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The American Journal of Managed Care February 2019
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Performance of the Adapted Diabetes Complications Severity Index Translated to ICD-10
Felix Sebastian Wicke, Dr Med; Anastasiya Glushan, BSc; Ingrid Schubert, Dr Rer Soc; Ingrid Köster, Dipl-Stat; Robert Lübeck, Dr Med; Marc Hammer, MPH; Martin Beyer, MSocSc; and Kateryna Karimova, MSc

Performance of the Adapted Diabetes Complications Severity Index Translated to ICD-10

Felix Sebastian Wicke, Dr Med; Anastasiya Glushan, BSc; Ingrid Schubert, Dr Rer Soc; Ingrid Köster, Dipl-Stat; Robert Lübeck, Dr Med; Marc Hammer, MPH; Martin Beyer, MSocSc; and Kateryna Karimova, MSc
We present an International Classification of Diseases, Tenth Revision (ICD-10) translation of the adapted Diabetes Complications Severity Index and show its performance in predicting hospitalizations, mortality, and healthcare-associated costs.
ABSTRACT

Objectives: To assess the performance of the adapted Diabetes Complications Severity Index (aDCSI) translated to International Classification of Diseases, Tenth Revision (ICD-10) in predicting hospitalizations, mortality, and healthcare-associated costs.

Study Design: Retrospective closed cohort study based on secondary data analysis.

Methods: We translated the aDCSI to ICD-10 and calculated aDCSI scores based on health insurance claims data. To assess predictive performance, we used multivariate regression models to calculate risk ratios (RRs) of hospitalizations and mortality and linear predictors of cost.

Results: We analyzed a sample of 157,115 patients with diabetes mellitus. RRs of hospitalizations (total and cause specific) rose with increasing aDCSI scores. Predicting total hospitalizations over a 4-year period, unadjusted RRs were 1.22 for an aDCSI score of 1 (compared with a score of 0), 1.55 for a score of 2, 1.77 for a score of 3, 2.11 for a score of 4, and 2.72 for scores of 5 and higher. Cause-specific hospitalizations and mortality showed similar results. Costs clearly increased in each successive score category.

Conclusions: Our study supports the validity of the aDCSI as a severity measure for complications of diabetes, as it correlates to and predicts total and cause-specific hospitalizations, mortality, and costs. The aDCSI’s performance in ICD-10–coded data is comparable with that in International Classification of Diseases, Ninth Revision–coded data.

Am J Manag Care. 2019;25(2):e45-e49
Takeaway Points
  • The adapted Diabetes Complications Severity Index (aDCSI) (translated to International Classification of Diseases, Tenth Revision [ICD-10]) correlates to and predicts hospitalizations (total and cause specific), mortality, and healthcare-associated costs.
  • Planned use of the aDCSI should consider that the performance differs for correlation and prediction and that results of correlative studies cannot necessarily be transferred to predictive applications and vice versa.
  • We provide further evidence that the aDCSI can be used with ICD-10–coded data.
Diabetes is among the top 10 causes of death worldwide, and its global prevalence is increasing.1-3 Healthcare expenditures for a patient with diabetes are more than twice as high as they are for an average patient, with costs mainly driven by inpatient care and medications used to treat diabetes-related complications.4,5 Risks of hospitalization, mortality, and healthcare costs are associated with the number and severity of diabetes-related complications.6-8 There is an urgent need for a validated diabetes-specific severity score for comorbidities to adjust for differences in diabetes-specific morbidity in a large array of studies. To enable epidemiological studies of large claims databases, such a score would ideally not include clinical data.

To systematically quantify diabetes complications, Young and colleagues developed the Diabetes Complications Severity Index (DCSI).6 The DCSI uses 7 categories of diabetes complications (ophthalmic, renal, neurologic, cerebrovascular, cardiovascular, peripheral vascular, and metabolic). Each category is scored with either 0 (no complication), 1 (nonsevere complication), or 2 (severe complication), except for neurologic complications, which score a maximum of 1. The highest possible DCSI score is therefore 13. As the DCSI needs laboratory values to calculate scores, Chang et al developed the adapted DCSI (aDCSI) specifically for use with claims data, which rarely contain laboratory results.9 The DCSI and aDCSI were validated with regard to hospitalization risk, mortality risk, and healthcare costs in patients with diabetes.6-9 Different approaches exist for the validation and use of the aDCSI, including correlative use to reflect current severity of diabetes complications and predictive use to reflect future risk of hospitalization, mortality, or costs. For example, Chang and colleagues9 correlated aDCSI scores over a 4-year period with hospitalizations during the same period, whereas Chen and Hsiao7 additionally reported on predictive performance. The development of both DCSI and aDCSI was based on International Classification of Diseases, Ninth Revision (ICD-9) codes. Although Glasheen et al10 translated the DCSI to International Classification of Diseases, Tenth Revision (ICD-10) and Wilke et al8 used the aDCSI with ICD-10 data, no systematic validation of the aDCSI with ICD-10 data has been performed with long-term follow-up. Because most healthcare systems use ICD-10–based diagnostic coding, studies on the performance of the aDCSI with ICD-10 data are urgently needed, especially after the switch from ICD-9 to ICD-10 in the United States in 2015.

Based on an analysis of health insurance claims data, the aims of this study are to translate and adapt the aDCSI to ICD-10 and show its performance for correlation with and prediction of hospitalizations, mortality, and healthcare costs over 4 years.

METHODS

Study Design and Setting

We conducted a retrospective closed cohort study based on secondary data analysis. The study is based on claims data from a large statutory health insurance fund in southern Germany (AOK Baden-Württemberg). This insurer covers 4 million inhabitants of the state of Baden-Württemberg (almost half the state’s population). Our data set contains data on all continuously insured persons 18 years and older living in Baden-Württemberg (see eAppendix Table 1 [eAppendix available at ajmc.com] for the complete list of inclusion criteria). The data include comprehensive information on ambulatory care, drug prescriptions, and hospital care. The analysis was carried out as part of an evaluation of general practitioner–centered healthcare and was fully approved by the Ethics Committee of Frankfurt University Hospital.

Participants

Individuals who had a diagnosis of diabetes mellitus in 2010 (ICD-10 codes E10-E14) and were receiving antidiabetic medication were included in the study cohort. To further increase diagnostic specificity, we required a diagnosis of diabetes to be coded in at least 3 calendar quarters per year. This should exclude cases of gestational diabetes.

Translation

On the basis of expert consensus, the ICD-9 version of the aDCSI9 was translated to ICD-10 by the Institute of General Practice (University of Frankfurt) and the PMV Research Group at the Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy (University of Cologne). The suggestions made by Wilke and colleagues8 were taken into consideration in the translation. Because our translation was undertaken prior to the translation of the DCSI by Glasheen and colleagues,10 their work was not considered. Our primary translation was to ICD-10-GM (German Modification, 201311), and our analysis is based on this translation. We also present a translation to the CDC’s ICD-10, Clinical Modification (ICD-10-CM)12 for comparison. The detailed translation can be found in eAppendix Table 2.


 
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