{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T16:24:19Z","timestamp":1781022259172,"version":"3.54.1"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2018,8,16]],"date-time":"2018-08-16T00:00:00Z","timestamp":1534377600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["NU50DD004946-01-00"],"award-info":[{"award-number":["NU50DD004946-01-00"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Public health surveillance programs worldwide implement a variety of case-finding strategies, and many rely at least in part on International Classification of Diseases (ICD)-based diagnostic codes in administrative and clinical databases. Over time, state- and national-level hospital discharge databases have been expanding the number of reported diagnosis code fields. This study aimed to evaluate the impact of these expansions on frequencies and rates of major birth defects, and the classification of birth defects as isolated vs multiple.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We used state-level 2006-2013 Florida Birth Defects Registry data and 2009-2012 data from a nationally representative database (Kids\u2019 Inpatient Database). We generated data under different scenarios by varying the number of diagnosis code fields available, and comparing counts and rates of major birth defects generated under each scenario.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The expansion from 10 to 31 diagnosis code fields improved ascertainment by preventing the loss of 1 in every 40 birth defect cases with defect-related diagnoses appearing only in code positions 11 to 31. Although there was variation by birth defect, the largest impact of the expansion tended to occur for less severe birth defects diagnosed in sicker infants. When restricting to fewer codes, not only were fewer cases diagnosed, but more were classified as being isolated due to the inability to capture co-occurring defects.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Our findings encourage additional research for other health outcomes in patients of all ages. Other disease registries rely at least in part on diagnostic codes documented by healthcare providers in their case-finding activities, irrespective of ascertainment protocols, making routine investigation of these databases essential.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocy096","type":"journal-article","created":{"date-parts":[[2018,8,3]],"date-time":"2018-08-03T20:11:35Z","timestamp":1533327095000},"page":"1524-1533","source":"Crossref","is-referenced-by-count":6,"title":["Evaluating the impact of expanding the number of diagnosis codes reported in inpatient discharge databases on the counts and rates of birth defects"],"prefix":"10.1093","volume":"25","author":[{"given":"Jason L","family":"Salemi","sequence":"first","affiliation":[{"name":"Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA"},{"name":"Birth Defects Surveillance Program, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel E","family":"Rutkowski","sequence":"additional","affiliation":[{"name":"Birth Defects Surveillance Program, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Paul","family":"Tanner","sequence":"additional","affiliation":[{"name":"Birth Defects Surveillance Program, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Matas","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell S","family":"Kirby","sequence":"additional","affiliation":[{"name":"Birth Defects Surveillance Program, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,8,16]]},"reference":[{"issue":"1\u20132","key":"2020110612234385300_ocy096-B1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1002\/(SICI)1096-9926(200001\/02)61:1\/2<9::AID-TERA3>3.0.CO;2-H","article-title":"Analytical resources for assessment of clinical genetics services in public health: current status and future prospects","volume":"61","author":"Kirby","year":"2000","journal-title":"Teratology"},{"issue":"4","key":"2020110612234385300_ocy096-B2","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1177\/003335491212700407","article-title":"A comparison of two surveillance strategies for selected birth defects in Florida","volume":"127","author":"Salemi","year":"2012","journal-title":"Public Health Rep"},{"key":"2020110612234385300_ocy096-B3","volume-title":"Guidelines for Conducting Birth Defects Surveillance","author":"Sever","year":"2004"},{"issue":"11","key":"2020110612234385300_ocy096-B4","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1002\/bdra.20294","article-title":"National estimates and race\/ethnic-specific variation of selected birth defects in the United States, 1999-2001","volume":"76","author":"Canfield","year":"2006","journal-title":"Birth Defect Res A"},{"issue":"1","key":"2020110612234385300_ocy096-B5","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1186\/1472-6963-10-316","article-title":"Health plan administrative records versus birth certificate records: quality of race and ethnicity information in children","volume":"10","author":"Smith","year":"2010","journal-title":"BMC Health Serv Res"},{"issue":"3","key":"2020110612234385300_ocy096-B6","first-page":"91","article-title":"Improving the completeness of ascertainment in Florida\u2019s Birth Defects Surveillance Program: the impact of adding infant death and emergency department data","volume":"42","author":"Rutkowski","year":"2015","journal-title":"J Registry Manag"},{"issue":"1","key":"2020110612234385300_ocy096-B7","first-page":"30","article-title":"The relative contribution of data sources to a birth defects registry utilizing passive multisource ascertainment methods: does a smaller birth defects case ascertainment net lead to overall or disproportionate loss?","volume":"38","author":"Salemi","year":"2011","journal-title":"J Registry Manag"},{"issue":"12","key":"2020110612234385300_ocy096-B8","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1002\/bdra.20718","article-title":"Birth defects surveillance in Florida: infant death certificates as a case ascertainment source","volume":"88","author":"Tanner","year":"2010","journal-title":"Birth Defects Res Part A Clin Mol Teratol"},{"issue":"1","key":"2020110612234385300_ocy096-B9","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/intqhc\/mzt090","article-title":"How many diagnosis fields are needed to capture safety events in administrative data? Findings and recommendations from the WHO ICD-11 Topic Advisory Group on Quality and Safety","volume":"26","author":"Drosler","year":"2014","journal-title":"Int J Qual Health Care"},{"issue":"1","key":"2020110612234385300_ocy096-B10","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1093\/cid\/cir246","article-title":"The impact of ICD-9-CM code rank order on the estimated prevalence of clostridium difficile infections","volume":"53","author":"Dubberke","year":"2011","journal-title":"Clin Infect Dis"},{"issue":"16","key":"2020110612234385300_ocy096-B11","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1001\/jama.267.16.2197","article-title":"Comorbidities, complications, and coding bias. Does the number of diagnosis codes matter in predicting in-hospital mortality?","volume":"267","author":"Iezzoni","year":"1992","journal-title":"JAMA"},{"issue":"4","key":"2020110612234385300_ocy096-B12","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1177\/1460458216647089","article-title":"Under-coding of secondary conditions in coded hospital health data: impact of co-existing conditions, death status and number of codes in a record","volume":"23","author":"Peng","year":"2017","journal-title":"Health Informatics J"},{"issue":"1","key":"2020110612234385300_ocy096-B13","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1097\/00005650-199401000-00006","article-title":"Bias in the coding of hospital discharge data and its implications for quality assessment","volume":"32","author":"Romano","year":"1994","journal-title":"Med Care"},{"key":"2020110612234385300_ocy096-B14","author":"Florida Department of Health"},{"issue":"1","key":"2020110612234385300_ocy096-B15","first-page":"10","article-title":"Developing a database management system to support birth defects surveillance in Florida","volume":"37","author":"Salemi","year":"2010","journal-title":"J Registry Manag"},{"issue":"1","key":"2020110612234385300_ocy096-B16","first-page":"14","article-title":"Creation and evaluation of a multi-layered maternal and child health database for comparative effectiveness research","volume":"40","author":"Salemi","year":"2013","journal-title":"J Registry Manag"},{"key":"2020110612234385300_ocy096-B17","volume-title":"HCUP Quality Control Procedures","author":"Barrett","year":"2017"},{"issue":"3","key":"2020110612234385300_ocy096-B18","doi-asserted-by":"crossref","first-page":"E9","DOI":"10.1097\/PHH.0000000000000291","article-title":"The accuracy of hospital discharge diagnosis codes for major birth defects: evaluation of a statewide registry with passive case ascertainment","volume":"22","author":"Salemi","year":"2016","journal-title":"J Public Health Manag Pract"},{"key":"2020110612234385300_ocy096-B19","author":"(HCUP)","year":"2016"},{"key":"2020110612234385300_ocy096-B20","author":"CDC, NBDPN"},{"key":"2020110612234385300_ocy096-B21","author":"CDC, NBDPN"},{"key":"2020110612234385300_ocy096-B22","author":"CDC, NBDPN","year":"2016"}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/25\/11\/1524\/34150513\/ocy096.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/25\/11\/1524\/34150513\/ocy096.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,6]],"date-time":"2020-11-06T17:29:40Z","timestamp":1604683780000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/25\/11\/1524\/5075385"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8,16]]},"references-count":22,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2018,8,16]]},"published-print":{"date-parts":[[2018,11,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocy096","relation":{},"ISSN":["1067-5027","1527-974X"],"issn-type":[{"value":"1067-5027","type":"print"},{"value":"1527-974X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2018,11]]},"published":{"date-parts":[[2018,8,16]]}}}