评估早期术后并发症监测中的准确性差距:ICD-10代码与手动治疗对比 - 临床和经济影响
Emilie Even Dencker1,2, Alexander Bonde1,2, Stephan Sloth Lorenzen3
1Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
国际疾病分类第10次修订 (ICD-10) 代码显著低估了手术术后并发症. 需要改进检测策略,因为实际的PC成本是目前估计的四倍.
科学领域:
- 医疗保健质量评估 医疗保健质量评估
- 手术成果研究的研究结果.
- 医疗信息学 医疗信息学
背景情况:
- 对手术结果,特别是术后并发症 (PC) 的准确评估对医疗保健系统至关重要.
- 目前依赖国际疾病分类,第10次修订 (ICD-10) 代码的PC识别可能是不够的.
- 电子医疗记录 (EHR) 为更准确的PC检测提供了一个潜在的替代方案.
研究的目的:
- 为了比较ICD-10代码的准确性与EHR的手动策划,在识别13个特定PC时.
- 通过这两种方法来评估与PC相关的资源利用情况.
- 量化PC在丹麦医疗保健系统中的经济影响.
主要方法:
- 分析了来自18家丹麦医院的11,827例手术病例的EHR数据 (2021年11月).
- 使用手动策划和ICD-10代码识别和提取PC.
- 评估资源消耗的代理:再接收,入院日,ICU停留,重新手术和放射程序.
- 统计和经济分析以量化资源利用和成本.
主要成果:
- 手动策划确定了1047个PC,而ICD-10代码只确定了439个.
- ICD-10代码正确地识别了只有20.8%通过手动策划发现的PC.
- 患有PC的患者表现出显著更高的资源利用率 (例如,6.6倍更高的再入院,6个额外的入院日,2个额外的ICU日,7.7倍更多的重复手术).
- 由于个人电脑导致的额外入院日的估计年度成本为2550万欧元,是ICD-10基于代码的估计的四倍以上.
结论:
- ICD-10代码不足以捕捉早期的术后并发症,需要改进检测策略.
- 个人电脑的实际经济负担远远超过目前的估计,强调需要加强监测.
- 针对PC检测的新策略对于改善手术质量监测,医疗保健决策和丹麦医疗保健系统资源配置至关重要.
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