Is diabetes mellitus correctly registered and classified in primary care? A population-based study in Catalonia, Spain
Por:
Mata-Cases, M, Mauricio, D, Real, J, Bolibar, B and Franch-Nadal, J
Publicada:
1 nov 2016
Resumen:
Objective: To assess the prevalence of miscoding, misclassification, misdiagnosis and under registration of diabetes mellitus (DM) in primary health care in Catalonia (Spain), and to explore use of automated algorithms to identify them.
Methods: In this cross-sectional, retrospective study using an anonymized electronic general practice database, data were collected from patients or users with a diabetes-related code or from patients with no DM or prediabetes code but treated with antidiabetic drugs (unregistered DM). Decision algorithms were designed to classify the true diagnosis of type 1 DM (T1DM), type 2 DM (T2DM), and undetermined DM (UDM), and to classify unregistered DM patients treated with antidiabetic drugs.
Results: Data were collected from a total of 376,278 subjects with a DM ICD-10 code, and from 8707 patients with no DM or prediabetes code but treated with antidiabetic drugs. After application of the algorithms, 13.9% of patients with T1DM were identified as misclassified, and were probably T2DM; 80.9% of patients with UDM were reclassified as T2DM, and 19.1% of them were misdiagnosed as DM when they probably had prediabetes. The overall prevalence of miscoding (multiple codes or UDM) was 2.2%. Finally, 55.2% of subjects with unregistered DM were classified as prediabetes, 35.7% as T2DM, 8.5% as UDM treated with insulin, and 0.6% as T1DM.
Conclusions: The prevalence of inappropriate codification or classification and under registration of DM is relevant in primary care. Implementation of algorithms could automatically flag cases that need review and would substantially decrease the risk of inappropriate registration or coding. (C) 2016 SEEN. Published by Elsevier Espana, S.L.U. All rights reserved.
Filiaciones:
:
Inst Univ Invest Atencio Primaria Jordi Gol IDIAP, DAP Cat Grp, Unitat Suport Recerca Barcelona Ciutat, Barcelona, Spain
Inst Salud Carlos III ISCIII, Ctr Invest Biomed Red Diabet & Enfermedades Metab, Madrid, Spain
Inst Catala Salut, Primary Hlth Care Ctr La Mina, Gerencia Ambit Atencio Primaria Barcelona Ciutat, St Adria De Besos, Spain
:
Inst Univ Invest Atencio Primaria Jordi Gol IDIAP, DAP Cat Grp, Unitat Suport Recerca Barcelona Ciutat, Barcelona, Spain
Inst Salud Carlos III ISCIII, Ctr Invest Biomed Red Diabet & Enfermedades Metab, Madrid, Spain
Hlth Sci Res Inst, Dept Endocrinol & Nutr, Badalona, Spain
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Real, J:
Inst Univ Invest Atencio Primaria Jordi Gol IDIAP, DAP Cat Grp, Unitat Suport Recerca Barcelona Ciutat, Barcelona, Spain
Univ Int Catalunya, Epidemiol & Salut Publ, Sant Cugat Del Valles, Spain
Bolibar, B:
Inst Univ Invest Atencio Primaria Jordi Gol IDIAP, Barcelona, Spain
Univ Autonoma Barcelona, Bellaterra, Cerdanyola Del, Spain
:
Inst Univ Invest Atencio Primaria Jordi Gol IDIAP, DAP Cat Grp, Unitat Suport Recerca Barcelona Ciutat, Barcelona, Spain
Inst Salud Carlos III ISCIII, Ctr Invest Biomed Red Diabet & Enfermedades Metab, Madrid, Spain
Inst Catala Salut, Primary Hlth Care Ctr Raval Sud, Gerencia Ambit Atencio Primaria Barcelona Ciutat, Barcelona, Spain
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