Identifying patients with opioid use disorder using International Classification of Diseases (ICD) codes: Challenges and opportunities

IF 5.2 1区医学 Q1 PSYCHIATRY Addiction Pub Date : 2023-09-15 DOI:10.1111/add.16338

Katie P. Osterhage, Yih-Ing Hser, Larissa J. Mooney, Seth Sherman, Andrew J. Saxon, Maja Ledgerwood, Caleb C. Holtzer, Margaret A. Gehring, Sarah E. Clingan, Megan E. Curtis, Laura-Mae Baldwin

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引用次数: 1

Abstract

Background and Aims

International Classification of Diseases (ICD) diagnosis codes are often used in research to identify patients with opioid use disorder (OUD), but their accuracy for this purpose is not fully evaluated. This study describes application of ICD-10 diagnosis codes for opioid use, dependence and abuse from an electronic health record (EHR) data extraction using data from the clinics' OUD patient registries and clinician/staff EHR entries.

Design

Cross-sectional observational study.

Setting

Four rural primary care clinics in Washington and Idaho, USA.

Participants

307 patients.

Measurements

This study used three data sources from each clinic: (1) a limited dataset extracted from the EHR, (2) a clinic-based registry of patients with OUD and (3) the clinician/staff interface of the EHR (e.g. progress notes, problem list). Data source one included records with six commonly applied ICD-10 codes for opioid use, dependence and abuse: F11.10 (opioid abuse, uncomplicated), F11.20 (opioid dependence, uncomplicated), F11.21 (opioid dependence, in remission), F11.23 (opioid dependence with withdrawal), F11.90 (opioid use, unspecified, uncomplicated) and F11.99 (opioid use, unspecified with unspecified opioid-induced disorder). Care coordinators used data sources two and three to categorize each patient identified in data source one: (1) confirmed OUD diagnosis, (2) may have OUD but no confirmed OUD diagnosis, (3) chronic pain with no evidence of OUD and (4) no evidence for OUD or chronic pain.

Findings

F11.10, F11.21 and F11.99 were applied most frequently to patients who had clinical diagnoses of OUD (64%, 89% and 79%, respectively). F11.20, F11.23 and F11.90 were applied to patients who had a diagnostic mix of OUD and chronic pain without OUD. The four clinics applied codes inconsistently.

Conclusions

Lack of uniform application of ICD diagnosis codes make it challenging to use diagnosis code data from EHR to identify a research population of persons with opioid use disorder.

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使用国际疾病分类(ICD)代码识别阿片类药物使用障碍患者:挑战和机遇。

背景和目的:国际疾病分类(ICD)诊断代码经常用于研究识别阿片类药物使用障碍(OUD)患者，但其准确性尚未得到充分评估。本研究描述了ICD-10诊断代码对阿片类药物使用、依赖和滥用的应用，这些代码来自电子健康记录(EHR)数据提取，使用的数据来自诊所的OUD患者登记和临床医生/工作人员EHR条目。设计:横断面观察性研究。地点:美国华盛顿州和爱达荷州的四个农村初级保健诊所。参与者:307例患者。测量方法:本研究使用了来自每个诊所的三个数据源:(1)从电子病历中提取的有限数据集，(2)基于临床的OUD患者注册表，(3)电子病历的临床医生/工作人员界面(例如进度记录，问题列表)。数据源一包括六个常用的ICD-10阿片类药物使用、依赖和滥用代码的记录:F11.10(阿片类药物滥用，不复杂)、F11.20(阿片类药物依赖，不复杂)、F11.21(阿片类药物依赖，缓解中)、F11.23(阿片类药物依赖伴戒断)、F11.90(阿片类药物使用，未指明，不复杂)和F11.99(阿片类药物使用，未指明伴未指明的阿片类药物诱导障碍)。护理协调员使用数据源2和数据源3对数据源1中确定的每个患者进行分类:(1)确诊的OUD诊断，(2)可能有OUD但未确诊的OUD诊断，(3)无OUD证据的慢性疼痛，(4)无OUD或慢性疼痛证据。结果:F11.10、F11.21和F11.99在临床诊断为OUD的患者中应用频率最高(分别为64%、89%和79%)。F11.20, F11.23和F11.90应用于诊断为OUD和无OUD的慢性疼痛混合的患者。这四家诊所使用的代码不一致。结论:由于缺乏ICD诊断代码的统一应用，使用电子病历的诊断代码数据来识别阿片类药物使用障碍的研究人群具有挑战性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.