仅仅使用ICD代码可能会错误地分类围产期人群中的过量服用
Amy Board1, Alana Vivolo-Kantor2, Shin Y Kim1
1Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
American journal of preventive medicine
|December 7, 2024
概括
ICD-9/10-CM代码在患有阿片类药物使用障碍的孕妇中识别药物过量时的准确性较低. 观察到高特异性和负预测值,但敏感性和正预测值较低.
科学领域:
- 围产期健康 围产期健康
- 公共卫生监督 公共卫生监督
- 医疗信息学 医疗信息学
背景情况:
- 随着周产期药物过量率的上升,需要改进监测策略.
- 准确识别在怀孕期间和产后发生过量事件至关重要.
- 药物治疗阿片类药物使用障碍 (MOUD) 是孕妇的一个关键干预措施.
研究的目的:
- 评估ICD-9/10-CM代码的准确性,以检测在接受MOUD的孕妇中药物过量事件.
- 确定这些代码的灵敏度,特异性,正预测值 (PPV) 和负预测值 (NPV).
- 在怀孕和产后期间评估代码性能.
主要方法:
- 对3,911例MOUD怀孕和已知的结果 (2014-2021) 的电子健康记录 (EHR) 的分析.
- 将ICD-9/10-CM代码与药物过量事件的抽象EHR数据进行比较.
- 使用CDC药物过量病例定义进行分类.
- 在2023年5月至2024年5月期间进行的分析.
主要成果:
- 在怀孕期间,ICD-9/10-CM过量剂的代码灵敏度为32.7% (NPV 99.0%,特异性98.5%,PPV 23.4%).
- 在产后,代码灵敏度为30.9% (NPV 98.8%,特异性98.4%,PPV 25.9%).
- 使用这些代码,低灵敏度和PPV表明过量事件的计数不足.
结论:
- ICD-9/10-CM代码显示低灵敏度和PPV用于识别MOUD患者的围产期药物过量服用.
- 高特异性和NPV表明代码是可靠的,可以在没有过量时排除过量.
- 为全面的过量监测,建议整合额外的EHR数据和外部来源.
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