Increased registration of hypertension and cancer diagnoses after the introduction of a new reimbursement system

Abstract Objective. To investigate the impact on ICD coding behaviour of a new case-mix reimbursement system based on coded patient diagnoses. The main hypothesis was that after the introduction of the new system the coding of chronic diseases like hypertension and cancer would increase and the vari...

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Vydané v:	Scandinavian journal of primary health care Ročník 30; číslo 4; s. 222 - 228
Hlavní autori:	Hjerpe, Per, Boström, Kristina Bengtsson, Lindblad, Ulf, Merlo, Juan
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	United States Informa Healthcare 01.12.2012 Taylor & Francis Taylor & Francis LLC
Predmet:	Aged Aged, 80 and over brief conceptual tutorial Cancer Chronic illnesses Clinical medicine Coding Cross-Sectional Studies Diagnosis Disease Doctors Electronic health records Electronic Health Records - utilization Fee-for-Service Plans Female general practice General Practice - organization & administration health Health care Health Care Service and Management, Health Policy and Services and Health Economy Health Sciences Health services Humans Hypertension Hypertension - diagnosis Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi Hälsovetenskap ICD codes imary care incentive International Classification of Diseases - trends Logistic Models Male Medical and Health Sciences Medical diagnosis Medicin och hälsovetenskap Middle Aged Motivation Multilevel Analysis Neoplasms - diagnosis Original Patients Physicians Primary care primary health Primary Health Care Registration reimbursement social epidemiology Sweden swedish primary-care Time periods Sweden
ISSN:	0281-3432, 1502-7724, 1502-7724
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Popis
Shrnutí:	Abstract Objective. To investigate the impact on ICD coding behaviour of a new case-mix reimbursement system based on coded patient diagnoses. The main hypothesis was that after the introduction of the new system the coding of chronic diseases like hypertension and cancer would increase and the variance in propensity for coding would decrease on both physician and health care centre (HCC) levels. Design. Cross-sectional multilevel logistic regression analyses were performed in periods covering the time before and after the introduction of the new reimbursement system. Setting. Skaraborg primary care, Sweden. Subjects. All patients (n = 76 546 to 79 826) 50 years of age and older visiting 468 to 627 physicians at the 22 public HCCs in five consecutive time periods of one year each. Main outcome measures. Registered codes for hypertension and cancer diseases in Skaraborg primary care database (SPCD). Results. After the introduction of the new reimbursement system the adjusted prevalence of hypertension and cancer in SPCD increased from 17.4% to 32.2% and from 0.79% to 2.32%, respectively, probably partly due to an increased diagnosis coding of indirect patient contacts. The total variance in the propensity for coding declined simultaneously at the physician level for both diagnosis groups. Conclusions. Changes in the healthcare reimbursement system may directly influence the contents of a research database that retrieves data from clinical practice. This should be taken into account when using such a database for research purposes, and the data should be validated for each diagnosis.
Bibliografia:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23
ISSN:	0281-3432 1502-7724 1502-7724
DOI:	10.3109/02813432.2012.735552