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OBJECTIVES: Describe the operating characteristics of a proposed set of revenue center codes to correctly identify ICU stays among hospitalized patients. DESIGN: Retrospective cohort study. We report the operating characteristics of all ICU-related revenue center codes for intensive and coronary care, excluding nursery, intermediate, and incremental care, to identify ICU stays. We use a classification and regression tree model to further refine identification of ICU stays using administrative data. The gold standard for classifying ICU admission was an electronic patient location tracking system. SETTING: The University of Pennsylvania Health System in Philadelphia, PA, United States. PATIENTS: All adult inpatient hospital admissions between July 1, 2013, and June 30, 2015. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among 127,680 hospital admissions, the proposed combination of revenue center codes had 94.6% sensitivity (95% CI, 94.3-94.9%) and 96.1% specificity (95% CI, 96.0-96.3%) for correctly identifying hospital admissions with an ICU stay. The classification and regression tree algorithm had 92.3% sensitivity (95% CI, 91.6-93.1%) and 97.4% specificity (95% CI, 97.2-97.6%), with an overall improved accuracy (χ = 398; p < 0.001). CONCLUSIONS: Use of the proposed combination of revenue center codes has excellent sensitivity and specificity for identifying true ICU admission. A classification and regression tree algorithm with additional administrative variables offers further improvements to accuracy.

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This study evaluates the agreement of nosologic coding of cardiovascular causes of death between a Chilean coder and one in the United States, in a stratified random sample of death certificates of persons aged ≥ 60, issued in 2008 in the Valparaíso and Metropolitan regions, Chile. All causes of death were converted to ICD-10 codes in parallel by both coders. Concordance was analyzed with inter-coder agreement and Cohen's kappa coefficient by level of specification ICD-10 code for the underlying cause and the total causes of death coding. Inter-coder agreement was 76.4% for all causes of death and 80.6% for the underlying cause (agreement at the four-digit level), with differences by the level of specification of the ICD-10 code, by line of the death certificate, and by number of causes of death per certificate. Cohen's kappa coefficient was 0.76 (95%CI: 0.68-0.84) for the underlying cause and 0.75 (95%CI: 0.74-0.77) for the total causes of death. In conclusion, causes of death coding and inter-coder agreement for cardiovascular diseases in two regions of Chile are comparable to an external benchmark and with reports from other countries.

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This study evaluates the agreement of nosologic coding of cardiovascular causes of death between a Chilean coder and one in the United States, in a stratified random sample of death certificates of persons aged ≥ 60, issued in 2008 in the Valparaíso and Metropolitan regions, Chile. All causes of death were converted to ICD-10 codes in parallel by both coders. Concordance was analyzed with inter-coder agreement and Cohen’s kappa coefficient by level of specification ICD-10 code for the underlying cause and the total causes of death coding. Inter-coder agreement was 76.4% for all causes of death and 80.6% for the underlying cause (agreement at the four-digit level), with differences by the level of specification of the ICD-10 code, by line of the death certificate, and by number of causes of death per certificate. Cohen's kappa coefficient was 0.76 (95%CI: 0.68-0.84) for the underlying cause and 0.75 (95%CI: 0.74-0.77) for the total causes of death. In conclusion, causes of death coding and inter-coder agreement for cardiovascular diseases in two regions of Chile are comparable to an external benchmark and with reports from other countries.

Este estudo avaliou a confiabilidade na codificação das causas de óbitos cardiovasculares entre um codificador no Chile e outro nos Estados Unidos, em uma amostra aleatória estratificada de declarações de óbito de pessoas ≥ 60 anos, emitidas em 2008 nas regiões de Valparaíso e Metropolitana do Chile. Todas as causas da morte foram convertidas em códigos CID-10 em paralelo por ambos os codificadores. A confiabilidade foi avaliada de acordo com o intercodificador e o coeficiente kappa de Cohen, segundo o nível de especificação do código CID-10 para a codificação de causa básica e para todas as causas de óbito. A concordância intercodificador foi de 76,4% para todas as causas de morte e 80,6% para a causa básica (acordo no nível de quatro dígitos), com diferenças por nível de especificação do código CID-10, linha da declaração de óbito, e por número de causas de morte por declaração de óbito. O coeficiente kappa foi 0,76 (IC95%: 0,68-0,84) para a causa básica e 0,75 (IC95%: 0,74-0,77) para todas as causas de óbito. Em conclusão, a codificação das causas de morte cardiovasculares e acordo intercodificador em duas regiões do Chile são comparáveis a uma referência externa e com os relatórios de outros países.

Este estudio evalúa la concordancia en la codificación de causas de muerte cardiovasculares entre un codificador en Chile y otro en EEUU en una muestra aleatoria estratificada de certificados de defunción de personas ≥ 60 años, emitidos el 2008 en las Regiones de Valparaíso y Metropolitana de Chile. Todas las causas de muerte fueron convertidas a códigos CIE-10 en paralelo por ambas codificadoras. La concordancia se analizó con el acuerdo inter-codificador y el coeficiente kappa de Cohen, según nivel de especificación del código CIE-10 para la codificación de la causa básica y para el total de causas de muerte. El acuerdo inter-codificador fue 76,4% para el total de causas de muerte y 80,6% para la causa básica (acuerdo a nivel de cuatro dígitos), con diferencias según nivel de especificación del código CIE, línea del certificado y número de causas de muerte por certificado. El coeficiente kappa de Cohen fue 0,76 (IC95%: 0,68-0,84) para la causa básica y 0.75 (IC95%: 0.74-0.77) para el total de causas de muerte. En conclusión, la codificación de causas de muerte cardiovasculares y el acuerdo inter-codificador en dos regiones de Chile son comparables a una referencia externa y a informes internacionales.

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Purpose: To evaluate retinal morphology and function of patients with advanced neovascular age-related macular degeneration (AMD) before, during, and after treatment with ranibizumab. Methods: Twenty-one eyes diagnosed with advanced AMD were studied with optical coherence tomography (OCT) and multifocal electroretinography (mfERG). Three intravitreal injections of ranibizumab were administered at 1-month intervals. Evaluations were performed before the first injection (D0) and at 30 (D30), 60 (D60), and 90 days (D90) after the first injection and compared to an age-matched control group (n=21 eyes). Results: The thickness of macular retinal layers increased before treatment due to the presence of intraretinal fluid. A thick retinal pigment epithelium-choriocapillaris complex (RPE-CC) suggested the presence of choroidal neovascular membrane. Intraretinal edema decreased after treatment (P<0.01), but persisting RPE-CC thickness resulted in a subretinal scar. Three different annular retinal areas were studied with mfERG (from center to periphery: rings R1, R2, and R3). The amplitude of the first negative component (N1) decreased in R1, R2, and R3 at D30, D60, and D90 when compared with that in controls (P<0.05); the N1 implicit time was delayed in R3 at D30 (P<0.05). The amplitude of the first positive component (P1) was reduced in R1 and R2 at D30, D60, and D90 when compared with that in controls (P<0.01); the P1 implicit time was delayed in R1 at D0 and D60 (P<0.05), in R2 at D0, D30, and D90 (P<0.01), and in R3 at D30 and D60 (P<0.05). Conclusion: Ranibizumab reduces intraretinal edema, even in advanced cases. Central macular activity appeared to increase after the initiation of treatment, improving over time. .

Objetivo: Avaliar a morfologia e função da retina em pacientes com doença macular relacionada à idade (DMRI), neovascular avançada, antes, durante e após o tratamento com ranibizumabe. Métodos: Vinte e um olhos com diagnóstico de DMRI avançada foram avaliados pela tomografia de coerência óptica (OCT) e eletrorretinografia multifocal (mfERG). Três injeções intravítreas de ranibizumabe foram administradas em intervalos de 1 mês. As avaliações foram realizadas antes da primeira injeção (D0) e aos 30 (D30), 60 (D60), e 90 dias (D90) após a primeira injeção e comparados com um grupo controle (n=21 olhos). Resultados: A espessura macular estava aumentada antes do tratamento devido à presença de fluido intrarretiniano, e o aumento da espessura do complexo EPR-CC foi compatível com a presença de membrana neovascular coroidal. O edema intrarretiniano diminuiu após o tratamento (P<0,01). Três diferentes áreas retinianas anulares (do centro para a periferia: anéis R1, R2 e R3) foram consideradas no mfERG. A amplitude do componente N1 diminuiu nos anéis R1, R2 e R3 em D30, D60 e D90 comparados com o grupo controle (P<0,05); e o tempo implícito de N1 aumentou no anel R3 em D30 (P<0,05). A amplitude do componente P1 diminuiu em R1 e R2 nos dias D30, D60 e D90 comparados com os controles (P<0,01); o tempo implícito de N1 aumentou no anel R1 em D0 e D60 (P<0,05), no anel R2 em D0, D30 e D90 (P<0,01) e no anel R3 em D30 e D60 (P<0,05). Conclusão: O ranibizumabe reduziu o edema intrarretiniano, mesmo em casos avançados. A atividade central macular parece aumentar após o início do tratamento e melhorar ao longo do tempo. .

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A qualidade da informação é um assunto muito complexo, cheio de meandros pelo fato de lidar com um número extremamente grande de variáveis, por essa razão é preciso investir em sistemas de informações gerenciais, implementar o processo de mudança organizacional e capacitar as pessoas para adaptação às novas realidades. Há grande necessidade de veracidade e exatidão nos registros de saúde para embasamento de estudos epidemiológicos, desenvolvimento de políticas de saúde e estratégias de prevenção e promoção da saúde. Dados incorretos trazem prejuizos do planejamento à execução da atenção. Método: Estudo longitudinal, qualitativo, retrospectivo para a análise da qualidade das codificações atribuidas aos 1194 diagósticos em prontuários de clínica médica, cirúrgica e UTI de um hospital de pequeno porte no Vale do Paraíba. Resultados: Foram consultados 1.194 prontuários, foram identificados: 465 diagnósticos sem a codificação atribuida (38,94 por cento ). Após a correção do banco de dados, realizada por um codificador treinado, 511 das 729 (70,10 por cento ) codificações estavam adequadas, 68 (9,33 por cento ) diagnósticos continham uma codificação completamente diferente da correta, 82 (11,24 por cento ) codificações estavam apenas com a sub categoria incorreta e 68 (9,33 por cento ) continham apenas o capítulo adequado. Conclusão: A qualidade de informação no que diz respeito à codificação diagnóstica tem um índice de concordância de 70,10...

The quality of information is a very complex subject, full of intricacies because dealing with an extremely large number of variables, therefore we must invest in management information systems, implement organizational change process and enable people to adaptat to new realities. There is great need for truthfulness and accuracy in health records for basis of epidemiological studies, health policy development and strategies for prevention and health promotion. Incorrect data bring losses from planning to implementation of the attention. Method: Longitudinal study, qualitative, retrospective to examine the quality of coding assigned to 1.194 diagnoses to general medical records, surgical and ICU of a small hospital in the Vale do Paraíba. Results: 1.194 records were consulted, were identified: 465 diagnoses without the assigned encoding (38.94 per cent ). After the database correction, performed by a trained coder, 511 of 729 (70.10 per cent ) encodings were appropriate, 68 (9.33 per cent ) diagnoses contained a completely different coding from the correct, 82 (11.24 per cent ) encodings were only with the subcategory incorrect and 68 (9.33 per cent ) contained only the appropriate chapter. Conclusions: quality information with respect to the diagnostic code has a concordance rate of 70.10 per cent and 29.90 per cent of mismatch. Flaws in the administrative flow, the unpreparedness of the operational teams to launch the information properly in the integrated...

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BACKGROUND: Undernotification is well recognized as a key challenge to the study of anaphylaxis mortality, but it is seldom mentioned that one of its reasons is the difficult coding of the condition under the tenth revision of the international classification of diseases (ICD-10), given that there are no anaphylaxis-specific ICD-10, which are considered valid for coding underlying causes-of-death, and that official mortality statistics consider exclusively the underlying and disregard the contributing causes-of-death data recorded on death certificates. Brazilian mortality data were used as a case study to call attention to the inadequacy of the ICD-10 for the measurement of anaphylaxis deaths. METHODS: Underlying and contributing causes-of-death data were used to estimate the rates of anaphylaxis deaths in the country over the years 2008-2010. RESULTS: Of 498 anaphylaxis deaths were found, of which 75% were classified as 'definite' and 25% as 'possible anaphylaxis deaths'. The average national rate for these years was 0.87 per million per year. None of these deaths would have been found had we exclusively considered information from the underlying cause-of-death field. CONCLUSION/RECOMMENDATIONS: The study of anaphylaxis mortality using secondary data requires the use of information derived from the underlying as well as from the contributing causes-of-death fields. Coding definitions should be standardized with a view of enabling trend analyses and international comparisons. The ICD-11 revision is a unique opportunity to improve the coding system so as to facilitate epidemiological studies of anaphylaxis mortality. Educational interventions targeted at improving the quality of death certificate completion are urgently needed.

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