住院原因对比判断与艾滋病毒感染者的ICD-10-CM编码,2016-2019年
Alexander C Commanday1,2, Lindsay E Browne3, Amanda E Moy3
1Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Bioinformatics Building CB#7030, Chapel Hill, NC, 27599-7030, USA. alexander.commanday@unchealth.unc.edu.
AIDS research and therapy
|February 19, 2026
概括
国际疾病分类 (ICD) 代码通常包括艾滋病毒感染者的住院原因. 然而,对于艾滋病毒控制不良或复杂的住院病例的PWH,需要进行裁决.
科学领域:
- 医疗信息学 医疗信息学
- 公共卫生 公共卫生
- 传染病流行病学 传染病流行病学
背景情况:
- 艾滋病毒感染者 (PWH) 的住院率很高,原因往往不清楚.
- 出院诊断代码,如国际疾病分类,第十次修订,临床修改 (ICD-10-CM),可能错误地分类PWH的住院原因.
- 准确分类住院原因对于了解医疗保健需求和改善PWH的结果至关重要.
研究的目的:
- 评估ICD-10-CM代码在代表艾滋病毒感染者 (PWH) 住院的主要原因方面的准确性.
- 将基于ICD的住院原因与专家判断进行比较.
- 为了确定与ICD编码和专家审查之间的差异相关的患者特征.
主要方法:
- 在UNC CFAR临床队列研究 (UCHCC) 中,从2016-2019年间的1428次住院治疗中,选择了302次住院治疗 (21%) 的随机样本.
- 基于ICD的住院原因是使用第一个或第二个列出的ICD出院诊断来确定的.
- 基于ICD的理由与专家的判断进行了比较,将结果分类为完全同意,部分同意,不同意或ICD编码不足.
主要成果:
- 专家判断在73%的住院病例中完全同意基于ICD的理由,在14%的病例中部分同意,在8%的病例中不同意,在6%的病例中不充分编码.
- 与较低协议相关的患者因素包括最近的CD4计数<200细胞/毫米3,最低CD4计数<50细胞/毫米3,≥15次出院诊断,停留时间≥4天,以及HIV作为主要诊断.
- 研究群体包括204名PWH (69%男性),平均年龄为51岁,住院时CD4细胞的中位数为539细胞/毫米3.
结论:
- 在大多数艾滋病毒感染者 (PWH) 病例中,ICD-10-CM代码有效地捕捉了住院的原因.
- 对于特定的患者子组,建议进行专家判断,包括那些控制不良的HIV (例如,低CD4计数) 和复杂住院的患者.
- 精细的编码实践和有针对性的裁决可以提高PWH住院数据的准确性,有助于更好的医疗保健管理和研究.
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