemic stroke is improved by modifier codes and how specific codes reflect stroke subtype diagnoses. METHODS: Available hospital charts for all patients discharged from a single hospital between May 1995 and June 1997 with ICD-9-CM codes 433 (occlusion and stenosis of precerebral arteries), 434 (occlusion of cerebral arteries), or 436 (acute but ill-defined cerebrovascular disease) listed in the first position were reviewed. The primary discharge diagnosis was verified, and a presumed stroke subtype was assigned on the basis of information provided in the medical record. RESULTS: Charts were available for 175 of the 198 identified patients (88%). Of these, 61% had an acute ischemic stroke (code 433, 4%; 434, 82%; 436, 79%) with the remaining patients having other conditions. Of the 130 patients with a modifier code indicating cerebral infarction, 79% had an acute stroke; of the 45 patients with a modifier code indicating an absence of cerebral infarction, 7% had acute stroke (sensitivity, 0.97; specificity, 0.60). The codes with the highest proportions of ischemic stroke cases were 434.11 (embolic occlusion of cerebral arteries with infarction, 85%), 434.91 (unspecified occlusion of precerebral arteries with infarction, 82%), and 436 (79%), with a combined sensitivity of 0.81 and specificity of 0.90. On review, 73% of patients with code 434.11 had embolic strokes, and 47% of those with code 436 had an identified stroke cause. Of patients with code 434.91, 39% had stroke of uncertain cause, 25% "lacunar," 17% atherothrombosis, and 15% embolism. CONCLUSIONS: Despite the use of modifier codes, 15% to 20% of patients with the indicated primary ICD-9-CM codes have conditions other than acute ischemic stroke. Although the proportion of patients with acute stroke increased from 61% to 79% with the use of modifier codes, the inclusion of modifier codes did not have an appreciable effect on the accuracy of the coding if patients with code 433 are excluded. Assignment of presumed ischemic stroke subtype is particularly inaccurate.

Acute Disease↗
PubMed2006

Billing effectively with the new health and behavior current procedural terminology codes in primary care and specialty clinics.

The health and behavior current procedural terminology (CPT) codes introduced in 2003 have gained nationwide acceptance through Medicare and limited acceptance through third party payers. The codes facilitate accurate description and quantification of behavioral medicine services within a primary care or specialty clinic setting. The author reviews their appropriate utilization to enhance reimbursement and facilitate development of self-sustaining behavioral medicine programs. Information is provided on increased use and reimbursement of codes within psychology. Future directions for continued advocacy, increased acceptance, training, and research are discussed.

Behavioral Medicine↗
PubMed1997

[International standardization of laboratory information systems].

The standardization of clinical laboratory information systems is one of the most difficult but important subjects for clinical laboratory community and laboratorians. International Standard Organization (ISO) has the projects in this field (JTC1/SC7) which is the part of approach to the international laboratory standardization (ISO/TC 212). US NCCLS and European CEN/TC 251 are working under ISO/TC 212. In the United States, the National Academy for Clinical Biochemistry (NACB) and the American Association for Clinical Chemistry (AACC) had started recently to organize the international collaboration program on the subject. The Japan Society of Clinical Pathology (JSCP)'s Council of Laboratory Informatics had joined this program in 1995. NACB/AACC's Ad Hoc Committee which was organized in 1996 is now trying to collect the general opinions ("what and how") through their internet home page. The current status of the works on the standardization of clinical laboratory information systems in the U.S., Europe, and Japan is reviewed briefly in this article. HL7 electronic data exchange specification and clinical testing coding systems such as LOINC coding project and JSCP's coding project are also reviewed.

Clinical Laboratory Information Systems↗
PubMed2002

Coding errors and the trauma patient--is nursing case management the solution?

The aim was to investigate the accuracy of clinical information coding and the financial consequence for trauma patients at a tertiary trauma centre using the resources of trauma nursing case managers. Clinical data for admitted trauma patients in August and September 2000 were compared with data routinely obtained by trauma case managers on their daily rounds. We audited patient injuries, in-hospital complications, investigations, and procedures. Clinical information records requiring alteration were returned to the clinical information manager with additional information and re-entered into the clinical information database. 100 trauma patient records (15% of admissions for 2000) were audited. 28% of recoded records had to have their diagnosis related group (DRG) changed, which resulted in the identification of additional funding of over $39,000. We conclude that the implementation of episode funding for acute episodes, such as the complex trauma patient, is placing increased importance on accuracy of coding. The validity of coding is dependent on legible, comprehensive and complete documentation and is improved dramatically by using nursing case manager patient progress summaries.

Case Management↗
PubMed1994

How to structure clinical practice guidelines for continuous quality improvement?

The purpose of this study was to evaluate the relevance of available practice guidelines to clinical quality improvement programs. A sample of 19 guidelines was evaluated in four prominent primary care areas. Two research assistants independently coded the clinical conditions and recommended/not recommended procedures abstracted from the guidelines (Cohen's kappa .67 and .50, respectively). An average of 35.1 (+/- 25.8) medical conditions and 48.4 (+/- 41.5) clinical procedures were defined by the guidelines. Most conditions were defined by using ICD-9-CM, age/sex group, or therapy, but 29% of definitions included symptoms which are not coded routinely. CPT codes alone were unable to identify most procedures. AHCPR guidelines mentioned significantly more procedures (p < .001) and fewer symptoms (p < .001) per clinical condition than other guidelines. The difficulty of finding codes for conditions and procedures, the high rate of non-codable items, and the lack of recommended measures limit the applicability of published clinical practice guidelines to continuous quality improvement programs.

Age Factors↗
PubMed2002

Clinical value of amplitude-coded colour Doppler sonography in paediatric neurosonography.

OBJECTIVE: The object of this study was to evaluate the potential of amplitude-coded colour Doppler sonography (aCDS) in paediatric neurosonography from the aspects of clinical value and impact. PATIENTS AND METHODS: Sixty neonates, infants, and children underwent 72 aCDS investigations after conventional ultrasound (US) studies including conventional colour Doppler. Their diagnoses included tumours, hydrocephalus and cerebral fluid collections, cerebral vascular disorders, cerebral bleeds and hypoxic-ischaemic lesions. The results of aCDS were prospectively compared with the findings obtained with conventional US findings, with CT/MRI results when available (34 patients with 41 investigations), with operative findings (7 patients), and with clinical, laboratory, EEG and follow-up results. RESULTS: Six patients showed normal findings. Fourteen cerebral bleeds were correctly recognised by both conventional US and aCDS; plexus haemorrhage was depicted only on aCDS in 4 additional neonates. In 4 of 6 patients with tumours and vascular malformations aCDS revealed additional information. aCDS improved early detection of focal ischaemic lesions in 10 of 13 cases and enabled Duplex sampling in 7 of 9 children with diffuse hypoxic brain injury. In 5 of 20 patients with hydrocephalus and/or fluid collections aCDS proved helpful (e.g. demonstration of liquor fistula), yielding a sensitivity of 93.75%, as against 43.75% for conventional US. CONCLUSION: aCDS is helpful in differentiating perfused structures such as a prominent ventricular plexus or tumours from structures without perfused vasculature, such as blood clots or ischaemic lesions. aCDS can be considered a valuable adjunct in the differential diagnosis of haemorrhage and ischaemic lesions as well as of vascular malformations and tumours.

Brain Diseases↗
PubMedDate not supplied

Risk-adjustment of cesarean delivery rates: a practical method for use in quality improvement.

Risk-adjustment of cesarean birthrates has been hampered by inadequacies in the existing secondary data sources or by the need for extensive chart review. This study presents an efficient risk-adjustment model for cesarean birth, based on easily retrievable ICD-9 codes and clinical risk factors least influenced by physician practice style. Data are presented for mothers undergoing 7322 deliveries from 1997-1998 at a large academic medical center with a cesarean birth rate of 15.9%. Multiple logistic regression was used to predict the likelihood of cesarean delivery controlled for maternal age, 10 risk factors identified through ICD-9 coding, and 3 additional clinical variables (nulliparity, birth weight, and gestational age) derived from a perinatal (birth certificate) database. All risk factors were significant predictors of cesarean birth, producing an area under the receiver-operating characteristic curve of 0.86 and a 60-fold increase in cesarean delivery from highest to lowest deciles of predicted risk. This methodology can be used widely for quality improvement without the need for extensive chart review.

Academic Medical Centers↗
PubMed2000

Does clinical evidence support ICD-9-CM diagnosis coding of complications?

BACKGROUND: Hospital discharge diagnoses, coded by use of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), increasingly determine reimbursement and support quality monitoring. Prior studies of coding validity have investigated whether coding guidelines were met, not whether the clinical condition was actually present. OBJECTIVE: To determine whether clinical evidence in medical records confirms selected ICD-9-CM discharge diagnoses coded by hospitals. RESEARCH DESIGN AND SUBJECTS: Retrospective record review of 485 randomly sampled 1994 hospitalizations of elderly Medicare beneficiaries in Califomia and Connecticut. MAIN OUTCOME MEASURE: Proportion of patients with specified ICD-9-CM codes representing potential complications who had clinical evidence confirming the coded condition. RESULTS: Clinical evidence supported most postoperative acute myocardial infarction diagnoses, but fewer than 60% of other diagnoses had confirmatory clinical evidence by explicit clinical criteria; 30% of medical and 19% of surgical patients lacked objective confirmatory evidence in the medical record. Across 11 surgical and 2 medical complications, objective clinical criteria or physicians' notes supported the coded diagnosis in >90% of patients for 2 complications, 80% to 90% of patients for 4 complications, 70% to <80% of patients for 5 complications, and <70% for 2 complications. For some complications (postoperative pneumonia, aspiration pneumonia, and hemorrhage or hematoma), a large fraction of patients had only a physician's note reporting the complication. CONCLUSIONS: Our findings raise questions about whether the clinical conditions represented by ICD-9-CM codes used by the Complications Screening Program were in fact always present. These findings highlight concerns about the clinical validity of using ICD-9-CM codes for quality monitoring.

Aged↗
PubMed1997

Right to bill may affect amount of tobacco counselling by MDs.

Unpublished data from Health Canada indicate that only 32% of Canada's family physicians believe they can bill their health plans for providing smoking-cessation counselling to patients with no smoking-related illness. A CMA study of provincial billing codes determined that all provinces and territories except British Columbia and Alberta have billing codes for clinical tobacco interventions, which include counselling. Ontario leads the way with 4 separate codes.

Canada↗
PubMed1996

Concordance between ANSI occupational back injury codes and claim form diagnoses and a lower bound estimate of the fraction associated with disc displacement/herniation.

The current BLS Annual Survey of Occupational Illnesses and Injuries and several recent analyses of factors affecting missed worktime in occupational back injuries rely on ANSI-based injury codes derived from injury narratives to classify occupational injuries and estimate incidence and outcome. No population-based studies of the concordance between back injury codes and clinical diagnoses have been reported. Back injury cases were identified in two large work-injured populations totaling almost 80,000 cases in the states of Michigan and Minnesota. In both populations, cases had been coded by the single nature-of-injury and part-of-body-injured codes assigned by an ANSI-based injury-coding system and by as many as four (Michigan) or three (Minnesota) clinical diagnoses according to the International Classification of Diseases-Clinical Modification, 9th Revision. Concordance was measured by the sensitivity and predictive value positive (PVP, aka PV+ or PPA) of the injury coding scheme for related diagnostic groups. We also used an algorithm based on the limited clinical information available to corroborate the diagnosis of displaced/herniated disc for cases that underwent spinal surgery. Cases identified by the algorithm were then used to obtain a lower bound estimate of the fraction with disc injury. The injury coding scheme had PVPs of 82.9-90.1% and overall sensitivities of 69.7-75.9%. Sensitivities for individual diagnostic groups show that their distribution in ANSI-coded injury groups is skewed slightly toward cases with sprain and disc displacement/herniation, but these shifts are modest. The lower bound estimate of the fraction of cases with disc displacement/herniation in a population of cases with back injuries producing at least 1 day of missed worktime is 5.8%. The demographic comparisons indicate that, as the time between injury and cohort ascertainment increases during the first 8 days of missed worktime following injury, the proportion of younger workers in an injury cohort decreases. The relationship between increasing age and increasing missed worktime disability, reported in various outcome studies, is also present during the first few days following injury. The use of ANSI injury codes underestimates the contribution of back injuries to missed worktime because 24-30% of cases are missed by the ANSI coding system. However, the distribution of diagnostic groups in the injury-coded groups approximates that observed with all diagnosed cases and supports the use of such data to study outcome. Our estimate, and one from Quebec, suggest that disc displacement/herniation occurs more frequently in the subset of occupational back injuries compared to the set of back injuries from all sources.

Adolescent↗