Validity of Using Inpatient and Outpatient Administrative Codes to Identify Acute Venous Thromboembolism: The CVRN VTE Study.
Validity of Using Inpatient and Outpatient Administrative Codes to Identify Acute Venous Thromboembolism: The CVRN VTE Study.
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DOI：
10.1097/mlr.0000000000000524
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发表时间：
2017-12
期刊：
影响因子：
3
通讯作者：
Go AS
中科院分区：
文献类型：
--
作者：
Fang MC;Fan D;Sung SH;Witt DM;Schmelzer JR;Steinhubl SR;Yale SH;Go AS
管理数据经常用于识别静脉血栓栓塞（VTE），用于研究和质量报告。然而，这些代码的有效性，特别是在门诊病人，还没有得到很好的确立。确定ICD-9编码对住院患者和门诊患者经图表证实的急性VTE的预测能力。我们从心血管研究网络静脉血栓栓塞队列研究中选择了2004年至2010年期间ICD-9诊断为VTE的4642例成人。审查病历以确定事件的有效性。ICD-9编码的阳性预测值（PPV）计算为图表验证的VTE事件数量除以特定VTE编码的数量。根据VTE类型（肺栓塞、深静脉血栓形成[DVT]）、代码位置（原发性、继发性）和环境（医院/急诊室[艾德]、门诊）对分析进行分层。住院/艾德患者中任何VTE诊断的PPV为64.6%，门诊患者为30.9%。医院/艾德患者的主要诊断代码比次要诊断代码更可能代表急性VTE（78.9% vs. 44.4%，p<0.001）。肺栓塞和下肢DVT的基层医院/艾德代码的PPV高于上肢DVT（分别为89.1%、74.9%和58.1%）。门诊代码对急性VTE的预测性较差：肺栓塞为28.0%，下肢DVT为53.6%。从门诊就诊或二级诊断代码中获得的VTE ICD-9代码不能可靠地反映急性VTE。在这些代码可以用于研究或政策目的之前，需要更准确的方法来识别门诊患者的VTE。
Administrative data are frequently used to identify venous thromboembolism (VTE) for research and quality reporting. However, the validity of these codes, particularly in outpatients, has not been well-established. To determine how well ICD-9 codes for VTE predict chart-confirmed acute VTE in inpatient and outpatients. We selected 4642 adults with an incident ICD-9 diagnosis of VTE between years 2004 and 2010 from the Cardiovascular Research Network Venous Thromboembolism cohort study. Medical charts were reviewed to determine validity of events. Positive predictive values (PPVs) of ICD-9 codes were calculated as the number of chart-validated VTE events divided by the number with specific VTE codes. Analyses were stratified by VTE type (pulmonary embolism, deep venous thrombosis [DVT]), code position (primary, secondary), and setting (hospital/emergency department [ED], outpatient). The PPV for any diagnosis of VTE was 64.6% for hospital/ED patients and 30.9% for outpatients. Primary diagnosis codes from hospital/ED patients were more likely to represent acute VTE than secondary diagnosis codes (78.9% vs. 44.4%, p<0.001). Primary hospital/ED codes for pulmonary embolism and lower extremity DVT had higher PPV than for upper extremity DVT (89.1%, 74.9%, and 58.1%, respectively). Outpatient codes were poorly predictive of acute VTE: 28.0% for pulmonary embolism and 53.6% for lower extremity DVT. ICD-9 codes for VTE obtained from outpatient encounters or from secondary diagnosis codes do not reliably reflect acute VTE. More accurate ways of identifying VTE in outpatients are needed before these codes can be adopted for research or policy purposes.