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PubMed2006

ICD-9-CM coding of emergency department visits for food and insect sting allergy.

PURPOSE: Little is known about the role of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for identification of specific allergic reactions in the emergency department (ED). METHODS: Investigators in 10 EDs reviewed 1395 charts of consecutive patients presenting with food allergy (ICD-9-CM codes 693.1 and 995.60 to 995.69) and insect sting allergy (code 989.5). They also reviewed charts of patients with "unspecified" allergic reactions (codes 995.0 [other anaphylactic shock] and 995.3 [allergy, unspecified]) to identify additional patients with food or insect sting allergy. RESULTS: Of 406 patients with food allergy, 216 patients (53%) were coded as food allergy, whereas the remaining 190 patients (47%) were not. Of 394 patients with insect sting allergy, 341 (87%) were coded as insect sting allergy, whereas 53 patients (13%) were not. Characteristics of ICD-9-CM-identified compared with chart-review-identified patients differed for both food and insect sting allergy. ICD-9-CM-identified patients with food allergy were less likely to experience anaphylaxis. CONCLUSIONS: Almost half the patients with food allergy would have been missed by using food-specific ICD-9-CM codes alone, whereas only 13% of patients with insect sting allergy would have been missed. Furthermore, characteristics of these allergy patients would have been biased by studying only patients identified by using the allergen-specific ICD-9-CM codes.

Adult↗

PubMed2005

Clinical assessment compared with breathalyser readings in the emergency room: concordance of ICD-10 Y90 and Y91 codes.

OBJECTIVES: The purpose of this study was to analyse the validity of clinical assessment of alcohol intoxication (ICD-10 Y91) compared with estimated blood alcohol concentration (BAC) using a breath analyser (ICD-10 Y90) among patients in the emergency room (ER). METHODS: Representative samples of ER patients reporting within six hours of injury (n = 4798) from 12 countries comprising the WHO Collaborative Study on Alcohol and Injuries were breath analysed and assessed blindly for alcohol intoxication at the time of ER admission. Data were analysed using Kendall's Tau-B to measure concordance of clinical assessment and BAC, and meta analysis to determine heterogeneity of effect size. RESULTS: Raw agreement between the two measures was 86% (Tau-B 0.68), but was lower among those reporting drinking in the six hours prior to injury (raw agreement 39%; Tau-B 0.32). No difference was found by gender or for timing of clinical assessment in relation to breath analysis. Patients positive for tolerance or dependence were more likely to be assessed as intoxicated at low levels of BAC. Estimates were homogeneous across countries only for females and for those negative for alcohol dependence. CONCLUSIONS: Clinical assessment is moderately concordant with level of BAC, but in those patients who have actually been drinking within the last six hours the concordance was much less, possibly because, in part, of a tendency on the part of clinicians to assign some level of intoxication to anyone who appeared to have been drinking.

Alcohol Drinking↗

PubMed1982

Subjective and objective admissions factors as predictors of clinical clerkship performance.

Subjective and objective measures available at the time of medical school admission were related to subjective and objective clinical performance measures during medical school. Strategies were developed for coding narrative faculty comments from admissions interviews and clinical performance evaluations. Factor analysis was used to examine underlying structures for both admission and clinical performance measures. Summed scores were calculated to represent each factor, and multiple regression was used in predicting each of the clinical factors from the admission factors. Multiple regression showed that admission interview comments best predict narrative clerkship performance, while objective scores best predict an objective measure of clinical knowledge. Conclusions were: (a) narrative information can be coded reliably. (b) Objective and subjective measures are distinct, identifiable structures both at admission and during the third year of medical school. (c) Prediction formulas will vary depending on what outcome variables are chosen.

Achievement↗

PubMed2006

Are statewide trauma registries comparable? Reaching for a national trauma dataset.

BACKGROUND: Statewide trauma registries have proliferated in the last decade, suggesting that information could be aggregated to provide an accurate depiction of serious injury in the United States. OBJECTIVES: To determine whether variability exists in the composition and content of statewide trauma registries, specifically addressing case-acquisition, case-definition (inclusion criteria), and registry-coding conventions. METHODS: A cross-sectional, two-part survey was administered to managers of all statewide trauma registries. State trauma registrars also provided inclusion and exclusion criteria from their state registry and abstracted a clinical vignette designed to identify coding inconsistencies. RESULTS: Thirty-two states maintain a centralized registry, but requirements for data submission vary significantly. Inclusion and exclusion criteria also vary, particularly for nontraumatic injuries. Coding conventions adopted by states for vague or missing information are dissimilar. When abstractions of the clinical vignette are compared, only 19% and 47% of states provided similar quantity or content for injury e-coding and diagnostic coding, respectively. Injury severity scores (based on diagnostic coding) demonstrated a range from 2 to 18. CONCLUSIONS: Statewide trauma registries are prevalent but vary significantly in composition and content. Standardizing inclusion criteria, variable definitions, and coding conventions would greatly enhance the usability of an aggregated, national trauma registry.

Cross-Sectional Studies↗

PubMed1999

Assessment of Left Ventricular Systolic Function Using Color-Coded Tissue Doppler Echocardiography.

Tissue Doppler echocardiography can be used to measure myocardial velocity data by using the Doppler shift data of ultrasound waves. Two methods have recently been described to calculate velocity data: pulsed tissue Doppler and color-coded tissue Doppler. This article focuses on color-coded tissue Doppler data to evaluate left ventricular systolic function. Technical considerations and validation studies are reviewed. Potential clinical applications of color-coded tissue Doppler are presented, including dobutamine stress echocardiography, assessment of left ventricular ejection dynamics using mitral annular velocity, and tissue Doppler assessment of cardiac transplant rejection.

Journal Article↗

PubMed2006

[The Medical Code of Practice: clear reasons for existing, benefit less certain].

The Medical Code of Practice (Dutch acronym TG) aims to maintain and advance the quality of professional practice. Working together, lawyers and medical practitioners consider and make judgements on the procedures and methods practiced by caregivers. They also aim to protect citizens against the inexpert and careless execution of medical practice. Are they successful in this? Where the quality of practice is concerned, more thought must be given to the lasting effects on medical practitioners of the decisions made by the TG. Where protection ofcitizens is concerned, patients have a legal right to complain and there are various ways of doing this. Moreover, the TG is not primarily meant as a right of complaint. More empirical research is necessary into the effects of the TG.

Clinical Competence↗

PubMed2006

Reduction in newborns with discharge coding of in utero alcohol effects in the United States, 1993 to 2002.

OBJECTIVE: To determine whether use of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for fetal alcohol effects has declined during the past 10 years among hospitalized newborns in the United States. DESIGN: Trends in use of the ICD-9-CM code 760.71, "alcohol affecting the fetus," among newborns from 1993 through 2002 were compared with trends in self-reported drinking during pregnancy and maternal diagnoses of alcohol abuse during childbirth. SETTING: Sampled short-term, nonfederal general and specialty hospitals. PARTICIPANTS: Infants born from 1993 to 2002 in the United States who were included in the Healthcare Cost and Utilization Project databases. MAIN OUTCOME MEASURES: Documentation of ICD-9-CM code 760.71 among newborns, self-reported drinking during pregnancy, and diagnoses of maternal alcohol abuse during childbirth from 1993 through 2002. RESULTS: The prevalence of the ICD-9-CM code 760.71 for alcohol affecting the fetus, as documented in the discharge record of newborns, declined from 0.73 (95% confidence interval, 0.56-0.92) per 1000 live births in 1993 to 0.17 (95% confidence interval, 0.13-0.20) per 1000 live births in 2002. Rates declined concurrently with those of self-reported alcohol consumption during pregnancy and diagnoses of maternal alcohol abuse during childbirth. CONCLUSIONS: Use of the ICD-9-CM code for alcohol affecting the fetus among newborns declined 75% throughout 10 years. Results may be due to decreases in drinking during pregnancy, decreases in disclosure of alcohol use by the mother, or more selective use of the discharge code. National hospital discharge databases may allow cost-effective monitoring of public health interventions that address rare conditions of the fetus and newborn.

Alcohol Drinking↗

PubMed1998

Diagnostic coding and medical rehabilitation length of stay: their relationship.

OBJECTIVE: To determine if diagnostic information provided in the form of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes improves rehabilitation length of stay (LOS) prediction when used in combination with the Functional Independence Measure-Function Related Groups (FIM-FRGs) classification system. DESIGN: Various models characterizing diagnostic information using ICD-9-CM codes were created that included individual ICD-9-CM codes and groupings of those codes by organ or etiology involved. Each method was evaluated using linear regression with the natural logarithm of LOS as the dependent variable. Separate validation data sets were held back to quantify the incremental effect of diagnosis when combined with the FIM-FRG classification system. SETTING: Records from 252 rehabilitation facilities and hospital units across the nation. PATIENTS: Analyses were undertaken using 82,646 records from patients discharged in 1992. RESULTS: The addition of ICD-9-CM diagnostic information to the FIM-FRG classification system increased the variance explained by a maximum of 1.9%, from 31.5% to 33.4%. CONCLUSIONS: Refinement of the FIM-FRGs to include ICD-9-CM diagnoses does not appear warranted on the basis of the small increase in the percentage of explained variance in LOS. We believe the lack of improved prediction with the addition of ICD-9-CM codes relates primarily to incomplete coding practices and to the effect of patients' diagnoses being absorbed in variables as already expressed by the FIM-FRG system. Although ICD-9-CM codes, overall, did not greatly improve LOS prediction, they appeared to have some impact in certain impairment categories.

Brain Injuries↗

PubMed1993

Detection of foot-and-mouth disease virus RNA in clinical samples and cell culture isolates by amplification of the capsid coding region.

Foot-and-mouth disease is one of the most economically important virus diseases of livestock. Two important requirements for the control of this disease are rapid laboratory diagnosis and epidemiological investigation. The use of the polymerase chain reaction method (PCR) to amplify specific nucleic acid regions offers the unique possibility of combining swift viral detection with the production of genetic material suitable for sequencing and other methods of molecular epidemiological analysis. The sequencing of the region of foot-and-mouth disease virus (FMDV) genome encoding the capsid proteins of the virus (approximately 2260 bps), provides valuable information that adds to the molecular characterisation of an isolate. This paper describes the use of the PCR for the amplification of this region of the FMDV genome from bovine clinical samples and cell culture isolates. Suitable pairs of oligonucleotide primers were selected from the published sequence of FMDV type O1, Kaufbeuren. One primer set amplified 2091 bps of the capsid coding region of all seven serotypes of FMDV. The other primer set amplified 216 bp from this region of FMDV type O1, BFS 1860, in nucleic acid extracts from several clinical samples. Nucleic acid extracts from the picornaviruses, bovine enterovirus and swine vesicular disease virus, which affect the same animals, were not amplified. Direct sequencing was carried out on the amplified fragments and showed that the PCR products were > 98% homologous to published FMDV sequences.

Animals↗

PubMed2003

The use of physical restraints for patients suffering from dementia.

This study reviews the ethical dilemmas of nursing staff about using restraints on patients suffering from dementia in two types of health care settings in Israel: internal medicine wards of three general hospitals; and psychogeriatric wards of three nursing homes. The nurses' level of knowledge about the Patient's Rights Law, the Israeli Code of Ethics, and the guidelines on restraints was analysed. The purposes of restraints were defined as beneficial to: (1) the patient; (2) other patients; or (3) the institution. The concept was evaluated in a realistic situation (expressing views of daily practice) and in an idealistic situation (expressing personal and professional beliefs and values). It was shown that nurses in internal medicine wards of general hospitals agreed more with the use of restraints than those in psychogeriatric wards in nursing homes. Differences were more pronounced when restraints were beneficial to the institution. In addition, nurses working in psychogeriatric wards of nursing homes had more knowledge about the guidelines on restraints and were less inclined than their counterparts to agree with the use of restraints for the benefit of other patients or the institution.

Accidental Falls↗

PubMed2006

Exploration of statistical dependence between illness parameters using the entropy correlation coefficient.

UNLABELLED: The entropy correlation coefficient (ECC) is a useful tool for measuring statistical dependence between variables. We employed this tool to search for pairs of variables that correlated in the chronic fatigue syndrome (CFS) Computational Challenge dataset. Highly related variables are candidates for data reduction, and novel relationships could lead to hypotheses regarding the pathogenesis of CFS. METHODS: Data for 130 female participants in the Wichita (KS, USA) clinical study [1] was coded into numerical values. Metric data was grouped using Gaussian mixture models; the number of groups was chosen using Bayesian information content. The pair-wise correlation between all variables was computed using the ECC. Significance was estimated from 1000 iterations of a permutation test and a threshold of 0.01 was used to identify significantly correlated variables. RESULTS: The five dimensions of multidimensional fatigue inventory (MFI) were all highly correlated with each other. Seven Short Form (SF)-36 measures, four CFS case-defining symptoms and the Zung self-rating depression scale all correlated with all MFI dimensions. No physiological variables correlate with more than one MFI dimension. MFI, SF-36, CDC symptom inventory, the Zung self-rating depression scale and three Cambridge Neuropsychological Test Automated Battery (CANTAB) measures are highly correlated with CFS disease status. DISCUSSION: Correlations between the five dimensions of MFI are expected since they are measured from the same instrument. The relationship between MFI and Zung depression index has been previously reported. MFI, SF-36, and Centers for Disease Control and Prevention (CDC) symptom inventory are used to classify CFS; it is not surprising that they are correlated with disease status. Only one of the three CANTAB measures that correlate with disease status has been previously found, indicating the ECC identifies relationships not found with other statistical tools. CONCLUSION: The ECC is a useful tool for measuring statistical dependence between variables in clinical and laboratory datasets. The ECC needs to be further studied to gain a better understanding of its meaning for clinical data.

Adult↗

PubMed1991

The impact of different coding systems on DRG assignment and data.

The Diagnosis Related Group (DRG) classification system is widely used to describe the casemix of acute care hospitals, making it possible to compare the casemix of hospitals from different countries. However, in order to fully understand these comparisons, it is necessary to clarify the impact which the different coding systems used in various countries may have had on the results. The DRG system is based on codes from the International Classification of Diseases 9th Revision Clinical Modification (ICD9CM). Countries which use other coding systems convert, i.e. map, their codes into the nearest ICD9CM equivalent before allocating the DRGs. The impact of mapping on both medical and surgical DRGs is discussed and new titles are given for the affected DRGs. As far as possible, problems caused by mapping are distinguished from those caused by differences in coding practices. Based on the analysis of the classification systems, the mapping tables and the resulting DRG data, it is concluded that using mapped data does not have a great impact on the DRGs. Only 37 DRGs (7.8%), 15 medical and 22 surgical classes, are affected by mapping problems. However, while the scale of these problems is not large, given the large number of different surgical classification systems currently in use in Europe, the introduction of a standard surgical classification system for Europe is recommended.

Abstracting and Indexing↗

PubMed1986

Data quality in a distributed data processing system: the SHEP Pilot Study.

The Systolic Hypertension in the Elderly Program (SHEP) Pilot was a collaborative clinical trial that distributed to the clinics all data processing tasks except for randomization assignment codes and morbidity and mortality data. The clinics used customized programs to enter and verify data interactively, to maintain their own local master files, and to transmit the data electronically to the Coordinating Center. We measured quality control based on criteria from centralized as well as distributed models: the error rate for baseline forms was 0.5 per 1000 items. Ninety-eight percent of the forms were query-free, and a central reentry of the data in a 5% sample yielded a miskey rate of 2 per 1000 items. The potential problems of distributed data processing are vulnerability of the local master files and the time demands on Coordinating Center programmers for maintaining clinic computer systems. The advantages are the active involvement of clinic staff in their own quality control, the functional accessibility of the clinics to the Coordinating Center in controlling protocol decisions and data monitoring, and the level of accuracy, completeness, and timeliness of the data that can be achieved.

Aged↗

PubMed1993

The application of a computerised diagnostic index for ophthalmic practice.

All 2792 patients seen in my private practice between July 1989 and September 1992 and receiving a diagnosis were coded according to the International Classification of Diseases-9 (Clinical Modification), 1979. Any procedures performed were coded according to the American Medical Association Current Procedural Terminology. Patient details and codes were filed by computer using a customised database in Foxpro 2.0 software. Those with minor refractive error or presbyopia alone and those who had no abnormality were excluded from the database. The set-up and maintenance of this diagnostic index is described and the database structure is specified. A modification of the glaucoma section of ICD-9, which better suited my needs, is presented. Examples of the potential information available from such a database is described, including some analysis of this general ophthalmic practice.

Adolescent↗

PubMed1982

The Howie code: is the price of safety too high?

The code of practice for the prevention of infection in clinical laboratories and postmortem rooms (the "Howie code") was produced in order to standardise laboratory safety procedures at a level which would minimise risks to laboratory workers. The costs of implementing this code, which were not given proper consideration when the code was drawn up, are seen to be very high. This paper questions whether the benefits of risk reduction resulting from the code can justify the high cost of its implementation. Beginning with an examination of the incidence in recent years of laboratory-acquired infections, the paper looks at the perceptions of risk by laboratory workers and the feasibility of low cost alternatives to those of the Howie code. The potential benefits of the code are then viewed against the cost of upgrading the laboratories of two Scottish hospitals to Howie standards. The fact of high costs relative to benefits reinforces the paper's call for the proper consideration of economic issues to be given at the development rather than the implementation stage of any regulatory codes.

Cost-Benefit Analysis↗

PubMed1988

Treatment of patients with no diagnosable mental disorders in CMHCs.

Community mental health centers (CMHCs) have been criticized for directing resources that should be used to treat the seriously mentally ill to the treatment of less impaired patients. Many of the latter group are assigned one of the DSM-III V codes for conditions that do not meet criteria for a mental disorder. This study compared patients with V-code conditions and those with diagnosed mental disorders on clinical, social, and economic variables. V-code patients were significantly less likely to have had prior care and to rely on third-party payments. They were significantly more likely to have been self-referred or referred by friends or family and to be white, well-educated, female, and married. CMHCs that treated fewer V-code patients reported proportionally more staff hours worked by physicians, indicating a greater medical orientation. The authors believe CMHCs should periodically evaluate whether, by serving patients with less serious conditions, they are diverting badly needed resources away from the seriously mentally ill.

Adolescent↗

PubMed2000

High-quality research and patient care: an overview of clinical trials.

BACKGROUND: One of the responsibilities of the dental profession is to protect and advance the well-being of the public through research of new pharmaceuticals and devices. The objective of this article is to present information about the scientific and regulatory process involved in the design and execution of randomized clinical trials. CONCLUSIONS: Dentists willing to serve as investigators in clinical trials--from Phase 1 to Phase 2 or Phase 3--need to be aware of the two main documents that contain the majority of guidelines and regulations governing clinical research: Title 21 of the U.S. Code of Federal Regulations and the guidelines for good clinical practice put forth by the International Conference on Harmonisation. CLINICAL IMPLICATIONS: Advancements in the frontiers of oral health science and the development of safe, innovative and effective treatment modalities are often the result of high-quality clinical research that is conducted by dental professionals. Knowledge of the research process, professionalism, scientific integrity and a detailed execution of the research plan are all required elements for a successful outcome.

American Dental Association↗

PubMed1983

Medicaid program; Medicaid Management Information System proposed system requirements--HCFA. Proposed notice.

In this notice, we are proposing five new system requirements for Medicaid Management Information Systems. We propose that the systems be required to accept and use exclusively: (a) A uniform diagnostic coding system (the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)), wherever diagnostic coding is used; (b) A common claim form for hospital billing (HCFA-1450); (c) A uniform electronic billing format for institutional billing; (d) A common claim form for noninstitutional providers (the revised version of the Health Insurance Claim Form, HCFA-1500); and (e) A uniform procedure coding system (HCFA Common Procedure Coding System (HCPCS)). These requirements would improve the efficiency and effectiveness of the Medicaid program.

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