Identifying sickle cell disease cases using administrative claims.

Area of Science:

• Pediatric Hematology
• Health Services Research
• Medical Informatics

Background:

• Accurate identification of children with sickle cell disease (SCD) is crucial for quality of care assessments.
• Administrative claims data offer a potential resource for identifying pediatric SCD cases.
• Existing methods for case identification may lack precision, necessitating improved approaches.

Purpose of the Study:

• To develop and validate an administrative claims-based method for identifying children with sickle cell disease (SCD).
• To enable robust quality of care assessments for children with SCD enrolled in Medicaid programs.

Main Methods:

• Utilized Michigan Medicaid administrative claims data from 2008-2011 for children aged 18 years and younger.
• Developed 37 distinct case definitions based on SCD diagnosis codes within claims.
• Validated case definitions against Michigan newborn screening administrative records as the gold standard.

Main Results:

• The most accurate case definition required at least three SCD claims in any position.
• This definition achieved an area under the receiver operating characteristic (ROC) curve of 0.91 (95% CI: 0.89, 0.93).
• Performance metrics like sensitivity and specificity varied across the 37 tested definitions.

Conclusions:

• An administrative claims definition of at least three SCD claims accurately identifies children with SCD.
• This validated method can facilitate more precise identification in future research and quality improvement initiatives.
• Further research is needed to confirm the generalizability of this method to other populations beyond Michigan Medicaid recipients.