Documentation

The diagnosis categories used in this MICA are based on the principal diagnosis which is submitted as the first of 23 possible diagnoses coded on the emergency room visit record.

For purposes of the data provided in the community data profiles and Missouri Information for Community Assessment (MICAs), the term EmergencyRoom Visits refers to episodes of care provided to Missouri residents at hospitals that have emergency room facilities.

The source of these data is the Patient Abstract System (PAS) data file, which is compiled from hospital discharges, emergency room visits, and outpatient surgery records that are reported to the Department of Health and Senior Services by state law. The reporting requirements for the PAS have been in place in Missouri continuously since 1993.

In some instances, certain data values in the patient record are missing or miscoded. Visits with missing or miscoded data values are included in the statewide totals, but may not be included within the displayed categories of certain variables (e.g., race, county of residence). Thus, a total of all categories of a variable may not equal the statewide total for that variable. Patients with a missing state of residence were deleted from the analysis file. Those visit records identified as Missouri residents, but missing a county identifier, are included in the statewide totals only.

Emergency Room Visits Definitions

Diagnoses and procedures associated with emergency room visits are classified in accordance with the Ninth Revision of the International Classification of Diseases (ICD-9). This classification is the result of close collaboration among many nations and non- governmental organizations, under the auspices of the World Health Organization. Its original use was to classify causes of mortality. Later, it was extended to include diagnoses in morbidity. For example, the "clinical modification" of the ICD is used in categorizing hospital diagnoses. In practice, the ICD has become the international standard diagnostic classification for all general epidemiological, as well as health management, purposes. The ninth revision of the ICD has been used to classify disease and procedures beginning January 1, 1979, to the present.

Clinical Classification Software

The diagnostic groupings used in the Emergency Room Visits profile and MICA are based on the Clinical Classification Software (CCS). CCS is a tool for clustering patient diagnoses and procedures into a manageable number of clinically meaningful categories. It was developed by the Agency for Healthcare Research and Quality (AHRQ - formerly known as the Agency for Health Care Policy and Research (AHCPR). The tool is updated periodically. It was originally named the Clinical Classifications for Health Policy Research (CCHPR). The CCS compresses the 12,000 diagnosis codes of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) into 259 mutually exclusive categories. In its multi-level mode, the system further categorizes these 259 into some 26 broader groupings. The system can be used with any data that are coded using the ICD-9-CM. It has been shown to be helpful in understanding and analyzing patient data by managed care plans, insurers and researchers.

Further information on the clinical classification, as well as the list of diagnoses and procedures utilized by CCS, can be found at http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp.