Predictive Value of International Classification of Diseases Codes for Idiopathic Intracranial Hypertension in a University Health System.
Predictive Value of International Classification of Diseases Codes for Idiopathic Intracranial Hypertension in a University Health System.
复制标题
大学卫生系统中特发性颅内高压疾病代码国际分类的预测价值。
DOI：
10.1097/wno.0000000000001563
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Moss,HeatherE
中科院分区：
文献类型：
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作者：
Khushzad,Fareshta;Kumar,Riya;Muminovic,Irma;Moss,HeatherE
背景：由于依赖于诊断编码而不是完整的医疗记录审查，因此在基于医疗索赔的研究中引入了错误分类偏倚。我们试图描述特发性颅内高压（IIH）的这种偏倚，并评估减少其的策略。方法：使用包含来自学术医疗中心的医疗记录和管理数据的临床数据仓库对医疗记录进行回顾性分析。有1例或多例IIH国际疾病分类（ICD）-9或-10代码（348.2或G93）的患者。2)研究纳入了1989年至2017年期间的神经影像学（头部CT或MRI）、腰椎穿刺和视神经检查的原始结果。根据对病历的审查，IIH的诊断分为明确、很可能、可能或不准确。计算所有受试者IIH ICD代码的阳性预测值（PPV），包括所有测试完成后具有IIH代码的受试者、具有大量IIH ICD代码和代码跨越时间较长的受试者、具有与专家会面相关的IIH ICD代码的受试者（眼科、神经病学或神经外科）和乙酰唑胺治疗的受试者。在1,005名ICD编码为IIH的患者中，103名患者有完整的检测结果并被纳入研究。IIH的ICD-9/-10代码的PPV为0.63。限制样本的PPV为0.82（眼科医生编码，n= 57）、0.70（乙酰唑胺治疗，n= 87）和0.72（所有检测后编码，n= 78）。大量的代码实例和较长的持续时间之间的第一个和最后一个代码实例也增加了PPV。结论：ICD-9或-10代码IIH的PPV为63%的可能或明确IIH的患者进行必要的诊断测试在一个单一的机构。眼科医生分配IIH ICD代码的患者编码准确性提高。使用编码算法考虑治疗提供者，代码数量和治疗是一种潜在的策略，以减少医疗索赔为基础的研究IIH的错误分类偏见。然而，这些都与样本量减少有关。
Background:Misclassification bias is introduced into medical claims–based research because of reliance on diagnostic coding rather than full medical record review. We sought to characterize this bias for idiopathic intracranial hypertension (IIH) and evaluate strategies to reduce it.Methods:A retrospective review of medical records was conducted using a clinical data warehouse containing medical records and administrative data from an academic medical center. Patients with 1 or more instances of International Classification of Diseases (ICD)-9 or-10 codes for IIH (348.2 or G93. 2) between 1989 and 2017 and original results of neuroimaging (head CT or MRI), lumbar puncture, and optic nerve examination were included in the study. Diagnosis of IIH was classified as definite, probable, possible, or inaccurate based on review of medical records. The positive predictive value (PPV) for IIH ICD codes was calculated for all subjects, subjects with an IIH code after all testing was completed, subjects with high numbers of IIH ICD codes and codes spanning longer periods, subjects with IIH ICD codes associated with expert encounters (ophthalmology, neurology, or neurosurgery), and subjects with acetazolamide treatment.Results:Of 1,005 patients with ICD codes for IIH, 103 patients had complete testing results and were included in the study. PPV of ICD-9/-10 codes for IIH was 0.63. PPV in restricted samples was 0.82 (code by an ophthalmologist n= 57), 0.70 (acetazolamide treatment n= 87), and 0.72 (code after all testing, n= 78). High numbers of code instances and longer duration between the first and last code instance also increased the PPV.Conclusions:An ICD-9 or-10 code for IIH had a PPV of 63% for probable or definite IIH in patients with necessary diagnostic testing performed at a single institution. Coding accuracy was improved in patients with an IIH ICD code assigned by an ophthalmologist. Use of coding algorithms considering treatment providers, number of codes, and treatment is a potential strategy to reduce misclassification bias in medical claims–based research on IIH. However, these are associated with a reduced sample size.