Are Increasing Trends in Opioid-Related Hospitalizations Attributable to Increases in Diagnosis Recordability? Evidence from 2 Large States. (July 2019)

• Record Type: Journal Article
• Authors: Denham, Alina; Mullaney, Teraisa; Hill, Elaine L; Veazie, Peter J
• Is Part Of: Health services insights. Volume 12(2019)
• Publication Date: 2019-07
• Subjects: opioids -- hospitalizations -- hospital use -- diagnosis field -- diagnosis coding; Medical care -- Periodicals; Public health -- Periodicals; Delivery of Health Care; Quality of Health Care; Medical care; Public health; Periodicals; Fulltext; Internet Resources; Periodicals; Periodicals; 362.105
• DOI: 10.1177/1178632919861338
• Languages: English
• ISSNs: 1178-6329

Abstract

Based on calculations using all-listed diagnoses, the Agency for Healthcare Research and Quality (AHRQ) reports increasing national trends in opioid-related hospitalizations. It is unclear whether the reported increases are attributable to increases in available diagnosis fields. We leveraged increases in available diagnosis fields, ie, diagnosis recordability, in 2 states to examine their effects on opioid-related hospitalizations, graphically and with nonlinear least squares. Hospitalization data from Texas (1999-2011, N = 36 593 049) and New York (2005-2015Q3, N = 27 582 208) were aggregated to quarter-year in each state. Opioid-related hospitalizations were identified using the same International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Diagnosis Codes as AHRQ. In Texas, the increase in diagnosis recordability resulted in a 29.9% discrete shift in the number of recorded opioid diagnoses and a 3-fold increase in the slope. In New York, a smaller discrete shift (3.1%) and a 3-fold increase in the slope were identified, although a more pronounced change in the trend occurred 5 years earlier (slope change from flat to increasing). Increases in recordability lead to a broader definition of opioid-related hospitalizations, if all-listed diagnoses are used; we found that more hospitalizations are identified using the postchange definition than with the prechange definition (9.7% more in Texas and 4.9% more in New York after 4 years). We conclude that reported increases in opioid-related hospitalizations are partially attributable to increases in diagnosis recordability. Cross-state and temporal comparisons of opioid-related hospitalization rates based on all-listed diagnoses can misrepresent the true relative extent of opioid-related hospital use and therefore of the opioid epidemic.