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Protocol for validating cardiovascular and cerebrovascular ICD-9-CM codes in healthcare administrative databases: the
Francesco Cozzolino1, Iosief Abraha1, Massimiliano Orso1
1Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy.
Insights
This study validates International Classification of Diseases, 9th Revision-Clinical Modification (ICD-9-CM) codes for cardiovascular diseases like heart attack and stroke. Accurate coding in administrative databases is crucial for reliable healthcare research.
Area of Science:
- Health Informatics
- Cardiovascular Research
- Epidemiology
Background:
- Administrative healthcare databases are valuable for assessing disease burden and research.
- Reliability of data within these databases, particularly diagnostic codes, is a critical concern.
- Accurate coding is essential for understanding the true impact of major cardiovascular diseases.
Purpose of the Study:
- To validate International Classification of Diseases, 9th Revision-Clinical Modification (ICD-9-CM) codes for major cardiovascular diseases.
- To assess the accuracy of ICD-9-CM codes for acute myocardial infarction (AMI), heart failure (HF), atrial fibrillation (AF), and stroke.
- To improve the reliability of administrative healthcare data for cardiovascular research.
Main Methods:
- Utilized administrative data from the Umbria Region, Italy (2012-2014).
- Identified patients with first hospital discharge for AMI, HF, AF, or stroke using specific ICD-9-CM codes.
- Validated codes by reviewing a random sample of medical charts with independent reviewers, calculating sensitivity and specificity.
Main Results:
- Sensitivity and specificity with 95% confidence intervals will be calculated for each condition.
- Validation process involved case adjudication based on symptoms, lab tests, and diagnostic findings from medical charts.
- Discrepancies between reviewers will be resolved through consensus.
Conclusions:
- The validation of ICD-9-CM codes will enhance the accuracy of administrative healthcare databases for cardiovascular disease research.
- Findings will contribute to more reliable assessments of disease burden, mortality, and healthcare resource utilization.
- This protocol supports evidence-based healthcare policy and clinical practice through improved data quality.
Introduction:
Administrative healthcare databases can provide a comprehensive assessment of the burden of diseases in terms of major outcomes, such as mortality, hospital readmissions and use of healthcare resources, thus providing answers to a wide spectrum of research questions. However, a crucial issue is the reliability of information gathered. Aim of this protocol is to validate International Classification of Diseases, 9th Revision-Clinical Modification (ICD-9-CM) codes for major cardiovascular diseases, including acute myocardial infarction (AMI), heart failure (HF), atrial fibrillation (AF) and stroke.
Methods And Analysis:
Data from the centralised administrative database of the entire Umbria Region (910 000 residents, located in Central Italy) will be considered. Patients with a first hospital discharge for AMI, HF, AF or stroke, between 2012 and 2014, will be identified in the administrative database using the following groups of ICD-9-CM codes located in primary position: (1) 410.x for AMI; (2) 427.31 for AF; (3) 428 for HF; (4) 433.x1, 434 (excluding 434.x0), 436 for ischaemic stroke, 430 and 431 for haemorrhagic stroke (subarachnoid haemorrhage and intracerebral haemorrhage). A random sample of cases, and of non-cases, will be selected, and the corresponding medical charts retrieved and reviewed for validation by pairs of trained, independent reviewers. For each condition considered, case adjudication of disease will be based on symptoms, laboratory and diagnostic tests, as available in medical charts. Divergences will be resolved by consensus. Sensitivity and specificity with 95% CIs will be calculated.
Ethics And Dissemination:
Research protocol has been granted approval by the Regional Ethics Committee. Study results will be disseminated widely through peer-reviewed publications and presentations at national and international conferences.