International variation in the definition of ‘main condition' in ICD-coded health data

Hospital-based medical records are abstracted to create International Classification of Disease (ICD) coded discharge health data in many countries. The ‘main condition' is not defined in a consistent manner internationally. Some countries employ a ‘reason for admission' rule as the basis for the main condition, while other countries employ a ‘resource use' rule. A few countries have recently transitioned from one of these approaches to the other. The definition of ‘main condition' in such ICD data matters when it is used to define a disease cohort to assign diagnosis-related groups and to perform risk adjustment. We propose a method of harmonizing the international definition to enable researchers and international organizations using ICD-coded health data to aggregate or compare hospital care and outcomes across countries in a consistent manner. Inter-observer reliability of alternative harmonization approaches should be evaluated before finalizing the definition and adopting it worldwid

International variation in the definition of 'main condition' in ICD-coded health data

Hospital-based medical records are abstracted to create International Classification of Disease (ICD) coded discharge health data in many countries. The 'main condition' is not defined in a consistent manner internationally. Some countries employ a 'reason for admission' rule as the basis for the main condition, while other countries employ a 'resource use' rule. A few countries have recently transitioned from one of these approaches to the other. The definition of 'main condition' in such ICD data matters when it is used to define a disease cohort to assign diagnosis-related groups and to perform risk adjustment. We propose a method of harmonizing the international definition to enable researchers and international organizations using ICD-coded health data to aggregate or compare hospital care and outcomes across countries in a consistent manner. Inter-observer reliability of alternative harmonization approaches should be evaluated before finalizing the definition and adopting it worldwide

Nitrous oxide emission budgets and land-use-driven hotspots for organic soils in Europe

Peer reviewe

Opportunities and challenges for quality and safety applications in ICD-11: an international survey of users of coded health data

ObjectiveIn 2018, the World Health Organization (WHO) plans to release the 11th revision of the International Classification of Diseases (ICD). The overall goal of the WHO is to produce a new disease classification that has an enhanced ability to capture health concepts in a manner that is compatible with contemporary information systems. Accordingly, our objective was to identify opportunities and challenges in improving the utility of ICD-11 for quality and safety applications.DesignA survey study of international stakeholders with expertise in either the production or use of coded health data.SettingInternational producers or users of ICD-coded health care data.Study participantsWe used a snowball sampling approach to identify individuals with relevant expertise in 12 countries, mostly from North America, Europe, and Australasia. An 8-item online survey included questions on demographic characteristics, familiarity with ICD, experience using ICD-coded data on healthcare quality and safety, opinions regarding the use of ICD classification systems for quality and safety measurement, and current limitations and potential future improvements that would permit better coding of quality and safety concepts in ICD-11.ResultsTwo-hundred fifty-eight unique individuals accessed the online survey; 246 provided complete responses. The respondents identified specific desires for the ICD revision: more code content for adverse events/complications; a desire for code clustering mechanisms; the need for diagnosis timing information; and the addition of better code definitions to reference materials.ConclusionThese findings reinforce the vision and existing work plan of the WHO's ICD revision process, because each of these desires is being addressed

Opportunities and challenges for quality and safety applications in ICD-11: an international survey of users of coded health data

OBJECTIVE: In 2018, the World Health Organization (WHO) plans to release the 11th revision of the International Classification of Diseases (ICD). The overall goal of the WHO is to produce a new disease classification that has an enhanced ability to capture health concepts in a manner that is compatible with contemporary information systems. Accordingly, our objective was to identify opportunities and challenges in improving the utility of ICD-11 for quality and safety applications. DESIGN: A survey study of international stakeholders with expertise in either the production or use of coded health data. SETTING: International producers or users of ICD-coded health care data. STUDY PARTICIPANTS: We used a snowball sampling approach to identify individuals with relevant expertise in 12 countries, mostly from North America, Europe, and Australasia. An 8-item online survey included questions on demographic characteristics, familiarity with ICD, experience using ICD-coded data on healthcare quality and safety, opinions regarding the use of ICD classification systems for quality and safety measurement, and current limitations and potential future improvements that would permit better coding of quality and safety concepts in ICD-11. RESULTS: Two-hundred fifty-eight unique individuals accessed the online survey; 246 provided complete responses. The respondents identified specific desires for the ICD revision: more code content for adverse events/complications; a desire for code clustering mechanisms; the need for diagnosis timing information; and the addition of better code definitions to reference materials. CONCLUSION: These findings reinforce the vision and existing work plan of the WHO's ICD revision process, because each of these desires is being addressed

Enhanced capture of healthcare-related harms and injuries in the 11th revision of the International Classification of Diseases (ICD-11)

The World Health Organization (WHO) plans to submit the 11th revision of the International Classification of Diseases (ICD) to the World Health Assembly in 2018. The WHO is working toward a revised classification system that has an enhanced ability to capture health concepts in a manner that reflects current scientific evidence and that is compatible with contemporary information systems. In this paper, we present recommendations made to the WHO by the ICD revision's Quality and Safety Topic Advisory Group (Q&S TAG) for a new conceptual approach to capturing healthcare-related harms and injuries in ICD-coded data. The Q&S TAG has grouped causes of healthcare-related harm and injuries into four categories that relate to the source of the event: (a) medications and substances, (b) procedures, (c) devices and (d) other aspects of care. Under the proposed multiple coding approach, one of these sources of harm must be coded as part of a cluster of three codes to depict, respectively, a healthcare activity as a 'source' of harm, a 'mode or mechanism' of harm and a consequence of the event summarized by these codes (i.e. injury or harm). Use of this framework depends on the implementation of a new and potentially powerful code-clustering mechanism in ICD-11. This new framework for coding healthcare-related harm has great potential to improve the clinical detail of adverse event descriptions, and the overall quality of coded health data