Sunday February 25, 1996

Doubts validity of database for research

The routine hospital-assigned ICD-9-CM database codings for total joint surgery are inaccurate, according to a study of the charts of 99 consecutive total joint surgery patients at Fitzsimons Army Medical Center, Aurora, Colo. The study, presented in scientific paper 398 Saturday, casts doubt on the validity of electronic databases that are frequently used as research tools and for health policy decisions.

Two independent reviewers used the same ICD-9-CM coding as the medical technicians at the time the patients were discharged. The reviewers identified 83 percent and 65 percent of the possible diagnoses, while medical records technicians reported 28 percent of the complete diagnoses. The reviewers identified 78 percent and 79 percent of the procedures performed; the technicians, 36 percent.

William T. Pace, MD, one of the co-authors of the study, observed that ICD-9-CM codings are broadly defined so that multiple procedures, diagnoses, and complications can be coded with the same number.

"Such broad definitions are not helpful for research purposes and require greater discretion and individual judgment by the medical records technicians than is usually acceptable for clinical research," he said. "This weakens the accuracy of any results that are obtained."

The study said the conclusions drawn from electronic databases "are probably intrinsically flawed because the information contained in the databases are frequently inaccurate and incomplete with respect to diagnoses, procedure performed, and complications. This has important implications for everyone in the health care system including patients, physicians, hospitals, and society as a whole because such information is used to form the current health care policy."

The co-authors of the study-all of Fitzsimons Army Medical Center-are Dr. Pace and Lori E. Harrington, MD, orthopaedic residents; and Howard M. Place, MD, is chief, spine surgery.

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