Musculoskeletal Injury Surveillance in the US Military: Analysis of the ICD10 Transition and Descriptive Report of Healthcare Utilization at Four Sites Adopting MHS GENESIS- MHSRS 2024

Yuan x, isaacson b

Abstract accepted for poster presentation at the 2024 Military Health System Research Symposium

The MHS transitioned to the ICD10 coding scheme in October 2015 and began the rollout of a new electronic health record (EHR) system, MHS GENESIS, in October 2017. Both changes may have affected the observed prevalence and healthcare utilization associated with musculoskeletal injuries (MSKIs) in Service members. The purpose of this study was to 1) determine the effect of the ICD10 transition on the prevalence of select MSKI conditions and 2) describe MSKI-related healthcare utilization at military treatment facilities (MTFs) during the transition to GENESIS.

We calculated monthly prevalence rates for six diagnostic groupings of MSKIs from October 2011 to February 2020. To determine if the transition to ICD10 influenced prevalence rates, we performed an interrupted time series analysis (ITSA), using the ICD10 transition date (1 October 2015) as the interruption point. To assess trends in direct and private sector care encounters during the GENESIS transition, we calculated monthly MSKI-related encounters at four MTFs from 1 November 2015 through 30 September 2021.

Differences in prevalence of MSKIs could be due to changes in the amount and/or specificity of available codes in ICD10. Those involved in MSKI surveillance should exercise caution when evaluating periods that span the ICD10 transition. For analyses that span such a transition, ITSA is a viable approach to capturing MSKI rates. Changes in healthcare utilization patterns in two of four MTFs during their adoption of GENESIS suggest MSKI care may have shifted from direct to private sector care during this period.