Positive Predictive Value of Administrative Data for Neonatal Abstinence Syndrome
Positive Predictive Value of Administrative Data for Neonatal Abstinence Syndrome
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DOI：
10.1542/peds.2017-4183
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发表时间：
2019-01-01
期刊：
影响因子：
8
通讯作者：
Patrick, Stephen W.
中科院分区：
文献类型：
--
作者：
Maalouf, Faouzi I.;Cooper, William O.;Patrick, Stephen W.
目的：新生儿戒断综合征（NAS）是一些接触阿片类药物的婴儿出现的一种产后戒断综合征。医院管理数据通常用于研究和监测，但尚未经过 NAS 验证。我们本研究的目标是验证 NAS 的诊断代码并开发优化识别的算法。 方法：获得了 2009 年至 2011 年（主要样本）和 2016 年（次要样本；国际疾病分类后第 10 次修订，临床修改 [ICD-10-CM]）的田纳西州医疗补助索赔。 NAS 病例采用国际疾病分类第九版修订版临床修改代码 (2009-2011) 779.5 和 ICD-10-CM 代码 (2016) P96.1 进行识别。然后由 2 名医生使用标准化算法对病历进行审查，并计算阳性预测值 (PPV)。开发了用于优化管理数据中 NAS 识别的算法。结果：在我们的 112029 名母婴二人组的主要样本中，从医疗补助索赔数据中识别出 950 个潜在 NAS 病例并进行了审查。在审查的记录中，863例被确认患有NAS（其中628例[66.1%]例被确定为需要药物治疗的NAS，224例[23.5%]例为不需要药物治疗的NAS，11例[1.2%]为医源性NAS），87例（9.2%）不符合NAS临床标准。临床确诊的 NAS 中的国际疾病分类第九版修订版 NAS 临床修改代码的 PPV 为 91%（95% 置信区间：88.8%-92.5%）。同样，二次样本中 ICD-10-CM 代码的 PPV 为 98.2%（95% 置信区间：95.4%-99.2%）。使用医疗补助索赔和住院时间要素的算法改善了 PPV。结论：在基于人口的大型医疗补助参与者队列中，医院管理数据在识别临床诊断的 NAS 病例方面具有较高的 PPV。
OBJECTIVES: Neonatal abstinence syndrome (NAS) is a postnatal withdrawal syndrome experienced by some infants with opioid exposure. Hospital administrative data are commonly used for research and surveillance but have not been validated for NAS. Our objectives for this study were to validate the diagnostic codes for NAS and to develop an algorithm to optimize identification.METHODS: Tennessee Medicaid claims from 2009 to 2011 (primary sample) and 2016 (secondary sample; post-International Classification of Diseases, 10th Revision, Clinical Modification [ICD-10-CM]) were obtained. Cases of NAS were identified by using International Classification of Diseases, Ninth Revision, Clinical Modification code (2009-2011) 779.5 and ICD-10-CM code (2016) P96.1. Medical record review cases were then conducted by 2 physicians using a standardized algorithm, and positive predictive value (PPV) was calculated. Algorithms were developed for optimizing the identification of NAS in administrative data.RESULTS: In our primary sample of 112029 mother-infant dyads, 950 potential NAS cases were identified from Medicaid claims data and reviewed. Among reviewed records, 863 were confirmed as having NAS (including 628 [66.1%] cases identified as NAS requiring pharmacotherapy, 224 [23.5%] as NAS not requiring pharmacotherapy, and 11 [1.2%] as iatrogenic NAS), and 87 (9.2%) did not meet clinical criteria for NAS. The PPV of the International Classification of Diseases, Ninth Revision, Clinical Modification code for NAS in clinically confirmed NAS was 91% (95% confidence interval: 88.8%-92.5%). Similarly, the PPV for the ICD-10-CM code in the secondary sample was 98.2% (95% confidence interval: 95.4%-99.2%). Algorithms using elements from the Medicaid claims and from length of stay improved PPV.CONCLUSIONS: In a large population-based cohort of Medicaid participants, hospital administrative data had a high PPV in identifying cases of clinically diagnosed NAS.