Tools for categorization of diagnostic codes in hospital data: Operationalizing CCSR into a patient data repository

Abstract

Background: The Clinical Classification Software refined version (CCSR) is a tool to aggregate International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) diagnosis codes into clinically meaningful categories. ICD-10-CM/PCS codes are primarily used in the United States and the tool has not been optimized for use with other country-specific ICD-10 coding systems. Method: We developed an automated procedure for mapping Canadian ICD-10 codes (ICD-10-CA) to CCSR categories using discharge diagnosis data from adult medical hospitalizations at 7 hospitals between Apr 1 2010 and Dec 31 2020, and manually validated the results. Results: There were 383,972 Canadian hospital admissions with 5,186 distinct ICD-10 discharge diagnosis codes. Only 46.6% of ICD-10-CA codes could be mapped directly to CCSR categories. Our algorithm improved mapping of hospital codes to CCSR categories to 98.2%. Validation of the algorithm demonstrated a high degree of accuracy with strong inter-rater agreement (observed proportionate agreement of 0.98). The algorithm was critical for mapping the majority of diagnosis codes associated with heart failure (96.6%), neurocognitive disorders (96.0%), skin and subcutaneous tissue infections (97.2%), and epilepsy (92.5%). Conclusion: Our algorithm for operationalizing CCSR into a patient data repository (https://github.com/GEMINI-Medicine/gemini-ccsr) has been validated for use with Canadian ICD-10 codes and may be useful to clinicians and researchers from diverse geographic locations.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study was funded by the NDRIO-Portage COVID-19 Data Curation Funding and Digital Research Alliance of Canada Data Champion Pilot Project. The development of the GEMINI data platform has been supported with funding from the Canadian Cancer Society, the Canadian Frailty Network, the Canadian Institutes of Health Research, the Canadian Medical Protective Association, Green Shield Canada Foundation, the Natural Sciences and Engineering Research Council of Canada, Ontario Health, the St. Michael's Hospital Association Innovation Fund, and the University of Toronto Department of Medicine, with in-kind support from partner hospitals and Vector Institute. Funders had no role in the design, conduct or interpretation of this study.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Research ethics board approval was obtained from the University Health Network (Toronto), Sunnybrook Health Sciences Centre (Toronto) and St. Michael's Hospital (Toronto) through the integrated Clinical Trials Ontario platform, with St. Michael's Hospital as the Board of Record (CTO project ID: 1394). Research ethics board approval was also obtained from Trillium Health Partners (Mississauga; REB# 742) and Mount Sinai Hospital (Toronto; REB# 15-0075-C)

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Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

Data Availability

Data from this manuscript can be accessed upon request to the corresponding author, to the extent that is possible in compliance with local research ethics board requirements and data sharing agreements.

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