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Defining and validating comorbidities and procedures in ICD-10 health data in ST-elevation myocardial infarction
Erik Youngson1, Robert C Welsh, Padma Kaul
1University of Alberta, Edmonton Alberta Health Services Mazankowski Alberta Heart Institute University of Calgary, Calgary, Alberta, Canada.
Insights
Administrative data accurately identifies ST-elevation myocardial infarction (STEMI) diagnoses and cardiac procedures. An algorithm using two prior visits effectively defines comorbidities for research without physician claims.
Area of Science:
- Health Informatics
- Cardiovascular Research
- Data Validation
Background:
- Administrative health databases are crucial for research, enabling the definition of diagnoses, procedures, and comorbid conditions.
- Validating these administrative codes against comprehensive registries is essential for reliable research outcomes.
- Physician claims databases are not universally available, necessitating alternative methods for data validation.
Purpose of the Study:
- To validate administrative coding for ST-elevation myocardial infarction (STEMI) diagnosis and invasive cardiac procedures.
- To determine an optimal algorithm for defining comorbidities using hospitalization and ambulatory data, excluding physician claims.
- To assess the performance of International Classification of Diseases, 10th Revision (ICD-10) and Canadian Classification of Health Interventions (CCI) codes.
Main Methods:
- A registry of STEMI patients served as the reference cohort, linked to administrative hospitalization and ambulatory databases.
- Four administrative case definitions for STEMI diagnosis, procedures, and comorbidities were evaluated using ICD-10 and CCI codes.
- Algorithm performance was assessed using metrics including the C statistic and Kappa statistic.
Main Results:
- Administrative records correctly identified STEMI diagnoses in 94.0% of patients.
- In-hospital cardiac procedures (coronary artery bypass grafting, percutaneous coronary intervention, angiogram) were accurately identified (Kappa 0.83-1.00).
- An algorithm using two inpatient/ambulatory visits in the prior two years maximized positive predictive value (PPV) for comorbidities, ranging from 28.6% (heart failure) to 95.7% (myocardial infarction).
Conclusions:
- International Classification of Diseases, 10th Revision (ICD-10) and Canadian Classification of Health Interventions (CCI) codes can reliably identify hospitalized STEMI patients and in-hospital cardiac procedures.
- Comorbidities can be defined with high positive predictive value (PPV) using a definition of two inpatient/ambulatory visits within the previous two years.
- This approach offers a validated method for using administrative data in cardiovascular research, even without access to physician claims.
Abstract:
Administrative health databases are used in research to define comorbid conditions, diagnosis, and procedures. Our objectives were to validate a diagnosis of ST-elevation myocardial infarction (STEMI) and invasive cardiac procedure coding against a comprehensive registry of STEMI patients and determine an optimal algorithm for defining comorbidities using administrative hospitalization and ambulatory databases, but without using a physician claims database, which is unavailable for use in many jurisdictions.A registry of consecutive STEMI patients was used to define a reference cohort and linked to the hospitalization and ambulatory databases. Four administrative case definitions for defining comorbidities, as well as STEMI diagnosis and in-hospital procedures using the International Classification of Diseases, 10th Revision (ICD-10) and the Canadian Classification of Health Interventions (CCI) were evaluated. Metrics were used to evaluate algorithm performance and compare discriminative ability using the C statistic.The 3236 patients had median age of 60 years (interquartile range 52-71) and 75.7% were male. A diagnosis of STEMI was correctly identified in the administrative records for 3043 (94.0%) patients. In-hospital procedures (coronary artery bypass grafting, percutaneous coronary intervention, and angiogram) were well identified using administrative definitions (Kappa statistic 0.83-1.00). Validation of comorbidities varied by condition but an algorithm using 2 inpatient/ambulatory visits in the previous 2 years maximized PPV, ranging from 28.6% for previous heart failure to 95.7% for previous MI. The c statistic was similar for each of the methods, ranging from 0.76 to 0.80.ICD-10 and CCI codes can identify hospitalized STEMI patients with high sensitivity and accurately define in-hospital cardiac procedures. Comorbidities can be defined with high PPV using a definition of 2 inpatient/ambulatory visits in the previous 2 years.
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