all US health care institutions and practitioners transitioned to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding system, raising concerns about the validity of examining trends over time in clinical care, costs, and quality. 1 For child mental health disorders, alignment with psychiatric diagnosis groups in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) is also required to consistently examine trends. This is because the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM diagnosis codes differ for individual disorders, and child mental health disorders are reclassified under new psychiatric diagnosis groups. We thus developed the Child and Adolescent Mental Health Disorders Classification System (CAMHD-CS), which classifies child mental health disorders across coding systems and aligns with DSM-5 psychiatric diagnosis groups. To examine our system's performance, we compared detection of these disorders in a Medicaid claims database against the Clinical Classification Software (CCS) groups 2 and then examined identification of the disorders across ICD-9-CM and ICD-10-CM coding systems using a national pediatric hospitalization database.Methods | Following the general equivalency mapping guidelines, 3 all ICD-9-CM and ICD-10-CM mental health diagnoses, source code descriptions, and corresponding DSM-5 categories were flagged as equal, approximate, or no match, and codes in the ICD-9-CM that linked to more than 1 ICD-10-CM code were identified. Backward and forward reference mappings were iteratively reviewed by a team of 2 board-certified child psychiatrists (B.T.Z. and C.R.), a senior pediatric researcher (J.C.G.), a statistician (J.R.), and a coding expert (A.D.). Of the 19 DSM-5 diagnostic groups, 15 were maintained, 3 were combined to create sexuality and gender identity disorders, and the former category neurodevelopmental disorders was broken out to include 7 discrete child-onset diagnosis groups. The ICD-10-CM codes that specified intentional self-harm were used to create the suicide or self-injury group. The remaining ICD-10-CM codes were grouped into 6 problem categories: namely, accidental or undetermined poisoning; maternal mental illness or substance abuse during pregnancy, delivery, or post partum; substance abuse-associated medical illness; fetal or newborn damage associated with maternal substance abuse; child mental health symptoms (eg, irritability); and miscellaneous conditions (eg, academic underachievement). The complete set of codes is available online. 4 To compare the results of the child mental health disorder groups with an existing adult-based classification scheme,
SDH V codes are infrequently utilized in inpatient settings for discharges other than those related to mental health and alcohol/substance use. Utilization incentives will likely need to be developed to realize the potential benefits of cataloging SDH information.
This study supports the view that this epidemic was larger than previously reported epidemics and the hypothesis that "thunderstorm associated asthma' is related to aeroallergens. Demands on resources were considerable; a larger proportion of patients needing intensive care would have caused greater problems.
IMPORTANCEThe scope of low-value care in children's hospitals is poorly understood. OBJECTIVE To develop and apply a calculator of hospital-based pediatric low-value care to estimate prevalence and cost of low-value services. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study developed and applied a calculator of hospital-based pediatric low-value care to estimate the prevalence and cost of low-value services among 1 011 950 encounters reported in 49 US children's hospitals contributing to the Pediatric Health Information System (PHIS) database. To develop the calculator, a multidisciplinary stakeholder group searched existing pediatric low-value care measures and used an iterative process to identify and operationalize relevant hospital-based measures in the PHIS database. Children with an eligible encounter in 2019 were included in the calculator-applied analysis. Two cohorts were analyzed: an emergency department cohort (with encounters resulting in emergency department discharge) and a hospitalized cohort. EXPOSURES Eligible condition-specific hospital encounters. MAIN OUTCOMES AND MEASURES The proportion and volume of encounters in which low-value services were delivered and their associated standardized costs. Measures were ranked by those outcomes. RESULTS There were 1 011 950 encounters eligible for 1 or more of 30 calculator-included measures in 2019; encounters were incurred by 816 098 unique patients with a median age of 3 years (IQR, 1-8 years). In the emergency department cohort, low-value services delivered in the greatest percentage of encounters were Group A streptococcal testing among children younger than 3 years with pharyngitis (3679 of 9785 [37.6%]), computed tomography scan for minor head injury (7541 of 42 602 [17.7%]), and bronchodilators for treatment of bronchiolitis (8899 of 55 616 [16.0%]). In the hospitalized cohort, low-value care was most prevalent for broad-spectrum antibiotics in the treatment of community-acquired pneumonia (3406 of 5658 [60.2%]), acid suppression therapy for infants with esophageal reflux (3814 of 7507 of [50.8%]), and blood cultures for uncomplicated community-acquired pneumonia (2277 of 5823 [39.1%]). Measured low-value services generated
BACKGROUND AND OBJECTIVES: The American Academy of Pediatrics endorses screening for social determinants of health (SDOH) and providing families resources for unmet needs. A systematic response to unmet needs requires identification, documentation, and provision of resources. Our goal was to compare SDOH International Classification of Diseases, 10th Revision (ICD-10), code use for pediatric inpatients after policy changes in 2018 permitting coding by nonphysicians. METHODS: We conducted a retrospective cohort study comparing data from the 2016 and 2019 Kid’s Inpatient Database for patients <21 years old. The primary variable was the presence of an SDOH code, defined as an ICD-10 Z-code (Z55–Z65) or 1 of 13 ICD-10 codes recommended by the American Academy of Pediatrics. We compared overall SDOH code usage between 2016 and 2019, and by Z-code category, demographic, clinical, and hospital characteristics using χ2 tests and odds ratios. Using logistic regression, we examined hospital-level characteristics for hospitals with >5% of discharges with an SDOH code. RESULTS: SDOH code documentation increased from 1.4% in 2016 to 1.9% in 2019 (P < .001), with no notable differences based on Z-code category. In both periods, SDOH code documentation was more common in adolescents, Native Americans, and patients with mental health diagnoses. The number of all hospitals using any SDOH code increased nearly 8% between 2016 and 2019. CONCLUSIONS: ICD-10 codes remain underused to track SDOH needs within the inpatient pediatric setting. Future research should explore whether SDOH code documentation is associated with increased response to unmet social needs and, if so, how to improve use of SDOH codes by all providers.
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