Validation of ICD-9 Code 787.2 for Identification of Individuals with Dysphagia from Administrative Databases

González-Fernández, Marlís; Gardyn, Michael; Wyckoff, Shamolie; Ky, Paul; Palmer, Jeffrey B.

doi:10.1007/s00455-009-9216-1

Cited by 37 publications

(31 citation statements)

References 12 publications

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“…While we observed disparities in PEG placement by race and socioeconomic status, the incidence of dysphagia did not substantially differ among the different racial groups or quartiles of income in our study population. In administrative databases, dysphagia is largely undercoded and extraction of information on dysphagia based on ICD9-CM coding has low sensitivity 23 ; however, specificity is high, and it is unlikely that dysphagia is differentially undercoded among various racial groups and surrogates or SES. Although the time-to-PEG did not differ among the various groups (median 11 days in minorities vs. 10 days in whites; median 10 days in the low income quartile and all other quartiles combined), it is possible that differential access to repeated speech-language-pathology (SLP) evaluations may account for differences in detection of early recovery.…”

Section: Discussionmentioning

confidence: 99%

Racial and Socioeconomic Disparities in Gastrostomy Tube Placement After Intracerebral Hemorrhage in the United States

Faigle

Bahouth

Urrutia

et al. 2016

Stroke

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Background and Purpose Percutaneous endoscopic gastrostomy (PEG) tubes are widely used for enteral feeding of patients after intracerebral hemorrhage (ICH). We sought to determine whether PEG placement after ICH differs by race and socioeconomic status. Methods Patient discharges with ICH as the primary diagnosis from 2007 to 2011 were queried from the Nationwide Inpatient Sample. Logistic regression was used to evaluate the association between race, insurance status, and household income with PEG placement. Results Of 49,946 included ICH admissions, a PEG was placed in 4,464 (8.94%). Among PEG recipients, 47.2% were minorities and 15.6% were Medicaid enrollees, while 33.7% and 8.2% of patients without a PEG were of a race other than white and enrolled in Medicaid, respectively (P<0.001). Compared to whites, the odds of PEG were highest among Asians/Pacific Islanders (OR 1.62, 95% CI 1.32-1.99) and blacks (OR 1.42, 95%, CI 1.28-1.59). Low household income (OR 1.25, 95% CI 1.09-1.44 in lowest compared to highest quartile) and enrollment in Medicaid (OR 1.36, 95% CI 1.17-1.59 compared to private insurance) were associated with PEG placement. Racial disparities (minorities versus whites) were most pronounced in small/medium-sized hospitals (OR 1.77, 95% CI 1.43-2.20 vs. OR 1.31, 95% CI 1.17-1.47 in large hospitals; p-value for interaction 0.011), and in hospitals with low ICH case volume (OR 1.58, 95% CI 1.38-1.81 vs. OR 1.29, 95% CI 1.12-1.50 in hospitals with high ICH case volume; p-value for interaction 0.007). Conclusion Minority race, Medicaid enrollment, and low household income are associated with PEG placement after ICH.

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Section: Discussionmentioning

confidence: 99%

Racial and Socioeconomic Disparities in Gastrostomy Tube Placement After Intracerebral Hemorrhage in the United States

Faigle

Bahouth

Urrutia

et al. 2016

Stroke

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“…This difference was likely due to the approach used to identify patients with post-stroke dysphagia: ICD-9 coding. In a study investigating the accuracy of ICD-9 coding of dysphagia for patients who underwent modified barium swallow studies (MBSSs), the code had a positive predictive value (PPV) of 94.4 and a negative predictive value (NPV) of 12.9 [6]. This indicates that when used, the code is accurate but that the code is often not used when a patient does indeed have dysphagia.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, Heckert et al [5] found that 64 % of patients in an inpatient rehabilitation facility had post-stroke dysphagia. It is generally believed that an underreporting of dysphagia via ICD-9 codes exists and that the number of patients with post-stroke swallowing impairment may be even higher than previous reports [6]. Given the frequency of post-stroke dysphagia and the expected growing burden to the US health system, it is helpful to understand the influence of dysphagia on stroke-related healthcare utilization in this time of healthcare reform.…”

Section: Introductionmentioning

confidence: 99%

The One-Year Attributable Cost of Post-stroke Dysphagia

et al. 2014

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With the recent emphasis on evidence-based practice and healthcare reform, understanding the cost of dysphagia management has never been more important. It is helpful for clinicians to understand and objectively report the costs associated with dysphagia when they advocate for their services in this economy. Having carefully estimated cost of illness, inputs are needed for cost-effectiveness analyses that help support the value of treatments. This study sought to address this issue by examining the 1-year cost associated with a diagnosis of dysphagia post-stroke in South Carolina. Furthermore, this study investigated whether ethnicity and residence differences exist in the cost of dysphagia post-stroke. Data on 3,200 patients in the South Carolina Medicare database from 2004 who had ICD-9 codes for ischemic stroke, 434 and 436, were retrospectively included in this study. Differences between persons with and without dysphagia post-stroke were compared with respect to age, gender, ethnicity, mortality, length of stay, comorbidity, rurality, discharge disposition, and cost to Medicare. Univariate analyses and a gamma-distributed generalized linear multivariable model with a log link function were completed. We found that the 1-year cost to Medicare for persons with dysphagia post ischemic stroke was $4,510 higher than that for persons without dysphagia post ischemic stroke when controlling for age, comorbidities, ethnicity, and proportion of time alive. Univariate analysis revealed that rurality, ethnicity, and gender were not statistically significantly different in comparisons of individuals with or without dysphagia post-stroke. Post-stroke dysphagia significantly increases post-stroke medical expenses. Understanding the expenditures associated with post-stroke dysphagia is helpful for optimal allocation and use of resources. Such information is needed to conduct cost-effectiveness studies.

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“…42,46,[49][50][51][52][53][54]57 As a result, a within-group comparison could not be made because there were too few studies within each index test. Methodologic limitations such as these add to the growing list of factors for the underreporting of dysphagia 3,12 and potential attenuation of screening accuracy. 72 There was a moderate amount of heterogeneity between studies.…”

Section: Discussionmentioning

confidence: 99%

“…9,11 There is a > 13-fold increased risk of mortality during hospitalization in rehabilitation patients. 3 These data, combined with the generally accepted belief that dysphagia is underreported, 3,4,12 suggest that patients on medical (ie, not neurologic or oncology) floors may not be recognized as having dysphagia, leading to increased hospitalization lengths and increased health-care costs. 13 Screening for aspiration can, therefore, reduce morbidity, mortality, and costs while increasing health-care quality.…”

mentioning

confidence: 99%