并发症,并发症和编码偏差. 在预测住院死亡率方面,诊断代码的数量是否重要?
L I Iezzoni1, S M Foley, J Daley
1Department of Medicine, Harvard Medical School, Beth Israel Hospital, Boston, MA 02215.
JAMA
|April 22, 1992
概括
增加诊断代码可能不会改善患者的风险评估. 研究表明,即使有更多的代码,糖尿病等疾病也与较低的死亡风险有关,这表明编码偏差.
科学领域:
- 医疗信息学 医疗信息学
- 临床流行病学临床流行病学
- 生物统计学 生物统计学
背景情况:
- 行政卫生数据库经常限制二次诊断,可能会影响患者的风险评估.
- 医疗保险计划正在增加诊断代码,以提高编码的完整性和改善风险评估.
研究的目的:
- 调查扩展诊断编码对患者风险评估的准确性,特别是死亡风险的影响.
- 评估是否增加可用的诊断代码数量可以改善对患者死亡风险的评估.
主要方法:
- 利用了1988年加利福尼亚州医院出院抽象数据,允许多达25种诊断.
- 评估了29种特定的二次诊断和老年患者 (≥65岁) 住院死亡风险之间的关系.
- 包括因中风,肺炎,急性心肌梗塞或充血性心力衰竭而住院的患者.
主要成果:
- 几种慢性或并发性疾病 (例如糖尿病,先前心肌梗塞) 矛盾地与较低的住院死亡风险有关.
- 研究结果表明,预期的增加风险的诊断在死亡的患者中被编码的频率较低.
结论:
- 在已故患者的出院摘要中对编码慢性或并发性疾病的偏见可能解释了观察到的矛盾结果.
- 仅仅增加可用的诊断代码的数量可能不会有效地提高编码的完整性或风险评估的准确性.
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