Identifying suicidal behavior among adolescents using administrative claims data.
Identifying suicidal behavior among adolescents using administrative claims data.
复制标题
使用行政索赔数据来识别青少年之间的自杀行为。
DOI：
10.1002/pds.3421
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发表时间：
2013-07
影响因子：
2.6
通讯作者：
Cooper, William O.
中科院分区：
文献类型：
--
作者：
Callahan, S. Todd;Fuchs, D. Catherine;Shelton, Richard C.;Balmer, Leanne S.;Dudley, Judith A.;Gideon, Patricia S.;DeRanieri, Michelle M.;Stratton, Shannon M.;Williams, Candice L.;Ray, Wayne A.;Cooper, William O.
为了评估儿童和青少年使用精神药物的安全性，能够从医疗索赔数据中识别自杀行为并将其与其他伤害区分开来至关重要。本研究的目的是开发一种使用行政索赔数据的算法，以识别儿童和青少年队列中接受药物治疗的自杀行为。该队列包括1995-2006年参加田纳西州医疗补助计划的80，183名青少年（6-18岁），他们服用抗抑郁药。使用外部损伤原因代码（E代码）和ICD-9-CM代码（对应于自杀行为的潜在机制或导致的损伤）确定自杀行为的潜在发作。对于每一个确定的事件，医疗记录进行了审查，以确定伤害是否是自己造成的，以及是否明确说明或可以推断出死亡的意图。对通过索赔数据确定的2676起潜在自我伤害事件的医疗记录进行了审查。在1162起被归类为自杀行为的事件中，1117起（96%）声称自杀和自我伤害，药物中毒或两者兼而有之。代码组预测自杀行为的阳性预测值（PPV）范围为0-88%，在伴随住院时有所改善，但有排除一些确认的自杀行为发作的限制。在这组青年中，几乎所有确认的自杀行为都包括自杀或药物中毒的ICD-9-CM代码。结合这些ICD-9-CM代码和住院时间的算法大大提高了识别药物治疗自杀行为的PPV。
In order to assess the safety of psychotropic medication use in children and adolescents, it is critical to be able to identify suicidal behaviors from medical claims data and distinguish them from other injuries. The purpose of this study was to develop an algorithm using administrative claims data to identify medically-treated suicidal behavior in a cohort of children and adolescents. The cohort included 80,183 youth (6–18 years) enrolled in Tennessee’s Medicaid program from 1995–2006 who were prescribed antidepressants. Potential episodes of suicidal behavior were identified using external cause-of-injury codes (E-codes) and ICD-9-CM codes corresponding to the potential mechanisms of or injuries resulting from suicidal behavior. For each identified episode, medical records were reviewed to determine if the injury was self-inflicted and if intent to die was explicitly stated or could be inferred. Medical records were reviewed for 2676 episodes of potential self-harm identified through claims data. Among 1162 episodes that were classified as suicidal behavior, 1117 (96%) had a claim for suicide & self-inflicted injury, poisoning by drugs, or both. The positive predictive value (PPV) of code groups to predict suicidal behavior ranged from 0–88% and improved when there was a concomitant hospitalization but with the limitation of excluding some episodes of confirmed suicidal behavior. Nearly all episodes of confirmed suicidal behavior in this cohort of youth included an ICD-9-CM code for suicide or poisoning by drugs. An algorithm combining these ICD-9-CM codes and hospital stay greatly improved the PPV for identifying medically-treated suicidal behavior.
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