Hyperbare Zuurstoftherapie: Rapid Assessment - KCE

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64 Hyperbaric Oxygenation Therapy KCE Reports 74 5.7.2.1 Description of the Minimal Clinical Data set The minimal clinical data (in Belgium: Résumé Clinique Minimal/Minimale Klinische Gegevens, RCM/MKG) is a compulsory registration of information concerning each hospital stay, whether in classical hospitalization or in one-day clinic. All information is transferred to the Ministry of Health, where the information is compiled by registration year. The data are validated internally and compared with reference lists (on the hospital level and by the Ministry) but the clinical coherency of recorded diagnoses and procedures are not specifically validated. The KCE report on Clinical Quality Indicators 132 provides more details about biases and flaws linked to MCD analysis. 5.7.2.2 Minimal Clinical Data set and Minimal Financial Data (MFD): methodology for this study Relevant ICD-9-CM procedure codes The following clinical ICD-9-CM procedure codes were selected (ICD-9-CM: International Classification of Diseases, Ninth Revision, Clinical Modification): • ICD-9-CM 93.95: “Hyperbaric oxygenation” • ICD-9-CM 93.97: “Decompression chamber” Relevant billing codes The following billing codes from the nomenclature apply: • 212520: “Installatie van en toezicht op zuurstoftherapie in hyperbare drukkamer (ongeacht het aantal zittingen): De eerste dag” / “Installation et surveillance d'une oxygénothérapie en caisson hyperbare (quel que soit le nombre de séances): Le premier jour” • 212542: “Installatie van en toezicht op zuurstoftherapie in hyperbare drukkamer (ongeacht het aantal zittingen): De tweede dag” / Installation et surveillance d'une oxygénothérapie en caisson hyperbare (quel que soit le nombre de séances): Le second jour The codes 212516 and 212531 do no apply for MCD/MFD analysis since these are ambulatory codes. The code 760642 does not apply since the military hospital is not registered in the MCD/MFD. Data selection The following data were analyzed for the years 2000-2004: • All coupled stays MCD-MFD o having ICD-9-CM 93.95 or 93.97 in field in dataset or o having 212520 or 212542 in field in dataset from MFD • All non-coupled stays from MCD and day stays having ICD-9-CM 93.95 or 93.97 in field in dataset • The non-coupled stays from MFD having 212520 or 212542 in field in dataset from MFD, were not analysed, since for the non-coupled MFD data, there is no diagnosis available. Neither the Anonymous Day Hospitalization data (available for 2004-2005) were analyzed for the same reason. Overview of retrieved MCD-MFD data In total 3 959 stays were retrieved, of which 3 179 correctly coupled stays, 60 incorrectly coupled stays, 323 non-coupled MCD stays and 397 non-coupled MFD stays. A full overview of the retrieved data set is provided in appendix.
KCE Reports 74 Hyperbaric Oxygenation Therapy 65 Diagnosis selection First of all, for MCD with a relevant procedure code, the diagnosis related to the procedure code was selected. If this related diagnosis was a dummy or a diagnosis ‘urgent care’, the primary diagnosis of the “deelverblijf” (with the same specialization number) was taken. If the resulting diagnosis still was a dummy or an ‘urgent care’ diagnosis, the primary diagnosis of the full stay was selected. After performing these steps, the diagnosis remained ‘urgent care’ in 13 cases. For the coupled MFD with a relevant billing code but no relevant procedure code, the primary diagnosis of the full stay (with the lowest specialization number, being 1) was taken. If the resulting diagnosis was a dummy or a diagnosis ‘urgent care’, the firstmentioned diagnosis from the full stay, not being a dummy or an ‘urgent care’ diagnosis, was taken. 5.7.2.3 Results: diagnoses in MCD-MFD data 13 12 11 10 6 9 5 8 7 A total of 3 534 stays between 2000 and 2004 were analyzed for diagnosis. For 2 263 stays, a diagnosis directly linked to the procedure code was available and for 1 271 stays a diagnosis was available through the linkage MCD-MFD (See Table 63 in appendix). After determining a relevant diagnosis code for each stay (see diagnosis selection), we obtained 726 different diagnoses. These diagnoses were grouped into 13 larger categories (Figure 30). Figure 30. Overview of HBOT in MCD-MFD by diagnosis (based on 3 238 hospital stays in 2000-2004) 4 3 2 1 1. 1. CO intoxication 2. Hearing disorders 3. Delayed wound healing 4. Anaerobic or mixed bacterial infections 5. Radio induced lesions 6. Acute soft tissue ischemia 7. Osteomyelitis 8. Acute ophtalmological ischemia 9. Burns 10. Decompression accidents 11. Post-anoxic encephalopathy 12. Gas embolism 13. Other indications / Not classifiable Note: From the 3 534 analyzed stays, 296 stays had a diagnosis which occurred only once in the list and were omitted from the analysis In the category ‘other indications’, we find, amongst others, the following related diagnoses: anaemia, depression, epilepsy, delivery (breech presentation or “foetal need”), cardiac arrest, headache, etc.
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