Use of physician billing claims to identify infections in children

Abstract

While medical records have detailed information, they are limited in reach to the availability and accessibility of those records. On the other hand, administrative data while limited in scope, have a much further reach in coverage of an entire population. However, few studies have validated the use of administrative data for identifying infections in pediatric populations. Pediatric patients from Ontario, Canada aged <18 years were randomly sampled from the Electronic Medical Record Administrative data Linked Database (EMRALD). Using physician diagnoses from the electronic medical record (EMR) as the reference standard, we determined the criterion validity of physician billing claims in administrative data for identifying infectious disease syndromes from 2012 to 2014. Diagnosis codes were assessed by infection category (respiratory, skin and soft tissue, gastrointestinal, urinary tract and otitis externa) and for all infections combined. Sensitivity analyses assessed the performance if patients had more than one reason to visit the physician. We analysed 2,139 patients and found 33.3% of all visits were for an infection, and respiratory infections accounted for 67.6% of the infections. When we combined all infection categories, sensitivity was 0.74 (95% CI 0.70–0.77), specificity was 0.95 (95% CI 0.93–0.96), positive predictive value (PPV) was 0.87 (95% CI 0.84–0.90), and negative predictive value (NPV) was 0.88 (95% CI 0.86–0.89). For respiratory infections, sensitivity was 0.77 (95% CI 0.73–0.81), specificity was 0.96 (95% CI 0.95–0.97), PPV was 0.85 (95% CI 0.81–0.88), and NPV was 0.94 (95% CI 0.92–0.95). Similar performance was observed for skin and soft tissue, gastrointestinal, urinary tract, and otitis externa infections, but with lower sensitivity. Performance measures were highest when the patient visited the physician with only one health complaint. We found when using linked EMR data as the reference standard, administrative billing codes are reasonably accurate in identifying infections in a pediatric population.

Validation of Administrative Codes for Palliative Care Consultation Among Critically Ill Children

“…16 Yet, such validation work is often not performed, although it may be increasing in the pediatric literature recently. [17][18][19][20][21][22][23][24] Our results revealed similar specificity but lower sensitivity than those reported in adult studies (specificity 98%-99% and sensitivity at 49.9%-84%) and 1 previous Canadian pediatric oncology study. [11][12][13] In the latter study, researchers compared the administrative records for children with cancer who had died to a regional PC database.…”

Unnecessary antibiotic prescribing in a Canadian primary care setting: a descriptive analysis using routinely collected electronic medical record data

“…Canadian physician billing claims for respiratory infections have previously been shown to have good positive predictive value in both adults and children. 21,22 However, we compared several different methods of assigning a diagnosis to encounters as sensitivity analyses (Appendix 2).…”

Long-Term Risk of Infections After Treatment of Childhood Leukemia: A Population-Based Cohort Study Using Administrative Health Data

“…To identify infections, leukemia survivors and controls were linked deterministically to the following administrative databases: Discharge Abstract Database (includes data related to hospitalizations), OHIP Claims (captures all physician billing claims for outpatient, inpatient, and communitybased services), and National Ambulatory Care Reporting System (captures data on ambulatory visits, including emergency department visits). Infections were determined using diagnostic codes from the International Classification of Diseases, Ninth Revision [ICD-9], or Tenth Revision [ICD-10]; Data Supplement) on the basis of a validated algorithm for infections that occur in the outpatient setting 20 (Data Supplement).…”