Ascertainment of Colonoscopy Indication Using Administrative Data
Ascertainment of Colonoscopy Indication Using Administrative Data
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DOI：
10.1007/s10620-010-1200-y
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发表时间：
2010-06-01
影响因子：
3.1
通讯作者：
Coffman, Cynthia J.
中科院分区：
文献类型：
--
作者：
Fisher, Deborah A.;Grubber, Janet M.;Coffman, Cynthia J.
行政程序代码数据可以估计结肠镜的使用情况；然而，确定结肠镜检查指征比较困难，因为程序代码本身并不反映结肠镜检查的目的（筛查、监测、诊断）。利用退伍军人健康管理局（VHA）的管理数据，提高已发表的识别结肠镜筛查算法的敏感性（70%）和特异性（72%）。我们在650名患者的全国样本中验证了三种确定结肠镜检查指征的算法，这些算法使用医疗记录作为金标准。算法采用国际疾病分类第九次修订版（ICD-9）和现行程序术语（CPT）代码。使用标准化协议手动提取医疗记录。最佳算法对筛查指征的敏感性为83%，特异性为76%。超过99%的结肠镜检查CPT代码与医疗记录中的结肠镜检查相对应。VHA程序代码对于结肠镜检查的应用是非常准确的；然而，确定指示的算法只有中等的准确性。
Administrative procedure code data can estimate colonoscopy utilization; however, determining colonoscopy indication is more difficult as procedure codes do not inherently reflect the purpose (screening, surveillance, diagnosis) of the colonoscopy.To improve the reported sensitivity (70%) and specificity (72%) of a published algorithm for identifying screening colonoscopies using Veterans Health Administration (VHA) administrative data.We validated three algorithms for determining colonoscopy indication using medical records as the gold standard in a national sample of 650 patients. Algorithms used International Classification of Diseases, 9th Revision (ICD-9) and Current Procedural Terminology (CPT) codes. Medical records were manually abstracted using standardized protocols.The best algorithm had 83% sensitivity and 76% specificity for screening indication. Over 99% of colonoscopy CPT codes corresponded to a colonoscopy in the medical record.VHA procedure codes are very accurate for colonoscopy utilization; however, algorithms to ascertain indication have only moderate accuracy.