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The impact of clinical vs administrative claims coding on hospital risk-adjusted outcomes.

ABSTRACT: BACKGROUND:Comorbid condition and hospital risk-adjusted outcomes prevalence were compared based on clinical registry vs administrative claims data. HYPOTHESIS:Risk-adjusted outcomes will vary depending on the source of comorbidity data used. METHODS:Clinical data from hospitalized Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association (ACC/AHA) Guidelines (CRUSADE) non-ST-segment elevation myocardial infarction (NSTEMI) patients ?65 years was linked to Medicare claims. Eight common comorbid conditions were coded and compared between registry data (derived from medical record review) and claims data; hospital-level observed vs expected ratios and outlier status for 30-day readmission and mortality were calculated using logistic generalized estimating equations for clinical vs claims data. RESULTS:Of 68 199 NSTEMI patients, 48.1% were female, 86.9% were white, and median age was 78. Degree of agreement between data sources for comorbid condition prevalence was 67.8% for myocardial infarction and 89.3% for diabetes. Overall, multivariable model performance was similar: Medicare mortality c-statistics is 0.69 vs CRUSADE is 0.71; readmission c-statistics is 0.59 for both. Hospital ratings were similar regardless of data source (mortality, R2 = 0.97863; readmission, R2 = 0.97858). Eighty-two hospitals were mortality outliers in claims-based models; of these, 70 were outliers in registry-based models. Forty-five hospitals were readmission outliers in claims-based models; of these, 39 were outliers in registry-based models. CONCLUSIONS:There were significant differences in individual comorbid condition prevalence when derived from registries vs claims, but hospital-level outcomes were comparable.

SUBMITTER: O'Brien EC

PROVIDER: S-EPMC6490103 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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The impact of clinical vs administrative claims coding on hospital risk-adjusted outcomes.

O'Brien Emily C EC Li Shuang S Thomas Laine L Wang Tracy Y TY Roe Matthew T MT Peterson Eric D ED

Clinical cardiology 20180922 9

<h4>Background</h4>Comorbid condition and hospital risk-adjusted outcomes prevalence were compared based on clinical registry vs administrative claims data.<h4>Hypothesis</h4>Risk-adjusted outcomes will vary depending on the source of comorbidity data used.<h4>Methods</h4>Clinical data from hospitalized Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association (ACC/AHA) Guidelines ...[more]

PMID: 30141213

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Project description:BackgroundTo effectively use administrative claims for healthcare research, clinical events must be inferred from coding data according to validated algorithms. In October 2015, the United States transitioned from the International Classification of Diseases Ninth Revision (ICD-9) to the Tenth Revision (ICD-10). We describe our method to derive new ICD-10 codes for outcomes after vascular procedures from our prior, validated ICD-9 codes.MethodsWe began with validated ICD-9 coding lists known to represent outcomes after lower extremity revascularization, thoracic aortic endograft placement, abdominal aortic aneurysm reintervention, and carotid revascularization. We used the publicly available general equivalence mapping tools to derive corresponding ICD-10 codes for each of the ICD-9 codes in our current lists. The resulting lists were then manually reviewed by multiple authors to ensure clinical relevance for appropriate event detection. Clinically nonrelevant and duplicated codes were removed.ResultsA total of 475 ICD-9 codes were translated to ICD-10 with a 98-fold increase (n = 46,630) in the total number of codes. Overall, we found that 77% of codes (n = 35,833) were either duplicated or not clinically relevant upon manual review. For example, for thoracic aortic endograft placement, 97 ICD-9 codes mapped to 14,661 ICD-10 codes in total. A total of 890 codes were removed as duplicates and 9035 codes were removed during manual clinical review. The resultant, reviewed list contained 4736 ICD-10 codes representing a 49-fold increase from the initial ICD-9 list. Findings were similar across the other procedures studied.ConclusionsICD-10 has expanded the number of codes necessary to describe outcomes after vascular procedures. More than 75% of the codes obtained using the general equivalence mapping database were either duplicated or not clinically relevant. Manual review of codes by researchers with clinical knowledge of the procedures is imperative.

Project description:IntroductionData are lacking on severe asthma burden in elderly people in Japan. We assessed the prevalence and clinical/economic burden of severe asthma and asthma-related hospitalizations in elderly and younger Japanese patients.MethodsThis retrospective study analyzed outpatient claims data and inpatient hospital discharge records among patients aged ≥ 15 years with asthma (defined as ≥ 2 prescriptions of inhaled corticosteroids [ICS] or ICS/long-acting beta-agonists [LABA]) between 1 July 2014 and 30 June 2017. We analyzed the outpatient visit assessment population with severe asthma (≥ 240-day prescription of high-dose ICS and ≥ 90-day prescription of ≥ 1 additional controllers) and the asthma-related hospitalization population (≥ 1 hospital admission[S] with a primary diagnosis of asthma/status asthmaticus and use of systemic corticosteroids) over a 1-year observation period before the date of each patient's latest asthma prescription or asthma-related hospitalization within the study period. The primary outcome was the proportion of elderly (≥ 65 years) and younger (15-39 and 40-64 years) patients among the outpatient visit assessment population. Secondary outcomes included outpatient and inpatient characteristics, asthma-related healthcare resource utilization, and asthma-associated costs, by age group.ResultsOf the outpatient visit assessment population (n = 35,742), 4211 had severe asthma, with the prevalence of 8.2%, 12.8%, and 12.4% for the 15-39, 40-64, and ≥ 65 years age groups, respectively. Elderly versus younger outpatients with severe asthma had higher cumulative oral corticosteroid doses. Among both outpatient visit assessment population and hospitalization assessment population, elderly versus younger outpatients with severe asthma or asthma-related hospitalizations had more comorbidities, required more biological, hematological, immunological, and microbiological tests, and incurred higher asthma-associated costs.ConclusionsIn addition to reaffirming the higher prevalence of severe asthma in Japanese patients ≥ 40 years versus those < 40 years of age, our results demonstrated higher clinical and economic burden in elderly versus younger patients.

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The impact of clinical vs administrative claims coding on hospital risk-adjusted outcomes.

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The impact of clinical vs administrative claims coding on hospital risk-adjusted outcomes.

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