Abstract
It is unknown whether the digital application of automated ICD-9-CM codes recorded in the medical history are useful for a first screening in the detection of polypathological patients. In this study, the objective was to identify the degree of intra- and inter-observer concordance in the identification of in-patient polypathological patients between the standard clinical identification method and a new automatic method, using the basic minimum data set of ICD-9-CM codes in the digital medical history. For this, a cross-sectional multicenter study with 1518 administratively discharged patients from Andalusian hospitals during the period of 2013–2014 has been carried out. For the concordance between the clinical definition of a polypathological patient and the polypathological patient classification according to ICD-9-CM coding, a 0.661 kappa was obtained (95% confidence interval (CI); 0.622–0.701) with p < 0.0001. The intraclass correlation coefficient between both methods for the number of polypathological patient categories was 0.745 (95% CI; 0.721–0.768; p < 0.0001). The values of sensitivity, specificity, positive-, and negative predictive values of the automated detection using ICD-9-CM coding were 78%, 88%, 78%, and 88%, respectively. As conclusion, the automatic identification of polypathological patients by detecting ICD-9-CM codes is useful as a screening method for in-hospital patients.
Highlights
In the last third of the 20th century, there has been a demographic revolution among developed countries, as evidenced by a high proportion of the elderly and a parallel increase in life expectancy at birth
As for the number of ICD-9-CM diagnoses grouped at discharge, 13.6% (n = 207) had 15 diagnoses, 8.8% (n = 133) had 9, and 8.5% (n = 129) had 8
It is noted that the concordance of the polypathological patient (PP) classification according to the clinical agreement between two or more researchers, and the PP classification according to the ICD-9-CM coding was good
Summary
In the last third of the 20th century, there has been a demographic revolution among developed countries, as evidenced by a high proportion of the elderly and a parallel increase in life expectancy at birth. Chronic diseases are very directly related with multimorbidity, involving comprehensive care both at a hospital level and at a primary care level [3]. In Europe, chronic diseases account for a significant proportion (77%) of the total burden of diseases and are responsible for 86% of all deaths [4]. Chronically-ill patients consume 70% of health expenditure, 60% of hospitalizations, and 70%–80% of primary care consultations [5]. There is a tendency towards the coexistence of more than one chronic disease in the same person as age increases, which multiplies expenditure by six, compared with the patients with just one chronic illness, and by four or twelve times in comparison with patients of a lower age [6,7]
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