Supplement ICD-9 Codes for Risk Factors



Online supplement

Eight year Trend of Acute Respiratory Distress Syndrome: A Population-Based Study in Olmsted County, Minnesota

Guangxi Li, Michael Malinchoc, Rodrigo Cartin-Ceba, Chakradhar V. Venkata, Daryl J. Kor, Steve G. Peters, Rolf D.Hubmayr, Ognjen Gajic,

Multidisciplinary Epidemiology and Translational Research in Intensive Care - METRIC

ICD-9 Codes for Risk Factors

Pneumonia

Code Description

480 Pneumonia Due To Adenovirus

480 Viral Pneumonia

480.1 Pneumonia Due To Respiratory Syncytial Virus

480.2 Pneumonia Due To Parainfluenza Virus

480.8 Pneumonia Due To Other Virus Not Elsewhere Classified

480.9 Viral Pneumonia, Unspecified

481 Pneumococcal Pneumonia (Streptococcus Pneumonial Pneumonia)

482 Pneumonia Due To Klebsiella Pneumoniae

482 Other Bacterial Pneumonia

482.1 Pneumonia Due To Pseudomonas

482.2 Pneumonia Due To Haemophilus Influenzae (H. Influenza)

482.3 Pneumonia Due To Streptococcus

482.3 Pneumonia Due To Streptococcus Unspecified

482.31 Group A Streptococcus Pneumonia

482.32 Group B Streptococcus Pneumonia

482.39 Other Streptococcus Pneumonia

482.4 Pneumonia Due To Staphylococcus

482.8 Pneumonia Due To Other Specified Bacteria

482.81 Anaerobes Pneumonia

482.82 Escherichia Coli Pneumonia

482.83 Pneumonia Due To Gram-Negative Bacteria

482.89 Pneumonia Due To Other Specified Bacteria

482.9 Bacterial Pneumonia, Unspecified

483 Pneumonia Due To Other Specified Organism

483 Mycoplasma Pneumoniae

483.1 Pneumonia Due To Chlamydia

483.8 Pneumonia Due To Other Specified Organism

484 Pneumonia In Infectious Diseases Classified Elsewhere

484.1 Pneumonia In Cytomegalic Inclusion Disease

484.3 Pneumonia In Whooping Cough

484.5 Pneumonia In Anthrax

484.6 Pneumonia In Aspergillosis

484.7 Pneumonia In Other Systemic Mycoses

484.8 Pneumonia In Other Infectious Diseases Classified Elsewhere

485 Bronchopneumonia, Organism Unspecified

486 Pneumonia, Organism Unspecified

487 Influenza With Pneumonia

Sepsis

Code Description

038 Septicemia

020.0 Septicemic

790.7 Bacteremia

117.9 Disseminated Fungal Infection

112.5 Disseminated Candida Infection

112.81 Disseminated Fungal Endocarditis

Trauma

Code Description

800 Brain Trauma

859 Brain Trauma

852 Brain Trauma

812 Humerus Fracture

807 Rib/Sternal Fracture

820 Femur Fracture

813 Femur Fracture

821 Femur Fracture

823 Tibia Fracture

860 Hemothorax

861 Pneumothorax

864 Spleen Injury

865 Liver Injury

Pancreatitis

Code Description

577 Acute Pancreatitis

Shock

Code Description

785.5 Shock

785.51 Shock, Cardiogenic

785.59 Other Shock Without Mention Of Trauma

634.5 Spontaneous Abortion Complicated By Shock

635.5 Legally Induced Abortion Complicated By Shock

636.5 Illegal Abortion, Unspecified, Complicated By Shock

637.5 Unspecified Abortion Complicated By Shock

638.5 Failed Attempted Abortion Complicated By Shock

639.5 Shock Following Abortion Ectopic And Molar Pregnancies

669.1 Obstetric Shock

958.4 Traumatic Shock

995 Anaphylactic Shock, Not Elsewhere Classified

E873.4 Failure In Dosage In Electroshock Or Insulin-Shock Therapy

E879.3 Shock Therapy As The Cause Of Abnormal Reaction Of Patient, Or If Later Complication, Without Mention Of Misadventure At Time Of Procedure

458.0 Hypotension, Postural

458.8 Hypotension, Specified Type, Not Elsewhere Classified

458.9 Hypotension, Arterial, Constitutional

796.3 Hypotension, Transient

Rochester Epidemiology Project

The Rochester Epidemiology Project (REP) Olmsted Census data maps the residency status of every person in the REP system who has ever shown Olmsted county residency.

The REP Census data compiles the residency status of each person at the time of visits to any institution included in the REP data system. Residency data from each record belonging to a person has been compiled and combined to build a residency status of each individual from 1/1/1966, or date of first contact in the system, up to 12/31/2008.

Olmsted county is an relatively isolated place in midwest. The closest competing medical centers are in Minneapolis, Minn (139.2 km to the north), LaCrosse, Wis (113.6 km to the east), Iowa City and Des Moines, Iowa (316.8 and 332.8 km to the south, respectively), and Sioux Falls, SD (376 km to the west). It is exceptional for any critically ill patients from this area to be admitted anywhere other than at the Mayo Clinic ICUs. The only other health care provider in town - Olmsted County hospital provides minimal critical care services and the patients who require mechanical ventilation for acute respiratory failure are transferred to Mayo ICUs.

The REP Browser residency timeline

[pic]

The REP Census timeline bar displays the residency data for a specific person in a graphical timeline format. Each section of the timeline can be hovered over with the mouse pointer to view the residency status and effective dates.

A person's residency status, based on medical record visit data, is represented in colored bars indicating the confirmed or implied residence of the person throughout time from 1/1/1966 to "current".

The person's age is indicated every 5 years along the timeline, along with an indicator of birth date and death date if they fall within the timeline.

Green

Olmsted County residency is indicated by a Green bar section. A Green section indicates the person was seen at an institution included in the REP and resided in Olmsted county at the time of that visit. A buffer zone of one year prior to and after the visit date is considered a Green section. A person age 2 and under has a 6 month buffer zone applied to visits. Overlapping buffer zones create a solid bar of residency status.

Yellow

A Yellow timeline section indicates the person had at least two Olmsted county resident visits, with a gap larger than two years, but less than or equal to 3 years between visits. This area between Olmsted visits becomes an "Implied Olmsted Resident" status.

Red

Non-Olmsted County residency is indicated by a Red bar section. A Red section indicates the person was seen at an institution included in the REP and did not reside in Olmsted county at the time of that visit. A buffer zone of one year prior to and after the visit date is considered a Red section. A person age 2 and under has a 6 month buffer zone applied to visits. Overlapping buffer zones create a solid bar of residency status.

Orange

An Orange timeline section indicates the person had at least two Non-Olmsted county resident visits, with a gap larger than two years, but less than or equal to 3 years between visits. This area between Non-Olmsted visits becomes an "Implied Non-Olmsted Resident" status.

White

A White section on the residency timeline indicates that there is not sufficient activity in the medical record data to determine residency for the person during the covered timeframe.

Gray Striped

The Gray horizontal striped section indicates the lack of medical record information prior to a person's first visit in the system, and/or after death.

Birth Indicator

A Purple arrow will be displayed along the age bar if the birth date of the person falls within the 1966-2008 timeframe covered by the timeline.

Death Indicator

A black arrow will appear on the timeline indicating date of death if the death falls within the 1966-2008 timeframe. If the death record indicates Olmsted county residency at the time of death, the black arrow will have a green shading around it. If the death record indicates Non-Olmsted county residency at the time of death, the black arrow will have a red shading around it. If no residency is known from the death record, the arrow will just be black. 

 Imputation of Residency Gaps

Confirmed Residency:

Each date of visit is assigned a residency status of Olmsted or Non-Olmsted.  The REP has implemented a buffer zone around each visit date of one year (12 months) before and one year after the visit where the person's residency will have a "confirmed" status of either Olmsted residency, or non-Olmsted residency, based on what the geocode indicates for that visit. The buffer zone for a child 2 years of age or younger is 6 months before and after the visit date. The two exceptions will be not placing a buffer before a known date of birth, or a buffer after a known date of death.

When two visits with conflicting residency occur close enough to have overlapping buffer zone (any gap shorter than 2 years), then the first visit's residency will carry forward for one year, and the remainder of the gap will be filled by the buffer zone of the 2nd visit. If the gap between the two visits is less than one year, then the first visit's buffer zone will only extend to the date of the 2nd visit (not beyond).

For example, if the gap is 1.5 years between the two visits, then the buffer zone of the early visit will only cover the first year after that visit, and the other ½ year near the 2nd date will be covered by its own buffer zone.

This buffer zone will also help give a larger window of residency for the initial and last visits occurring in the REP system, creating more generous left and right anchoring points on this persons REP timeline, and indicating a high level of certainty about a person's residency in that timeframe.

 

Implied Residency:

If a person has a gap of more than 2 years and less than 4 years between 2 visits of the same residency status (Olmsted or Non-Olmsted), the gap is given a status of 'Implied Olmsted Resident' or 'Implied Non-Olmsted Resident'.

To determine the magnitude of the time gap between visits to be used to imply residency status, some detailed analyses was done to determine the likelihood that a person would have a second visit within a certain range of time. These analyses were also broken down by gender, age, and year timeframes based on historical REP information.

Note: There are two types of gaps between visits in the REP system. The first type is where the residency is the same on both endpoints of the gap. The second type is where the endpoints have different residency statuses (Olmsted vs. non-Olmsted).

When a patient has a gap with Olmsted residency on both endpoints, then the determination was that for male patients, the REP will bridge a four year gap between visits with an implied residency status between the visits. For females the data showed that the REP could use a three year gap between visits to determine the implied residency status. These gap sizes indicate that when looking at past visit information, when a female or male patient has two visits, 97% of the time they will fall within the three or four year windows respectively.

The same gap year ranges for men and women will apply when there is different residency information for the visits on either side of the gap. Patients with a gap size within 4 years for men and 3 years for women, and with different residency information on either side will have the previous visits residency status carried forward until the subsequent visits buffer date. If the gap between the visits is larger than the acceptable gap size, then an "Unknown Residency" status will be assigned between the visits.

 

Unknown Residency:

If a patient has a gap of time which exceeds our approved gap window (4 years for men, 3 years for women), then the time from the end of the previous visits buffer window until the beginning of the subsequent visits buffer window will be flagged as "unknown". This indicator means that we do not have enough information to give a residency status for that person at that point in time. This unknown status will also be applied after the patients last visit in the REP system (plus the buffer window) up to present if no date of death is known.

Residency Rules

In an effort to filter out people who are not "true" residents of Olmsted county, a set of residency rules was developed and applied to the Olmsted residents in the REP.

Rule 1: The date of first medical diagnosis with an Olmsted County geocode is date of first residency, with the exception of first diagnosis given at a Nursing Home, State Hospital, Sanitarium, or Mental Health Center

Rule 2: Persons residing in a Nursing Home, Sanitarium, or State Hospital need to have established Olmsted residency prior to their stay at the listed institutions. This is done by having a diagnosis given as an Olmsted resident at an Olmsted medical facility previous to their Nursing Home, Sanitarium, or State Hospital stay. The purpose of this prerequisite is to reduce possible inflation of incidence/prevalence rates (e.g. Schizophrenia). Nursing home residents with no other legitimate Olmsted county address on any of their records, and less than one year of Olmsted visits within the nursing home, will be removed from the census and not counted as an Olmsted resident. If the time between the first and last Olmsted visit within the nursing home is longer than 12 months, the person will be included in the REP census.

Rule 3: College students attending college at a campus in Olmsted County, or returning from college and residing in Olmsted County will be included as Olmsted residents.

Rule 4: "Care Of" addresses need to be verified as being an Olmsted resident by having a diagnosis code with an Olmsted geocode one visit previous to the date of the listed "care of" address.

Rule 5: People who move between two residences during the year (snowbirds) will be included as residents of Olmsted County as long as they maintain an Olmsted address when registering at an Olmsted County medical facility.

Rule 6: Retired nuns living at Assisi Heights, Rochester, MN are considered Olmsted County residents.

Rule 7: People with addresses such as Guest House, Gables Recovery Center, Dorothy Day House, Women's Shelter, Ronald McDonald House, Transplant House, area hotels and motels, and other treatment programs will be considered not Olmsted County residents unless a legitimate address with Olmsted residency is shown on another diagnosis for that person.

Rule 8: Persons receiving care while in the Olmsted County jail have an address of the "Olmsted County Adult Detention Center". These persons will be considered an Olmsted resident if they have a legitimate Olmsted address on their record.

Rule 9: Addresses which fall near a county border, or have older ambiguous rural route information, will be matched electronically with the "Rural Route To E911 Conversion" database. This will provide a for-sure translation between ambiguous addresses bordering the County line and let us define the residents once and for all based on Olmsted County Planning and Zoning information. We will then translate this information over to the appropriate diagnosis codes where geocode was assigned based on these addresses. (Cities of main concern: Chatfield, St. Charles, Pine Island, Plainview, Byron, Stewartville, Kasson)

Rule 10: Charter House residents with no other legitimate Olmsted county address on any of their records, and less than one year of Olmsted visits will be removed from the census. If the Charter House resident has more than 12 months from first Olmsted visit to last Olmsted visit, the person will be included in the REP Census.

Rule 11: Persons in the Federal / State prisons in Olmsted County are excluded from being classified as residents.

Mayo Clinic Life Sciences System Data Source

Medical Revenue Information System (MRIS)

The MRIS contains billing related information about patient visits to Mayo clinic. This information is also fed into the Mayo Decision Support System (DSS). Highlights of available data include:

• Clinic billing information

• Data from 1997 to present

• Dates: visit, procedure, service, etc.

• Diagnoses (ICD-9 Codes)

• Procedures (ICD-9 & CPT4 Codes)

• Services (CPT4 Codes)

• This is a nightly feed and contains data from the previous day.

HealthQuest

HealthQuest contains billing related information about inpatient and outpatient visits to Mayo hospitals; St. Mary's and Rochester Methodist. This information is also fed into the Mayo Decision Support System (DSS). Highlights of available data include:

• Hospital billing information

• Data from 1985 to Present

• Admit and discharge dates

• Admit and discharge information

• Physicians

• Accident information

• Diagnosis Related Group (DRG) Codes

• Diagnoses (ICD-9 Codes)

• Procedures (ICD-9 & CPT4 Codes)

• Patient Services (CPT4 Codes)

• This is a nightly feed and contains data from the previous day.

Master Patient Identification Index (MPII)/Registration

The MPII/Registration database contains Patient Demographics. Highlights of available data include:

• Name

• Address

• Gender

• Birth Date

• This is a nightly feed and contains data from the previous day.

Mayo Integrated Clinical Systems (MICS) LastWord

MCLSS contains a subset of information from the Electronic Medical Record (MICS LastWord). Highlights of available data include:

• Data from 1994 to Present

• Patient Demographics

• Laboratory Test Results

• FlowSheet Data

• Patient Services

• This is a real time feed and contains up to date data.

Clinical Notes

Clinical Notes contains textual information collected during a patient visit. Highlights of available data include:

• Data from 1994 to Present

• Full Text of Clinical Note

• Note Date

• Service Area

• Patient Vital Signs (Height, Weight, Temperature, Blood Pressure)

• This is a real time feed and contains data from the previous day.

Pathology Data

Pathology data contains textual information as well as specimen detail. Highlights of available data include:

• Data from 1992 to Present (Data prior to 1992 is available but not well documented. Specimen Ids from pre 1992 refer to "card" numbers rather than accession numbers and may not be consistant with other data.)

• Full Text of Pathology Report

• Accession Date

• Pathology Snomed Codes

• Part/Block/Slide Detail

• This is not a real time feed and the data is usually 1-2 weeks old.

Description of the ALI Screening Tool

The Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) database (METRIC Datamart) and Mayo Clinic Life Sciences System (MCLSS) were used in this project. This SQL-based integrative database accumulated data within 1 h from its entry into the electronic medical records and served as the main data source. Data access was accomplished through Data Discovery and Query Builder (DDQB) and open database connectivity (ODBC) connections to a relational database using Microsoft SQL Server. ALI sniffer was triggered when both criteria listed below were met within a single 24-h period:

(1) Qualifying arterial blood gas analysis: the ratio of partial pressure of oxygen over inspired oxygen concentration (PaO2/FiO2) ................
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