scholarly journals Diagnosed or prescribed only? A national analysis of initial evaluation and management of insomnia among older adult Medicare beneficiaries

2021 ◽  
Author(s):  
Emerson M Wickwire ◽  
Sophia L Jobe ◽  
Jennifer L Martin ◽  
Scott G Williams ◽  
Vincent F Capaldi ◽  
...  
Keyword(s):  
National Sample ◽  
Administrative Claims ◽  
Medicare Beneficiaries ◽  
International Classification Of Disease ◽  
Diagnostic Codes ◽  
Younger Age ◽  
Potentially Inappropriate Prescription ◽  
Data Source ◽  
National Analysis

Abstract Study Objectives To describe initial insomnia-related encounters among a national sample of Medicare beneficiaries, and to identify older adults at risk for potentially inappropriate prescription insomnia medication usage. Methods Our data source was a random 5% sample of Medicare administrative claims data (2006-2013). Insomnia was operationalized as International Classification of Disease, Ninth Revision, Clinical Modification diagnostic codes. Insomnia medications included FDA-approved insomnia-related medication classes and drugs. Logistic regression was employed to identify predictors of being “prescribed only” (i.e., being prescribed an insomnia medication without a corresponding insomnia diagnosis). Results A total of N=60,362 beneficiaries received either an insomnia diagnosis or a prescription for an insomnia medication as their first sleep-related encounter during the study period. Of these, 55.1% (n=33,245) were prescribed only, whereas 44.9% (n=27,117) received a concurrent insomnia diagnosis. In a fully adjusted regression model, younger age (odds ratio (OR) 0.98; 95% confidence interval (CI) 0.98, 0.99), male sex (OR 1.15; 95% CI 1.11, 1.20), and several comorbid conditions (i.e., dementia [OR 1.21; 95% CI 1.15, 1.27] and anemia [OR 1.17; 95% CI 1.13, 1.22]) were positively associated with being prescribed only. Conversely, black individuals (OR 0.83; 95% CI 0.78, 0.89) and those of “other” race (OR 0.89; 95% CI 0.84, 0.94) were less likely to be prescribed only. Individuals who received care from a board-certified sleep medicine provider (BCSMP) were less likely to be prescribed only (OR 0.27; 95% CI 0.16, 0.46). Conclusions Fewer than half of Medicare beneficiaries prescribed insomnia medications ever received a formal sleep-related diagnosis.

scholarly journals Adverse drug event rates in pediatric pulmonary hypertension: a comparison of real-world data sources

2019 ◽  
Vol 27 (2) ◽  
pp. 294-300 ◽  
Author(s):  
Alon Geva ◽  
Steven H Abman ◽  
Shannon F Manzi ◽  
Dunbar D Ivy ◽  
Mary P Mullen ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Claims Data ◽  
Data Sources ◽  
Drug Event ◽  
Administrative Claims ◽  
Diagnostic Code ◽  
Real World Data ◽  
Clinical Notes ◽  
Diagnostic Codes ◽  
Data Source

Abstract Objective Real-world data (RWD) are increasingly used for pharmacoepidemiology and regulatory innovation. Our objective was to compare adverse drug event (ADE) rates determined from two RWD sources, electronic health records and administrative claims data, among children treated with drugs for pulmonary hypertension. Materials and Methods Textual mentions of medications and signs/symptoms that may represent ADEs were identified in clinical notes using natural language processing. Diagnostic codes for the same signs/symptoms were identified in our electronic data warehouse for the patients with textual evidence of taking pulmonary hypertension-targeted drugs. We compared rates of ADEs identified in clinical notes to those identified from diagnostic code data. In addition, we compared putative ADE rates from clinical notes to those from a healthcare claims dataset from a large, national insurer. Results Analysis of clinical notes identified up to 7-fold higher ADE rates than those ascertained from diagnostic codes. However, certain ADEs (eg, hearing loss) were more often identified in diagnostic code data. Similar results were found when ADE rates ascertained from clinical notes and national claims data were compared. Discussion While administrative claims and clinical notes are both increasingly used for RWD-based pharmacovigilance, ADE rates substantially differ depending on data source. Conclusion Pharmacovigilance based on RWD may lead to discrepant results depending on the data source analyzed. Further work is needed to confirm the validity of identified ADEs, to distinguish them from disease effects, and to understand tradeoffs in sensitivity and specificity between data sources.

scholarly journals Coding reliability and agreement of international classification of disease, 10th revision (ICD-10) codes in emergency department data

2018 ◽  
Vol 3 (1) ◽  
Author(s):  
Mingkai Peng ◽  
Cathy Eastwood ◽  
Alicia Boxill ◽  
Rachel Joy Jolley ◽  
Laura Rutherford ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
International Classification ◽  
Main Diagnosis ◽  
International Classification Of Disease ◽  
Diagnostic Codes ◽  
Clinical Encounters ◽  
Diagnosis Codes ◽  
Icd 10

Introduction: Administrative health data from the emergency department (ED) play important roles in understanding health needs of the public and reasons for health care resource use. International Classification of Disease (ICD) diagnostic codes have been widely used for code reasons of clinical encounters for administrative purposes in EDs. Objective: The purpose of the study is to examine the coding agreement and reliability of ICD diagnosis codes in ED through auditing the routinely collected data. Methods: We randomly sampled 1 percent of records (n=1636) between October and December from 11 emergency departments in Alberta, Canada. Auditors were employed to review the same chart and independently assign main diagnosis codes. We assessed coding agreement and reliability through comparison of codes assigned by auditors and hospital coders using the proportion of agreement and Cohen’s kappa. Error analysis was conducted to review diagnosis codes with disagreement and categorized them into six groups. Results: Overall, the agreement was 86.5% and 82.2% at 3 and 4 digits levels respectively, and reliability was 0.86 and 0.82 respectively. Variation of agreement and reliability were identified across different emergency departments. The major two categories of coding discrepancy were the use of different codes for the same condition (23.6%) and the use of codes at different levels of specificity (20.9%). Conclusions: Diagnosis codes in emergency department show high agreement and reliability. More strict coding guidelines regarding the use of unspecified codes are needed to enhance coding consistency.

scholarly journals Development and validation of 15-month mortality prediction models: a retrospective observational comparison of machine-learning techniques in a national sample of Medicare recipients

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e022935 ◽  
Author(s):  
Gregory D Berg ◽  
Virginia F Gurley
Keyword(s):  
Neural Network ◽  
Logistic Regression ◽  
Predictive Model ◽  
National Sample ◽  
Administrative Claims ◽  
Charlson Score ◽  
Medicare Beneficiaries ◽  
C Statistic ◽  
Selection Of Variables ◽  
Selection Of

ObjectiveThe objective is to develop and validate a predictive model for 15-month mortality using a random sample of community-dwelling Medicare beneficiaries.Data sourceThe Centres for Medicare & Medicaid Services’ Limited Data Set files containing the five per cent samples for 2014 and 2015.ParticipantsThe data analysed contains de-identified administrative claims information at the beneficiary level, including diagnoses, procedures and demographics for 2.7 million beneficiaries.SettingUS national sample of Medicare beneficiaries.Study designEleven different models were used to predict 15-month mortality risk: logistic regression (using both stepwise and least absolute shrinkage and selection operator (LASSO) selection of variables as well as models using an age gender baseline, Charlson scores, Charlson conditions, Elixhauser conditions and all variables), naïve Bayes, decision tree with adaptive boosting, neural network and support vector machines (SVMs) validated by simple cross validation. Updated Charlson score weights were generated from the predictive model using only Charlson conditions.Primary outcome measureC-statistic.ResultsThe c-statistics was 0.696 for the naïve Bayes model and 0.762 for the decision tree model. For models that used the Charlson score or the Charlson variables the c-statistic was 0.713 and 0.726, respectively, similar to the model using Elixhauser conditions of 0.734. The c-statistic for the SVM model was 0.788 while the four models that performed the best were the logistic regression using all variables, logistic regression after selection of variables by the LASSO method, the logistic regression using a stepwise selection of variables and the neural network with c-statistics of 0.798, 0.798, 0.797 and 0.795, respectively.ConclusionsImproved means for identifying individuals in the last 15 months of life is needed to improve the patient experience of care and reducing the per capita cost of healthcare. This study developed and validated a predictive model for 15-month mortality with higher generalisability than previous administrative claims-based studies.

scholarly journals Early Dental Caries and Their Associated International Classifications of Disease Morbidity: A 16-Year Population Study

2021 ◽  
pp. 1-6
Author(s):  
David Cawthorpe ◽  
David Cawthorpe
Keyword(s):  
Dental Caries ◽  
Odds Ratios ◽  
Study Objective ◽  
Physician Visits ◽  
International Classification Of Disease ◽  
Cohort Group ◽  
Diagnostic Codes ◽  
Cohort Groups ◽  
The Relationship

Objective: The study objective was to examine the relationship between dental caries diagnosed before the age of four and ICD diseases over a 16-year period. Methods: The sample of approximately 33,531 (48% female) individuals having a total of 2,864,790 physician diagnoses over 16 years comprised a the cohort two groups, one with (2.7% of the sample) and one without dental caries (dependent variable) that were under the age of four years in the first two years of the sample data. Categories of dental caries and associated gingivitis and periodontal disease were based on the International Classification of Disease (ICD Version 9) diagnostic codes 521-523. The sample was described. Odds ratios comparing those with and without dental caries and the main ICD classes were calculated. Additionally, the ratio of each ICD diagnosis frequency comparing the cohort groups were calculated and represented the diagnoses assigned over the first 15 physician visits. Results: Males had proportionally more dental caries diagnosed. Diagnoses were made predominantly by general practitioners. Within the dental caries cohort group, associated ICD diagnoses were over-represented in both odds ratios and within individual ICD diagnoses on the first diagnosis and over the first 15 diagnoses in time. Conclusion: Dental caries diagnosed in very young children before the age of four are associated with multi-morbidity over subsequent years. Sex differences and patterns of associated morbidity may contribute to a better understanding of early life vulnerability to dental caries and their sequelae.

Future Directions

2020 ◽  
pp. 476-479
Author(s):  
Marc N. Potenza ◽  
Kyle A. Faust ◽  
David Faust
Keyword(s):  
Technology Development ◽  
Digital Technologies ◽  
World Health ◽  
International Classification Of Disease ◽  
Levels Of Use ◽  
Pornography Use ◽  
Negative Impacts ◽  
Mental Health Treatments ◽  
The Many

As digital technology development continues to expand, both its positive and negative applications have also grown. As such, it is essential to continue gathering data on the many types of digital technologies, their overall effects, and their impact on public health. The World Health Organization’s inclusion of Gaming Disorder in the eleventh edition of the International Classification of Disease (ICD-11) indicates that some of the problematic effects of gaming are similar to those of substance-use disorders and gambling. Certain behaviors easily engaged in via the internet may also lead to compulsive levels of use in certain users, such as shopping or pornography use. In contrast, digital technologies can also lead to improvements in and wider accessibility to mental health treatments. Furthermore, various types of digital technologies can also lead to benefits such as increased productivity or social functioning. By more effectively understanding the impacts of all types of digital technologies, we can aim to maximize their benefits while minimizing or preventing their negative impacts.

scholarly journals Neue Terminologie für Sprachentwicklungsstörungen?

2021 ◽  
Author(s):  
K. Neumann ◽  
B. Arnold ◽  
A. Baumann ◽  
C. Bohr ◽  
H. A. Euler ◽  
...  
Keyword(s):  
International Classification Of Diseases ◽  
International Classification ◽  
International Classification Of Disease ◽  
Diagnostik Und Therapie ◽  
Classification Of Diseases ◽  
Icd 10

Zusammenfassung Hintergrund Sprachtherapeutisch-linguistische Fachkreise empfehlen die Anpassung einer von einem internationalen Konsortium empfohlenen Änderung der Nomenklatur für Sprachstörungen im Kindesalter, insbesondere für Sprachentwicklungsstörungen (SES), auch für den deutschsprachigen Raum. Fragestellung Ist eine solche Änderung in der Terminologie aus ärztlicher und psychologischer Sicht sinnvoll? Material und Methode Kritische Abwägung der Argumente für und gegen eine Nomenklaturänderung aus medizinischer und psychologischer Sicht eines Fachgesellschaften- und Leitliniengremiums. Ergebnisse Die ICD-10-GM (Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme, 10. Revision, German Modification) und eine S2k-Leitlinie unterteilen SES in umschriebene SES (USES) und SES assoziiert mit anderen Erkrankungen (Komorbiditäten). Die USES- wie auch die künftige SES-Definition der ICD-11 (International Classification of Diseases 11th Revision) fordern den Ausschluss von Sinnesbehinderungen, neurologischen Erkrankungen und einer bedeutsamen intellektuellen Einschränkung. Diese Definition erscheint weit genug, um leichtere nonverbale Einschränkungen einzuschließen, birgt nicht die Gefahr, Kindern Sprach- und weitere Therapien vorzuenthalten und erkennt das ICD(International Classification of Disease)-Kriterium, nach dem der Sprachentwicklungsstand eines Kindes bedeutsam unter der Altersnorm und unterhalb des seinem Intelligenzalter angemessenen Niveaus liegen soll, an. Die intendierte Ersetzung des Komorbiditäten-Begriffs durch verursachende Faktoren, Risikofaktoren und Begleiterscheinungen könnte die Unterlassung einer dezidierten medizinischen Differenzialdiagnostik bedeuten. Schlussfolgerungen Die vorgeschlagene Terminologie birgt die Gefahr, ätiologisch bedeutsame Klassifikationen und differenzialdiagnostische Grenzen zu verwischen und auf wertvolles ärztliches und psychologisches Fachwissen in Diagnostik und Therapie sprachlicher Störungen im Kindesalter zu verzichten.

Is Cauda Equina Syndrome Being Treated Within the Recommended Time Frame?

Neurosurgery ◽  
2011 ◽  
Vol 68 (6) ◽  
pp. 1520-1526 ◽  
Author(s):  
Robert T. Arrigo ◽  
Paul Kalanithi ◽  
Maxwell Boakye
Keyword(s):  
Cauda Equina Syndrome ◽  
Medical Condition ◽  
Cauda Equina ◽  
Time Frame ◽  
Current Guideline ◽  
International Classification Of Disease ◽  
Lumbar Disk ◽  
Urgent Surgery ◽  
Spine Surgeon

Abstract BACKGROUND: Cauda equina syndrome (CES) is a rare but devastating medical condition requiring urgent surgery to halt or reverse neurological compromise. Controversy exists as to how soon surgery must be performed after diagnosis, and clinical and medicolegal factors make this question highly relevant to the spine surgeon. It is unclear from the literature how often CES patients are treated within the recommended time frame. OBJECTIVE: To determine whether CES patients are being treated in compliance with the current guideline of surgery within 48 hours and to assess incidence, demography, comorbidities, and outcome measures of CES patients. METHODS: We searched the 2003 to 2006 California State Inpatient Databases to identify degenerative lumbar disk disorder patients surgically treated for CES. An International Classification of Disease, ninth revision, clinical modification, diagnosis code was used to identify CES patients with advanced disease. RESULTS: The majority (88.74%) of California's CES patients received surgery within the recommended 48-hour window after diagnosis. The incidence of CES in surgically treated degenerative lumbar disk patients was 1.51% with an average of 397 cases per year in California. CES patients had worse outcomes and used more healthcare resources than other surgically treated degenerative lumbar disk patients; this disparity was more pronounced for patients with advanced CES. CES patients treated after 48 hours had 3 times the odds of a nonroutine discharge as patients treated within 48 hours (odds ratio = 3.082; P < .001). CONCLUSION: In California, patients are being treated within the recommended 48-hour time frame.

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