Validity of Diagnostic Codes for Identification of Psoriasis Patients in Korea

BACKGROUND: Recently, the number of nationwide medical researches on psoriasis using the National Health Insurance Service database has been on the rise. However, identification of psoriasis using diagnostic codes alone can lead to misclassification. Accuracy of the diagnostic codes and their concordance with medical records should be validated first to identify psoriasis patients correctly.OBJECTIVE: To validate the diagnostic codes of psoriasis (International Classification of Diseases, 10th Revision L40) and to find the algorithm for the identification of psoriasis.METHODS: We collected medical records of patients who received their first diagnostic codes of psoriasis during 5 years from five hospitals. Fifteen percent of psoriasis patients were randomly selected from each hospital. We performed a validation by reviewing medical records and compared 5 algorithms to identify the best algorithm.RESULTS: Total of 538 cases were reviewed and classified as psoriasis (n=368), not psoriasis (n=159), and questionable (n=11). The most accurate algorithm was including patients with ≥1 visits with psoriasis as primary diagnostic codes and prescription of vitamin D derivatives. Its positive predictive value was 96.5% (95% confidence interval [CI], 93.9%~98.1%), which was significantly higher than those of the algorithm, including patients with ≥1 visits with psoriasis as primary diagnostic codes or including ≥1 visits with diagnostic codes of psoriasis (primary or additional) (91.0% and 69.8%). Sensitivity was 90.8% (95% CI, 87.2%~93.4%) and specificity was 92.5% (95% CI, 86.9%~95.9%).CONCLUSION: Our study demonstrates a validated algorithm to identify psoriasis, which will be useful for the nationwide population-based study of psoriasis in Korea.

Case study on diabetes mellitus morbidity pattern of elderly population / 国际药学研究杂志

Crosssectional study undertaken in the meadow repetition area of the RHC, Poonjeri, Kancheepuram District, Tamil Nadu between June 2015 – September 2016. 337 persons aged 60 years and over were particular by multi stage random sample. Data was composed by family to family survey using a pre tested structured questionnaire. Quality of life was evaluated using WHO-QOL BREF. Chi square, ANOVA were used. This research work focuses to determine the morbidity pattern of elderly population based on the hypertension in a rural area of Tamil Nadu.

Are Registration of Disease Codes for Adult Anaphylaxis Accurate in the Emergency Department?

PURPOSE: There has been active research on anaphylaxis, but many study subjects are limited to patients registered with anaphylaxis codes. However, anaphylaxis codes tend to be underused. The aim of this study was to investigate the accuracy of anaphylaxis code registration and the clinical characteristics of accurate and inaccurate anaphylaxis registration in anaphylactic patients. METHODS: This retrospective study evaluated the medical records of adult patients who visited the university hospital emergency department between 2012 and 2016. The study subjects were divided into the groups with accurate and inaccurate anaphylaxis codes registered under anaphylaxis and other allergy-related codes and symptom-related codes, respectively. RESULTS: Among 211,486 patients, 618 (0.29%) had anaphylaxis. Of these, 161 and 457 were assigned to the accurate and inaccurate coding groups, respectively. The average age, transportation to the emergency department, past anaphylaxis history, cancer history, and the cause of anaphylaxis differed between the 2 groups. Cutaneous symptom manifested more frequently in the inaccurate coding group, while cardiovascular and neurologic symptoms were more frequently observed in the accurate group. Severe symptoms and non-alert consciousness were more common in the accurate group. Oxygen supply, intubation, and epinephrine were more commonly used as treatments for anaphylaxis in the accurate group. Anaphylactic patients with cardiovascular symptoms, severe symptoms, and epinephrine use were more likely to be accurately registered with anaphylaxis disease codes. CONCLUSIONS: In case of anaphylaxis, more patients were registered inaccurately under other allergy-related codes and symptom-related codes rather than accurately under anaphylaxis disease codes. Cardiovascular symptoms, severe symptoms, and epinephrine treatment were factors associated with accurate registration with anaphylaxis disease codes in patients with anaphylaxis.

Validation of Administrative Big Database for Colorectal Cancer Searched by International Classification of Disease 10th Codes in Korean: A Retrospective Big-cohort Study

BACKGROUND: As the number of big-cohort studies increases, validation becomes increasingly more important. We aimed to validate administrative database categorized as colorectal cancer (CRC) by the International Classification of Disease (ICD) 10th code. METHODS: Big-cohort was collected from Clinical Data Warehouse using ICD 10th codes from May 1, 2003 to November 30, 2016 at Seoul National University Bundang Hospital. The patients in the study group had been diagnosed with cancer and were recorded in the ICD 10th code of CRC by the National Health Insurance Service. Subjects with codes of inflammatory bowel disease or tuberculosis colitis were selected for the control group. For the accuracy of registered CRC codes (C18–21), the chart, imaging results, and pathologic findings were examined by two reviewers. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for CRC were calculated. RESULTS: A total of 6,780 subjects with CRC and 1,899 control subjects were enrolled. Of these patients, 22 subjects did not have evidence of CRC by colonoscopy, computed tomography, magnetic resonance imaging, or positron emission tomography. The sensitivity and specificity of hospitalization data for identifying CRC were 100.00% and 98.86%, respectively. PPV and NPV were 99.68% and 100.00%, respectively. CONCLUSIONS: The big-cohort database using the ICD 10th code for CRC appears to be accurate.

The Significance and Limitations of Korean Diagnosis-Related Groups in Psychiatric Inpatients' Hospital Charges / 신경정신의학

OBJECTIVES: This study was conducted to investigate whether the charges associated with Korean Diagnosis-Related Groups for mental health inpatients adequately reflect the degree of medical resource consumption for inpatient treatment in the psychiatric ward. METHODS: This study was conducted with psychiatric inpatients data for 2014 from the National Health Insurance claim database. The main diagnoses required for admission, classification of the hospitals, and main treatment services were analyzed by examining descriptive statistics. Homogeneities of the major diagnostic criteria were assessed by calculating coefficient variances. Explanation power was determined by R2 values. RESULTS: The most frequent disorders for psychiatric inpatient treatment were alcohol-use disorder, depressive episodes, bipolar affective disorder, and dementia in Alzheimer's disease. Hospitalization and psychotherapy fees were the main medical expenses. Regardless of the homogeneity of the disease group, duration of hospital stay was the factor that most influenced medical expenses. In the psychiatric area, explanation power of Korean Diagnosis-Related Groups was 16.52% (p<0.05), which was significantly lower than that for other major diagnostic area. CONCLUSION: Most psychiatric illnesses are chronic, and the density of services can vary depending on illness severity or associated complications. The current Korean Diagnosis-Related Groups criteria did not adequately represent the amount of in-hospital medical expenditures. A novel Korean classification system that reflects the expenditures of medical resources in psychiatric hospitals should be developed in order to provide appropriate reimbursements.

Integration of Chinese medicine with Western medicine could lead to future medicine: molecular module medicine / 中国结合医学杂志

The development of an effective classification method for human health conditions is essential for precise diagnosis and delivery of tailored therapy to individuals. Contemporary classification of disease systems has properties that limit its information content and usability. Chinese medicine pattern classification has been incorporated with disease classification, and this integrated classification method became more precise because of the increased understanding of the molecular mechanisms. However, we are still facing the complexity of diseases and patterns in the classification of health conditions. With continuing advances in omics methodologies and instrumentation, we are proposing a new classification approach: molecular module classification, which is applying molecular modules to classifying human health status. The initiative would be precisely defining the health status, providing accurate diagnoses, optimizing the therapeutics and improving new drug discovery strategy. Therefore, there would be no current disease diagnosis, no disease pattern classification, and in the future, a new medicine based on this classification, molecular module medicine, could redefine health statuses and reshape the clinical practice.

A review of classification of disease in Ayurveda.

According to Charaka Samhita, the disease is the state in which both the body and mind are subject to pain and misery. There is need of classification of disease which is caused by exogenous and endogenous factors. Generally, the classification gives the idea about the type and difference between diseases. Classification of disease is very essential for the treatment of the diseased individual. Unskilled physicians, who are unable to identify nature of disease, examine patient by applying sensory organ which provides only superficial knowledge of disease. To know the whole nature of disease, one should know the classification of disease which is based on origin of disease causative factor, surgical cure or nonsurgical cure, infected organ etc.

The Analysis on compared between before and post application of coding on classification of disease clinical modification of Beijing / 中华医院管理杂志

ObjectiveFrom the view of the frequence of codes applying,investigate the situation of the Tenth Revision of the International Classification of Disease Clinical Modification of Beijing and to support the further development and application.MethodsFigure out the difference of the frequence of codes between before and post application of coding on clinical modification,to compare and make analysis for them.Results Got lists of percentage periods frequence of codes on classification of disease calculated from all secondary and above level hospitals in Beijing in the year of 2006,2007 and 2008.Conclusionthe Tenth Revision of the International Classification of Disease Clinical Modification of Beijing is well compatible with WHO ICD-10 on the level of applicable codes set; the refine work is effective and balance for codes applying; the localization should be done first before applying ICD-10.

Impact and Application of the Internal Classification Functioning, Disability and Health in the Medical Rehabilitation

Historically WHO has concentrated on infection control and mortality reduction. However, diagnosis alone does not explain what patients can do, what their prognosis will be. To answer these questions, significant challenges are presented in model the International Classification of Impairment, Disability and Handicap (ICIDH) announced in 1980. Following several revisions of ICIDH, WHO (2001) finally approved the International Classification of Functioning, Disability and Health (ICF), which is universal and clear terminology with qualifiable assessment measures. The ICF is a new form which (1) is not based on disability, rather on human function, (2) is interactive rather than linearly progressive, and (3) is not medical or social model, rather integration model. Also, the new language ICF is an landmark event for rehabilitation. Key to successful rehabilitation management is the understanding and proper assessment of the relationship between disease (ICD-10) and impaired body functions and structures and psychosocial and environmental factors(ICF).

Analysis of Blood Use at Dankook University Hospital according to International Statistical Classification of Diseases (ICD)-10 / 대한혈액학회지

BACKGROUND: A few recent studies have been conducted to analyzing the blood usage with regard to diagnosis of Korean recipients. We performed a study to analyze the usage of blood components. METHODS: Transfused components such as packed red blood cells (RBC), whole blood (WB), fresh frozen plasma (FFP), and platelet components (PLT) were estimated by the principal diagnoses of the patients, who were discharged from February 1998 to January 1999, according to the International Statistical Classification of Diseases (ICD)-10. RESULTS: Eleven percentage (2,227/20,650) of inpatients were transfused. The transfusion rate of hospitalized patients for RBCs, WBs, FFPs, and PLTs was 10.1%, 0.4%, 4.0% and 16.2 %, respectively. There was a difference in the sex ratio (1.6 male/female) in all blood components transfused. Of all investigated blood components (22,523 units), 10,729 units (47.6%) of RBCs, 240 units (1.1%) of WBs, 5,355 units (23.8%) of FFPs, and 6,199 units (27.5%) of PLTs were transfused. The hospitalized patients who received 1 unit of RBCs was 12.9%, and 2 units were most frequent transfused units (25.6%). Seventy-four percent of all 22,523 units were used in four diagnostic categories of highest blood usage; injury and poisoning (29.2%), nonhematologic neoplasms (16.3%), digestive system disease (16.1%) and circulatory system disease (12.5%). CONCLUSION: We performed usage analysis of blood components with regard to diagnosis, comparing the previous studies in other hospitals. This study could provide baseline transfusion information in relation to diagnosis, and help improve the quality control of blood utilization and transfusion practice.

Correction of International Classification of Disease, for Effective Management of Dermatologic Disease / 대한피부과학회지

In our country the ICD-10(International classification of disease) is used to classify disease. But it has many problems in classifying and managing statistics in the field of dermatology. For instance, there are many diseases that are not included in the ICD-10, and the classification is not organized. Also, in many cases the classification of ICD-10 has problems in computerizing. Even though we need a classification overcoming these problems, National health insurance corporation is using the ICD-10. In this study, we corrected the problems of the ICD-10 to make an improved ICD-10 to use in dermatologic fields. To do this, we had to search all the dermatologic disease code contained in the ICD-10, and find all the disease listed in the book of domestic and foreign. We had to compare and analyse these. Subsequently, we add the diseases that are not contained in the ICD-10, organized the classification and improved the dermatologic disease code of ICD-10. This classification would be useful for the management of disease in the dermatologic field.

Blood Use According to Diagnoses in Hospitalized Adults of Ajou University Hospital / 대한임상병리학회지

BACKGROUND: There is paucity of data on the use of blood and its products with regard to the diagnoses of recipients in Korea. The objective of this study is to report the characteristics of the recipients and the usage in relation to diagnoses among Koreans. METHODS: We assessed the blood usage of adult patients (18 years or older) in a tertiary teaching hospital during the past 2 years (1998-2000). The red blood cells (RBCs), fresh frozen plasmas (FFPs) and platelets (PLTs, platelet concentrates and apheresis platelets) were evaluated in relation to the characteristics of the recipients and the discharge diagnoses according to the International Classification of Diseases (10th Ed). Data were extracted from the hospital information system. RESULTS: Approximately twenty percent of the hospitalized patients were transfused. RBCs, FFPs and PLTs were transfused 18.9%, 4.8% and 3.2% of hospitalized patients, respectively. Fifty-six percent of 54,049 RBCs and 64.9% of 19,549 FFPs were transfused in the patients with nonhematological neoplasms, disorders of the digestive system, injury and poisoning. Sixty-two percent of 50,621 PLTs were transfused in the patients with hematological and non-hematological neoplasms and disorders of the digestive system. CONCLUSIONS: This survey showed the trends of the transfusion practice as different from those for Caucasians and the usage of FFPs and PLTs was restricted for some recipients. These results could help in predicting the blood needs and medical costs for a variety of patients.