4 research outputs found
ICD-10-AM codes for cirrhosis and related complications: key performance considerations for population and healthcare studies
The utility of International ClassiïŹcation of Diseases (ICD) codes relies on the accuracy of clinical reporting and administrative coding, which may be influenced by country-specific codes and coding rules. This study explores the accuracy and limitations of the Australian Modification of the 10th revision of ICD (ICD-10-AM) to detect the presence of cirrhosis and a subset of key complications for the purpose of future large-scale epidemiological research and healthcare studies.ICD-10-AM codes in a random sample of 540 admitted patient encounters at a major Australian tertiary hospital were compared with data abstracted from patients' medical records by four blinded clinicians. Accuracy of individual codes and grouped combinations was determined by calculating sensitivity, positive predictive value (PPV), negative predictive value and Cohen's kappa coefficient (Îș).The PPVs for 'grouped cirrhosis' codes (0.96), hepatocellular carcinoma (0.97) ascites (0.97) and 'grouped varices' (0.95) were good (Îș all >0.60). However, codes under-detected the prevalence of cirrhosis, ascites and varices (sensitivity 81.4%, 61.9% and 61.3%, respectively). Overall accuracy was lower for spontaneous bacterial peritonitis ('grouped' PPV 0.75; Îș 0.73) and the poorest for encephalopathy ('grouped' PPV 0.55; Îș 0.21). To optimise detection of cirrhosis-related encounters, an ICD-10-AM code algorithm was constructed and validated in an independent cohort of 116 patients with known cirrhosis.Multiple ICD-10-AM codes should be considered when using administrative databases to study the burden of cirrhosis and its complications in Australia, to avoid underestimation of the prevalence, morbidity, mortality and related resource utilisation from this burgeoning chronic disease
Longitudinal change in simple scores identifies fibrosis status in people with nonalcoholic fatty liver disease
Towards collaborative management of nonalcoholic fatty liver disease (TCM-NAFLD): a âreal-worldâ pathway for fibrosis risk assessment in primary care
Background: The optimal strategy to support primary care practitioners (PCPs) to assess fibrosis severity in nonalcoholic fatty liver disease (NAFLD) and thereby make appropriate management decisions remains unclear.Aims: We aimed to examine the feasibility of using a 2-step pathway that combined simple scores (NAFLD Fibrosis Score and Fibrosis-4 Index) with transient elastography (FibroScanÂź) to streamline NAFLD referrals from a âroutineâ primary care population to specialist hepatology management clinics (HMC).Methods: The 2-step âTowards Collaborative Management of NAFLDâ (TCM-NAFLD) fibrosis risk assessment pathway was implemented at two outer metropolitan primary healthcare practices in Brisbane. Patients aged â„18âyears with a new or established PCP-diagnosis of NAFLD were eligible for assessment. The pathway triaged patients at âhigh riskâ of clinically significant fibrosis to HMC for specialist review, and âlow riskâ patients to receive ongoing management and longitudinal follow-up in primary care.Results: A total of 162 patient assessments between Jun-2019 and Dec-2020 were included. Mean age was 58.7 ±â11.7âyears, 30.9% were male, 54.3% had type 2 diabetes or impaired fasting glucose, and mean body mass index was 34.2 ±â6.9 kg/m2. 122 patients were considered âlow riskâ for clinically significant fibrosis, two patients had incomplete assessments, and 38 (23.5%) were triaged to HMC. Among 31 completed HMC assessments to date, 45.2% were considered to have clinically significant (or more advanced) fibrosis, representing 9.2% of 153 completed assessments.Conclusion: Implementation of the 2-step TCM-NAFLD pathway streamlined hepatology referrals for NAFLD and may facilitate a more cost-effective and targeted use of specialist hepatology resources
Assessment of health-related quality of life and health utilities in Australian patients with cirrhosis
Background and Aim Healthârelated qualityâofâlife measurements are important to understand lived experiences of patients who have cirrhosis. These measures also inform economic evaluations by modelling qualityâadjusted life years (QALYs). We aimed to describe healthârelated quality of life, specifically multiattribute utility (scale anchors of death = 0.00 and full health = 1.00), across various stages and etiologies of cirrhosis. Methods Faceâtoâface interviews were used to collect Short Form 36 (SFâ36) questionnaire responses from CirCare study participants with cirrhosis (June 2017 to December 2018). The severity of cirrhosis was assessed using the ChildâPugh score classified as class A (5â6 points), B (7â9), or C (10â15) and by the absence (âcompensatedâ) versus presence (âdecompensatedâ) of cirrhosisârelated complications. Results Patients (n =â562, average 59.8âyears [SD = 11.0], male 69.9%) had a range of primary etiologies (alcoholârelated 35.2%, chronic hepatitis C 25.4%, nonâalcoholic fatty liver disease (NAFLD) 25.1%, chronic hepatitis B 5.9%, âotherâ 8.4%). Significantly lower (all P <â0.001) mean multiattribute utility was observed in the health states of patients with decompensated (mean = 0.62, SD = 0.15) versus compensated cirrhosis (mean = 0.68, SD = 0.12), ChildâPugh class C (mean = 0.59, SD = 0.15) or B (mean = 0.63, SD = 0.15) versus A (mean = 0.68, SD = 0.16), and between those of working age (18â64âyears; mean = 0.64, SD = 0.16) versus those aged 65+ years (mean = 0.70, SD = 0.16). The greatest decrements in healthârelated quality of life relative to Australian population norms were observed across physical SFâ36 domains. Conclusions Persons with more advanced cirrhosis report greater life impacts. Estimates from this study are suitable for informing economic evaluations, particularly costâutility modelling, which captures the benefits of effective prevention, surveillance, and treatments on both the quality and quantity of patients' lives