Coding Variation and Adherence to Methodological Standards in Cardiac Research Using the National Inpatient Sample
John W Ostrominski1, Javier Amione-Guerra1, Brian Hernandez2
1Department of Medicine, Division of Cardiology, UT Health San Antonio, San Antonio, TX, United States.
Insights
Coding for cardiac research using administrative data shows significant variation and widespread non-adherence to standards. This impacts the accuracy and generalizability of studies on acute myocardial infarction (AMI) and other cardiac conditions.
Area of Science:
- Health Services Research
- Cardiovascular Research
- Data Science in Healthcare
Background:
- Accurate coding is vital for reliable administrative health data research.
- Existing research lacks a comprehensive analysis of coding trends for major cardiac conditions.
- Methodological adherence in cardiac research using administrative data needs evaluation.
Purpose of the Study:
- To assess trends in administrative code use for key cardiac diagnoses and procedures.
- To evaluate adherence to research best practices in cardiac studies.
- To compare hospitalization estimates based on different acute myocardial infarction (AMI) case definitions.
Main Methods:
- Analysis of ICD-9-CM codes for acute myocardial infarction (AMI), heart failure, atrial fibrillation, percutaneous coronary intervention, and coronary artery bypass grafting in 445 articles.
- Utilized the National Inpatient Sample (NIS) to compare AMI case definitions.
- Abstracted methodological elements from studies to assess adherence to research standards.
Main Results:
- Significant variation in code selection was found for all assessed cardiac diagnoses and procedures.
- The number of unique case definitions and publications increased over time.
- 8.8% of studies used off-target codes; 84% failed to adhere to at least one research practice.
- Different AMI case definitions produced significantly different hospitalization estimates.
- Higher adherence to standards was observed in higher-impact journals.
Conclusions:
- Widespread variation in code selection and non-adherence to methodological standards are prevalent in cardiac research using administrative data.
- These issues significantly affect the accuracy and generalizability of findings from the National Inpatient Sample (NIS).
- Standardization of coding practices is crucial for improving the reliability of cardiovascular research.
Abstract:
Background: Code selection is crucial to the accuracy and reproducibility of studies using administrative data, however a comprehensive assessment of coding trends for major cardiac diagnoses and procedures is lacking. We aimed to evaluate trends in administrative code utilization for major cardiac diagnoses and procedures, and adherence to required methodological practices in cardiac research using the National Inpatient Sample (NIS). Methods: In this observational study of 445 articles, ICD-9-CM codes corresponding to acute myocardial infarction (AMI), heart failure, atrial fibrillation, percutaneous coronary intervention, and coronary artery bypass grafting were collected and analyzed. The NIS was used to compare the number of hospitalizations between the most frequently encountered AMI case definitions. Key elements were abstracted from each article to evaluate adherence to required methodological practices. Results: Variation in code utilization was observed for each diagnosis and procedure assessed, and the number of unique case definitions published per year increased throughout the study period (P < 0.001), driven largely by the significant increase in articles per year (P < 0.001). Off-target codes were observed in 39 (8.8%) studies. Upon reintroduction into the NIS for 2008-2012, the most commonly encountered case definitions for AMI were found to yield significantly different estimates of AMI hospitalizations and hospitalization trends over time. Three hundred and ninety-nine articles (84%) did not adhere to one or more required research practices. Overall adherence was superior for publications in higher-impact journals (P = 0.002). Conclusions: Substantial variation in code selection exists for major cardiac diagnoses and procedures, and non-adherence to methodological standards is widespread. These data have important implications for the accuracy and generalizability of analyses using the NIS.
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