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A Validation Study: How Predictive Is a Diagnostic Coding Algorithm at Identifying Rheumatic Heart Disease in Western
Jordan Ashlea Fitz-Gerald1, Chris Olivia Ongzalima1, Andre Ng1
1Medical School, University of Western Australia, Perth, WA, Australia.
Heart, Lung & Circulation
|January 22, 2020
Summary
An expert algorithm improves rheumatic heart disease (RHD) case identification using hospital codes. It shows high accuracy in high-risk populations and for probable RHD diagnoses.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- International Classification of Diseases (ICD-10) codes for rheumatic heart disease (RHD) lack specificity.
- Existing codes (I05-I08) include unspecified valvular heart disease, hindering accurate RHD burden estimation.
- An expert-developed algorithm was created to enhance RHD epidemiological case ascertainment.
Purpose of the Study:
- To evaluate the positive predictive value (PPV) of hospital admissions identified by an expert algorithm for RHD.
- To compare the algorithm's accuracy across different population risk groups, age demographics, and coding classifications.
Main Methods:
- Chart reviews of 368 RHD-coded hospital admissions in Western Australia (2009-2016).
- Selection of cases based on algorithm-positive codes from high-risk RHD populations and a random sample from low-risk groups.
- RHD diagnosis confirmation via echocardiography or clinical records; PPVs compared across various patient and coding strata.
Main Results:
- High-risk patients demonstrated significantly higher PPVs (83.8%) compared to low-risk patients (54.9%).
- Algorithm-defined 'probable RHD' codes yielded higher PPVs (91.5%) than 'possible' codes (51.5%).
- In low-risk groups, principal diagnoses had higher PPVs (84.5%) than secondary diagnoses (44.8%).
Conclusions:
- The algorithm is effective for identifying RHD when coded as a principal diagnosis, using 'probable' codes, or in high-risk populations.
- Further refinement of the algorithm is necessary to improve the accuracy of RHD identification in low-risk patient groups.
Keywords:
AustraliaInternational Classification of DiseasesRheumatic heart diseaseSurveillanceValidationMore Related Videos
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