Stability of diagnostic coding of psychiatric outpatient visits across the transition from the second to the third version of the Danish National Patient Registry
Authors: Bernstorff Martin , Hansen Lasse , Perfalk Erik , Danielsen Andreas Aalkjær , Østergaard Søren Dinesen 
Published: March 2022

AbstractBackgroundIn Denmark, data on hospital contacts are reported to the Danish National Patient Registry (DNPR). The ICD-10 main diagnoses from the DNPR are often used as proxies for mental disorders in psychiatric research. With the transition from the second version of the DNPR (DNPR2) to the third (DNPR3) in February-March 2019, the way main diagnoses are coded in relation to outpatient treatment changed substantially. Specifically, in the DNPR2, each outpatient treatment course was labelled with only one main diagnosis. In the DNPR3, however, each visit during an outpatient treatment course is labelled with a main diagnosis. We assessed whether this change led to a break in the diagnostic time-series represented by the DNPR, which would pose a threat to the research relying on this source.MethodsAll main diagnoses from outpatients attending the Psychiatric Services of the Central Denmark Region from 2013 to 2021 (n=100,501 unique patients) were included in the analyses. The stability of the DNPR diagnostic time-series at the ICD-10 subchapter level was examined by comparing means across the transition from the DNPR2 to the DNPR3.ResultsWhile the proportion of psychiatric outpatients with diagnoses from some ICD-10 subchapters changed statistically significantly from the DNPR2 to the DNPR3, the changes were small in absolute terms (e.g., +0.9% for F2 - psychotic disorders and +0.1% for F3 - mood disorders).ConclusionThe change from the DNPR2 to the DNPR3 is unlikely to pose a substantial threat to the validity of most psychiatric research at the diagnostic subchapter level.Data availabilityDue to restrictions in Danish law for protecting patient privacy, the data used in this study is only available for research projects conducted by employees in the Central Denmark Region following approval from the Legal Office under the Central Denmark Region (in accordance with the Danish Health Care Act §46, Section 2). However, similar data can be accessed through Statistics Denmark. Danish institutions can apply for authorization to work with data within Statistics Denmark, and such organisations can provide access to affiliated researchers inside and outside of Denmark.Significant OutcomesA significant administrative change in diagnostic coding of psychiatric outpatient treatment in Denmark did not induce marked destabilisation in the incidence of psychiatric diagnoses or the number of diagnoses received by each patient.In the DNPR3, most outpatient treatment courses are labelled with the same main diagnosis (subchapter level) at the first and last visit.LimitationsAnalyses were performed on data from the Central Denmark Region. While the administrative change was at the national level, and results should generalise, this is not testable from these data.Data was obtained from the Business Intelligence Office. While this source receives data from the same source as the National Patient Registry, and should be identical, this could not be tested.