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. 2021 Mar;14(3):e006570.
doi: 10.1161/CIRCOUTCOMES.120.006570. Epub 2021 Mar 3.

Acute Myocardial Infarction Cohorts Defined by International Classification of Diseases, Tenth Revision Versus Diagnosis-Related Groups: Analysis of Diagnostic Agreement and Quality Measures in an Integrated Health System

Andrew E Levy  1   2 , Andrew Hammes  3 , Debra L Anoff  4 , Joshua D Raines  5 , Natalie M Beck  5 , Eric W Rudofker  5 , Kimberly J Marshall  1 , Jessica D Nensel  1 , John C Messenger  1 , Frederick A Masoudi  1 , Read G Pierce  6 , Larry A Allen  1 , Karen S Ream  1 , P Michael Ho  5   7
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Acute Myocardial Infarction Cohorts Defined by International Classification of Diseases, Tenth Revision Versus Diagnosis-Related Groups: Analysis of Diagnostic Agreement and Quality Measures in an Integrated Health System

Andrew E Levy et al. Circ Cardiovasc Qual Outcomes. 2021 Mar.

Abstract

Background: Among Medicare value-based payment programs for acute myocardial infarction (AMI), the Hospital Readmissions Reduction Program uses International Classification of Diseases, Tenth Revision (ICD-10) codes to identify the program denominator, while the Bundled Payments for Care Improvement Advanced program uses diagnosis-related groups (DRGs). The extent to which these programs target similar patients, whether they target the intended population (type 1 myocardial infarction), and whether outcomes are comparable between cohorts is not known.

Methods: In a retrospective study of 2176 patients hospitalized in an integrated health system, a cohort of patients assigned a principal ICD-10 diagnosis of AMI and a cohort of patients assigned an AMI DRG were compared according to patient-level agreement and outcomes such as mortality and readmission.

Results: One thousand nine hundred thirty-five patients were included in the ICD-10 cohort compared with 662 patients in the DRG cohort. Only 421 patients were included in both AMI cohorts (19.3% agreement). DRG cohort patients were older (70 versus 65 years, P<0.001), more often female (48% versus 30%, P<0.001), and had higher rates of heart failure (52% versus 33%, P<0.001) and kidney disease (42% versus 25%, P<0.001). Comparing outcomes, the DRG cohort had significantly higher unadjusted rates of 30-day mortality (6.6% versus 2.5%, P<0.001), 1-year mortality (21% versus 8%, P<0.001), and 90-day readmission (26% versus 19%, P=0.006) than the ICD-10 cohort. Two observations help explain these differences: 61% of ICD-10 cohort patients were assigned procedural DRGs for revascularization instead of an AMI DRG, and type 1 myocardial infarction patients made up a smaller proportion of the DRG cohort (34%) than the ICD-10 cohort (78%).

Conclusions: The method used to identify denominators for value-based payment programs has important implications for the patient characteristics and outcomes of the populations. As national and local quality initiatives mature, an emphasis on ICD-10 codes to define AMI cohorts would better represent type 1 myocardial infarction patients.

Keywords: International Classification of Diseases; Medicare; diagnosis-related groups; heart failure; myocardial infarction.

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Conflict of interest statement

Disclosures: The authors report no conflicts of interest. This program evaluation was determined to not be human subjects research by the Colorado Multiple Institutional Review Board.

Figures

Figure 1.
Figure 1.
AMI cohort agreement in an integrated health system Abbreviations: AMI = acute myocardial infarction; DRG = diagnosis related group; ICD-10 = international classification of diseases, 10th revision.
Figure 2.
Figure 2.
DRG assignments in the ICD-10 cohort for AMI Abbreviations: AMI = acute myocardial infarction; PCI = percutaneous coronary intervention, CABG = coronary artery bypass grafting.
Figure 3.
Figure 3.
ICD10-UCH and DRG-UCH subgroups stratified by chart review diagnosis* *Part of a subgroup analysis of all patients cared for at the University of Colorado Hospital (UCH). Abbreviations: UCH = University of Colorado Hospital, DRG = diagnosis related group; ICD-10 = international classification of diseases, 10th revision; Type 1 MI = Type 1 myocardial infarction; Type 2 MI = Type 2 myocardial infarction; non-ischemic = non-ischemic myocardial injury
See this image and copyright information in PMC

References

    1. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019;139:e56–e66. - PubMed
    1. Jneid H, Addison D, Bhatt DL, Fonarow GC, Gokak S, Grady KL, Green LA, Heidenreich PA, Ho PM, Jurgens CY, et al. 2017 AHA/ACC Clinical Performance and Quality Measures for Adults With ST-Elevation and Non–ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Circ Cardiovasc Qual Outcomes. 2017;10:e000032. - PubMed
    1. Center for Medicare and Medicaid Innovation (CMMI). BPCI Advanced. innovation.cms.gov. https://innovation.cms.gov/initiatives/bpci-advanced. Published May 31, 2019. Accessed June 5, 2019.
    1. Centers for Medicare & Medicaid Services (CMS). Measure Methodology Reports: Mortality Measures. qualitynet.org. https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%.... Published March 2019. Accessed March 30, 2019.
    1. Centers for Medicare & Medicaid Services (CMS). Measure Methodology Reports: Readmission Measures. qualitynet.org. https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%.... Published March 2019. Accessed March 30, 2019.

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