用于评估药物过量发病率指标性能的中断时间序列分析显示 ICD-9-CM 到 ICD-10-CM 过渡的不连续性,Injury Prevention

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用于评估药物过量发病率指标性能的中断时间序列分析显示 ICD-9-CM 到 ICD-10-CM 过渡的不连续性
Injury Prevention ( IF 2.5 ) Pub Date : 2021-03-01 , DOI: 10.1136/injuryprev-2019-043522
Hannah Yang ₁ , Emilia Pasalic ₂ , Peter Rock _{3,

4} , James W Davis ₅ , Sarah Nechuta ₆ , Ying Zhang ₇

Affiliation

简介 2015 年 10 月 1 日，美国从国际疾病分类第 9 版临床修订版 (ICD-9-CM) 过渡到国际疾病分类第 10 版 (ICD-10-CM)。考虑到药物过量编码的重大变化，我们研究了使用不同方法定义 ICD-9-CM 中的所有药物过量和阿片类药物过量发病率指标如何影响跨越过渡的纵向分析，使用急诊科 (ED) 和住院数据来自六个州的出院数据系统。方法我们从 2010 年 1 月开始，按州计算每月所有药物和阿片类药物过量的急诊就诊率和住院率（每 10 万人）。我们应用了三个 ICD-9-CM 指标定义，其中包括相同的所有药物或阿片类药物相关代码，但在不同程度上限制了搜索的字段数量。在 ICD-10-CM 下，所有字段都搜索了相关代码。调整季节性和自相关性后，我们在 2015 年 10 月使用具有水平和斜率变化参数的间断时间序列模型来比较采用不同 ICD-9-CM 定义时的趋势连续性。结果与 ICD-9-CM 相比，大多数州在 ICD-10-CM 编码的出院数据中观察到所有药物和阿片类药物过量病例的捕获一致或增加。更具包容性的 ICD-9-CM 指标定义降低了显着水平变化的幅度，但并未消除过渡的影响。

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Interrupted time series analysis to evaluate the performance of drug overdose morbidity indicators shows discontinuities across the ICD-9-CM to ICD-10-CM transition

Introduction On 1 October 2015, the USA transitioned from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) to the International Classification of Diseases, 10th Revision (ICD-10-CM). Considering the major changes to drug overdose coding, we examined how using different approaches to define all-drug overdose and opioid overdose morbidity indicators in ICD-9-CM impacts longitudinal analyses that span the transition, using emergency department (ED) and hospitalisation data from six states’ hospital discharge data systems. Methods We calculated monthly all-drug and opioid overdose ED visit rates and hospitalisation rates (per 100 000 population) by state, starting in January 2010. We applied three ICD-9-CM indicator definitions that included identical all-drug or opioid-related codes but restricted the number of fields searched to varying degrees. Under ICD-10-CM, all fields were searched for relevant codes. Adjusting for seasonality and autocorrelation, we used interrupted time series models with level and slope change parameters in October 2015 to compare trend continuity when employing different ICD-9-CM definitions. Results Most states observed consistent or increased capture of all-drug and opioid overdose cases in ICD-10-CM coded hospital discharge data compared with ICD-9-CM. More inclusive ICD-9-CM indicator definitions reduced the magnitude of significant level changes, but the effect of the transition was not eliminated. Discussion The coding change appears to have introduced systematic differences in measurement of drug overdoses before and after 1 October 2015. When using hospital discharge data for drug overdose surveillance, researchers and decision makers should be aware that trends spanning the transition may not reflect actual changes in drug overdose rates.

更新日期：2021-03-05

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