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Identifying perianal fistula complications in pediatric patients with Crohn's disease using administrative claims
Jeremy Adler1,2, Hannah K Jary2, Sally J Eder1,2
1Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, University of Michigan, Ann Arbor, Michigan, United States of America.
Insights
Developing accurate health claims methods can identify pediatric Crohn's disease patients with perianal fistulas. This study validates claims-based case definitions for improved health services research in pediatric inflammatory bowel disease.
Area of Science:
- Pediatric Gastroenterology
- Health Services Research
- Biostatistics
Background:
- Perianal fistulas are common in pediatric Crohn's disease (CD).
- Evaluating health services for pediatric CD with perianal fistulas is challenging due to a lack of validated claims-based identification methods.
- Accurate case definitions are needed to identify these patients in administrative data.
Purpose of the Study:
- To develop and validate accurate case definitions for identifying perianal fistulas in pediatric CD patients using administrative claims data.
- To compare the performance of novel claims-based case definitions against a reference definition and gold standard medical records.
Main Methods:
- Retrospective cohort study of pediatric patients (5-21 years) with CD enrolled in Michigan Medicaid between 2005-2012.
- Candidate case definitions for perianal fistula were developed and tested using administrative claims.
- Performance metrics (sensitivity, specificity, PPV, NPV, ROC) were calculated by comparing case definitions against a gold standard derived from abstracted medical records.
Main Results:
- A total of 843 patients were identified via claims, with 274 meeting CD inclusion criteria. The true perianal fistula rate was 18%.
- The top-performing candidate case definition achieved 77.6% sensitivity, 98.2% specificity, 90.5% PPV, and 95.3% NPV (ROC AUC 0.88).
- The reference definition (ICD9 565.1) had lower sensitivity (51.0%) and a lower ROC AUC (0.75), despite high specificity (99.6%).
Conclusions:
- Administrative claims data can be reliably used to identify pediatric patients with perianal fistulas in Crohn's disease.
- Validated claims-based case definitions offer high accuracy, enabling future health services research where chart review is not feasible.
- These methods support evaluations of health services utilization and comparative effectiveness of treatments for pediatric CD complications.
Background:
Although perianal fistulas occur commonly in pediatric Crohn's disease (CD), evaluations of health services have been limited since no validated claims-based methods exist for identifying cases.
Objective:
To develop and validate accurate case definitions for perianal fistulas among pediatric patients with CD from administrative claims.
Methods:
Retrospective cohort study in which we developed and tested candidate case definitions for perianal fistula. Patients (age 5-21 years between 2005-2012) with CD enrolled in Michigan Medicaid with healthcare at University of Michigan were identified via claims. Medical records were obtained from all identified patients, whose entire records were abstracted. Medical record evidence for perianal fistula was considered the "gold standard" against which candidate case definitions were compared. The reference case definition of perianal fistula (ICD9 565.1) and candidate case definitions were evaluated.
Results:
Of 843 patients identified via claims, 274 (33%) met CD criteria for inclusion. The true perianal fistula rate among CD patients was 18% (n = 49). The top-performing candidate case definition identified 15% (n = 42), had sensitivity of 77.6%, specificity of 98.2%, positive predictive value (PPV) 90.5%, negative predictive value (NPV) 95.3%, and area under receiver operator characteristic curve (ROC) of 0.88. In contrast, the reference case definition identified 9% (n = 26), sensitivity 51.0%, specificity 99.6%, PPV 96.2%, NPV 90.3%, and had an area under ROC of 0.75.
Conclusions:
We demonstrated that it is feasible to use administrative claims data to accurately identify pediatric patients with perianal fistula complications. Claims-based case definitions were found to be highly accurate through medical record review, providing a high degree of confidence for future studies where chart review is not feasible. These claims-based methods can be applied to claims data in other settings for the evaluation of health services utilization as well as to assess the comparative effectiveness of prevention and treatment strategies.