Relevant ICD-10 Codes Research Articles

Abstract 19212: Racial Differences in Clinical Outcomes and Resource Utilization Associated With Heart Failure Hospitalizations in the United States: A Nationwide Analysis From 2011-2012

Background and objectives: Heart failure (HF) incidence is higher among Blacks compared to Whites. There is a paucity of recent data on racial differences in in-hospital mortality and resource utilization in a nationally representative, multiracial cohort of HF hospitalizations. Hypothesis: There are significant racial-ethnic differences in HF hospitalization outcomes. Methods: We used the 2011-2012 Nationwide/National Inpatient Sample to identify hospitalizations with a primary diagnosis of HF using relevant ICD-9 codes. Outcomes of interest were in-hospital mortality, length of stay (LOS) and mean inflation adjusted charges. The effect of race on outcomes was ascertained using logistic or linear regression. Results: 375,740 primary HF hospitalizations representing 1.8 million hospitalizations nationwide were included. Mean age was 72.6 (SD 14.6) years and 50.1% were females. After adjusting for age, sex, hypertension, diabetes, APR-DRG mortality risk and socioeconomic status, in-hospital mortality was significantly lower for Blacks (OR 0.69, 95% CI 0.64 - 0.74; p<0.001), Hispanics (OR 0.82, 95% CI 0.75 - 0.91; p<0.001) and Asians or Pacific Islanders (OR 0.85, 95% CI 0.73 - 0.99; p=0.04) compared to Whites. Average inflation adjusted charges were significantly higher for all minorities compared to Whites except for Native Americans for whom charges were significantly lower than Whites (p<0.05 for Black, Hispanic, Asian, NA or Others vs. Whites). LOS was modestly higher for Blacks or Other races vs. Whites (p=0.01 B vs. W and Others vs. W) and lower for Native Americans vs. Whites (p<0.001). Conclusions: Blacks, Hispanics and Asians hospitalized for HF are significantly less likely to die in the hospital compared to Whites. Hospital charges for racial-ethnic minorities are significantly higher compared to Whites. The reasons for racial differences in HF hospitalization outcomes require further investigation.

The Financial Burden and Health Care Utilization Related to Intentional Versus Unintentional Foreign Body Ingestion in a University Hospital: A Pilot Study

Introduction: Foreign body ingestion is a common problem faced by gastroenterologists. Previous literature has focused on accidental foreign body ingestion, primarily in the form of esophageal food impactions. Recently, the cost associated with intentional foreign body ingestion has been recognized as a significant problem. There are no studies assessing the financial impact of intentional foreign body ingestion compared to accidental ingestion. This study assesses the total hospital-related costs of intentional foreign body ingestion compared with unintentional ingestion. Methods: Retrospective review comparing the demographics, hospital length of stay (LOS), and overall cost for episodes of intentional ingestion of foreign bodies (IFB) compared to unintentional foreign body ingestions and esophageal food impactions (UFI) at the University of Arizona Medical Center. Hospital billing data from 2006-2012 generated from relevant ICD-9 codes was utilized to identify potential cases of foreign body ingestion. Due to initial availability of the data, we analyzed cases from 2010-2011 and identified appropriate cases from a detailed review of hospital charts and electronic medical records. Total cost based on emergency room, procedural, and inpatient costs were calculated. Total hospital length of stay, concurrent medical or psychiatric issues, endoscopic findings, and documented reason for ingestion were also assessed. Results: From Jan 2010-Dec 2011, 20 cases, consisting of 13 patients met criteria for IFB, and 29 cases consisting of 27 patients, met criteria for UFI. Two patients had 3 intentional foreign body ingestions, and 4 patients had two episodes of IFB. Two patients had a second episode of UFI. 75% of the IFB cases (9 patients) were reported suicidal attempts and 10 of the 13 patients with intentional foreign body ingestions had a psychiatric disorder. 70.6% of IFB cases required hospitalization compared to 11.1% UFI cases. Average LOS was 2.5 days for IFB compared to 0.78 days for UFI. The average total cost of medical care for IFB was $208,668.95 compared to $11349.94 for UFI (p=0.03350) (see table 1). Conclusion: In this study, the cost associated with IFB were significantly higher than for UFI. Patients with IFB also had higher rates of hospitalization, longer average LOS, more repeat episodes, and were more likely to have psychiatric disorders compared to UFI. To decrease the costs associated with IFB, additional resources for prevention including psychiatric care may be beneficial.Table 1

Obesity and risk of infection: results from the Danish Blood Donor Study.

It is well known that obesity complicates the course of several diseases. However, it is unknown whether obesity affects the risk of infection among healthy individuals. We included 37,808 healthy participants from the Danish Blood Donor Study, who completed a questionnaire on health-related items. Obesity was defined as a body mass index ≥ 30 kg/m(2). Infections among participants were identified by relevant ICD-10 codes in the Danish National Patient Register and Anatomical Therapeutic Chemical (ATC) codes in the Danish Prescription Register. Multivariable Cox proportional hazards analysis with age as the underlying timescale was used as the statistical model. During 113,717 person-years of observation, 1,233 participants were treated for infection at a hospital. Similarly, during 58,411 person-years of observation, 15,856 participants filled at least one prescription of antimicrobials. Obesity was associated with risk of hospital-based treatment for infection (women: hazard ratio [HR] = 1.5, 95% confidence interval [CI] = 1.1, 1.9; men: HR = 1.5, 95% CI = 1.2, 1.9). For specific infections, obesity was associated with increased risk of abscesses (both sexes), infections of the skin and subcutaneous tissue (men), and respiratory tract infections and cystitis (women). Similarly, obesity was associated with filled prescriptions of antimicrobials overall (women: HR = 1.22, 95% CI = 1.14, 1.30; men: HR = 1.23, 95% CI: 1.15, 1.33) and particularly with phenoxymethylpenicillin, macrolides, dicloxacillin and flucloxacillin, and broad-spectrum penicillins. In a large cohort of healthy individuals, obesity was associated with risk of infection. This result warrants further studies of metabolism and the immune response.

PTH-169 Global inverse associations between gastric and oesophageal adenocarcinoma supports h. pylori infection protecting from latter

<h3>Introduction</h3> H.pylori atrophic gastritis and associated hypochlorhydria have been suggested to protect against oesophageal adenocarcinoma (OAD), so that the falling incidence of the former might be linked to the rising incidence of the latter seen recently. If so, a negative association should exist between the incidences of OAD and non-cardia gastric cancer, mediated by atrophic gastritis. <h3>Method</h3> In a cross-sectional study, world age-standardised incidences rates (WASR), for the period 2003–07, were abstracted from “Cancer Incidence in Five Continents” Volume X together with 2012 estimates from GLOBOCAN 2012. Relevant ICD-10 codes were used to locate oesophageal and gastric cancers anatomically, and ICD-O3 codes for the histological diagnosis of OAD. In a longitudinal study, trends in WASRs of OAD and total gastric cancer (TGC) were extracted from Cancer in Five Continents Plus (CI5C-Plus). Average annual percentage change (AAPC) in WASRs were calculated for the period 1989–2007 using joinpoint regression. <h3>Results</h3> WASRs for the year 2012 were available for 51 countries and showed a negative correlation between OAD and both TGC (men: CC=-0.38, p = 0.006, women: CC=-0.41, p = 0.003) and non-cardia gastric cancer (men: CC=-0.41, p = 0.003 and women: CC=-0.43, p = 0.005). AAPCs were analysed for 38 populations and showed a significant decrease of TGC in 89% and increase of OAD in 66% of the populations, with no population showing a fall in the latter. Significant negative correlations between the incidences of the two cancers were observed in 28 of the 39 populations over the 18–49 years of available observation time. Super-imposition of the longitudinal and cross-sectional data indicated that populations with currently high incidence of OAD and low incidence of gastric cancer had previously resembled countries with high incidence of gastric cancer and low incidence of oesophageal adenocarcinoma. <h3>Conclusion</h3> The negative association between OAD and gastric cancer in both recent incidence and over time supports the hypothesis of atrophic gastritis protecting against OAD and also the falling incidence of the gastritis contributing to the rise in the incidence of OAD. Our study also demonstrates the value of the global cancer registry network in identifying disease trends and their implications. <h3>Disclosure of interest</h3> None Declared.

Does hospital accreditation impact bariatric surgery safety?

To evaluate the impact of hospital accreditation upon bariatric surgery outcomes. Since 2004, the American College of Surgeons and the American Society of Metabolic and Bariatric Surgery have accredited bariatric hospitals. Few studies have evaluated the impact of hospital accreditation on all bariatric surgery outcomes. Bariatric surgery hospitalizations were identified using International Classification of Diseases, Ninth Revision (ICD9) codes in the 2010 Nationwide Inpatient Sample (NIS). Hospital names and American Hospital Association (AHA) codes were used to identify accredited bariatric centers. Relevant ICD9 codes were used for identifying demographics, length of stay (LOS), total charges, mortality, complications, and failure to rescue (FTR) events. There were 117,478 weighted bariatric patient discharges corresponding to 235 unique hospitals in the 2010 NIS data set. A total of 72,615 (61.8%) weighted discharges, corresponding to 145 (61.7%) named or AHA-identifiable hospitals were included. Among the 145 hospitals, 66 (45.5%) were unaccredited and 79 (54.5%) accredited. Compared with accredited centers, unaccredited centers had a higher mean LOS (2.25 vs 1.99 days, P < 0.0001), as well as total charges ($51,189 vs $42,212, P < 0.0001). Incidence of any complication was higher at unaccredited centers than at accredited centers (12.3% vs 11.3%, P = 0.001), as was mortality (0.13% vs 0.07%, P = 0.019) and FTR (0.97% vs 0.55%, P = 0.046). Multivariable logistic regression analysis identified unaccredited status as a positive predictor of incidence of complication [odds ratio (OR) = 1.08, P < 0.0001], as well as mortality (OR = 2.13, P = 0.013). Hospital accreditation status is associated with safer outcomes, shorter LOS, and lower total charges after bariatric surgery.

PF.45 Comparison of Antenatal Detection Rates of Fetal Anomalies Betweeneight Trusts in the East Midlands and South Yorkshire. Are the Fetal Anomaly Screening Programme Targets Achievable?

BackgroundIn 2010, the UK Fetal Anomaly Screening Programme (FASP)introduced targets varying between 50% and 98% for the antenatal detectionof elevencongenital anomalies*. Auditing these standards is complex, requiring an understanding oftrust...

The effect of July admission on inpatient outcomes following spinal surgery

The presence of a "July effect," where the influx of new residents and fellows at teaching hospitals every July may negatively affect patient care and outcomes, is widely debated. The authors used the Nationwide Inpatient Sample (NIS) to identify all cases of spinal surgery and examine outcomes among patients who underwent surgery in July compared with those who underwent surgery in other months. Spinal surgery hospitalizations from 2001 to 2008 were identified in the NIS by extracting relevant ICD-9 codes. Rates of in-hospital mortality, discharge to a long-term care facility, and postoperative complications were compared between admission months and between teaching and nonteaching hospitals using the Wilcoxon rank-sum test, Fisher exact test, and multivariate regression analysis. Compared with patients admitted in other months, patients who were admitted to teaching hospitals in July for spinal surgery showed a similar likelihood of in-hospital mortality (OR 0.94 [95% CI 0.78-1.11], p = 0.46), reaction to implanted device/instrumentation (OR 0.88 [95% CI 0.77-1.02], p = 0.09), and postoperative wound dehiscence (OR 1.12 [95% CI 0.94-1.33], p = 0.25). A significantly higher likelihood of discharge to a long-term care facility (OR 1.03 [95% CI 1.00-1.07], p = 0.0467) and postoperative infection (OR 1.11 [95% CI 1.05-1.17], p = 0.0341) was observed in teaching hospitals in July compared with other months; however, incidence rates were similar regardless of admission month. Higher-risk patients (Charlson score ≥ 2) admitted to teaching hospitals in July had a similar likelihood of all outcomes regardless of admission month. This study of nationwide hospitalizations demonstrates that the influx of new residents and fellows in July has a negligible effect on periprocedural outcomes following spinal surgery.

Factors affecting adherence to evidence-based guidelines in the treatment of URI, sinusitis, and pharyngitis

IntroductionSinus infections, sore throats, and upper respiratory tract infections (URI) are common reasons patients seek medical care. Well-established treatment guidelines exist for prescribing antibiotics in these clinical scenarios, but are not often followed.ObjectiveThe objective of this study is to determine practice patterns related to prescribing antibiotics for sinusitis, URI, and pharyngitis. The main hypothesis is that attending physicians improve their adherence to antibiotic guidelines with a learner present.MethodsA retrospective cohort study was performed on patients treated for URI, sinusitis, and pharyngitis at an ambulatory faculty practice. The use of relevant ICD-9 codes from January 1, 2008 to January 30, 2012 resulted in 1,548 patient encounters which were reviewed for guideline adherence. Univariate analysis and multivariate logistic regression was performed for each outcome variable to determine if they influence antibiotic adherence. Variables studied were physician, presence of a learner, BMI, age, gender, day of the week, month, diabetes, immunosuppression, and COPD.ResultsMultivariate analysis showed the statistically significant variables were age (p=0.038) for pharyngitis and provider (p=0.013) for URI. There were no significant findings for sinusitis. Guideline adherence was 24% in patients with pharyngitis, 42% in acute sinusitis, 79% in URI, and 57% overall.ConclusionGuideline adherence varies depending on the treating physician and decreases when treating younger patients with pharyngitis. The presence of a learner did not improve prescribing habits. The reason for these findings remain unclear, but considerations for improvement could include following antibiotic adherence as a quality measure, giving patients handouts educating them about the impact of overprescribing antibiotics, and further education amongst faculty and residents about adhering to nationally recognized guidelines.

Exposure-Based, ‘Like-for-Like’ Assessment of Road Safety by Travel Mode Using Routine Health Data

BackgroundOfficial reports on modal risk have not chosen appropriate numerators and denominators to enable like-for-like comparisons. We report age- and sex-specific deaths and injury rates from equivalent incidents in England by travel mode, distance travelled and time spent travelling.MethodsHospital admissions and deaths in England 2007–2009 were obtained for relevant ICD-10 external codes for pedestrians, cyclists, and car/van drivers, by age-group and sex. Distance travelled by age-group, sex and mode in England (National Travel Survey 2007–2009 data) was converted to time spent travelling using mean trip speeds. Fatality rates were compared with age-specific Netherlands data.ResultsAll-age fatalities per million hours’ use (f/mhu) varied over the same factor-of-three range for both sexes (0.15–0.45 f/mhu by mode for men, 0.09–0.31 f/mhu for women). Risks were similar for men aged 21–49 y for all three modes and for female pedestrians and drivers aged 21–69 y. Most at risk were: males 17–20 y (1.3 f/mhu (95% CI 1.2–1.4)) for driving; males 70+ (2.2 f/mhu(1.6–3.0)) for cycling; and females 70+ (0.95 f/mhu (0.86–1.1)) for pedestrians. In general, fatality rates were substantially higher among males than females. Risks per hour for male drivers <30 y were similar or higher than for male cyclists; for males aged 17–20 y, the risk was higher for drivers (33/Bn km (30–36), 1.3 f/mhu (1.2–1.4)) than cyclists (20/Bn km (10–37), 0.24 f/mhu (0.12–0.45)) whether using distance or time. Similar age patterns occurred for cyclists and drivers in the Netherlands. Age-sex patterns for injuries resulting in hospital admission were similar for cyclists and pedestrians but lower for drivers.ConclusionsWhen all relevant ICD-10 codes are used, fatalities by time spent travelling vary within similar ranges for walking, cycling and driving. Risks for drivers were highest in youth and fell with age, while for pedestrians and cyclists, risks increased with age. For the young, especially males, cycling is safer than driving.

Syndromic surveillance for influenza in two hospital emergency departments. Relationships between ICD-10 codes and notified cases, before and during a pandemic

BackgroundInterest in the use of emergency department (ED) data by syndromic surveillance systems to detect influenza outbreaks has been growing. Evaluations of these systems generally focus on events during influenza seasons. The aims of this study were to identify which emergency department disease codes best correlated with confirmed influenza cases and to determine if these same codes would be useful in the non-influenza season. The 2009 influenza pandemic in Victoria, Australia, provided further opportunity to examine the performance of the syndromic surveillance system during this event.MethodsWe undertook a retrospective analysis of data from the Victorian Department of Health's pilot syndromic surveillance programme, 'SynSurv'. SynSurv automatically captures patient information as it is entered by ED staff. This information includes patient demographics, their presenting symptoms and a preliminary diagnosis using ICD-10 coding. To determine which codes were best correlated with influenza notifications, weekly counts for each of the ICD-10 diagnosis codes ever used in the dataset were calculated and compared with the corresponding weekly count of confirmed influenza cases. Correlations between these codes and confirmed influenza cases in the non-influenza season were then undertaken. The data covered the period from July 2001 until August 2009 and included the 2009 influenza pandemic.ResultsThere was a marked increase in weekly counts of both laboratory-confirmed influenza cases and relevant ICD-10 codes during the influenza pandemic period. The increase in laboratory confirmed cases was more than four times greater than the previous highest number reported, in 2007, even though the influenza-like-illness activity in the community was considered comparable to 2003 and 2007. We found five ICD-10 codes to be moderately and significantly correlated with influenza cases. None of these codes was correlated with laboratory confirmed influenza notifications outside the influenza season, at least in part because of the small number of influenza cases notified during that period.ConclusionsThis study suggests that the choice of codes made by ED staff to record a case of influenza-like illness is influenced by their perceptions of how much influenza is circulating at the time. The ability of syndromic surveillance to detect outbreaks early may be impeded because case diagnosis is influenced by what ED staff believes to be occurring in the community.

Electronic Health Record Analysis of the Primary Care of Adults with Intellectual and Other Developmental Disabilities.

Adults with intellectual and other developmental disabilities (IDD) are at risk for sub-optimal primary health care. Electronic Health Record (EHR) analyses are an under-utilized resource for studying the health and primary care of this population. This was a case-control EHR analysis of adults with IDD provided primary care through the Cleveland Clinic between 2005 and 2008. The IDD cohort was identified by relevant ICD-9 codes in problem list and encounter diagnoses. A comparison cohort matched by age, sex, race, and insurance was also specified. Demographic, health and health service characteristics of the two cohorts were compared. The IDD cohort consisted of 1267 individuals, mean age 39 years, 54% male, 78% Caucasian. Age, sex, racial, and health insurance characteristics were similar in the 2534 individuals in the comparison cohort. Individuals with IDD were significantly more likely to carry diagnoses of epilepsy, constipation, osteoporosis, obesity, and hyperlipidemia; but were significantly less likely to bear diagnoses of hypertension, diabetes, osteoarthritis, heart failure, coronary heart disease, and COPD. Despite a lower mean BMI, individuals with IDD were more likely to be labeled obese. Only genetic consultation rates were higher in the IDD cohort. Health services research related to persons with IDD is becoming more feasible as large health systems adopt EHRs. Further analyses from this dataset will investigate whether variations in disease rates in adults with IDD represent true differences in disease prevalence versus disparities in health care.

Is Age-Related Macular Degeneration Associated with Stroke Among Elderly Americans?§

Objective:To investigate whether age-related macular degeneration (AMD) is associated with the development of ischemic and hemorrhagic stroke among elderly Americans.Design:Population-based cohort study.Participants:The five percent random sample of 2000-2003 Medicare enrollees was obtained. The cohort (n=1,519,086) consisted of enrollees who were aged 65 or older at the first two-year (January 1, 2000 to December 31, 2001).Methods:Baseline demographic variables and chronic conditions (AMD and type, history of myocardial infarction (MI), stroke, hypertension, and diabetes) were defined based on the occurrence of relevant ICD-9 codes in relevant diagnosis fields of the baseline Medicare Data. We excluded 215,900 persons who had a diagnosis of MI or stroke during baseline period to form a cohort of 1,303,186 individuals who were free of major cardio-cerebral vascular disease (CVD) at baseline.Main Outcome Measures:In two years of follow-up (January 1, 2002 to December 31, 2003), a total of 89,501 incident stroke cases were identified, including 80,018 ischemic, 7048 hemorrhagic, and 2,435 stroke cases of both types.Results:Baseline mean age was 75 years (Standard Divination=7.7), with 60% women and 88% whites. The prevalence of AMD was 10.6%, with 19.7% being neovascular AMD and 80.3% being non-neovascular AMD. Baseline age, gender, race, hypertension, and diabetes adjusted 2-year incident odds ratios and 95% confidence internal of stroke associated with AMD were 1.31 (1.26, 1.36) for neovascular AMD, 1.18 (1.15, 1.21) for non-neovascular AMD, and 1.21 (1.18, 1.23) for either neovascular or non-neovascular AMD.Conclusion:The findings are suggestive of an association between AMD, especially neovascular AMD, and incident stroke, independent of demographic factors and co-morbidity. These findings, if confirmed by other studies that control for smoking and other lifestyle covariables not measured in this study, suggest the possibility of shared common antecedents between stroke and AMD.

Trends in Medication Prescribing for Pediatric Sleep Difficulties in US Outpatient Settings

This study examined trends in physician-prescribing of medications for children with sleep difficulties in outpatient settings in the US. Additionally, we explored the incidence of physician prescribing patterns of medications with high abuse potential for children with sleep difficulties. A cross-sectional study was conducted on patients aged < or =17 years with sleep difficulties from 1993-2004 using data from the National Ambulatory Medical Care Survey (NAMCS). Office visits were considered related to sleep difficulties if relevant ICD-9 codes were recorded and if sleep difficulties were reported as the reason for the visits. Medications were retrieved using the NAMCS drug codes, and all analyses were weighted to determine national estimates. During 1993 to 2004, approximately 18.6 million visits occurred for sleep related difficulty in children. The highest percentage of visits were by school-aged children (6 to 12 years). Pediatricians saw 35% of patients, psychiatrists saw 24%, and general/family practice physicians saw 13% of the patients. Eighty-one percent of visits among children with sleep difficulties resulted in a prescription for a medication. Many of these medications prescribed lack FDA approved labeling to assure their effectiveness and safety in this population. The findings of this study suggest that physicians frequently prescribed medications for sleep difficulties in children in US outpatient settings. Of particular concern is prescribing of many unapproved medications for this population.

Deaths related to lead poisoning in the United States, 1979–1998

This study was conducted to describe trends in US lead poisoning-related deaths between 1979 and 1998. The predictive value of relevant ICD-9 codes was also evaluated. Multiple cause-of-death files were searched for records containing relevant ICD-9 codes, and underlying causes and demographic characteristics were assessed. For 1979–1988, death certificates were reviewed; lead source information was abstracted and accuracy of coding was determined. An estimated 200 lead poisoning-related deaths occurred from 1979 to 1998. Most were among males (74%), Blacks (67%), adults of age ⩾45 years (76%), and Southerners (70%). The death rate was significantly lower in more recent years. An alcohol-related code was a contributing cause for 28% of adults. Only three of nine ICD-9 codes for lead poisoning were highly predictive of lead poisoning-related deaths. In conclusion, lead poisoning-related death rates have dropped dramatically since earlier decades and are continuing to decline. However, the findings imply that moonshine ingestion remains a source of high-dose lead exposure in adults.