Quantifying the Improvement in Sepsis Diagnosis, Documentation and Coding: the Marginal Causal Effect of Year of Hospitalization on Sepsis Diagnosis

Details

• Alternative Title:
  Ann Epidemiol
• Personal Author:
  Jafarzadeh, S. Reza ; Thomas, Benjamin S. ; Marschall, Jonas ; Fraser, Victoria J. ; Gill, Jeff ; Warren, David K.
• Description:
  Purpose ; To quantify the coinciding improvement in the clinical diagnosis of sepsis, its documentation in the electronic health records and subsequent medical coding of sepsis for billing purposes in recent years. ; Methods ; We examined 98,267 hospitalizations in 66,208 patients who met systemic inflammatory response syndrome (SIRS) criteria at a tertiary-care center from 2008-2012. We used g-computation to estimate the causal effect of the year of hospitalization on receiving an ICD-9-CM discharge diagnosis code for sepsis by estimating changes in the probability of getting diagnosed and coded for sepsis during the study period. ; Results ; When adjusted for demographics, Charlson-Deyo comorbidity index, blood culture frequency per hospitalization and ICU admission, the causal risk difference for receiving a discharge code for sepsis per 100 SIRS hospitalizations, had the hospitalization occurred in 2012, was estimated to be 3.9% (95% confidence interval CI: 3.8%, 4.0%), 3.4% (95% CI: 3.3%, 3.5%), 2.2% (95% CI: 2.1%, 2.3%) and 0.9% (95% CI: 0.8%, 1.1%) from 2008-2011, respectively. ; Conclusions ; Patients with similar characteristics and risk factors had a higher of probability of getting diagnosed, documented and coded for sepsis in 2012 than in previous years, which contributed to an apparent increase in sepsis incidence.
• Keywords:
  • causality
  • ICD-9-CM
  • sepsis
  • systemic inflammatory response syndrome
  • risk difference
  • Adult
  • Aged
  • Clinical Coding
  • Documentation
  • Electronic Health Records
  More +
• Source:
  Ann Epidemiol. 26(1):66-70
• Pubmed ID:
  26559330
• Pubmed Central ID:
  PMC4688185
• Document Type:
  Journal Article
• Funding:
  TL1 TR000449/TR/NCATS NIH HHSUnited States/ ; U54 CK000162/CK/NCEZID CDC HHSUnited States/ ; U54 CK000609/CK/NCEZID CDC HHSUnited States/ ; UL1 TR000448/TR/NCATS NIH HHSUnited States/
• Volume:
  26
• Issue:
  1
• Download URL:
  https://stacks.cdc.gov/view/cdc/37019/cdc_37019_DS1.pdf
• File Type:
  [PDF - 170.31 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:40da8c6b885ece811bcb2a9112a30b2bb058a2dd8adcfee388f5d6d5e351a5dc