Comparison of the performance of mental health, drug and alcohol comorbidities based on ICD-10-AM and medical records for predicting 12-month outcomes in trauma patients

Abstract

BackgroundMany outcome studies capture the presence of mental health, drug and alcohol comorbidities from administrative datasets and medical records. How these sources compare as predictors of patient outcomes has not been determined. The purpose of the present study was to compare mental health, drug and alcohol comorbidities based on ICD-10-AM coding and medical record documentation for predicting longer-term outcomes in injured patients.MethodsA random sample of patients (n = 500) captured by the Victorian State Trauma Registry was selected for the study. Retrospective medical record reviews were conducted to collect data about documented mental health, drug and alcohol comorbidities while ICD-10-AM codes were obtained from routinely collected hospital data. Outcomes at 12-months post-injury were the Glasgow Outcome Scale – Extended (GOS-E), European Quality of Life Five Dimensions (EQ-5D-3L), and return to work. Linear and logistic regression models, adjusted for age and gender, using medical record derived comorbidity and ICD-10-AM were compared using measures of calibration (Hosmer-Lemeshow statistic) and discrimination (C-statistic and R2).ResultsThere was no demonstrable difference in predictive performance between the medical record and ICD-10-AM models for predicting the GOS-E, EQ-5D-3L utility sore and EQ-5D-3L mobility, self-care, usual activities and pain/discomfort items. The area under the receiver operating characteristic (AUC) for models using medical record derived comorbidity (AUC 0.68, 95% CI: 0.63, 0.73) was higher than the model using ICD-10-AM data (AUC 0.62, 95% CI: 0.57, 0.67) for predicting the EQ-5D-3L anxiety/depression item. The discrimination of the model for predicting return to work was higher with inclusion of the medical record data (AUC 0.69, 95% CI: 0.63, 0.76) than the ICD-10-AM data (AUC 0.59, 95% CL: 0.52, 0.65).ConclusionsMental health, drug and alcohol comorbidity information derived from medical record review was not clearly superior for predicting the majority of the outcomes assessed when compared to ICD-10-AM. While information available in medical records may be more comprehensive than in the ICD-10-AM, there appears to be little difference in the discriminative capacity of comorbidities coded in the two sources.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3248-x) contains supplementary material, which is available to authorized users.

Does patient preference for online or telephone follow-up impact on response rates and data completeness following injury?

“…Demographic, injury event, injury severity, level of definitive care in the trauma system, and in-hospital outcome data were extracted from the registries to enable a comparison of cases opting for email or telephone completion. The International Classification of Diseases, Tenth Revision, Australian Modification diagnosis codes were mapped to the Charlson Comorbidity Index and indicators for preexisting mental health, drug, and alcohol conditions 19,20 . The patient’s residential postcode was used to map to quintiles of the Index of Relative Socioeconomic Advantage and Disadvantage to provide a measure of socioeconomic status.…”

“…The International Classification of Diseases, Tenth Revision, Australian Modification diagnosis codes were mapped to the Charlson Comorbidity Index and indicators for preexisting mental health, drug, and alcohol conditions. 19,20 The patient's residential postcode was used to map to quintiles of the Index of Relative Socioeconomic Advantage and Disadvantage to provide a measure of socioeconomic status. The Index of Relative Socioeconomic Advantage and Disadvantage uses information about the economic and social conditions of households and people in an area to provide a summary measure of socioeconomic advantage and disadvantage.…”

Measuring socioeconomic outcomes in trauma patients up to one year post-discharge: A systematic review and meta-analysis

“…The pooled estimate of effect size was 0.52 (95% CI 0.43,0.6) (I 2 = 98.9%); i.e., 52% of the participants returned to some form of employment. There were 14 studies (45,47,48,50,53,(55)(56)(57)(58)(59)(60)(61)(62)(63) that reported on RTW up to 12 months, one of which had reported on two groups of trauma patients. The pooled estimate of effect size was 0.64 (95% CI 0.53,0.5) (I 2 = 99.2%); i.e., 64% of the participants returned to some form of employment.…”

“…4B(i). EQ-5D Index Five studies (53,56,68,78,79) provided relevant data for calculation of a summarized estimate of effect size for EQ-5D Index. Of these, two studies (53,79) measured the QOL at different time points, while one study (78) included two groups of trauma patients.…”

The Australian Injury Comorbidity Index to Predict Mortality

“…Some studies have found the prevalence of comorbidities to be lower in administrative data than in medical chart review, 30,31 whereas others have reported that there was no notable difference. 32,33 One of the latter studies was based on a population with acute trauma in Victoria, in which an institution-specific administrative data set, which captures details similar to those in the Victorian Admitted Episodes Dataset and much more, was compared with medical records. Therefore, we consider that using administrative admissions data rather than chart reviews in our Victorian study most likely had no significant influence on the findings while offering a great practical advantage.…”