{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T07:02:10Z","timestamp":1789974130649,"version":"4.0.1"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:00:00Z","timestamp":1789862400000},"content-version":"vor","delay-in-days":262,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004543","name":"China Scholarship Council","doi-asserted-by":"publisher","award":["202500560013"],"award-info":[{"award-number":["202500560013"]}],"id":[{"id":"10.13039\/501100004543","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010061","name":"University of Waikato","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010061","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Nursing Management"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Existing comorbidity indices such as the Charlson Comorbidity Index (CCI) summarise comorbidity burden but do not capture how a patient\u2019s diagnoses are distributed across clinical speciality domains, a dimension hypothesised to relate to cross\u2010system care coordination demands. This gap limits their utility for nursing workforce planning in settings with high multimorbidity prevalence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This study aimed to provide preliminary evidence for the construct validity of diagnostic entropy as an administrative measure of cross\u2010system diagnostic dispersion, by testing its incremental predictive value for prolonged hospitalisation, beyond diagnosis count and the CCI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective methodological validation study used inpatient discharge records from a tertiary hospital in southwest China, 2023\u20132025 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200931,470). Diagnostic entropy was calculated using the Shannon entropy formula applied to ICD\u201010 chapter distributions across each patient\u2019s valid diagnoses. Four nested binary logistic regression models were fitted with LOS\u2009&gt;\u200910\u2009days as the primary outcome. Four sensitivity analyses examined robustness to extreme LOS values, coding inclusion rules, insurance\u2010type stratification and repeat admissions from the same patient.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Diagnostic entropy had a mean of 1.746 (SD: 0.569); 72.3% of patients were in the high\u2010entropy group (\n                      <jats:italic>H<\/jats:italic>\n                      \u2009\u2265\u20091.5). Entropy showed low\u2010to\u2010moderate correlation with the CCI (Spearman\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.304,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001) and moderate correlation with diagnosis count (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.544,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001), suggesting that entropy captures a related but nonequivalent aspect of comorbidity\u2010related complexity. After controlling for demographic characteristics, diagnosis count and CCI, entropy remained independently associated with prolonged hospitalisation (OR\u2009=\u20091.112, 95% CI: 1.072\u20131.153,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001), with an incremental Nagelkerke\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.0014. This association was evident primarily among patients with seven or more diagnoses and was not statistically significant among patients with fewer diagnoses. High\u2010entropy patients had longer stays, higher costs and higher rates of prolonged hospitalisation compared to low\u2010entropy patients. Sensitivity analyses produced consistent results (OR range: 1.103\u20131.126).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings contribute discriminant evidence toward the construct validity of diagnostic entropy as an administrative measure of cross\u2010system diagnostic dispersion. Whether this dispersion translates into greater nursing coordination burden remains a hypothesis requiring prospective validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for Nursing Management<\/jats:title>\n                    <jats:p>Diagnostic entropy, calculated from routinely collected discharge diagnoses, may offer nurse managers a low\u2010cost, scalable indicator of cross\u2010system diagnostic dispersion among NCD inpatients. Wards with a higher proportion of high\u2010entropy patients could potentially require greater coordination across speciality teams, though this application awaits prospective, multicentre validation linking entropy to nursing\u2010sensitive outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/jonm\/6726900","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T06:20:31Z","timestamp":1789971631000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Entropy as an Administrative Measure of Cross\u2010System Diagnostic Dispersion in Noncommunicable Disease Inpatients: A Methodological Validation Study"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6853-7723","authenticated-orcid":false,"given":"Yanhua","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2914-433X","authenticated-orcid":false,"given":"Mengxue","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1807-1580","authenticated-orcid":false,"given":"Xingwen","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8535-1149","authenticated-orcid":false,"given":"Qin","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0440-2615","authenticated-orcid":false,"given":"Xin","family":"An","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1031-0382","authenticated-orcid":false,"given":"Oratanasataporn","family":"Soonthree","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,20]]},"reference":[{"key":"e_1_2_12_1_2","doi-asserted-by":"publisher","DOI":"10.1111\/jan.16292"},{"key":"e_1_2_12_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2023.101860"},{"key":"e_1_2_12_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-46227-4"},{"key":"e_1_2_12_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afac155"},{"key":"e_1_2_12_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-15723-4"},{"key":"e_1_2_12_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-025-02967-y"},{"key":"e_1_2_12_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199801000-00004"},{"key":"e_1_2_12_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000182534.19832.83"},{"key":"e_1_2_12_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"e_1_2_12_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2022.03.022"},{"key":"e_1_2_12_11_2","doi-asserted-by":"publisher","DOI":"10.15256\/joc.2015.5.39"},{"key":"e_1_2_12_12_2","first-page":"355","article-title":"Care Fragmentation, Quality, and Costs Among Chronically Ill Patients","volume":"21","author":"Frandsen B. R.","year":"2015","journal-title":"American Journal of Managed Care"},{"key":"e_1_2_12_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/nop2.1607"},{"key":"e_1_2_12_14_2","doi-asserted-by":"publisher","DOI":"10.3233\/THC-199037"},{"key":"e_1_2_12_15_2","doi-asserted-by":"publisher","DOI":"10.1038\/srep37767"},{"key":"e_1_2_12_16_2","first-page":"52","article-title":"Analysis of Age and Gender Structures for ICD-10 Diagnoses in Outpatient Treatment Using Shannon\u2019s Entropy","volume":"243","author":"Schuster F.","year":"2017","journal-title":"Studies in Health Technology and Informatics"},{"key":"e_1_2_12_17_2","doi-asserted-by":"publisher","DOI":"10.3390\/e20100769"},{"key":"e_1_2_12_18_2","article-title":"Comorbidity: An R Package for Computing Comorbidity Scores","volume":"23","author":"Gasparini A.","year":"2018","journal-title":"Journal of Open Source Software"},{"key":"e_1_2_12_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwq433"},{"key":"e_1_2_12_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2010.01.006"},{"key":"e_1_2_12_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2005.10.036"},{"key":"e_1_2_12_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-019-05366-z"},{"key":"e_1_2_12_23_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-024-11073-1"},{"key":"e_1_2_12_24_2","doi-asserted-by":"publisher","DOI":"10.37765\/ajmc.2021.88639"},{"key":"e_1_2_12_25_2","doi-asserted-by":"publisher","DOI":"10.1177\/23779608231158157"},{"key":"e_1_2_12_26_2","doi-asserted-by":"publisher","DOI":"10.3390\/nursrep15040135"},{"key":"e_1_2_12_27_2","doi-asserted-by":"publisher","DOI":"10.1111\/jnu.13045"},{"key":"e_1_2_12_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gerinurse.2026.103986"},{"key":"e_1_2_12_29_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.16.1987"},{"key":"e_1_2_12_30_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1001025"},{"key":"e_1_2_12_31_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2018-008043"},{"key":"e_1_2_12_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2022.104311"},{"key":"e_1_2_12_33_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12960-020-0446-5"},{"key":"e_1_2_12_34_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1448871"},{"key":"e_1_2_12_35_2","doi-asserted-by":"publisher","DOI":"10.3389\/ijph.2023.1605521"},{"key":"e_1_2_12_36_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-020-1145-5"},{"key":"e_1_2_12_37_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1363764"}],"container-title":["Journal of Nursing Management"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/jonm\/6726900","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/jonm\/6726900","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/jonm\/6726900","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T06:20:32Z","timestamp":1789971632000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/jonm\/6726900"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":37,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/jonm\/6726900"],"URL":"https:\/\/doi.org\/10.1155\/jonm\/6726900","archive":["Portico"],"relation":{},"ISSN":["0966-0429","1365-2834"],"issn-type":[{"value":"0966-0429","type":"print"},{"value":"1365-2834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2026-06-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"6726900"}}