title: Improved accuracy of co-morbidity coding over time after the introduction of ICD-10 administrative data.
abstract: BACKGROUND
  Co-morbidity information derived from administrative data needs to be validated to allow its regular use. We assessed evolution in the accuracy of coding for Charlson and Elixhauser co-morbidities at three time points over a 5-year period, following the introduction of the International Classification of Diseases, 10th Revision (ICD-10), coding of hospital discharges.
  
  
  METHODS
  Cross-sectional time trend evaluation study of coding accuracy using hospital chart data of 3'499 randomly selected patients who were discharged in 1999, 2001 and 2003, from two teaching and one non-teaching hospital in Switzerland. We measured sensitivity, positive predictive and Kappa values for agreement between administrative data coded with ICD-10 and chart data as the 'reference standard' for recording 36 co-morbidities.
  
  
  RESULTS
  For the 17 the Charlson co-morbidities, the sensitivity - median (min-max) - was 36.5% (17.4-64.1) in 1999, 42.5% (22.2-64.6) in 2001 and 42.8% (8.4-75.6) in 2003. For the 29 Elixhauser co-morbidities, the sensitivity was 34.2% (1.9-64.1) in 1999, 38.6% (10.5-66.5) in 2001 and 41.6% (5.1-76.5) in 2003. Between 1999 and 2003, sensitivity estimates increased for 30 co-morbidities and decreased for 6 co-morbidities. The increase in sensitivities was statistically significant for six conditions and the decrease significant for one. Kappa values were increased for 29 co-morbidities and decreased for seven.
  
  
  CONCLUSIONS
  Accuracy of administrative data in recording clinical conditions improved slightly between 1999 and 2003. These findings are of relevance to all jurisdictions introducing new coding systems, because they demonstrate a phenomenon of improved administrative data accuracy that may relate to a coding 'learning curve' with the new coding system.
authors.affiliation: Institute of Social and Preventive Medicine, CHUV and University of Lausanne, Switzerland. Jean-Marie.Januel@chuv.ch
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Januel
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Luthi
authors.forename: Hude
authors.initials: H
authors.lastname: Quan
authors.forename: François
authors.initials: F
authors.lastname: Borst
authors.forename: Patrick
authors.initials: P
authors.lastname: Taffé
authors.forename: William A
authors.initials: WA
authors.lastname: Ghali
authors.forename: Bernard
authors.initials: B
authors.lastname: Burnand
mesh_terms: D059019:Clinical Coding / Q000592:standards*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010351:Patient Discharge; D013557:Switzerland