BackgroundBecause the collection of mental health information through interviews is expensive and time consuming, interest in using population-based administrative health data to conduct research on depression has increased. However, there is concern that misclassification of disease diagnosis in the underlying data might bias the results. Our objective was to determine the validity of International Classification of Disease (ICD)-9 and ICD-10 administrative health data case definitions for depression using review of family physician (FP) charts as the reference standard.MethodsTrained chart reviewers reviewed 3362 randomly selected charts from years 2001 and 2004 at 64 FP clinics in Alberta (AB) and British Columbia (BC), Canada. Depression was defined as presence of either: 1) documentation of major depressive episode, or 2) documentation of specific antidepressant medication prescription plus recorded depressed mood. The charts were linked to administrative data (hospital discharge abstracts and physician claims data) using personal health numbers. Validity indices were estimated for six administrative data definitions of depression using three years of administrative data.ResultsDepression prevalence by chart review was 15.9–19.2% depending on year, region, and province. An ICD administrative data definition of ‘2 depression claims with depression ICD codes within a one-year window OR 1 discharge abstract data (DAD) depression diagnosis’ had the highest overall validity, with estimates being 61.4% for sensitivity, 94.3% for specificity, 69.7% for positive predictive value, and 92.0% for negative predictive value. Stratification of the validity parameters for this case definition showed that sensitivity was fairly consistent across groups, however the positive predictive value was significantly higher in 2004 data compared to 2001 data (78.8 and 59.6%, respectively), and in AB data compared to BC data (79.8 and 61.7%, respectively).ConclusionsSensitivity of the case definition is often moderate, and specificity is often high, possibly due to undercoding of depression. Limitations to this study include the use of FP charts data as the reference standard, given the potential for missed or incorrect depression diagnoses. These results suggest that that administrative data can be used as a source of information for both research and surveillance purposes, while remaining aware of these limitations.
There is no evidence for a direct association between social support and preterm birth. Social support, however, may provide a buffering mechanism between stress and preterm birth.
Background and aims COVID-19 pandemic lockdown and restrictions had significant disruption to patient care. We aimed to evaluate the impact of COVID-19 restrictions on hospitalizations of patients with alcoholic and non-alcoholic cirrhosis as well as alcoholic hepatitis (AH) in Alberta, Canada. Methods We used validated international clinical classification (ICD-9 and ICD-10) coding algorithms to identify liver-related hospitalizations for non-alcoholic cirrhosis, alcoholic cirrhosis, and AH in the province of Alberta between March 2018 and September 2020. We used the provincial inpatient discharge and laboratory databases to identify our cohorts. We used elevated ALT or AST, elevated international normalized ratio (INR) or bilirubin to identify AH patients. We compared COVID-19 restrictions (April-September 2020) to prior study periods. Joinpoint regression was used to evaluate the temporal trends among the three cohorts. Results We identified 2,916 hospitalizations for non-alcoholic cirrhosis, 2,318 hospitalizations for alcoholic cirrhosis, and 1,408 AH hospitalizations during our study time. The in-hospital mortality rate was stable in relation to the pandemic for alcoholic cirrhosis and AH. However, non-alcoholic cirrhosis patients had lower in-hospital mortality rate post March 2020 (8.5% vs. 11.5%, p =0.033). There was a significant increase in average monthly admission in the AH cohort (22.1/ 10,000 admissions during the pandemic vs. 11.6/10,000 admissions prior to March 2020, p<0.001). Conclusion Pre- and during COVID-19 monthly admission rates were stable for non-alcoholic and alcoholic cirrhosis, however, there was a significant increase in AH admissions. As alcohol sales surged during the pandemic, future impact on alcoholic liver disease could be detrimental.
Background: It is essential that clinical documentation and clinical coding be of high quality for the production of healthcare data. Objective: This study assessed qualitatively the strengths and barriers regarding clinical coding quality from the perspective of health information managers. Method: Ten health information managers and clinical coding quality coordinators who oversee clinical coders (CCs) were identified and recruited from nine provinces across Canada. Semi-structured interviews were conducted, which included questions on data quality, costs of clinical coding, education for health information management, suggestions for quality improvement and barriers to quality improvement. Interviews were recorded, transcribed and analysed using directed content analysis and informed by institutional ethnography. Results: Common barriers to clinical coding quality included incomplete and unorganised chart documentation, and lack of communication with physicians for clarification. Further, clinical coding quality suffered as a result of limited resources (e.g. staffing and budget) being available to health information management departments. Managers unanimously reported that clinical coding quality improvements can be made by (i) offering interactive training programmes to CCs and (ii) streamlining sources of information from charts. Conclusion: Although clinical coding quality is generally regarded as high across Canada, clinical coding managers perceived quality to be limited by incomplete and inconsistent chart documentation, and increasing expectations for data collection without equal resources allocated to clinical coding professionals. Implications: This study presents novel evidence for clinical coding quality improvement across Canada.
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