scholarly journals Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study

BMJ ◽  
2019 ◽  
pp. k5092 ◽  
Author(s):  
Kao-Ping Chua ◽  
Michael A Fischer ◽  
Jeffrey A Linder
Keyword(s):  
Classification Scheme ◽  
Antibiotic Prescription ◽  
Antibiotic Prescribing ◽  
Diagnosis Code ◽  
Diagnosis Codes ◽  
The Us ◽  
Look Back ◽  
Icd 10 ◽  
Recent Diagnosis ◽  
Privately Insured

Abstract Objective To assess the appropriateness of outpatient antibiotic prescribing for privately insured children and non-elderly adults in the US using a comprehensive classification scheme of diagnosis codes in ICD-10-CM (international classification of diseases-clinical modification, 10th revision), which replaced ICD-9-CM in the US on 1 October 2015. Design Cross sectional study. Setting MarketScan Commercial Claims and Encounters database, 2016. Participants 19.2 million enrollees aged 0-64 years. Main outcome measures A classification scheme was developed that determined whether each of the 91 738 ICD-10-CM diagnosis codes “always,” “sometimes,” or “never” justified antibiotics. For each antibiotic prescription fill, this scheme was used to classify all diagnosis codes in claims during a look back period that began three days before antibiotic prescription fills and ended on the day fills occurred. The main outcome was the proportion of fills in each of four mutually exclusive categories: “appropriate” (associated with at least one “always” code during the look back period, “potentially appropriate” (associated with at least one “sometimes” but no “always” codes), “inappropriate” (associated only with “never” codes), and “not associated with a recent diagnosis code” (no codes during the look back period). Results The cohort (n=19 203 264) comprised 14 571 944 (75.9%) adult and 9 935 791 (51.7%) female enrollees. Among 15 455 834 outpatient antibiotic prescription fills by the cohort, the most common antibiotics were azithromycin (2 931 242, 19.0%), amoxicillin (2 818 939, 18.2%), and amoxicillin-clavulanate (1 784 921, 11.6%). Among these 15 455 834 fills, 1 973 873 (12.8%) were appropriate, 5 487 003 (35.5%) were potentially appropriate, 3 592 183 (23.2%) were inappropriate, and 4 402 775 (28.5%) were not associated with a recent diagnosis code. Among the 3 592 183 inappropriate fills, 2 541 125 (70.7%) were written in office based settings, 222 804 (6.2%) in urgent care centers, and 168 396 (4.7%) in emergency departments. In 2016, 2 697 918 (14.1%) of the 19 203 264 enrollees filled at least one inappropriate antibiotic prescription, including 490 475 out of 4 631 320 children (10.6%) and 2 207 173 out of 14 571 944 adults (15.2%). Conclusions Among all outpatient antibiotic prescription fills by 19 203 264 privately insured US children and non-elderly adults in 2016, 23.2% were inappropriate, 35.5% were potentially appropriate, and 28.5% were not associated with a recent diagnosis code. Approximately 1 in 7 enrollees filled at least one inappropriate antibiotic prescription in 2016. The classification scheme could facilitate future efforts to comprehensively measure outpatient antibiotic appropriateness in the US, and it could be adapted for use in other countries that use ICD-10 codes.

scholarly journals Digital Care Providers Antibiotic Prescribing Compared to Traditional Primary Healthcare: A Retrospective Database Study of 332,987 Healthcare Visits in Sweden.

2021 ◽  
Author(s):  
Justyna Ivarsson ◽  
Thorne Wallman ◽  
Andy Wallman
Keyword(s):  
Primary Healthcare ◽  
Antibiotic Prescription ◽  
Personal Information ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Place Of Residence ◽  
Diagnosis Codes ◽  
Icd 10 ◽  
Virtual Visits ◽  
Retrospective Database

Abstract ObjectivesThe aim of this study was to examine if there was a difference in antibiotic prescribing between private digital care providers, and traditional primary healthcare, and to investigate if the prescriptions differed regarding diagnosis between virtual visits and physical visits adjusted for age, sex, and place of residence for patients seeking care digitally and in person.MethodsAntibiotic prescribing based on ATC-codes during the period of two months in 2020 was studied. Prescriptions issued by online doctors and by physicians working within PHC Sörmland County, Sweden were considered. Information about healthcare provider, date of the visit, staff category that patient had contact with, ICD-10-diagnosis codes, ATC-codes of prescribed medicines and personal information such as: age, sex, and place of residence were used. Statistical analysis and logistic regression were performed.ResultsAltogether 332,987 healthcare visits were registered. Of all visits to physicians at PHC in Region Sörmland, antibiotics were prescribed in 5.9% of cases, and 3.9% of all visits to online doctors. The total number of visits that led to infection diagnosis was 112,354. Within physical visits at PHC 21.5% infection visits ended with antibiotic prescription, while within online visits the corresponding percentage was 10.1%. Additionally, the study focused on seventeen infection diagnoses.ConclusionThis study has shown that private digital care providers do not prescribe more antibiotics than doctors at PHC. Probability of receiving antibiotic prescription during digital visits was 4.88 times lower compared to physical visits.

scholarly journals Patterns of dental antibiotic prescribing in 2017: Australia, England, United States, and British Columbia (Canada)

2021 ◽  
pp. 1-8
Author(s):  
Wendy Thompson ◽  
Leanne Teoh ◽  
Colin C. Hubbard ◽  
Fawziah Marra ◽  
David M. Patrick ◽  
...  
Keyword(s):  
United States ◽  
British Columbia ◽  
Broad Spectrum ◽  
Antibiotic Prescription ◽  
Population Level ◽  
The United States ◽  
Antibiotic Prescribing ◽  
Prescribing Behavior ◽  
The Us ◽  
Amoxicillin Clavulanic Acid

Abstract Objective: Our objective was to compare patterns of dental antibiotic prescribing in Australia, England, and North America (United States and British Columbia, Canada). Design: Population-level analysis of antibiotic prescription. Setting: Outpatient prescribing by dentists in 2017. Participants: Patients receiving an antibiotic dispensed by an outpatient pharmacy. Methods: Prescription-based rates adjusted by population were compared overall and by antibiotic class. Contingency tables assessed differences in the proportion of antibiotic class by country. Results: In 2017, dentists in the United States had the highest antibiotic prescribing rate per 1,000 population and Australia had the lowest rate. The penicillin class, particularly amoxicillin, was the most frequently prescribed for all countries. The second most common agents prescribed were clindamycin in the United States and British Columbia (Canada) and metronidazole in Australia and England. Broad-spectrum agents, amoxicillin-clavulanic acid, and azithromycin were the highest in Australia and the United States, respectively. Conclusion: Extreme differences exist in antibiotics prescribed by dentists in Australia, England, the United States, and British Columbia. The United States had twice the antibiotic prescription rate of Australia and the most frequently prescribed antibiotic in the US was clindamycin. Significant opportunities exist for the global dental community to update their prescribing behavior relating to second-line agents for penicillin allergic patients and to contribute to international efforts addressing antibiotic resistance. Patient safety improvements will result from optimizing dental antibiotic prescribing, especially for antibiotics associated with resistance (broad-spectrum agents) or C. difficile (clindamycin). Dental antibiotic stewardship programs are urgently needed worldwide.

scholarly journals 1123. Specificity of Diagnosis Codes and Adequacy of Supportive Documentation for Common Acute Pediatric Infections: Implications for Ambulatory Stewardship

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S399-S399
Author(s):  
Zachary Willis ◽  
Elizabeth Walters
Keyword(s):  
Acute Otitis Media ◽  
Antibiotic Prescribing ◽  
National Guidelines ◽  
Laboratory Findings ◽  
Healthcare Settings ◽  
Diagnosis Codes ◽  
Icd 10 ◽  
Pediatric Infections ◽  
Data Elements ◽  
Physical Findings

Abstract Background Assessing the appropriateness of antibiotic prescribing in ambulatory care generally relies on the accuracy of diagnosis codes, which is uncertain. It is also uncertain if documented history and physical findings support antibiotic indications (AI). We completed a retrospective study of pediatric primary care (PPC) encounters to determine: A) if documented findings supported documented AI; and B) whether diagnosis codes captured documented AI (figure). Methods We conducted point-prevalence audits of the 9 PPC clinics in our healthcare system, randomly selecting one weekday per month to review all visits between 9/2017 and 4/2018. We included only encounters with antibiotic prescribing. We reviewed clinician notes, orders, laboratory results, and ICD-10 diagnosis codes. We recorded demographics; visit date/location; AI as documented in notes; history, examination, and laboratory findings; and diagnosis codes. We used national guidelines to determine whether documentation supported AI. We calculated the sensitivity of diagnosis codes using documented AI as the gold standard. Results The sample included 452 encounters. The most common AI were acute otitis media (AOM), pharyngitis, and sinusitis. For AOM, 163 of 168 encounters (97.0%) had an appropriate diagnosis code; for pharyngitis, 127 of 138 (92.0%); and for sinusitis, 68 of 75 (90.7%). For AOM, 160 of 168 encounters (95.2%) had adequate documentation of supportive findings. For sinusitis, 44 of 75 encounters had adequate supporting history and/or examination findings (58.7%). For pharyngitis, while 135 of 139 (97.1%) had a positive streptococcal test, 104 of 139 (74.8%) had history and examination findings to support testing. Conclusion By chart review, we identified each AI and evaluated whether findings supported those AI. The sensitivity of diagnosis codes for AI ranged from 90.7–97.0% for common conditions; this result can inform the design of ambulatory stewardship programs. Only 74.8% of children treated for pharyngitis and 58.7% of children treated for sinusitis had sufficient supporting documentation. Use of discrete data elements alone (Figure 1) may result in overestimates of the proportion of children for whom antibiotics are appropriate. Further research is needed across healthcare settings. Disclosures All authors: No reported disclosures

scholarly journals Use of ICD-10 Codes for Identification of Injection Drug Use–Associated Infective Endocarditis Is Nonspecific and Obscures Critical Findings on Impact of Medications for Opioid Use Disorder

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Laura R Marks ◽  
Nathanial S Nolan ◽  
Linda Jiang ◽  
Dharushana Muthulingam ◽  
Stephen Y Liang ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Opioid Use Disorder ◽  
Injection Drug ◽  
Diagnosis Code ◽  
Opioid Use ◽  
Diagnosis Codes ◽  
All Cause Mortality ◽  
Icd 10

Abstract Background No International Classification of Diseases, 10th revision (ICD-10), diagnosis code exists for injection drug use–associated infective endocarditis (IDU-IE). Instead, public health researchers regularly use combinations of nonspecific ICD-10 codes to identify IDU-IE; however, the accuracy of these codes has not been evaluated. Methods We compared commonly used ICD-10 diagnosis codes for IDU-IE with a prospectively collected patient cohort diagnosed with IDU-IE at Barnes-Jewish Hospital to determine the accuracy of ICD-10 diagnosis codes used in IDU-IE research. Results ICD-10 diagnosis codes historically used to identify IDU-IE were inaccurate, missing 36.0% and misclassifying 56.4% of patients prospectively identified in this cohort. Use of these nonspecific ICD-10 diagnosis codes resulted in substantial biases against the benefit of medications for opioid use disorder (MOUD) with relation to both AMA discharge and all-cause mortality. Specifically, when data from all patients with ICD-10 code combinations suggestive of IDU-IE were used, MOUD was associated with an increased risk of AMA discharge (relative risk [RR], 1.12; 95% CI, 0.48–2.64). In contrast, when only patients confirmed by chart review as having IDU-IE were analyzed, MOUD was protective (RR, 0.49; 95% CI, 0.19–1.22). Use of MOUD was associated with a protective effect in time to all-cause mortality in Kaplan-Meier analysis only when confirmed IDU-IE cases were analyzed (P = .007). Conclusions Studies using nonspecific ICD-10 diagnosis codes for IDU-IE should be interpreted with caution. In the setting of an ongoing overdose crisis and a syndemic of infectious complications, a specific ICD-10 diagnosis code for IDU-IE is urgently needed.

scholarly journals Prescribing of different antibiotics, rates of bacteremia/septicemia and associated mortality in the US and England, and the utility of antibiotic replacement vs. reduction in prescribing

2019 ◽  
Author(s):  
Edward Goldstein
Keyword(s):  
Bacterial Infections ◽  
Age Groups ◽  
Epidemiological Data ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Antibiotic Prescribing ◽  
Limited Information ◽  
E Coli ◽  
The Us ◽  
Icd 10

AbstractBackgroundAntibiotic use contributes to the rates of bacteremia, sepsis and associated mortality, particularly through lack of clearance of resistant infections following antibiotic treatment. At the same time, there is limited information on the effects of prescribing of some antibiotics vs. others, of antibiotic replacement and of reduction in prescribing on the rates of severe outcomes associated with bacterial infections.MethodsFor each of several antibiotic types/classes, we looked at associations (univariate, and multivariable for the US data) between the proportions (state-specific in the US, Clinical Commissioning Group (CCG)-specific in England) of a given antibiotic type/class among all prescribed antibiotics in the outpatient setting, and rates of outcomes (mortality with septicemia, ICD-10 codes A40-41 present on the death certificate in different age groups of adults in the US, and E. coli or MSSA bacteremia in England) per unit of antibiotic prescribing (defined as the rate of outcome divided by the rate of prescribing of all antibiotics).ResultsIn the US, prescribing of penicillins was positively associated with rates of mortality with septicemia for persons aged 75-84y and 85+y between 2014-2015, while multivariable analyses also suggest an association between the percent of individuals aged 50-64y lacking health insurance, as well as the percent of individuals aged 65-84y who are African-American and rates of mortality with septicemia. In England, prescribing of penicillins other than amoxicillin/co-amoxiclav was positively associated with rates of both MSSA and E. coli bacteremia for the period between financial years 2014/15 through 2017/18. Additionally, as time progressed, correlations between prescribing for both trimethoprim and co-amoxiclav and rates of bacteremia in England decreased, while correlations between amoxicillin prescribing and rates of bacteremia increased.ConclusionsOur results suggest that prescribing of penicillins is associated with rates of E. coli and MSSA bacteremia in England, and rates of mortality with septicemia in older US adults, which agrees with our earlier findings. Those results, as well as the related epidemiological data suggest that antibiotic replacement rather than reduction in prescribing may be the more effective mechanism for reducing the rates of severe bacterial infections.

Accuracy and Validity Outpatient Diagnosis Code Base On ICD-10 at Imogiri I Health Center Bantul Yogyakarta

2022 ◽  
Vol 2 (1) ◽  
pp. 26-31
Author(s):  
Hendra Rohman
Keyword(s):  
Health Center ◽  
Medical Record ◽  
Total Sample ◽  
Accurate Diagnosis ◽  
Diagnosis Code ◽  
Validation Data ◽  
Diagnosis Codes ◽  
Code Base ◽  
Icd 10

Background: Analysis of accuracy and validity fill code diagnosis on medical record document is very important because if diagnosis code is not appropriate with ICD-10, will cause decline in quality services health center, generated data have this validation data level is low, because accuracy code very important for health center such as index process and statistical report, as basis for making outpatient morbidity report and top ten diseases reports, as well as influencing policies will be taken by primary health center management. This study aims to analyze accuracy and validity diagnosis disease code based on ICD-10 fourth quarter in 2020 Imogiri I Health Center Bantul.Methods: Descriptive qualitative approach, case study design. Subject is a doctor, nurse, head record medical and staff. Object is outpatients medical record document in Imogiri I Health Center Bantul. Total sample 99 medical record file. Obtaining data from this study through interviews and observations.Results: Number of complete accurate diagnosis codes is 60 (60,6%), incomplete accurate diagnosis codes is 26 (26.3%) and inaccurate diagnosis codes is 13 (13.1%). Inaccuracies include errors in determining code, errors in determining 4th character ICD-10 code, not adding 4th and 5th characters, not including external cause, and multiple diseases.Conclusions: Inaccuracy factors are not competence medical record staff, incomplete diagnosis writing and no training, no evaluation or coding audit has been carried out, and standard operational procedure is not socialized.

scholarly journals Which Dermatological Conditions Present to an Emergency Department in Australia?

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Julia Lai-Kwon ◽  
Tracey J. Weiland ◽  
Alvin H. Chong ◽  
George A. Jelinek
Keyword(s):  
Emergency Department ◽  
Specialty Training ◽  
Skin Involvement ◽  
Diagnosis Code ◽  
Varicella Zoster ◽  
Diagnosis Codes ◽  
Dermatological Disease ◽  
Icd 10 ◽  
Minimal Data ◽  
Varicella Zoster Infection

Background/Objectives. There is minimal data available on the types of dermatological conditions which present to tertiary emergency departments (ED). We analysed demographic and clinical features of dermatological presentations to an Australian adult ED.Methods. The St. Vincent’s Hospital Melbourne (SVHM) ED database was searched for dermatological presentations between 1 January 2009 and 31 December 2011 by keywords and ICD-10 diagnosis codes. The lists were merged, and the ICD-10 codes were grouped into 55 categories for analysis. Demographic and clinical data for these presentations were then analysed.Results. 123 345 people presented to SVHM ED during the 3-year period. 4817 (3.9%) presented for a primarily dermatological complaint. The most common conditions by ICD-10 diagnosis code were cellulitis (n=1741, 36.1%), allergy with skin involvement (n=939, 19.5%), boils/furuncles/pilonidal sinuses (n=526, 11.1%), eczema/dermatitis (n=274, 5.7%), and varicella zoster infection (n=161, 3.3%).Conclusion. The burden of dermatological disease presenting to ED is small but not insignificant. This information may assist in designing dermatological curricula for hospital clinicians and specialty training organisations as well as informing the allocation of dermatological resources to ED.

scholarly journals 1632. Non-Visit-Based and Non-Infection-Related Ambulatory Antibiotic Prescribing

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S43-S43 ◽  
Author(s):  
Jeffrey A Linder ◽  
Tiffany Brown ◽  
Ji Young Lee ◽  
Kao-Ping Chua ◽  
Michael A Fischer
Keyword(s):  
Nurse Practitioners ◽  
Physician Assistants ◽  
Antibiotic Prescribing ◽  
Face To Face ◽  
Health Delivery ◽  
Online Portal ◽  
Diagnosis Codes ◽  
Icd 10 ◽  
Primary Care Clinicians ◽  
Attending Physicians

Abstract Background Many studies have examined or intervened on ambulatory antibiotic prescribing based on infection-related diagnosis codes. However, clinicians may prescribe antibiotics without seeing patients face-to-face or without documenting an infection-related diagnosis. Methods We measured the prevalence of non-visit-based and non-infection-related oral, antibacterial–antibiotic prescribing between November 2015 and October 2017 using the EHR of an integrated health delivery system. We examined the visit type (in-person vs. other) and classified prescriptions into 3 mutually exclusive groups based on same-day diagnosis codes: (1) infection-related for prescriptions associated with at least one of 21,730 ICD-10 codes that may signify infection; (2) non-infection-related for prescriptions only associated with the 72,519 ICD-10 codes that do not signify infections; and (3) associated with no diagnosis. Results There were 509,534 antibiotic prescriptions made to 279,169 unique patients by 2,413 clinicians in 514 clinics. Patients had a mean age of 43 years old, were 60% women, and 75% white. Clinicians were 54% women; were 63% attending physicians, 18% residents/fellows, 10% nurse practitioners, and 7% physician assistants; and were 41% medical specialists, 21% primary care clinicians, and 7% surgical specialists. The most common antibiotic classes were penicillins (30%), macrolides (23%), cephalosporins (14%), fluoroquinolones (11%), tetracyclines (10%), and sulfonamides (6%). Clinicians prescribed 20% of antibiotics outside of an in-person visit; prescription encounters were in-person (80%), telephone (10%), order-only (4%), refill (4%), and online portal (1%). Clinicians prescribed 46% of antibiotics without an infection-related diagnosis: 54% of antibiotic prescriptions were infection-related, 29% were non-infection-related, and 17% were associated with no diagnosis. Various look-back and look-forward durations for diagnosis codes changed the results only slightly. Conclusion Clinicians prescribed 20% of antibiotics outside of in-person visits and 46% of antibiotics without an infection-related diagnosis. Interventions that target visit-based, diagnosis-specific prescriptions miss a large share of antibiotic prescribing. Disclosures All authors: No reported disclosures.

scholarly journals Diagnosis Code Accuracy Analysis Of Acute Gastroenteritis Disease Based on Medical Record Document in Balung Hospital Jember

1970 ◽  
Vol 2 (2) ◽  
pp. 12
Author(s):  
Rinda Nurul Karimah ◽  
Dony Setiawan ◽  
Puput Septining Nurmalia
Keyword(s):  
Medical Record ◽  
Acute Gastroenteritis ◽  
Medical Records ◽  
Disease Diagnosis ◽  
Accuracy Analysis ◽  
Diagnosis Code ◽  
Diagnosis Codes ◽  
Icd 10

Accuracy analysis of replenishment diagnosis codes on the document medical records is very important because if the diagnosis code is not right or not in accordance with the ICD-10, it can cause a decline in the quality of care in hospitals as well as the influence of data, information reporting, and accuracy rates of INA-CBG's that are currently used as a method of payment for patient care. The purpose of this study was to analyze the accuracy of diagnosis codes acute gastroenteritis disease in hospitalized patients by medical record documents in the first quarter of 2015 in the Balung Hospital Jember. This research used qualitative data. Acquisition of data from this study through interviews and observations. Results obtained from the observation of medical record documents at the inpatient unit in the first quarter 2015 in Balung Hospital Jember, there are some numbers determining the accuracy of disease diagnosis codes as many as 17 medical record documents with acute gastroenteritis illness and the determination of improper diagnosis codes as many as 63 medical records document acute gastroenteritis illness. After analyzing, the cause of the problem is the accuracy of the diagnosis that affects the accuracy of writing code, beside it has never been disseminated to physicians and medical records personnel related to the management of medical records. Therefore, it is necessary to carry out activities that can improve the accuracy of disease diagnosis code and quality of human resources, among others, include doctors and medical records personnel in training and socialization related to the management of medical records. Key Words : Diagnosis codes , medical record, acute gastroenteritis

scholarly journals Relationship Between Specificity and Precision in Writing the Main Diagnosis and Accuracy of Main Diagnosis Codes with Financing Claims in Cases of DM in Dr Radjiman Wediodiningrat Hospital, Lawang

2019 ◽  
Vol 2 (2) ◽  
pp. p26
Author(s):  
Endang Sri Dewi Hastuti Suryandari
Keyword(s):  
Monitoring And Evaluation ◽  
Simple Random Sampling ◽  
Main Diagnosis ◽  
Diagnosis Code ◽  
Cross Sectional ◽  
Independent Variables ◽  
Diagnosis Codes ◽  
Periodic Monitoring ◽  
Icd 10 ◽  
The Cost

Specificity and precision in writing the main diagnosis will give the accuracy of diagnosis code, and proper code will give an impact on the appropriate of the cost using INA-CBGs. Research objectives was to analyze the specificity and precision in writing the main diagnosis and the accuracy of main diagnosis code based on ICD-10, also the claims of financing in the case of Diabetes Mellitus (DM) in RSJ Dr. Radjiman Wediodiningrat Lawang, as well as analyzed their relationship. This type of research was a cross sectional correlasional. Independent variables were the specificity and precision in writing the main diagnosis and the accuracy of main diagnosis code, and the dependent variable was the claim of financing. The number of samples analyzed were 50 inpatient medical record document (MRD) of DM cases which hospitalization from January to September 2017, selected by simple random sampling. The results showed the unspecific and unprecise in writing the main diagnosis of DM disease had a risk 1.6 times greater impacting the inaccuracy the main diagnosis code of DM disease (95% CI: 1.05 - 2.30) and 1.8 times greater resulting in the claims for financing treatment not accordance (95% CI: 1.03 - 3.12). An internal verification team is needed for submission of financing claims, consisting of elements from the medical committee, medical recorders and other related elements, as well as conducting periodic monitoring and evaluation of how to write the main diagnoses and their coding.

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