Accuracy of veterans administration databases for a diagnosis of rheumatoid arthritis
Accuracy of veterans administration databases for a diagnosis of rheumatoid arthritis
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DOI：
10.1002/art.20827
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发表时间：
2004-12-15
期刊：
影响因子：
--
通讯作者：
Noorbaloochi, S
中科院分区：
文献类型：
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作者：
Singh, JA;Holmgren, AR;Noorbaloochi, S
Objective.确定国际疾病分类（ICD）代码714在退伍军人管理局（VA）医院数据库中诊断类风湿性关节炎（RA）的准确性，并检查在ICD代码714中添加实验室和药房数据对RA诊断准确性的影响。我们随机抽取了2001年1月至2002年7月期间至少有1次风湿病门诊就诊的明尼阿波利斯VA风湿病门诊患者。对184例患者的病历进行了审查。RA诊断的金标准是由风湿病学家在间隔大于或等于6周的2次访视中诊断RA的图表文件。RA诊断的数据定义包括单独存在ICD代码714或ICD代码714的各种组合、阳性类风湿因子（RF）和疾病缓解抗风湿药物（DMARD）处方。通过计算敏感性、特异性、阳性和阴性预测值以及受试者操作特征曲线下面积来评估RA数据定义的准确性。ICD编码714诊断的敏感性为100%，但特异性仅为55%，因为假阳性率为34%。将阳性RF和/或DMARD处方添加到ICD代码714显著提高特异性至83-97%，阳性预测值至81-97%;然而，灵敏度降低至76- 88%。单独ICD 714诊断的阴性预测值最高，为100%。当同时包含ICD代码714和RF阳性时，曲线下面积最大，而单独使用ICD代码时曲线下面积最小。VA管理数据库中的ICD代码714是在风湿病临床人群中识别RA患者的非常敏感的筛查工具。在选择标准中增加DMARD处方和/或阳性RF的存在可提高诊断的特异性。
Objective. To determine the accuracy of International Classification of Diseases (ICD) code 714 for rheumatoid arthritis (RA) diagnosis in a Veterans Administration (VA) hospital database and to examine the effects of adding laboratory and pharmacy data to ICD code 714 on accuracy of RA diagnosis.Methods. We drew a random sample of patients from all Minneapolis VA rheumatology clinic patients who had at least 1 rheumatology clinic visit between January 2001 and July 2002. Charts of 184 patients were reviewed. The gold standard for RA diagnosis was chart documentation of RA diagnosis by a rheumatologist on greater than or equal to2 visits >6 weeks apart. The data definitions of RA diagnosis included presence of ICD code 714 alone or various combinations of ICD code 714, a positive rheumatoid factor (RF), and prescription for a disease-modifying antirheumatic drug (DMARD). Accuracy of data definitions of RA was assessed by calculating sensitivity, specificity, positive and negative predictive values, and area under the receiver operator characteristics curve.Results. Diagnosis by ICD code 714 had 100% sensitivity, but specificity was only 55% because of a false-positive rate of 34%. The addition of a positive RF and/or a DMARD prescription to ICD code 714 dramatically improved specificity to 83-97% and positive predictive value to 81-97%; however, sensitivity decreased to 76-88%. Diagnosis by ICD 714 alone had the highest negative predicative value of 100%. The area under the curve was the greatest when both ICD code 714 and a positive RF were included, and the least when ICD code alone was used.Conclusion. ICD code 714 in the VA administrative database is a very sensitive screening tool for identifying patients with RA in the rheumatology clinic population. Addition of the presence of a DMARD prescription and/or a positive RF to selection criteria improves specificity of the diagnosis.