Validation of claims‐based algorithms for pulmonary arterial hypertension

Abstract

Administrative claims studies do not adequately distinguish pulmonary arterial hypertension (PAH) from other forms of pulmonary hypertension (PH). Our aim is to develop and validate a set of algorithms using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and electronic medical records (EMR), to identify patients with PAH. From January 2012 to August 2015, the EMRs of patients with ICD-9-CM codes for PH with an outpatient visit at the University of Texas Medical Branch were reviewed. Patients were divided into PAH or non-PAH groups according to EMR encounter diagnosis. Patient demographics, echocardiography, right heart catheterization (RHC) results, and PAH-specific therapies were assessed. RHC measurements were reviewed to categorize cases as hemodynamically determined PAH or not PAH. Weighted sensitivity, specificity, and positive and negative predictive values were calculated for the developed algorithms. A logistic regression analysis was conducted to determine how well the algorithms performed. External validation was performed at the University of Virginia Health System. The cohort for the development algorithms consisted of 683 patients with PH, PAH group (n = 191) and non-PAH group (n = 492). A hemodynamic diagnosis of PAH determined by RHC was recorded in the PAH (26%) and non-PAH (3%) groups. The positive predictive value for the algorithm that included ICD-9-CM and PAH-specific medications was 66.9% and sensitivity was 28.2% with a c-statistic of 0.66. The positive predictive value for the EMR-based algorithm that included ICD-9-CM, EMR encounter diagnosis, echocardiography, RHC, and PAH-specific medication was 69.4% and a c-statistic of 0.87. A validation cohort of 177 patients with PH examined from August 2015 to August 2016 using EMR-based algorithms yielded a similar positive predictive value of 62.5%. In conclusion, claims-based algorithms that included ICD-9-CM codes, EMR encounter diagnosis, echocardiography, RHC, and PAH-specific medications better-identified patients with PAH than ICD-9-CM codes alone.

Cardiovascular Outcomes of Patients With Pulmonary Hypertension Undergoing Noncardiac Surgery

“…In particular, a recent study raises questions about the accuracy of administrative coding data to diagnose pulmonary arterial hypertension. 18 Second, the results of echocardiography were not recorded in the NIS, and left ventricular function and pulmonary artery pressures are unknown. World Health Organization (WHO) Group classifications were not available.…”

Evaluation of code‐based algorithms to identify pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension patients in large administrative databases

“…Using the ATLAS tool within the Observational Health Data Sciences and Informatics (OHDSI) toolset, 15 PAH and CTEPH cohorts were created in the three selected datasets, based on the code-based algorithms identified in the literature. When available, the exact source codes were used for creating the cohorts, otherwise standardised coding concepts from the Common Data Model Vocabularies of the Observational Medical Outcomes Partnership (OMOP) 16 were applied.…”

Accuracy of Algorithms to Identify Pulmonary Arterial Hypertension in Administrative Data

“…Details of the included studies are summarized in Table 1 [19][20][21][22] (validated algorithms, n ¼ 4) and e- Table 3 (unvalidated algorithms, n ¼ 28). Of the 32 included articles, most (n ¼ 26) were from the United States, with the remaining studies from Canada (n ¼ 2), Europe (n ¼ 3), and Taiwan (n ¼ 1).…”

“…Nearly all studies used International Classification of Diseases (ICD) diagnosis codes linked to inpatient or outpatient visits, pharmacy claims, procedure claims, or a combination of these to identify PAH, hereafter termed claims-based algorithms. Only one study used physician-entered diagnoses from EHRs, 22 hereafter termed EHRbased algorithms. The included studies examined a variety of outcomes, including prevalence, mortality rates, length of hospital stay, and health-care costs associated with PAH.…”