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Position matters: Validation of medicare hospital claims for myocardial infarction against medical record review in the atherosclerosis risk in communities study.

TitlePosition matters: Validation of medicare hospital claims for myocardial infarction against medical record review in the atherosclerosis risk in communities study.
Publication TypeJournal Article
Year of Publication2018
AuthorsBush M, Sturmer T, Stearns SC, Simpson RJ, M Brookhart A, Rosamond WD
Secondary AuthorsKucharska-Newton AMaria
JournalPharmacoepidemiol Drug Saf
Volume27
Issue10
Pagination1085-1091
Date Published2018 10
ISSN1099-1557
KeywordsAged, Aged, 80 and over, Atherosclerosis, Cohort Studies, Female, Hospitalization, Humans, Insurance Claim Review, International Classification of Diseases, Male, Medical Records, Medicare, Middle Aged, Myocardial Infarction, Patient Discharge, Prospective Studies, Reproducibility of Results, Residence Characteristics, Risk Factors, United States
Abstract

PURPOSE: The objectives of this study were to investigate sensitivity and specificity of myocardial infarction (MI) case definitions using multiple discharge code positions and multiple diagnosis codes when comparing administrative data to hospital surveillance data.

METHODS: Hospital surveillance data for ARIC Study cohort participants with matching participant ID and service dates to Centers for Medicare and Medicaid Services (CMS) hospitalization records for hospitalizations occurring between 2001 and 2013 were included in this study. Classification of Definite or Probable MI from ARIC medical record review defined "gold standard" comparison for validation measures. In primary analyses, an MI was defined with ICD9 code 410 from CMS records. Secondary analyses defined MI using code 410 in combination with additional codes.

RESULTS: A total of 25Ā 549 hospitalization records met study criteria. In primary analysis, specificity was at least 0.98 for all CMS definitions by discharge code position. Sensitivity ranged from 0.48 for primary position only to 0.63 when definition included any discharge code position. The sensitivity of definitions including codes 410 and 411.1 were higher than sensitivity observed when using code 410 alone. Specificity of these alternate definitions was higher for women (0.98) than for men (0.96).

CONCLUSION: Algorithms that rely exclusively on primary discharge code position will miss approximately 50% of all MI cases due to low sensitivity of this definition. We recommend defining MI by code 410 in any of first 5 discharge code positions overall and by codes 410 and 411.1 in any of first 3 positions for sensitivity analyses of women.

DOI10.1002/pds.4396
Alternate JournalPharmacoepidemiol Drug Saf
PubMed ID29405474
PubMed Central IDPMC6233317
Grant ListHHSN268201100012C / HL / NHLBI NIH HHS / United States
HHSN268201100009I / HL / NHLBI NIH HHS / United States
HHSN268201100010C / HL / NHLBI NIH HHS / United States
HHSN268201100008C / HL / NHLBI NIH HHS / United States
HHSN268201100005G / HL / NHLBI NIH HHS / United States
HHSN268201100008I / HL / NHLBI NIH HHS / United States
HHSN268201100007C / HL / NHLBI NIH HHS / United States
HHSN268201100011I / HL / NHLBI NIH HHS / United States
HHSN268201100011C / HL / NHLBI NIH HHS / United States
HHSN268201100006C / HL / NHLBI NIH HHS / United States
HHSN268201100005I / HL / NHLBI NIH HHS / United States
HHSN268201100009C / HL / NHLBI NIH HHS / United States
HHSN268201100005C / HL / NHLBI NIH HHS / United States
HHSN268201100007I / HL / NHLBI NIH HHS / United States