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An algorithm to identify preterm infants in administrative claims data.

Efe Eworuke¹, Christian Hampp, Arwa Saidi

¹Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA. efe1odia@ufl.edu

Pharmacoepidemiology and Drug Safety

|April 17, 2012

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A new algorithm effectively identifies preterm infants using Medicaid data when birth certificates are missing. This prematurity score offers a more comprehensive approach than traditional ICD-9-CM codes.

Area of Science:

Health Informatics
Pediatric Health
Public Health Data Analysis

Background:

Accurate identification of preterm infants is crucial for targeted interventions and resource allocation.
Existing methods for identifying preterm infants in administrative datasets like Medicaid claims data can be limited, especially when birth certificates are unavailable.

Purpose of the Study:

To develop and validate a novel algorithm for identifying preterm infants within Medicaid data, specifically addressing scenarios where birth certificates are absent.
To create a prematurity score based on diagnostic and procedure codes to enhance the identification accuracy of preterm infants.

Main Methods:

Utilized Medicaid fee-for-service claims data from Florida and Texas, linked with vital statistics data.
Developed a logistic regression model using International Classification of Disease version 9, Clinical Modification (ICD-9-CM) codes associated with preterm care.

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Defined prematurity as less than 34 weeks gestational age and selected a score cutoff to maximize sensitivity while maintaining a positive predictive value (PPV) of at least 90%.

Main Results:

The developed prematurity score model demonstrated excellent discriminatory validity (c-statistic of 0.928).
The algorithm achieved a sensitivity of 52.6% and a PPV of 91.7% in Florida, and 46.8% sensitivity and 82.2% PPV in Texas.
Compared to using only gestational age ICD-9-CM codes (25.7% sensitivity in FL, 12.5% in TX), the prematurity score significantly improved identification.

Conclusions:

Identification of prematurity solely based on gestational age ICD-9-CM codes is insufficiently sensitive.
The developed prematurity score algorithm offers superior construct validity and a more comprehensive method for identifying preterm infants in Medicaid data without birth certificates.