Validation of an ICD-code-based case definition for psychotic illness across three health systems.
Validation of an ICD-code-based case definition for psychotic illness across three health systems.
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跨三个卫生系统验证基于 ICD 代码的精神病病例定义。
DOI：
10.1101/2024.02.28.24303443
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Gasman
中科院分区：
文献类型：
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作者：
Deo,AnthonyJ;Castro,VictorM;Baker,Ashley;Carroll,Devon;Gonzalez-Heydrich,Joseph;Henderson,DavidC;Holt,DaphneJ;Hook,Kimberly;Karmacharya,Rakesh;Roffman,JoshuaL;Madsen,EmilyM;Song,Eugene;Adams,WilliamG;Camacho,Luisa;Gasman
背景和假设精神病相关的诊断代码越来越多地被用作基于电子健康记录（EHR）的算法的病例定义，以预测和检测精神病。然而，有关精神病相关诊断代码有效性的数据有限。我们评估了国际疾病分类 (ICD) 代码对精神病的阳性预测值 (PPV)。研究设计使用 3 个卫生系统的 EHR，将包含原发性精神障碍和伴有精神病的情绪障碍的 ICD 代码分为 5 个高阶组。使用完整的 EHR 对 1133 条记录进行了抽样以进行图表审查。在多个治疗环境中计算 PPV（根据 ICD 精神病代码，图表确认精神病的概率）。研究结果所有诊断组和医院系统的 PPV 超过 70%：麻省总医院布里格姆总医院 0.72 [95% CI 0.68–0.77]、波士顿儿童医院 0.80 [0.75–0.84] 和波士顿医疗中心 0.83 [0.79–0.86]。精神分裂情感性障碍 PPV 始终是各个站点中最高的 (0.80–0.92)，而伴有精神病的重度抑郁症则变化最大 (0.57–0.79)。为了确定第一个记录的代码是否捕获了首发精神病 (FEP)，我们排除了先前有精神病诊断或治疗图表证据的病例，从而得到显着较低的 PPV (0.08–0.62)。 结论我们发现第一个记录的精神病诊断代码准确地捕获了精神病的真实发作，但 FEP 指数较差。这些数据对于开发旨在预测或检测未诊断精神病的风险预测模型中使用的病例定义具有重要意义。
Background and HypothesisPsychosis-associated diagnostic codes are increasingly being utilized as case definitions for electronic health record (EHR)-based algorithms to predict and detect psychosis. However, data on the validity of psychosis-related diagnostic codes is limited. We evaluated the positive predictive value (PPV) of International Classification of Diseases (ICD) codes for psychosis.Study DesignUsing EHRs at 3 health systems, ICD codes comprising primary psychotic disorders and mood disorders with psychosis were grouped into 5 higher-order groups. 1133 records were sampled for chart review using the full EHR. PPVs (the probability of chart-confirmed psychosis given ICD psychosis codes) were calculated across multiple treatment settings.Study ResultsPPVs across all diagnostic groups and hospital systems exceeded 70%: Mass General Brigham 0.72 [95% CI 0.68–0.77], Boston Children’s Hospital 0.80 [0.75–0.84], and Boston Medical Center 0.83 [0.79–0.86]. Schizoaffective disorder PPVs were consistently the highest across sites (0.80–0.92) and major depressive disorder with psychosis were the most variable (0.57–0.79). To determine if the first documented code captured first-episode psychosis (FEP), we excluded cases with prior chart evidence of a diagnosis of or treatment for a psychotic illness, yielding substantially lower PPVs (0.08–0.62).ConclusionsWe found that the first documented psychosis diagnostic code accurately captured true episodes of psychosis but was a poor index of FEP. These data have important implications for the case definitions used in the development of risk prediction models designed to predict or detect undiagnosed psychosis.