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Inverse Probability of Treatment Weighting (Propensity Score) using the Military Health System Data Repository and National Death Index

Inverse Probability of Treatment Weighting (Propensity Score) using the Military Health System Data Repository and National Death Index

Published on: January 8, 2020

Is administratively coded comorbidity and complication data in total joint arthroplasty valid?

Kevin J Bozic¹, Ravi K Bashyal, Shawn G Anthony

¹Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA. kevin.bozic@ucsf.edu

Clinical Orthopaedics and Related Research

|April 25, 2012

Summary

Administrative claims data for total joint arthroplasty (TJA) show high accuracy but incomplete reporting of patient comorbidities and complications. While specific diagnoses are reliable, many conditions may be underreported in claims data.

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Area of Science:

Health Services Research
Medical Informatics
Orthopedic Surgery

Background:

Administrative claims data are vital for public reporting and health services research.
The accuracy of administrative claims data compared to clinical records in total joint arthroplasty (TJA) is not well understood.

Purpose of the Study:

To assess the agreement between administrative claims and clinical records for 13 common comorbidities and complications in TJA patients.

Main Methods:

Compared 13 administratively coded comorbidities/complications from hospital billing records with clinical documentation.
Analyzed data from 1350 consecutive primary and revision TJA procedures at three high-volume institutions in 2009.

Main Results:

Concordance varied by condition, with high agreement (kappa > 0.80) for diabetes and myocardial infarction.
Moderate agreement (kappa 0.60-0.79) was found for chronic lung disease, coronary artery disease, and venous thromboembolic events.
Lower agreement (kappa 0.40-0.59) was observed for several other conditions, including heart failure and bleeding complications. Specificity was high (>92%), but sensitivity was lower (29%-100%).

Conclusions:

Administrative claims data generally correlate well with clinical records for TJA comorbidities and complications.
Administrative data demonstrate high specificity but low sensitivity, meaning coded conditions are accurate but often incomplete.