Data Gathering and analysis
This
is a cross-sectional and descriptive-analytical study that conducted at
Zanjan province, Iran. The sample included
patients’
information records who admitted in hospitals with CVDs problem in the
period from March 20, 2012 to March 22, 2019. The data were taken from
the eight hospital information system (HIS) databases. The sample
limited to records which the ICD-10 codes of ADX and
DDX were between I00 and I99. Records with
ADX or DDX missing were excluded. CVDs
were classified to 10 subgroups by using the International
Classification of Diseases 10th revision (ICD-10)
(Table 1). The discrepancy measured by comparing the ICD-10 codes of the
ADX and DDX, if these two codes did not
match accurately at the terminal digit, classified as a discrepancy or
mismatch. Data analyzed using R (v3.6.0) and Rstudio (v1.2.1335)
software. The analysis of the diagnostic agreement according to the CVDs
subgroups was conducted using Cohen’s Kappa statistic and 95% of the
confidence interval. In case of perfect matching, the value of the Kappa
coefficient is 1. If the value of the Kappa coefficient is close to 0,
that means that matching is coincidental, and if it is less than 0, the
probability of matching is even less than
coincidental.10 The Chi Square statistic was used for
testing relationships between variables such as length of stay (LOS),
age, gender and married state.
Result
From the total of 515273 patient records, in 126874 case the ICD-10
codes of ADX or DDX were between I00 and
I99. 20971 (16.5%) case lacked ADX or
DDX which excluded. By analyzing only the complete
ICD-10 codes of ADX and DDX, a total of
105903, there was a discrepancy in 17503 (16.5%) records. The value of
the Kappa coefficient in the specified period of time was 0.76
(0.75–0.77) (Table 1). The kappa coefficients in men (0.77) and singles
(0.99) are higher than women (0.74) and married (0.75). (Table 2)
The
analysis of CVDs subgroups showed that the value of the Kappa
coefficient range was from κ = 0.34 for CRHD to κ = 0.93 for ARF (Table
3). The highest prevalence CVDs were IHD (47.8%) with κ = 0.78. DVLL
had the highest (91.3%) and CRHID had the lowest (24.5%) diagnostic
agreement. (Table 3)
The
type of discharge indicates the efficiency of health care services.
Correctly and timely ADX led to appropriate
interventions, improved the quality of care and finally patient will be
release from the hospital in planned discharged
type.11 In planned discharge type the patient
completes the initial, actual management in the hospital and cured
completely and not to be under direct supervision of that hospital. The
result of this study show that there was a relationship between the
discharge type and the diagnostic agreement (P<0/004). In
diagnostic agreement, (85.5%) of patients were discharged in the
planned discharge but (4.3%) died. While in diagnostic disagreement,
(81.4%) of patients were discharged in planned discharge type and (8%)
died. Discrepancy between the ADX and
DDX was associated with a 34% longer of LOS (P
< 0.001), translating into a 35-hours increase. (Tables 4 and
5).
Atherosclerosis
(I25.1) was the highest prevalence in CVDs (28.9%). The analysis of the
most 10 prevalent ICD-10 codes showed that the values of the Kappa
coefficient was from κ = 0. 44 for I25.9 to κ = 0. 77 for I80.2 (Table
6).
The
order of occurrence of CVDs admission and discharge diagnostic subgroups
is shown in the Table 7. Disease of the Cerebrovascular diseases(CD)
tract as an admission diagnostic group occupied the 2nd place and as a
discharge diagnostic group it occupied the 3th place with the κ =0.85.
(Table 7)
CVDs
prevalence rate analysis between 2012 and 2018 showed that it had been
increased in recent years. For example, IHD has been increased from
5,000 patients in 2012 to more than 8,000 patients in 2018. In
gender-specific prevalence rates, men had higher quantity than women in
all subgroups of CVDs with Kappa coefficient value of (0.77). In
additions, men (85%) had the highest diagnosis agreement than women
(81%). (p<0.001) (Chart 1, 2)
The
prevalence of CVDs had also increased with age in men and women
(p<0/004).
The
incidence of CVDs in different age groups were (~3%)
from 0–24 years, (~11%) from 25–44 years,
(~40%) from 45–64 years, (~33%) from
65–80 years and (~13%) above the age of 80. (Chart 3)
There was a relationship between the marriage state and diagnostic
agreement (P<0/001). The diagnosis agreement in singles (93%)
was higher than married (83%) with κ =0.91. (Chart 4). The findings
showed that DVLL had the highest and CRHD had the lowest diagnostic
agreement and the most discrepancy was between the CRHD and OFHD groups.
(Table 8)