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)