Development of an ICD Coding Definition for Inflammatory Bowel ...

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definition for identification of IBD patients in the Calgary Health Region to facilitate epidemiologic and health services research. 2
2.1 Inflammatory Bowel disease Chapter Two: BACKGROUND CD and UC are chronic inflammatory conditions of the gastrointestinal tract and share several pathologic and clinical presentations. Occasionally these two diseases are not clinically or histologically distinguishable, a condition called indeterminate colitis (IC). Although several hypotheses suggest a combination of environmental factors, genetic predisposition and dysfunctional immunoregulation for the etiology of IBD, the exact etiology of IBD remains uncertain. 2.1.1 Crohn‘s disease CD or regional enteritis is a chronic relapsing granulomatous condition that involves mainly the terminal ileum; however, the entire gastrointestinal tract from mouth to anus can be affected by this disease. Inflammation extends through the intestinal wall from mucosa to serosa. Compared to UC, CD is a more complex and diverse entity. Patients experience a variety of manifestations and a fluctuating clinical course [3]. Anatomic distribution of the disease has three major patterns: (1) In 40% of the cases disease is present both in the ileum and the cecum (ileocolitis); (2) 30% have disease limited to the small intestine and (3) in 25% of the cases disease is confined to colon. The predominant symptoms are diarrhea (100% of ileocolitis cases), abdominal pain (62%), weight loss (19%), and perianal disease (38%) [4]. In addition, several debilitating exteraintestinal manifestations such as arthritis, ankylosing spondylitis, and hepatic complications can emerge in CD patients [5]. 3
Page 1 and 2: UNIVERSITY OF CALGARY DEVELOPMENT O
Page 3 and 4: Abstract INTRODUCTION: To facilitat
Page 5 and 6: Dedication To my parents and my sis
Page 7 and 8: 4.3.1 Computerized search..........
Page 9 and 10: List of Tables Table1. Incidence an
Page 11 and 12: List of Abbreviations Symbol Defini
Page 13: Chapter One: INTRODUCTION Crohn‘s
Page 17 and 18: are usually apparent. Potentially l
Page 19 and 20: Incidence and prevalence rates of I
Page 21 and 22: contact in 1989 or later, to allow
Page 23 and 24: significant condition of the patien
Page 25 and 26: Young et al.[36] found that agreeme
Page 27 and 28: 3.1 Significance Chapter Three: Sig
Page 29 and 30: 4.1 Summarized design Chapter Four:
Page 31 and 32: 4.2.4 Ambulatory Care Classificatio
Page 33 and 34: 4.4 Retrieving the personal health
Page 35 and 36: 4.7 Preliminary development of the
Page 37 and 38: Each time frame 1 (i.e. ”t‘ in
Page 39 and 40: 4.7.1 Sensitivity Sensitivity (true
Page 41 and 42: hospitals were reviewed for each pa
Page 43 and 44: final two definitions was founded o
Page 45 and 46: Figure 1. Distribution of the proce
Page 47 and 48: 5.4.1 IP database (FY 1994 œ FY 20
Page 49 and 50: 5.4.2 PC database (FY 1995 œ FY 20
Page 51 and 52: Diagram 4. Frequency of ACCS contac
Page 53 and 54: Table 3. 2×2 contingency table and
Page 55 and 56: within 5 years“. Of 137 false pos
Page 57 and 58: —IP≥1 or PC≥5 or ACCS≥2 wit
Page 59 and 60: 5.6.2 False negative patients Defin
Page 61 and 62: definitions were selected as our fi
Page 63 and 64: • Incomplete documentation of lin
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94.5% of our subjects were regarded
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prevalence of IBD in the Calgary He
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with no flare in the last 10 years
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• At least two independent and se
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FP rate (i.e. 1-specificity or ). T
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CD, IC patients who become CD or UC
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6.5 Limitations When extrapolating
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egions that do not have access to t
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17. Trallori, G., et al., A populat
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APPENDIX 1. INTERNATIONAL CLASSIFIC
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556.8 Other ulcerative colitis 556.
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• ICD-10-CA Enteritis, NOS, diete
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APPENDIX 2. SEARCH TERMS IN ENDOPRO
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INVOLVEMENT Shade the corresponding
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APPENDIX 4. ETHICAL APPROVAL 81
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IP = 1 PC =3 ACCS =2 IP = 1 PC = 3
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IP = 1 PC = 5 ACCS = 2 IP = 1 PC =
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IP = 2 PC = 2 ACCS = 2 IP = 2 PC =
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IP = 2 PC = 4 ACCS = 2 IP = 2 PC =
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IP = 2 PC = 6 ACCS = 2 IP = 2 PC =
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IP = 1 PC =4 IP = 1 PC = 5 Criteria
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IP = 2 PC = 3 IP = 2 PC = 4 Criteri
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APPENDIX 7. 2×2 TABLES AND TEST CH
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• Definition —IP≥1 or PC≥4
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IBD patients had a median number of
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Diagram 8. Frequency of ACCS contac
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IP = 1 PC =3 ACCS =2 IP = 1 PC = 3
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IP = 1 PC = 5 ACCS = 2 IP = 1 PC =
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IP = 2 PC = 2 ACCS = 2 IP = 2 PC =
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IP = 2 PC = 4 ACCS = 2 IP = 2 PC =
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IP = 2 PC = 6 ACCS = 2 IP = 2 PC =
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IP = 1 PC =4 IP = 1 PC = 5 Criteria
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IP = 2 PC = 3 IP = 2 PC = 4 Criteri
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APPENDIX 11. 2×2 TABLES AND TEST C
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