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PubMed2006

Impact of a pediatric primary care office-based mock code program on physician and staff confidence to perform life-saving skills.

BACKGROUND: Previous studies have described that pediatric offices are ill-prepared for medical emergencies. Pediatric "mock codes" have been utilized to increase the emergency preparedness of inpatient medical units for several decades. These practice drills have been shown to both increase practitioners' confidence and decrease anxiety during actual resuscitations. Although the use of mock codes is recommended in the outpatient setting, these benefits have yet to be demonstrated for office-based practitioners. OBJECTIVE: We conducted this study to determine whether mock codes performed in pediatric primary care offices increase practitioner confidence to perform life-saving skills. METHODS: Pediatric group practices participated in a clinical trial of an office-based, 2-step, emergency preparedness training. First, physicians and staffs attended a 1-hour didactic program which included staff education, office emergency protocols, emergency equipment and medications, and guidelines on instituting a mock code program. Second, each practice participated in a 10-15-minute mock code exercise. The drill was conducted by pediatric advanced life support instructors. After the code, a 30-minute feedback session was conducted which reviewed office coordination, individual skill performance, and approach to resuscitation. Each participating practice also received an infant manikin and a text complete with several mock codes scenarios written specifically for the pediatric primary care office. Evaluation of the intervention consisted of 2 components. (1) Pre- and postintervention completion of a self-administered survey assessed participants' comfort in emergency situations and confidence to perform specific life-saving skills, using an ordinal scale: 1 = "strongly agree" to 5 = "strongly disagree". (2) Practices were contacted by telephone 12 months after the training to determine whether they had implemented improvements in emergency preparedness, including instituting mock codes, preparing a written emergency protocol and purchasing new emergency equipment and medications. RESULTS: Eleven group pediatric practices participated, which were representative of urban, suburban, and rural offices in southwestern Pennsylvania. Ninety-seven of a total 164 (59%) physicians and staff members completed both pre- and postintervention surveys. Practitioner participants were analyzed in 2 groups. Group 1 consisted of physicians, nurse practitioners, and physician assistants; group 2 consisted of registered nurses, licensed practical nurses, and medical assistants. Comparison of pre- versus postintervention surveys in both of these groups revealed significant improvement in reported confidence to perform resuscitation skills that were included in the mock code after the training: airway positioning (group 1, 67% vs. 94%, P < 0.001; group 2, 55% vs. 75%, P = 0.003), airway suctioning, (group 1, 64% vs. 88%, P = 0.005; group 2, 27% vs. 51%, P < 0.001), and bag-mask assisted ventilation (group 1, 82% vs. 91%, P = 0.003; group 2, 39% vs. 71%, P < 0.001). In addition, group 1 reported more confidence in their ability to place an intraossesous line (24% vs. 39%, P = 0.003) and group 2 showed a significant increase in their confidence to administer oxygen (65% vs. 84%, P < 0.001). As a result of the mock code, 83% of all participants, both medical and nonmedical staffs, and 96% of physicians felt less anxious about medical emergencies in the office. Twelve months after the conclusion of the program, 18% of offices had conducted 1 or more mock codes, 64% of offices had written an emergency protocol, and 27% of offices had acquired essential resuscitation medications or equipment. CONCLUSIONS: The results of this study support the recommendation that mock codes should be performed in the pediatric primary care setting to improve practitioner confidence and decrease practitioner anxiety.

Child↗

PubMed2006

Accuracy of injury coding under ICD-9 for New Zealand public hospital discharges.

OBJECTIVE: To determine the level of accuracy in coding for injury principal diagnosis and the first external cause code for public hospital discharges in New Zealand and determine how these levels vary by hospital size. METHOD: A simple random sample of 1800 discharges was selected from the period 1996-98 inclusive. Records were obtained from hospitals and an accredited coder coded the discharge independently of the codes already recorded in the national database. RESULTS: Five percent of the principal diagnoses, 18% of the first four digits of the E-codes, and 8% of the location codes (5th digit of the E-code), were incorrect. There were no substantive differences in the level of incorrect coding between large and small hospitals. CONCLUSIONS: Users of New Zealand public hospital discharge data can have a high degree of confidence in the injury diagnoses coded under ICD-9-CM-A. A similar degree of confidence is warranted for E-coding at the group level (for example, fall), but not, in general, at higher levels of specificity (for example, type of fall). For those countries continuing to use ICD-9 the study provides insight into potential problems of coding and thus guidance on where the focus of coder training should be placed. For those countries that have historical data coded according to ICD-9 it suggests that some specific injury and external cause incidence estimates may need to be treated with more caution.

Abbreviated Injury Scale↗

PubMed2006

Unspecified falls among youth: predictors of coding specificity in the emergency department.

BACKGROUND: Deficiencies in emergency department (ED) charting is a common international problem. While unintentional falls account for the largest proportion of injury related ED visits by youth, insufficient charting details result in more than one third of these falls being coded as "unspecified". Non-specific coding compromises the utility of injury surveillance data. OBJECTIVE: To re-examine the ED charts of unspecified youth falls to determine the possibility of assigning more specific codes. METHODS: 400 ED charts for youth (aged 0-19 years) treated at four EDs in an urban Canadian health region between 1997 and 1999 and coded as "Other or unspecified fall" (ICD-9 E888) were randomly selected. A structured chart review was completed and a blinded nosologist recoded the cause of injury using the extracted data. Differences in coding specificity were compared with the original data, and logistic regression was undertaken to examine variables that predicted assignment of a specific E-code. RESULTS: A more specific code was assigned to 46% of cases initially coded as unspecified. Of these, 73% were recoded as "Slips, trips, and stumbles" (E885), which still lacks the specificity required for injury prevention planning; 2% of charts had no fall documented. Multivariate analysis revealed that dichotomized injury severity (adjusted odds ratio (OR) = 1.75 (95% confidence interval, 1.11 to 2.78)), arrival at the ED by ambulance (adjusted OR = 5.41 (1.07 to 27.0)), and the availability of nurse's notes or triage forms, or both, in the chart (adjusted OR = 3.75 (2.17 to 6.45)) were the strongest predictors of a more specific E-code assignment. CONCLUSIONS: Deficiencies in both chart documentation and coding specificity contribute to the use of non-specific E-codes. More comprehensive triage coding, improved chart documentation, and alternative methods of data collection in the acute care setting are required to improve ED injury surveillance initiatives.

Accidental Falls↗

PubMed1998

Drowning surveillance: how well do E codes identify submersion fatalities.

OBJECTIVES: The aim was to determine in New Zealand: (1) to what degree the International Classification of Diseases Supplementary Classification (ICD) external cause (E) codes for drowning identify all deaths involving drowning; (2) how the other drowning deaths are distributed across E codes; and (3) whether the proportion of drownings not identified by traditional ICD E codes has changed over time. METHODS: Mortality files for the period 1977-92, which were coded in the range E800-E999 (external causes of injury and poisoning), were searched electronically using the keyword "drown". RESULTS: 2718 cases that involved drowning were identified. This represents a 17.7% increase in the number of cases one would identify using ICD drowning E codes alone. The majority (65%) of the 408 drownings not coded as such were coded as motor vehicle traffic crashes. The number of drownings that were not identified by ICD E codes remained relatively constant over time, although the number of deaths E coded as drowning declined significantly in recent years. CONCLUSION: Standard ICD E codes for drowning do not identify all drowning related deaths, which may make comparisons of injury rates between countries difficult, especially for injuries such as drownings and burns that can be both nature of injury and external cause codes. Multiple cause coding and the inclusion of free text narratives are an important tool to improve the value of a country's vital statistics for injury prevention, and facilitate comparisons with other countries.

Cause of Death↗

PubMed1989

Orchestration of multiple codes in developing readers: an alternative model of lexical access.

An alternative model of lexical access, based on recent PET scan studies showing localized coding operations in multiple brain sites, is proposed. Lexical access is viewed as a process of orchestrating multiple connections between corresponding visible language and oral language coding operations instead of a place--the internal lexicon--to which stimulus words gain access directly or indirectly. In both Study 1 (end of 1st grade) and Study 2 (mid 2nd and mid 4th grade) speed of naming phonically regular words, in which every letter can be phonemically coded, and of naming phonically irregular words, in which every letter cannot be phonemically coded, was not significantly different, indicating that naming can be based on a phonetic code connection rather than phonemic code connections. In both Study 1 and Study 2 speed of correctly accepting phonically regular real words was significantly faster than speed of correctly rejecting nonsense words on lexical decision, showing that absence of a semantic code is not detected as quickly as presence of a semantic code is. In both Study 1 and Study 2 speed of naming a phonically regular real word was significantly faster than speed of naming a nonsense word, demonstrating that naming is facilitated when two connections--between a printed word and its phonetic code and between a printed word and its semantic code--are activated. These findings held whether a key press (Study 1) or voice key (Study 2) response was used. Taken together, the results suggest that the whole word-phonetic code connection may be completed before the whole word-semantic code connection, both of which may precede the letter-phoneme connection in time.

Brain↗

PubMed2001

Evaluation of a method that supports pathology report coding.

OBJECTIVES: The paper focuses on the problem of adequately coding pathology reports using SNOMED. Both the agreement between pathologists in coding and the quality of a system that supports pathologists in coding pathology reports were evaluated. METHODS: Six sets of three pathologists each received a different set of 40 pathology reports. Five different SNOMED code lines accompanied each pathology report. Three pathologists evaluated the correctness of each of these code lines. Kappa values and values for the reliability coefficients were determined to gain insight in the variance observed when coding pathology reports. The system that is evaluated compares a newly entered report, represented as a multi-dimensional word vector, with reports in a library, represented in the same way. The reports in the library are already coded. The system presents the code lines belonging to the five library reports most similar to the newly entered one to the pathologist in this way supporting the pathologist in determining the correct codes. A high similarity between two reports is indicated by a large value of the inproduct of the vector of the newly entered report and the vector of a report in the library. RESULTS: Agreement between pathologists in coding was fair (average kappa of 0.44). The reliability coefficient varied from 0.81 to 0.89 for the six sets of pathology reports. The system gave correct suggestions in 50% of the reports. In another 30% it was helpful for the pathologists. CONCLUSIONS: On the basis of the level of the reliability coefficients it could be concluded that three pathologists are indeed sufficient for obtaining a gold standard for evaluating the system. The method used for comparing reports is not strong enough to allow fully automatic coding. It could be shown that the system induces a more uniform coding by pathologists. An evaluation of the incorrect suggestions of the system indicates that the performance of the system can still be improved.

Clinical Laboratory Information Systems↗

PubMed2000

CPT 2000: interventional pain management coding in the new millennium.

UNLABELLED: Current Procedural Terminology is a systematic listing and coding of procedures and services performed by physicians and other providers. The CPT is the most widely accepted nomenclature for the reporting of procedures by physicians and other providers for health-care services provided by the government, and private health-insurance programs. It is most widely accepted for claim processing, and for the development of guidelines for medical care review, and it provides the uniform language applicable to medical education, research, and utilization. The CPT 2000 includes a multitude of changes. Those of most important interest to interventional pain management specialists include neural blockade where the codes used in pain management have been totally revamped. The entire section of neural blockade codes has been substantially altered, either by deletion, modification, or addition of a new code. Various deleted codes include 62274 to 62279, 62288, 62289, 62298, and 64440 to 64445. The definitions for CPT codes 62273, 62280, 62281, 62282, 62287, 62291, 62350, 64622, 64623, and 72285 have been modified and changed. Multiple new codes not only include replacement codes for epidurals, but also creation of codes for sacroiliac-joint injection, sacroiliac-joint arthrography, percutaneous lysis of epidural adhesions, facet-joint injections at the cervical and thoracic levels, neurolytic facet-joint neural blockade for cervical and thoracic levels, transforaminal injection codes for cervical/thoracic and lumbar/sacral, epidurography and radiological examination. The several advantages and disadvantages of new codes and future directions in CPT coding are described. KEYWORDS: Interventional pain management, CPT 1999, CPT 2000, epidural injections, facet-joint.

Journal Article↗

PubMed1997

Towards improved coding of acute myocardial infarction in hospital discharge abstracts: a pilot project.

OBJECTIVE: To pilot-test a simple checklist designed to improve coding of acute myocardial infarction (AMI) in hospital discharge abstracts. BACKGROUND: Health records technologists review hospital charts to code discharge diagnoses according to the International Classification of Diseases, 9th revision (ICD-9). Many studies have suggested that there is a high false positive rate in coding AMI, ie, ICD-9 410, on hospital discharge abstracts. PATIENTS AND METHODS: The checklist required either at least two of suggestive symptoms, diagnostic electrocardiographic changes, or diagnostic rise in serum cardiac enzymes; or confirmation by autopsy. First case of use was confirmed-typical time to complete the checklist was 3 to 4 mins. Then 16 Ontario community hospitals were recruited to apply the checklist on a blinded basis to 1000 randomly drawn in-patient records-10% were audited for another study to confirm AMI; and 90% were originally coded with 'most responsible diagnosis' (MRD) of AMI, other cardiovascular diagnoses and various noncardiac conditions. Percentage agreement (95% CI) between the checklist and the confirmed or coded diagnosis was analyzed; coding of AMI as a secondary diagnosis was examined in further analyses. RESULTS: One hospital withdrew for logistical reasons; the final useable sample from 15 hospitals was 943 records. The checklist correctly identified 100% of AMIs independently confirmed for another study; usual coding identified 89.7% of cases (70 of 78; 95% CI 80.8 to 95.5). For cases not confirmed, but where the physician had nonetheless diagnosed AMI, six of 11 charts were miscoded as AMI in hospital records; none were miscoded by the checklist. For records with AMI as MRD, 11.6% (44 of 380; 95% CI 8.5 to 15.2) were classified as false positives by the checklist. Where an AMI was coded as a secondary diagnosis, 52.9% (36 of 68; 95% CI 40.5 to 65.2) met the checklist criteria for AMI. Finally, among records where the MRD was other than AMI, 6.8% (38 of 563; 95% CI 4.8 to 9.2) met checklist criteria for AMI during admission, but 94.7% had an ICD-9410 code as a secondary diagnosis. CONCLUSION: A simple checklist can be very easily applied, has extremely high sensitivity for confirming the presence of AMI, and identifies a clinically significant proportion of charts with false positive codes for AMI. Conversely, these findings support the high sensitivity (low false negative rates) of conventional coding practices for AMI in Canadian hospital records, be it as a primary or secondary diagnosis (eg, 95% detection rate). Usual coding, combined with the checklist for tentative ICD-9 410 diagnoses, would improve the accuracy of Canadian hospital records.

Canada↗

PubMed1999

Physicochemical optimization in the genetic code origin as the number of codified amino acids increases.

We have assumed that the coevolution theory of genetic code origin (Wong JT, Proc Natl Acad Sci USA 72:1909-1912, 1975) is essentially correct. This theory makes it possible to identify at least 10 evolutionary stages through which genetic code organization might have passed prior to reaching its current form. The calculation of the minimization level of all these evolutionary stages leads to the following conclusions. (1) The minimization percentages increased linearly with the number of amino acids codified in the codes of the various evolutionary stages when only the sense changes are considered in the analysis. This seems to favor the physicochemical theory of genetic code origin even if, as discussed in the paper, this observation is also compatible with the coevolution theory. (2) For the first seven evolutionary stages of the genetic code, this trend is less clear and indeed is inverted when we consider the global optimisation of the codes due to both sense changes and synonymous changes. This inverse correlation between minimization percentages and the number of amino acids codified in the codes of the intermediate stages seems to favor neither the physicochemical nor the stereochemical theories of genetic code origin, as it is in the early and intermediate stages of code development that these theories would expect minimization to have played a crucial role, and this does not seem to be the case. However, these results are in agreement with the coevolution theory, which attributes a role to the physicochemical properties of amino acids that, while important, is nevertheless subordinate to the mechanism which concedes codons from the precursor amino acids to the product amino acids as the primary factor determining the evolutionary structuring of the genetic code. The results are therefore discussed in the context of the various theories proposed to explain genetic code origin.

Algorithms↗

PubMed2006

The coevolution of genes and genetic codes: Crick's frozen accident revisited.

The standard genetic code is the nearly universal system for the translation of genes into proteins. The code exhibits two salient structural characteristics: it possesses a distinct organization that makes it extremely robust to errors in replication and translation, and it is highly redundant. The origin of these properties has intrigued researchers since the code was first discovered. One suggestion, which is the subject of this review, is that the code's organization is the outcome of the coevolution of genes and genetic codes. In 1968, Francis Crick explored the possible implications of coevolution at different stages of code evolution. Although he argues that coevolution was likely to influence the evolution of the code, he concludes that it falls short of explaining the organization of the code we see today. The recent application of mathematical modeling to study the effects of errors on the course of coevolution, suggests a different conclusion. It shows that coevolution readily generates genetic codes that are highly redundant and similar in their error-correcting organization to the standard code. We review this recent work and suggest that further affirmation of the role of coevolution can be attained by investigating the extent to which the outcome of coevolution is robust to other influences that were present during the evolution of the code.

Animals↗

PubMed1983

Changes in the amino acid code.

The genetic code is characterized by a pattern arising from "wobble-pairing" between codons and anticodons, so that one nucleotide in the first anticodon position can pair with more than one nucleotide in the third position of a codon. Earlier codes may have existed in which there were fewer anticodons than at present, so that these earlier codes contained fewer amino acids. The universal code was formerly thought to be the only currently existing code used by terrestrial species. It is now known that differences exist from the universal code in mitochondrial coding systems, and also that mitochondrial systems differ from each other. These findings lend support to the proposal that archetypal codes preceded the present universal code. Such archetypal codes may have had some resemblances to mitochondrial codes.

Amino Acids↗

PubMed2003

Some possible codes for encrypting data in DNA.

Three codes are reported for storing written information in DNA. We refer to these codes as the Huffman code, the comma code and the alternating code. The Huffman code was devised using Huffman's algorithm for constructing economical codes. The comma code uses a single base to punctuate the message, creating an automatic reading frame and DNA which is obviously artificial. The alternating code comprises an alternating sequence of purines and pyrimidines, again creating DNA that is clearly artificial. The Huffman code would be useful for routine, short-term storage purposes, supposing--not unrealistically--that very fast methods for assembling and sequencing large pieces of DNA can be developed. The other two codes would be better suited to archiving data over long periods of time (hundreds to thousands of years).

Algorithms↗

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↗

PubMed1996

Educating residents: the effects of a mock code program.

Housestaff residents are often the primary participants in codes that occur in a hospital setting, yet it is unknown how much confidence and knowledge they possess in the management of these medical emergencies. A study to learn the effect of a mock code program on residents' level of confidence and knowledge regarding code situations was initiated in a children's tertiary care hospital. Thirty-three residents completed a questionnaire before initiation of the study. The questionnaire revealed that codes scare them (79%), and that they felt a need for more knowledge (76%) and more experience (82%) before supervising a code. They did not feel confident in performing certain procedures such as treating dysrhythmias (79%), obtaining i.v. access (64%), and doing intubations (30%). Sixteen residents then participated in mock codes, and the other seventeen residents served as controls. Compared to the pre-study questionnaire, residents who had participated in mock codes had more confidence in their ability to supervise and felt less of a need for more knowledge before supervising a code. The participants also felt more confident in obtaining i.v. access and performing intubations during a code situation. There was no difference in the pre- and post-questionnaires of the control group. Residency programs are not meeting the educational and confidence needs of pediatric residents. A mock code program improves residents' perceived need for more knowledge before supervising a code and improves their confidence in doing many lifesaving procedures.

Cardiopulmonary Resuscitation↗

PubMed2006

Relation between mRNA expression and sequence information in Desulfovibrio vulgaris: combinatorial contributions of upstream regulatory motifs and coding sequence features to variations in mRNA abundance.

The context-dependent expression of genes is the core for biological activities, and significant attention has been given to identification of various factors contributing to gene expression at genomic scale. However, so far this type of analysis has been focused either on relation between mRNA expression and non-coding sequence features such as upstream regulatory motifs or on correlation between mRNA abundance and non-random features in coding sequences (e.g., codon usage and amino acid usage). In this study multiple regression analyses of the mRNA abundance and all sequence information in Desulfovibrio vulgaris were performed, with the goal to investigate how much coding and non-coding sequence features contribute to the variations in mRNA expression, and in what manner they act together. Using the AlignACE program, 442 over-represented motifs were identified from the upstream 100bp region of 293 genes located in the known regulons. Regression of mRNA expression data against the measures of coding and non-coding sequence features indicated that 54.1% of the variations in mRNA abundance can be explained by the presence of upstream motifs, while coding sequences alone contribute to 29.7% of the variations in mRNA abundance. Interestingly, most of contribution from coding sequences is overlapping with that from upstream motifs; thereby a total of 60.3% of the variations in mRNA abundance can be explained when coding and non-coding information was included. This result demonstrates that upstream regulatory motifs and coding sequence information contribute to the overall mRNA expression in a combinatorial rather than an additive manner.

Base Sequence↗

PubMed2005

Speech perception with the ACE and the SPEAK speech coding strategies for children implanted with the Nucleus cochlear implant.

OBJECTIVE: The aim of this study is to determine whether implanted children using the ACE speech coding strategy demonstrate superior performances compared to implanted children using the SPEAK speech coding strategy over time. METHODS: Cochlear implanted children with prelinguistic sensorineural bilateral deafness of profound degree, using either the ACE or SPEAK coding strategy, were evaluated and compared. Both groups of children used one of the speech coding strategies continuously from the initial programming session and for a period of 2 years post-switch-on. One group comprised children who were retrospectively implanted and had received the SPEAK speech coding strategy (n=32) and the second group consisted of prospectively implanted children who received the ACE speech coding strategy (n=26). Both populations were homogenous as far as age of implantation, degree of hearing loss, anatomy of the cochlea, depth of electrode insertion, and educational and rehabilitative support provided. Children were assessed at 6, 12 and 24 months post switch-on via pure-tone audiometry and for speech perception tests. Children using the ACE speech coding strategy were additionally evaluated using the MAIS and MUSS language scales. RESULTS: Satisfactory benefits in speech perception were demonstrated by both groups of implanted children. No significant difference between the mean pure tone thresholds was observed postoperatively between the groups. Two years post switch-on the group using the ACE speech coding strategy demonstrated superior results for vowel discrimination in comparison to children using the SPEAK coding strategy. No significant difference was observed between the groups for performance on discrimination of syllable patterns (ESP) or for disyllablic word recognition tests. Additionally, the group of ACE users demonstrated maximum performance on MAIS and MUSS scales, 2 years post switch-on. CONCLUSIONS: The results clearly demonstrate significant benefit of cochlear implantation in prelinguistically deafened children for speech perception ability when using either the SPEAK or ACE speech coding strategies. Children using the ACE speech coding strategy demonstrate more rapid progress in improved speech perception ability initially, however 2 years post switch-on, no significant difference in performance on open-set speech recognition tests can be noted irrespective of the strategy in use.

Audiometry, Pure-Tone↗

PubMed1999

Positive predictive value of ICD-9th codes for upper gastrointestinal bleeding and perforation in the Sistema Informativo Sanitario Regionale database.

We identified patients whose records in the Sistema Informativo Sanitario Regionale database in the Italian region of Friuli-Venezia Giulia showed a code of upper gastrointestinal bleeding (UGIB) and perforation according to codes of the International Classification of Diseases (ICD)-9th revision. The validity of site- and lesion-specific codes (531 to 534) and nonspecific codes (5780, 5781, and 5789) was ascertained through manual review of hospital clinical records. The initial group was made of 1779 potential cases of UGIB identified with one of these codes recorded. First, the positive predictive values (PPV) were calculated in a random sample. As a result of the observed high PPV of 531 and 532 codes, additional hospital charts were solely requested for all remaining potential cases with 533, 534, and 578 ICD-9 codes. The overall PPV reached a high of 97% for 531 and 532 site-specific codes, 84% for 534 site-specific codes, and 80% for 533 lesion-specific codes, and a low of 59% for nonspecific codes. These data suggest a considerable research potential for this new computerized health care database in Southern Europe.

Adult↗

PubMed2005

Coding and reimbursement for weight loss surgery: best practice recommendations.

OBJECTIVE: To review the use and usefulness of billing codes for services related to weight loss surgery (WLS) and to examine third party reimbursement policies for these services. RESEARCH METHODS AND PROCEDURES: The Task Group carried out a systematic search of MEDLINE, the Internet, and the trade press for publications on WLS, coding, reimbursement, and coding and reimbursement policy. Twenty-eight articles were each reviewed and graded using a system based on established evidence-based models. The Massachusetts Dietetics Association provided reimbursement data for nutrition services. Three suppliers of laparoscopic WLS equipment provided summaries of coding and reimbursement information. WLS program directors were surveyed for information on use of procedure codes related to WLS. RESULTS: Recommendations focused on correcting or improving on the current lack of congruity among coding practices, reimbursement policies, and accepted clinical practice; lack of uniform coding and reimbursement data across institutions; inconsistent and/or inaccurate diagnostic and billing codes; inconsistent insurance reimbursement criteria; and inability to leverage reimbursement and coding data to track outcomes, identify best practices, and perform accurate risk-benefit analyses. DISCUSSION: Rapid changes in the prevalence of obesity, our understanding of its clinical impact, and the technologies for surgical treatment have yet to be adequately reflected in coding, coverage, and reimbursement policies. Issues identified as key to effective change include improved characterization of the risks, benefits, and costs of WLS; anticipation and monitoring of technological advances; encouragement of consistent patterns of insurance coverage; and promotion of billing codes for WLS procedures that facilitate accurate tracking of clinical use and outcomes.

Costs and Cost Analysis↗