在百万退伍军人计划队伍中确定骨关节炎病例:诊断代码与临床笔记的比较
Chelsea T Nguyen1,2, Joshua S Richman2,3, Joe W Chiles1,2
1Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294, USA.
Osteoarthritis and cartilage open
|March 9, 2026
概括
在使用诊断代码的退伍军人中识别骨关节炎 (OA) 显示了与临床笔记的中度一致,因关节部位而异. 需要精细的算法来更好地检测电子健康记录中的OA.
科学领域:
- 生物医学信息学 生物医学信息学
- 类风湿病学 类风湿病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 骨关节炎 (OA) 是影响退伍军人的普遍疾病.
- 在电子医疗记录 (EMR) 中准确识别OA病例对于研究和临床护理至关重要.
- 目前使用诊断代码的方法可能无法完全捕捉OA患病率.
研究的目的:
- 为了比较使用诊断代码与退伍军人的临床笔记识别骨关节炎 (OA) 的准确性.
- 评估不同联合站点之间编码的OA数据和图表记录的OA之间的协议.
- 评估电子医疗记录 (EMR) 在老兵人口中OA表型化方面的实用性.
主要方法:
- 使用来自百万退伍军人计划 (MVP) 的电子病历 (EMR) 数据进行回顾性队列研究.
- 通过ICD-9-CM/ICD-10-CM代码对手册图表抽象进行OA识别的比较.
- 利用科恩的卡帕和麦克纳马的测试来评估对一般和特定场所的OA和关节置换的同意.
主要成果:
- 对于代码和图表之间的一般OA识别,发现了适度的协议 (kappa = 0.53).
- 对于膝盖 (kappa = 0.63) 和部OA (kappa = 0.58),观察到实质性的一致性,但对于其他位置较低.
- 对于关节 (kappa = 0.86) 和膝关节置换 (kappa = 0.69),注意到高度一致,有证据表明较轻微的OA表型的代码不足.
结论:
- 退伍军人的诊断代码和图表记录的OA之间的协议是可变的,并且取决于联合站点.
- 较轻微的OA表型的不足编码表明当前诊断编码实践的局限性.
- 改进的表型算法和标准化的诊断协议是准确的OA检测在退伍军人的必要.
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