Validating Use of Electronic Health Data to Identify Patients with Urinary Tract Infections in Outpatient Settings

Objective: To validate the use of electronic algorithms based on International Classification of Diseases (ICD)-10 codes to identify outpatient visits for urinary tract infections (UTI), one of the most common reasons for antibiotic prescriptions. Methods: ICD-10 symptom codes (e.g., dysuria) alone or in addition to UTI diagnosis codes plus prescription of a UTI-relevant antibiotic were used to identify outpatient UTI visits. Chart review (gold standard) was performed by two reviewers to confirm diagnosis of UTI. The positive predictive value (PPV) that the visit was for UTI (based on chart review) was calculated for three different ICD-10 code algorithms using (1) symptoms only, (2) diagnosis only, or (3) both. Results: Of the 1087 visits analyzed, symptom codes only had the lowest PPV for UTI (PPV = 55.4%; 95%CI: 49.3–61.5%). Diagnosis codes alone resulted in a PPV of 85% (PPV = 84.9%; 95%CI: 81.1–88.2%). The highest PPV was obtained by using both symptom and diagnosis codes together to identify visits with UTI (PPV = 96.3%; 95%CI: 94.5–97.9%). Conclusions: ICD-10 diagnosis codes with or without symptom codes reliably identify UTI visits; symptom codes alone are not reliable. ICD-10 based algorithms are a valid method to study UTIs in primary care settings.

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A Trade-off Analysis of Routine Newborn Circumcision

PEDIATRICS ◽

10.1542/peds.105.s2.246 ◽

2000 ◽

Vol 105 (Supplement_2) ◽

pp. 246-249

Author(s):

Dimitri A. Christakis ◽

Eric Harvey ◽

Danielle M. Zerr ◽

Chris Feudtner ◽

Jeffrey A. Wright ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Penile Cancer ◽

International Classification Of Diseases ◽

Population Based ◽

Complication Rates ◽

Safe Procedure ◽

Trade Offs ◽

Classification Of Diseases ◽

Tract Infections

Background. The risks associated with newborn circumcision have not been as extensively evaluated as the benefits. Objectives. The goals of this study were threefold: 1) to derive a population-based complication rate for newborn circumcision; 2) to calculate the number needed to harm for newborn circumcision based on this rate; and 3) to establish trade-offs based on our complication rates and published estimates of the benefits of circumcision including the prevention of urinary tract infections and penile cancer. Methods. Using the Comprehensive Hospital Abstract Reporting System for Washington State, we retrospectively examined routine newborn circumcisions performed over 9 years (1987–1996). We used International Classification of Diseases, Ninth Revision codes to identify both circumcisions and complications and limited our analyses to children without other surgical procedures performed during their initial birth hospitalization. Results. Of 354 297 male infants born during the study period, 130 475 (37%) were circumcised during their newborn stay. Overall 287 (.2%) of circumcised children and 33 (.01%) of uncircumcised children had complications potentially associated with circumcision coded as a discharge diagnosis. Based on our findings, a complication can be expected in 1 out every 476 circumcisions. Six urinary tract infections can be prevented for every complication endured and almost 2 complications can be expected for every case of penile cancer prevented. Conclusions. Circumcision remains a relatively safe procedure. However, for some parents, the risks we report may outweigh the potential benefits. This information may help parents seeking guidance to make an informed decision.

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Hospital-Acquired Catheter-Associated Urinary Tract Infection: Documentation and Coding Issues May Reduce Financial Impact of Medicare's New Payment Policy

Infection Control and Hospital Epidemiology ◽

10.1086/652523 ◽

2010 ◽

Vol 31 (6) ◽

pp. 627-633 ◽

Cited By ~ 59

Author(s):

Jennifer Meddings ◽

Sanjay Saint ◽

Laurence F. McMahon

Keyword(s):

Urinary Tract ◽

Medical Record ◽

Urinary Tract Infections ◽

Length Of Hospital Stay ◽

International Classification Of Diseases ◽

Secondary Diagnosis ◽

Diagnosis Codes ◽

Tract Infections ◽

Hospital Acquired ◽

Present On Admission

Objective.To evaluate whether hospital-acquired catheter-associated urinary tract infections (CA-UTIs) are accurately documented in discharge records with the use of International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes so that nonpayment is triggered, as mandated by the Centers for Medicare and Medicaid Services (CMS) Hospital-Acquired Conditions Initiative.Methods.We conducted a retrospective medical record review of 80 randomly selected adult discharges from May 2006 through September 2007 from the University of Michigan Health System (UMHS) with secondary-diagnosis urinary tract infections (UTIs). One physician-abstractor reviewed each record to categorize UTIs as catheter associated and/or hospital acquired; these results (considered “gold standard”) were compared with diagnosis codes assigned by hospital coders. Annual use of the catheter association code (996.64) by UMHS coders was compared with state and US rates by using Healthcare Cost and Utilization Project data.Results.Patient mean age was 58 years; 56 (70%) were women; median length of hospital stay was 6 days; 50 patients (62%) used urinary catheters during hospitalization. Hospital coders had listed 20 secondary-diagnosis UTIs (25%) as hospital acquired, whereas physician-abstractors indicated that 37 (46%) were hospital acquired. Hospital coders had identified no CA-UTIs (code 996.64 was never used), whereas physician-abstractors identified 36 CA-UTIs (45%; 28 hospital acquired and 8 present on admission). Catheter use often was evident only from nursing notes, which, unlike physician notes, cannot be used by coders to assign discharge codes. State and US annual rates of 996.64 coding (~1% of secondary-diagnosis UTIs) were similar to those at UMHS.Conclusions.Hospital coders rarely use the catheter association code needed to identify CA-UTI among secondary-diagnosis UTIs. Coders often listed a UTI as present on admission, although the medical record indicated that it was hospital acquired. Because coding of hospital-acquired CA-UTI seems to be fraught with error, nonpayment according to CMS policy may not reliably occur.

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A Descriptive Analysis of Outpatient Antimicrobial Use for Urinary Tract Infections in Virginia

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1125 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s453-s454

Author(s):

Hasti Mazdeyasna ◽

Shaina Bernard ◽

Le Kang ◽

Emily Godbout ◽

Kimberly Lee ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Private Insurance ◽

Geographic Region ◽

Study Cohort ◽

Antibiotic Prescribing ◽

Prescribing Trends ◽

Icd 10 ◽

Tract Infections ◽

Insurance Payer

Background: Data regarding outpatient antibiotic prescribing for urinary tract infections (UTIs) are limited, and they have never been formally summarized in Virginia. Objective: We describe outpatient antibiotic prescribing trends for UTIs based on gender, age, geographic region, insurance payer and International Classification of Disease, Tenth Revision (ICD-10) codes in Virginia. Methods: We used the Virginia All-Payer Claims Database (APCD), administered by Virginia Health Information (VHI), which holds data for Medicare, Medicaid, and private insurance. The study cohort included Virginia residents who had a primary diagnosis of UTI, had an antibiotic claim 0–3 days after the date of the diagnosis and who were seen in an outpatient facility in Virginia between January 1, 2016, and December 31, 2016. A diagnosis of UTI was categorized as cystitis, urethritis or pyelonephritis and was defined using the following ICD-10 codes: N30.0, N30.00, N30.01, N30.9, N30.90, N30.91, N39.0, N34.1, N34.2, and N10. The following antibiotics were prescribed: aminoglycosides, sulfamethoxazole/trimethoprim (TMP-SMX), cephalosporins, fluoroquinolones, macrolides, penicillins, tetracyclines, or nitrofurantoin. Patients were categorized based on gender, age, location, insurance payer and UTI type. We used χ2 and Cochran-Mantel-Haenszel testing. Analyses were performed in SAS version 9.4 software (SAS Institute, Cary, NC). Results: In total, 15,580 patients were included in this study. Prescriptions for antibiotics by drug class differed significantly by gender (P < .0001), age (P < .0001), geographic region (P < .0001), insurance payer (P < .0001), and UTI type (P < .0001). Cephalosporins were prescribed more often to women (32.48%, 4,173 of 12,846) than to men (26.26%, 718 of 2,734), and fluoroquinolones were prescribed more often to men (53.88%, 1,473 of 2,734) than to women (47.91%, 6,155 of 12,846). Although cephalosporins were prescribed most frequently (42.58%, 557 of 1,308) in northern Virginia, fluoroquinolones were prescribed the most in eastern Virginia (50.76%, 1677 of 3,304). Patients with commercial health insurance, Medicaid, and Medicare were prescribed fluoroquinolones (39.31%, 1,149 of 2,923), cephalosporins (56.33%, 1,326 of 2,354), and fluoroquinolones (57.36%, 5,910 of 10,303) most frequently, respectively. Conclusions: Antibiotic prescribing trends for UTIs varied by gender, age, geographic region, payer status and UTI type in the state of Virginia. These data will inform future statewide antimicrobial stewardship efforts.Funding: NoneDisclosures: Michelle Doll reports a research grant from Molnlycke Healthcare.

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Assessment of symptoms on patients with urinary tract infections and adherence to medications

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v12i3.4776 ◽

2021 ◽

Vol 12 (3) ◽

pp. 1740-1744

Author(s):

Eva Lorel Kouassi ◽

Abdul Wahid Ishaque ◽

Amulya P. Shetty ◽

Rimpa Devi ◽

Sheethal Kuriakose ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Bacterial Infections ◽

Developed Countries ◽

P Value ◽

Strong Positive Correlation ◽

Early Assessment ◽

Tract Infections ◽

Outpatient Settings ◽

The Impact

Although urinary tract infections (UTIs) are considered to be the most common bacterial infections worldwide, their assessment remains a big clinical challenge, because they are not reportable diseases in developed countries like United States and any other parts of the world including India. This situation is further complicated by the fact that accurate diagnosis depends on both the presence of symptoms and a positive urine culture, although in most outpatient settings this diagnosis is made without the benefit of culture. Our study aimed to appraise the impact of urinary tract infections symptoms on selected patients and comprehend their adherence to medications despite the challenges of antimicrobial susceptibility and resistance observed. One hundred and twenty patients with confirmed cases of urinary tract infections were recruited for the study. The mean age of females and males patients was found to be 59.86±2.37and 52.27±3 years respectively. Pertinent descriptive and inferential statistics were performed. Spearman correlation test revealed a strong positive correlation between overall UTIs’ symptoms and their impact on patients at baseline (0.84) and at follow up (0.799) with p value =0.5. On the other hand the majority of patients were found to be adherent to the medications after discharge. The current study revealed that Urinary tract infections if left untreated can negatively impact the lives of patients suffering from it and hinder their adherence to medications. Consequently, accurate and early assessment of UTIs’ symptoms in clinics and hospitals becomes a necessity.

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Challenges and remediation for Patient Safety Indicators in the transition to ICD-10-CM

Journal of the American Medical Informatics Association ◽

10.1136/amiajnl-2013-002491 ◽

2014 ◽

Vol 22 (1) ◽

pp. 19-28 ◽

Cited By ~ 3

Author(s):

Andrew D Boyd ◽

Young Min Yang ◽

Jianrong Li ◽

Colleen Kenost ◽

Mike D Burton ◽

...

Keyword(s):

Patient Safety ◽

Adverse Events ◽

International Classification Of Diseases ◽

Healthcare Research ◽

Coding System ◽

Patient Safety Indicators ◽

Safety Reporting ◽

Diagnosis Codes ◽

Classification Of Diseases ◽

Icd 10

Abstract Reporting of hospital adverse events relies on Patient Safety Indicators (PSIs) using International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes. The US transition to ICD-10-CM in 2015 could result in erroneous comparisons of PSIs. Using the General Equivalent Mappings (GEMs), we compared the accuracy of ICD-9-CM coded PSIs against recommended ICD-10-CM codes from the Centers for Medicaid/Medicare Services (CMS). We further predict their impact in a cohort of 38 644 patients (1 446 581 visits and 399 hospitals). We compared the predicted results to the published PSI related ICD-10-CM diagnosis codes. We provide the first report of substantial hospital safety reporting errors with five direct comparisons from the 23 types of PSIs (transfusion and anesthesia related PSIs). One PSI was excluded from the comparison between code sets due to reorganization, while 15 additional PSIs were inaccurate to a lesser degree due to the complexity of the coding translation. The ICD-10-CM translations proposed by CMS pose impending risks for (1) comparing safety incidents, (2) inflating the number of PSIs, and (3) increasing the variability of calculations attributable to the abundance of coding system translations. Ethical organizations addressing ‘data-, process-, and system-focused’ improvements could be penalized using the new ICD-10-CM Agency for Healthcare Research and Quality PSIs because of apparent increases in PSIs bearing the same PSI identifier and label, yet calculated differently. Here we investigate which PSIs would reliably transition between ICD-9-CM and ICD-10-CM, and those at risk of under-reporting and over-reporting adverse events while the frequency of these adverse events remain unchanged.

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Cost of peripheral neuropathy in patients receiving treatment for multiple myeloma: a US administrative claims analysis

Therapeutic Advances in Hematology ◽

10.1177/2040620719839025 ◽

2019 ◽

Vol 10 ◽

pp. 204062071983902 ◽

Cited By ~ 8

Author(s):

Xue Song ◽

Kathleen L. Wilson ◽

Jerry Kagan ◽

Sumeet Panjabi

Keyword(s):

Multiple Myeloma ◽

Peripheral Neuropathy ◽

Economic Burden ◽

Proteasome Inhibitors ◽

International Classification Of Diseases ◽

Administrative Claims ◽

Novel Treatments ◽

Diagnosis Codes ◽

Classification Of Diseases ◽

Icd 10

Background: Peripheral neuropathy (PN) is a common consequence of multiple myeloma (MM) among those commonly treated with older-generation proteasome inhibitors (PIs). In this study, we evaluated the economic burden attributable to PN among MM patients in real-world practice settings in the US. Methods: Adults diagnosed with MM and first treated (index event) between 1 July 2006 and 28 February 2017 were identified from MarketScan® Commercial and Medicare claim databases. Continuous enrollment for at least 12 months without treatment and PN diagnoses were required pre-index. Patients were followed for at least 3 months until inpatient death or end of data. The International Classification of Diseases, ninth revision, Clinical Modification (ICD-9-CM) and ICD-10-CM diagnosis codes were used to identify PN. Propensity-score matching was applied to match every patient with PN to two MM patients without a PN diagnosis (controls). Healthcare utilization and expenditures per patient per month (PPPM) in the postindex period were estimated. Results: Of 11,851 patients meeting the study criteria, 15.5% had PN. After matching 1387 patients with PN and 2594 controls were identified. Baseline characteristics were well balanced between cohorts; mean follow up was 23–26 months. PPPM total costs were significantly higher by $1509 for patients with PN than controls, driven by higher hospitalization (PN 77.4%, controls 67.2%; p < 0.001) and emergency department rates (PN 67.8%, controls 58.4%; p < 0.001) and more outpatient hospital-based visits PPPM (PN 13.5 ± 14.7, controls 11.5 ± 18.0; p < 0.001). Conclusions: PN is a prevalent MM treatment complication associated with a significant economic burden adding to the complexity and cost of MM treatment. Highly effective novel treatments such as carfilzomib may reduce the overall disease burden.

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Frequency and Etiology of Gross Hematuria in a General Pediatric Setting

PEDIATRICS ◽

10.1542/peds.59.4.557 ◽

1977 ◽

Vol 59 (4) ◽

pp. 557-561 ◽

Cited By ~ 2

Author(s):

Julie R. Ingelfinger ◽

Alvin E. Davis ◽

Warren E. Grupe

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Pediatric Emergency ◽

Glomerular Disease ◽

Gross Hematuria ◽

Pediatric Setting ◽

Tract Infections ◽

Outpatient Settings

Since the frequency of gross hematuria in general, unselected, pediatric outpatient settings has not been reported, we reviewed all patients with this symptom or sign at a pediatric emergency walk-in clinic during 24 consecutive months. Of a total of 128,395 patient visits, gross hematuria was proven in 158 (1.3/1,000 visits). Fifty-six percent of all patients had readily apparent causes for their gross hematuria. Twenty-six percent of all hematuric patients had documented urinary tract infections, but only 9% had apparent glomerular disease.

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Two Simple Rules for Improving the Accuracy of Empiric Treatment of Multidrug-Resistant Urinary Tract Infections

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01638-15 ◽

2015 ◽

Vol 59 (12) ◽

pp. 7593-7596 ◽

Cited By ~ 15

Author(s):

Katherine Linsenmeyer ◽

Judith Strymish ◽

Kalpana Gupta

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Broad Spectrum ◽

Empiric Therapy ◽

Multidrug Resistant ◽

Veterans Affairs ◽

Department Of Veterans Affairs ◽

Simple Rules ◽

Tract Infections ◽

Outpatient Settings

ABSTRACTThe emergence of multidrug-resistant (MDR) uropathogens is making the treatment of urinary tract infections (UTIs) more challenging. We sought to evaluate the accuracy of empiric therapy for MDR UTIs and the utility of prior culture data in improving the accuracy of the therapy chosen. The electronic health records from three U.S. Department of Veterans Affairs facilities were retrospectively reviewed for the treatments used for MDR UTIs over 4 years. An MDR UTI was defined as an infection caused by a uropathogen resistant to three or more classes of drugs and identified by a clinician to require therapy. Previous data on culture results, antimicrobial use, and outcomes were captured from records from inpatient and outpatient settings. Among 126 patient episodes of MDR UTIs, the choices of empiric therapy against the index pathogen were accurate in 66 (52%) episodes. For the 95 patient episodes for which prior microbiologic data were available, when empiric therapy was concordant with the prior microbiologic data, the rate of accuracy of the treatment against the uropathogen improved from 32% to 76% (odds ratio, 6.9; 95% confidence interval, 2.7 to 17.1;P< 0.001). Genitourinary tract (GU)-directed agents (nitrofurantoin or sulfa agents) were equally as likely as broad-spectrum agents to be accurate (P= 0.3). Choosing an agent concordant with previous microbiologic data significantly increased the chance of accuracy of therapy for MDR UTIs, even if the previous uropathogen was a different species. Also, GU-directed or broad-spectrum therapy choices were equally likely to be accurate. The accuracy of empiric therapy could be improved by the use of these simple rules.

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