Abstract
BackgroundIn recent years, several primary care databases recording information from computerized medical records have been established and used for quality assessment of medical care and research. However, to be useful for research purposes, the data generated routinely from every day practice require registration of high quality. In this study we aimed to investigate (i) the frequency and validity of ICD code and drug prescription registration in the new Skaraborg primary care database (SPCD) and (ii) to investigate the sources of variation in this registration.MethodsSPCD contains anonymous electronic medical records (ProfDoc III) automatically retrieved from all 24 public health care centres (HCC) in Skaraborg, Sweden. The frequencies of ICD code registration for the selected diagnoses diabetes mellitus, hypertension and chronic cardiovascular disease and the relevant drug prescriptions in the time period between May 2002 and October 2003 were analysed. The validity of data registration in the SPCD was assessed in a random sample of 50 medical records from each HCC (n = 1200 records) using the medical record text as gold standard. The variance of ICD code registration was studied with multi-level logistic regression analysis and expressed as median odds ratio (MOR).ResultsFor diabetes mellitus and hypertension ICD codes were registered in 80-90% of cases, while for congestive heart failure and ischemic heart disease ICD codes were registered more seldom (60-70%). Drug prescription registration was overall high (88%). A correlation between the frequency of ICD coded visits and the sensitivity of the ICD code registration was found for hypertension and congestive heart failure but not for diabetes or ischemic heart disease.The frequency of ICD code registration varied from 42 to 90% between HCCs, and the greatest variation was found at the physician level (MORPHYSICIAN = 4.2 and MORHCC = 2.3).ConclusionsSince the frequency of ICD code registration varies between different diagnoses, each diagnosis must be separately validated. Improved frequency and quality of ICD code registration might be achieved by interventions directed towards the physicians where the greatest amount of variation was found.
Highlights
In recent years, several primary care databases recording information from computerized medical records have been established and used for quality assessment of medical care and research
Since the frequency of ICD code registration varies between different diagnoses, each diagnosis must be separately validated
The main findings of this study were that the sensitivity of ICD code registration varied between diagnoses, being highest for diabetes mellitus (89%) and hypertension (83%) and lowest for congestive heart failure (CHF) (66%), and that there was a large variation between physicians and between health care centres (HCC) in the frequency of ICD coding with the largest difference being between physicians
Summary
Several primary care databases recording information from computerized medical records have been established and used for quality assessment of medical care and research. To be useful for research purposes, the data generated routinely from every day practice require registration of high quality. The Skaraborg Primary Care Database (SPCD) was initiated in the year 2000 by linking information from the 24 public health care centres (HCCs) in the county of Skaraborg in Sweden. SPCD was one of the first large databases of this kind launched in Sweden In this database, diagnoses are coded according the Swedish version of the 10th version of the International Classification of Diseases (ICD-10) adapted for primary care [5]. We have found no study focusing on the role that different health care levels (e.g., patient, physician, HCC) play for understanding differences in ICD coding at the visit level
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