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Validation of diagnoses of peptic ulcers and bleeding from administrative databases: a multi-health maintenance
Susan E Andrade1, Jerry H Gurwitz, K Arnold Chan
1Meyers Primary Care Institute-Fallon Healthcare System and University of Massachusetts Medical School, Worcester, MA 01605, USA.
Insights
This study evaluated International Classification of Diseases, 9th revision (ICD-9) codes for peptic ulcers and gastrointestinal bleeding. Many codes showed low positive predictive values (PPVs), indicating potential inaccuracies in automated health databases.
Area of Science:
- Medical Informatics
- Gastroenterology
- Health Services Research
Background:
- Automated health plan databases are increasingly used for research.
- Accurate diagnostic coding is crucial for reliable data analysis.
- The validity of International Classification of Diseases, 9th revision (ICD-9) codes for gastrointestinal conditions needs evaluation.
Purpose of the Study:
- To assess the positive predictive values (PPVs) of ICD-9 codes for peptic ulcers and upper gastrointestinal bleeding.
- To determine the accuracy of diagnoses recorded in automated health plan databases.
Main Methods:
- Utilized data from automated health plan records and medical chart abstractions from eight large health maintenance organizations (HMOs).
- Evaluated PPVs for specific ICD-9 codes related to duodenal ulcer, gastric/gastrojejunal ulcer, peptic ulcer, and gastrointestinal hemorrhage.
- Confirmed diagnoses through surgery, endoscopy, X-ray, or autopsy.
Main Results:
- Overall, only 23% (207 of 884) of cases of peptic ulcers and upper gastrointestinal bleeding were confirmed.
- PPVs varied significantly by diagnosis: duodenal ulcer (66%), gastric/gastrojejunal ulcer (61%), peptic ulcer (1%), and gastrointestinal hemorrhage (9%).
- PPVs were consistent across different HMOs and geographical regions.
Conclusions:
- The accuracy of ICD-9 codes for peptic ulcers and upper gastrointestinal bleeding in automated health plan databases is often low.
- There is a critical need to validate diagnostic codes from automated health databases.
- Findings highlight the importance of rigorous data accuracy assessment in health services research.
Abstract:
The automated health plan data and data from medical chart abstractions from eight large health maintenance organizations were used to evaluate the positive predictive values (PPVs) of the International Classification of Diseases, 9th revision (ICD-9) codes for cases of peptic ulcers and upper gastrointestinal bleeding. Overall, 207 of 884 cases of peptic ulcers and upper gastrointestinal bleeding (23%) were confirmed by surgery, endoscopy, X-ray, or autopsy. The PPVs were 66% for hospitalizations with codes for duodenal ulcer (ICD-9-CM 532), 61% for gastric/gastrojejunal ulcer (ICD-9-CM 531, 534), 1% for peptic ulcer (ICD-9-CM 533), and 9% for gastrointestinal hemorrhage (ICD-9-CM578). The overall and diagnostic category-specific PPVs were generally similar for the various HMOs. This study, using data from a large number of health plans located in different geographical regions, underscores the importance of evaluating the accuracy of the diagnoses from automated health plan databases.