{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T03:03:42Z","timestamp":1793070222408,"version":"4.5.0"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2016,6,13]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Epidemiological and health services research often use International Classification of Diseases, Ninth Revision, Clinical Modification (\n              <jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\n              \u20109\u2010\n              <jats:styled-content style=\"fixed-case\">CM<\/jats:styled-content>\n              ) codes to identify patients with clinical conditions in administrative databases. We determined whether there are systematic variations between stroke patient clinical diagnoses and\n              <jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\n              \u20109\u2010\n              <jats:styled-content style=\"fixed-case\">CM<\/jats:styled-content>\n              codes, stratified by hospital characteristics and stroke severity.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We used the records of patients discharged from hospitals participating in the Paul Coverdell National Acute Stroke Program in 2013. Within this stroke\u2010enriched cohort, we compared agreement between the attending physician's clinical diagnosis and principal\n              <jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\n              \u20109\u2010\n              <jats:styled-content style=\"fixed-case\">CM<\/jats:styled-content>\n              code and determined whether disagreements varied by hospital characteristics (presence of a stroke unit, stroke team, number of hospital beds, and hospital location). For patients with a documented National Institutes of Health Stroke Scale score at admission, we assessed whether diagnostic agreement varied by stroke severity. Agreement was generally high (&gt;89%); differences between the physician diagnosis and\n              <jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\n              \u20109\u2010\n              <jats:styled-content style=\"fixed-case\">CM<\/jats:styled-content>\n              codes were primarily attributed to discordance between ischemic stroke and transient ischemic attack (\n              <jats:styled-content style=\"fixed-case\">TIA)<\/jats:styled-content>\n              , and subarachnoid and intracerebral hemorrhage. Agreement was higher for patients in metropolitan hospitals with stroke units, stroke teams, and &gt;200 beds (all\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Agreement was lowest (60.3%) for rural hospitals with \u2264200 beds and without stroke units or teams. Agreement was also lower for milder (94.9%) versus more\u2010severe (96.4%) ischemic strokes (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We identified disagreements in stroke\/\n              <jats:styled-content style=\"fixed-case\">TIA<\/jats:styled-content>\n              coding by hospital characteristics and stroke severity, particularly for milder ischemic strokes. Such systematic variations in\n              <jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\n              \u20109\u2010\n              <jats:styled-content style=\"fixed-case\">CM<\/jats:styled-content>\n              coding practices can affect stroke case identification in epidemiological studies and may have implications for hospital\u2010level quality metrics.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.115.003056","type":"journal-article","created":{"date-parts":[[2016,6,1]],"date-time":"2016-06-01T03:09:23Z","timestamp":1464750563000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":42,"title":["Accuracy of ICD\u20109\u2010CM Codes by Hospital Characteristics and Stroke Severity: Paul Coverdell National Acute Stroke Program"],"prefix":"10.1161","volume":"5","author":[{"given":"Tiffany E.","family":"Chang","sequence":"first","affiliation":[{"name":"Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith H.","family":"Lichtman","sequence":"additional","affiliation":[{"name":"Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry B.","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Department of Neurology, Kentucky Neuroscience Institute, University of Kentucky, Lexington, KY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary G.","family":"George","sequence":"additional","affiliation":[{"name":"Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000152"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.49.3.660"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000160417.39497.a9"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.29.2.415"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.30.1.56"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.82.2.243"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.29.8.1602"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwh314"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(99)00188-2"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.006316"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.113.000743"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.003408"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.25.12.2348"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwf152"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/pds.1518"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000160755.94884.4a"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000032240.28636.BD"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/pds.1924"},{"key":"e_1_3_2_20_2","unstructured":"Development of prototypes for The Paul Coverdell National Acute Stroke Registry; Notice of Availability of Funds. 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