Validity of Incident Opioid Use Disorder (OUD) Diagnoses in Administrative Data: a Chart Verification Study
Validity of Incident Opioid Use Disorder (OUD) Diagnoses in Administrative Data: a Chart Verification Study
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DOI：
10.1007/s11606-020-06339-3
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发表时间：
2020-11-11
影响因子：
5.7
通讯作者：
Becker, William C.
中科院分区：
文献类型：
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作者：
Howell, Benjamin A.;Abel, Erica A.;Becker, William C.
解决阿片类药物过量流行的一个重要策略是确定过量风险较高的人群，特别是那些有阿片类药物使用障碍（OUD）的人。然而，目前尚不清楚行政资料中OUD诊断的不准确性。目的了解突发性OUD诊断患者中不准确诊断的患病率。研究对象：2016年10月1日至2018年6月1日期间，在三家退伍军人健康管理局医疗中心随机抽取90名突发OUD诊断与面对面接触指数相关的患者。设计在索引就诊前后120天内回顾所有就诊记录、转诊、处方和实验室值的直接图表。使用所有可用的图表数据，我们确定OUD的诊断是否可能准确，可能不准确或不确定准确。然后，我们进行了双变量分析，以评估与可能不准确诊断相关的人口学或临床特征。我们发现1337名退伍军人有突发性OUD诊断。在图表验证子样本中，我们评估了26例（29%）OUD诊断可能不准确；系统差错20例，临床差错6例；另外，有8个没有足够的信息来确定准确性。诊断可能不准确的退伍军人更有可能更年轻，并且处方阿片类药物治疗疼痛。与可能不准确诊断相关的临床环境包括非精神健康临床环境、小组访问和非患者护理环境。结论：我们的研究发现，在有偶发性OUD诊断的退伍军人中，可能存在不准确的OUD诊断。这些情况中的大多数反映了易于寻址的系统错误。由于临床错误和文件不足造成的比例较小，可以通过增加对临床医生的培训来解决。如果这些不准确在整个VHA中普遍存在，它们可能会使卫生服务研究和卫生系统反应复杂化。
Background An important strategy to address the opioid overdose epidemic involves identifying people at elevated risk of overdose, particularly those with opioid use disorder (OUD). However, it is unclear to what degree OUD diagnoses in administrative data are inaccurate. Objective To estimate the prevalence of inaccurate diagnoses of OUD among patients with incident OUD diagnoses. Subjects A random sample of 90 patients with incident OUD diagnoses associated with an index in-person encounter between October 1, 2016, and June 1, 2018, in three Veterans Health Administration medical centers. Design Direct chart review of all encounter notes, referrals, prescriptions, and laboratory values within a 120-day window before and after the index encounter. Using all available chart data, we determined whether the diagnosis of OUD was likely accurate, likely inaccurate, or of indeterminate accuracy. We then performed a bivariate analysis to assess demographic or clinical characteristics associated with likely inaccurate diagnoses. Key Results We identified 1337 veterans with incident OUD diagnoses. In the chart verification subsample, we assessed 26 (29%) OUD diagnoses as likely inaccurate; 20 due to systems error and 6 due to clinical error; additionally, 8 had insufficient information to determine accuracy. Veterans with likely inaccurate diagnoses were more likely to be younger and prescribed opioids for pain. Clinical settings associated with likely inaccurate diagnoses were non-mental health clinical settings, group visits, and non-patient care settings. Conclusions Our study identified significant levels of likely inaccurate OUD diagnoses among veterans with incident OUD diagnoses. The majority of these cases reflected readily addressable systems errors. The smaller proportion due to clinical errors and those with insufficient documentation may be addressed by increased training for clinicians. If these inaccuracies are prevalent throughout the VHA, they could complicate health services research and health systems responses.