Diabetes Complications Severity Index (DCSI) – Update and ICD-10 Translation

• Published in: Journal of diabetes and its complications Vol. 31; no. 6; pp. 1007 - 1013
• Main Authors: Glasheen, William P, Renda, Andrew, Dong, Yanting
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2017; Elsevier Limited
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Clinical outcomes; Codes; Diabetes; Diabetes Complications - classification; Diabetes Complications - mortality; Diabetes Complications - pathology; Diabetes Complications - therapy; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - mortality; Diabetes Mellitus, Type 1 - pathology; Diabetes Mellitus, Type 1 - therapy; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - mortality; Diabetes Mellitus, Type 2 - pathology; Diabetes Mellitus, Type 2 - therapy; Diagnostic Techniques, Endocrine - standards; Diagnostic Techniques, Endocrine - trends; Disease management; Endocrinology & Metabolism; Female; Health care expenditures; Hospital Mortality; Humans; ICD-10; International Classification of Diseases - standards; Male; Medical diagnosis; Middle Aged; Mortality; Patient Admission - statistics & numerical data; Patient Admission - trends; Population health; Practice Guidelines as Topic - standards; Research Design; Risk Adjustment; Severity of Illness Index; Survival Analysis; Young Adult; United States > US; risk adjustment; ICD-10; population health; diabetes; disease management; Diabetes; Disease management; Risk adjustment; Population health
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/j.jdiacomp.2017.02.018

The Diabetes Complications Severity Index (DCSI) converts diagnostic codes and laboratory results into a 14-level metric quantifying the long-term effects of diabetes on seven body systems. Adoption of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) necessitates translation from ICD-9-CM and creates refinement opportunities. ICD-9 codes for secondary and primary diabetes plus all five ICD-10 diabetes categories were incorporated into an updated tool. Additional modifications were made to improve the accuracy of severity assignments. The tools were tested in a Medicare Advantage population. In the type 2 subpopulation, prevalence steadily declined with increasing score according to the updated DCSI tool, whereas the original tool resulted in an aberrant local prevalence peak at DCSI = 2. In the type 1 subpopulation, score prevalence was greater in type 1 versus type 2 subpopulations (3 versus 0) according to both instruments. Both instruments predicted current-year inpatient admissions risk and near-future mortality, using either purely ICD-9 data or a mix of ICD-9 and ICD-10 data. While the performance of the tool with purely ICD-10 data has yet to be evaluated, this updated tool makes assessment of diabetes patient severity and complications possible in the interim.