Identifying musculoskeletal conditions in electronic medical records: a prevalence and validation study using the Deliver Primary Healthcare Information (DELPHI) database

Abstract

Background Musculoskeletal (MSK) conditions are a common presentation in primary care. This study sought to determine the prevalence of MSK conditions in primary care in Ontario and to validate the extent to which health administrative date billing codes accurately represent MSK diagnoses. Methods De-identified electronic medical records (EMR) from the DELPHI database in southwestern Ontario, which contains 2493 patients (55.6% female, mean age 50.3 years (SD = 22.2)) and 21,964 encounters (July 1, 2006-June 30, 2010) were used for the analyses. Outcomes included: validation measures of agreement between International Classification of Diseases (ICD-9) diagnostic codes (health administrative data) and International Classification of Primary Care (ICPC) diagnoses defined as the reference standard, time to first ICD-9 code, prevalence, and healthcare utilization. Results There were 2940 true positive MSK encounters with primary care practitioners for 998 patients. Performance of the ICD-9 diagnostic codes included sensitivity = 76.5%, specificity = 95.2%, PPV = 94.6%, and NPV = 78.7%, compared to the ICPC reference standard. The majority of 998 patients were coded with both an ICPC and ICD-9 MSK code at their first or second encounter (67.4%). However, 23.5% of patients with the ICPC reference standard MSK were never coded with ICD-9. Four-year prevalence of MSK was 52.3% and varied by age (4.5% 0-17 years, 20.1% 18–44, 42.7% 45–64, and 32.7% 65+). Patients at MSK encounters had a higher number of: investigations (17.9% compared to 9.1%, p < .0001); referrals (17.6% compared to 14.3%, p < .0001); and prescriptions for opioids (17.2% compared to 5.3%, p < .0001). Conclusions This study determined the prevalence of musculoskeletal conditions in primary care in Ontario using a reference standard definition. The study highlighted the value of using primary care ICPC codes to validate a definition for musculoskeletal conditions. Health administrative data can be used to ascertain the presence of musculoskeletal conditions; however, ICD-9 codes may underrepresent the prevalence of MSK conditions. Electronic supplementary material The online version of this article (10.1186/s12891-019-2568-2) contains supplementary material, which is available to authorized users.

Leaving the Walkman and ICD-9 Behind: Modernizing the Disease Classification System Used by Canadian Physicians

“…The legacy of ICD development disproportionately affects primary healthcare settings, where many encounters are symptom-based or undifferentiated and where preventive activities are common. Previous research has shown that neither do ICD-9 codes consistently capture the main problems addressed during a primary care encounter nor do they reflect the true complexity of a primary care visit ( Katz et al 2012 ; Ryan et al 2019 ). This becomes a problem when physician claims databases are used to describe complex patients, assess family physician workloads or inform the reorganization of primary care (e.g., alternative remuneration models, value-based care, Patient's Medical Home models).…”

“…This becomes problematic when physicians record details about patient visits in their EMR: open text, rather than a code, is often used to capture relevant information and observations, which is more difficult to search for or utilize for secondary uses. Furthermore, the development of advanced features within EMRs, such as predictive or automated coding, is not possible with ICD-9, given that many encounters, conditions and symptoms do not have a corresponding ICD-9 code that accurately reflects the primary care visit ( Bhise et al 2018 ; Katz et al 2012 ; Ryan et al 2019 ). Another limitation is that ICD-9 is not extensible, which means that new conditions (e.g., COVID-19) cannot be easily added; most of its disease categories are considered full.…”

Prevalence and characteristics of musculoskeletal complaints in primary care: an analysis from the population level and analysis reporting (POLAR) database

“…General practice databases have been used to determine the prevalence of some musculoskeletal complaints including arthritis, chronic back pain, gout, osteoporosis, spondyloarthropathies and rheumatoid arthritis in various countries [ 13 – 17 ]. Trends and trajectories of opioid prescription for people with general musculoskeletal conditions, [ 18 , 19 ] use of osteoporosis medicines in people with osteoporosis [ 16 ] and use of biologic drugs in people with psoriatic arthritis and ankylosing spondylitis [ 20 ] have also been examined.…”

Prevalence and characteristics of musculoskeletal complaints: an analysis from the POpulation Level and Analysis Reporting (POLAR) database

“…General practice databases have been used to determine the prevalence of some musculoskeletal complaints including arthritis, chronic back pain, gout, osteoporosis, spondyloarthropathies and rheumatoid arthritis in various countries. [13][14][15][16][17] Trends and trajectories of opioid prescription for people with general musculoskeletal conditions, 18 19 use of osteoporosis medicines in people with osteoporosis 16 and use of biologic drugs in people with psoriatic arthritis and ankylosing spondylitis 20 have also been examined. However, to date the characteristics of patients presenting to general practice with musculoskeletal complaints and the healthcare utilisation at the primary care level has not been comprehensively examined using primary care databases.…”

“…They have been used internationally to examine patterns of care for various conditions including respiratory tract infection, 6 cardiovascular disease, 7 chronic hepatitis C, 8 chronic kidney disease, 9 and diabetes [10][11][12] .General practice databases have been used to determine the prevalence of some musculoskeletal complaints including arthritis, chronic back pain, gout, osteoporosis, spondyloarthropathies and rheumatoid arthritis in various countries. [13][14][15][16][17] Trends and trajectories of opioid prescription for people with general musculoskeletal conditions, 18 19 use of osteoporosis medicines in people with osteoporosis 16 and use of biologic drugs in people with psoriatic arthritis and ankylosing spondylitis 20 have also been examined. However, to date the characteristics of patients presenting to general practice with musculoskeletal complaints and the healthcare utilisation at the primary care level has not been comprehensively examined using primary care databases.This study forms part of a larger project that is using data from the POpulation Level Analysis and Reporting (POLAR) dataset from 2014 to 2018 inclusive to examine patterns of care provided by GPs for people with musculoskeletal complaints.…”