PMID- 30552852
OWN - NLM
STAT- MEDLINE
DCOM- 20190226
LR  - 20190226
IS  - 1424-3997 (Electronic)
IS  - 0036-7672 (Linking)
VI  - 148
DP  - 2018 Dec 3
TI  - Diagnostic diversity - an indicator of institutional and regional healthcare 
      quality.
PG  - w14691
LID - Swiss Med Wkly. 2018;148:w14691 [pii]
LID - 10.4414/smw.2018.14691 [doi]
AB  - AIM: Our aim was to estimate the diagnostic performance of institutions and 
      healthcare regions from a nationwide hospitalisation database. METHODS: The 
      Shannon diversity index was used as an indicator of diagnostic performance based 
      on the International Classification of Disease, 10th revision, German 
      Modification (ICD-10-GM codes). The dataset included a total of 9,325,326 
      hospitalisation cases from 2009 to 2015 and was provided by the Swiss Federal 
      Office for Statistics. A total of 16,435 diagnostic items from the ICD-10-GM 
      codes were taken as the basis for the calculation of the diagnostic diversity 
      index (DDI). Numerical simulations were performed to evaluate the effect of 
      misdiagnoses in the DDI. We arbitrarily defined the minimum clinically important 
      difference (MCID) as 10% misdiagnoses. The R statistical software was used for 
      all analyses. RESULTS: Diagnostic performance of institutions and healthcare 
      regions as measured by the DDI were strongly associated with caseload and number 
      of inhabitants, respectively. A caseload of >7217 hospitalisations per year 
      for institutions and a population size >363,522 for healthcare regions were 
      indicators of an acceptable diagnostic performance. Among hospitals, there was 
      notable heterogeneity of diagnostic diversity, which was strongly associated with 
      caseload. Application of misdiagnosis-thresholds within each ICD-10-GM category 
      allowed classification of hospitals in four distinct groups: high-volume 
      hospitals with an all-over comprehensive diagnostic performance; high- to 
      mid-volume hospitals with extensive to relevant basic diagnostic performance in 
      most categories; low-volume specialised hospitals with a high diagnostic 
      performance in a single category; and low-volume hospitals with inadequate 
      diagnostic performance in all categories. The diagnostic diversity observed in 
      the 26 Swiss healthcare regions showed relevant heterogeneity, an association 
      with ICD-10-GM code utilisation, and was strongly associated with the size of the 
      healthcare region. The limited diagnostic performance in small healthcare regions 
      was partially, but not fully, compensated for by consumption of health services 
      outside of their own healthcare region. CONCLUSION: Calculation of the DDI from 
      ICD-10 codes is easy and complements the information derived from other quality 
      indicators as it sheds a light on the fitness of the institutionalised interplay 
      between primary and specialised medical inpatient care. &nbsp.
FAU - Brutsche, Martin
AU  - Brutsche M
AD  - Lung Centre, Cantonal Hospital St Gallen, Switzerland.
FAU - Rassouli, Frank
AU  - Rassouli F
AD  - Lung Centre, Cantonal Hospital St Gallen, Switzerland.
FAU - Gallion, Harald
AU  - Gallion H
AD  - Department of Medical Coding, Cantonal Hospital St Gallen, Switzerland.
FAU - Kalra, Sanjay
AU  - Kalra S
AD  - Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, 
      Minnesota, USA.
FAU - Roger, Veronique L
AU  - Roger VL
AD  - Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo 
      Clinic, Rochester, Minnesota, USA.
FAU - Baty, Florent
AU  - Baty F
AD  - Lung Centre, Cantonal Hospital St Gallen, Switzerland.
LA  - eng
PT  - Journal Article
DEP - 20181215
PL  - Switzerland
TA  - Swiss Med Wkly
JT  - Swiss medical weekly
JID - 100970884
SB  - IM
CIN - Swiss Med Wkly. 2019 Feb 15;149:w20029. PMID: 30769344
MH  - Databases, Factual
MH  - Diagnostic Errors/statistics & numerical data
MH  - Health Services
MH  - Hospitalization/statistics & numerical data
MH  - Hospitals/standards/*statistics & numerical data
MH  - Humans
MH  - *International Classification of Diseases
MH  - Quality of Health Care/*standards/*statistics & numerical data
EDAT- 2018/12/16 06:00
MHDA- 2019/02/27 06:00
CRDT- 2018/12/16 06:00
PHST- 2018/12/16 06:00 [entrez]
PHST- 2018/12/16 06:00 [pubmed]
PHST- 2019/02/27 06:00 [medline]
AID - Swiss Med Wkly. 2018;148:w14691 [pii]
AID - 10.4414/smw.2018.14691 [doi]
PST - epublish
SO  - Swiss Med Wkly. 2018 Dec 15;148:w14691. doi: 10.4414/smw.2018.14691. eCollection 
      2018 Dec 3.